Scaling Up Community-Based Distribution of Injectable Contraceptives in Tigray, Ethiopia
Project Dates: September 2011-June 2014
Injectable contraceptives are the leading method of family planning in Sub-Saharan Africa and have played a major role in the recent increase in contraceptive prevalence in the region. Ethiopia is the second most populous country in Africa, with the highest levels of fertility found in rural areas and among the poorest and least-educated women. For most rural Ethiopian women, injectable contraceptives are their preferred method of contraception. However, the distance from health facilities and need for privacy has impeded their ability to easily access injectable contraceptives. The obstacles to access for rural women demonstrate the need for inclusion of injectable contraceptives in community-based distribution (CBD) systems.
After a 2009 pilot study conducted by the Bixby Center and its partners, Tigray Regional Health Bureau and Venture Strategies for Health and Development, demonstrated the effectiveness of community based reproductive health agents (CBRHAs) as community-based distributors of injectable contraceptives, the next step was to scale up this intervention. However, analyses of CBD programs suggest that the relative cost-effectiveness of CBD alone is less cost effective than other means of contraceptive distribution. Consequently, Bixby researchers set out to develop a model of CBD that supported the regular presence of CBRHAs in the community without burdening the public health system.
From September 2011 to June 2014, 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 access to injectable contraceptives. 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 CBRHAs as rural social marketing agents to distribute injectable contraceptives. Combining social marketing with CBD offered an opportunity to tap into CBRHAs’ existing community networks, recover some program costs and compensate CBRHAs with the profits from the contraceptive sales.
The study, funded by Joffe Charitable Trust, Rotary Foundation and the Bixby Center, investigated the scalability and sustainability of combining social marketing with existing CBD strategies. The study concluded in June 2014 and demonstrated that program planners can tailor interventions to match family planning preferences and create more sustainable contraceptive service provision with greater impact. CBRHAs demonstrated their ability to make a significant contribution to improving rural access to injectable contraceptives. 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.