Expanding Access to Family Planning through Community-Based Services in Zambia: A Longitudinal Study

Background

In Zambia, facility-based family planning (FP) provision is low due to limited access. Global evidence suggests that community-based distributors (CBDs) play a crucial role in expanding access to FP services in rural districts. In 2009, the Zambian Ministry of Health approved training to administer Depo Provera (DMPA) for an initial 40 CBDs in ChildFund Zambia's (CFZ's) catchment areas in Mumbwa and Luangwa districts. We conducted a study to determine the safety, acceptability, impact, and cost of adding (DMPA) to CFZ's established FP program.

Methodology

Longitudinal data were obtained from all CBD clients who were FP acceptors over the 12-month data collection period and from an overlapping 24-month period of district-level data to examine trends in DMPA uptake. Interviews were conducted with 11 CFZ and district supervisors, all CBDs, and 253 DMPA clients. Costs of adding DMPA to CFZ's FP program were tracked throughout the intervention.

Results

No adverse events associated with injections occurred during training or were reported by clients. Of the 4,241 clients who received FP services during the study period, 82% accepted DMPA from a newly-trained CBD agent, and 41% were new to FP. Ninety-four percent of early acceptors received a second DMPA injection. Clients reported high levels of satisfaction with CBD provision of DMPA. Costs of protecting a couple from pregnancy for one year were higher than clinic provision but lower than costs for antenatal care in Zambia.

Conclusion

Based on the success of the program, the Zambian government decided to scale-up CBD-provision of DMPA nationwide.