Scaling Up Community-Based Distribution of Injectable Contraceptives in Tigray, Ethiopia
Project Dates: September 2011-March 2015
The Bixby Center, in collaboration with Mekelle University, Women’s Association of Tigray, and the Tigray Regional Health Bureau, tested a model for scaling up community-based distribution (CBD) of injectable contraceptives following a 2009 pilot study. By incorporating private sector strategies such as willingness-to-pay, social marketing, and a drug revolving fund, the project aimed to create a sustainable contraceptive service delivery model that used community health workers (CHWs) as rural social marketing agents to distribute injectable contraceptives. Combining social marketing with CBD offered an opportunity to tap into CHWs’ existing community networks, recover some program costs, and compensate CHWs with the profits from the contraceptive sales.
Out of 626 CHWs trained, 87% were still active in March 2015. On average, CBRHAs were 45 minutes from the nearest government health post and spent approximately 5 hours per week marketing injectable contraceptives. 8,604 women were reached by CHWs with 15,410 injections, equivalent to 3,853 couple years of protection. With 19% of their clients new to family planning and 25% new to injectable contraceptives, CHWs were providing services to women who experienced challenges accessing family planning services elsewhere. Eighty-seven percent of injections were paid for at provision. The programmatic cost of the project was assessed at 2.96 USD per CYP, based on data from implementation in year 1 of project.Findings were shared at a dissemination workshop hosted by the Tigray Health Bureau in Mekelle, Ethiopia in March 2015, and key stakeholders unanimously agree that this important program should be continued and expanded by the Tigray Health Bureau and local partners.
For more information on this study, please download our program brief.
To view results from the baseline and endline household surveys, please click on the following:
- Prata N, Gessessew A, Cartwright A, Fraser A. Provision of injectable contraceptives in Ethiopia through community-based reproductive health agents. B World Health Organ 2011 August; 89(8):556-64.
- Prata N, Bell S, Weidert K, Gessessew A. Potential for Cost Recovery: Women’s Willingness to Pay for Injectable Contraceptives in Tigray, Ethiopia. PLoS ONE 2013; 8(5): e64032.
- Prata N, Weidert K, Fraser A, Gessessew A. Meeting Rural Demand: A case for combining community-based distribution and social marketing in Tigray, Ethiopia. PLoS ONE 2013; 8(7): e68794.
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