This document summarizes a community-based family planning and HIV/AIDS services project in Malawi. It outlines the project team and rationale, describes the project's geographic scope across several districts, and summarizes its approaches of building supply and demand. It then provides results and accomplishments in areas of family planning service provision, HIV testing and counseling, and demand creation. Challenges, lessons learned, and monitoring and evaluation of the project are also summarized.

1. Community Based Family Planning and HIV/
AIDS Services Project
Project Team: Mexon Nyirongo – COP; Njuru Nganga – DCOP;
Joyce Wachepa – FP Advisor; Flora Khomani – HIV/AIDS Advisor;
Chimwemwe Msukwa – M&E Advisor; Olive Mtema – Policy
Specialist; Carol Bakasa – Gender/Communication; Ricky Nyaleye
– Gender/Communication

2. RATIONALE
• FP is the key to improvement of socio-economic
wellbeing of people in developing countries.
• Access to FP services in rural areas is limited.
• Modern FP method can help avert unwanted
pregnancies thereby reducing MMR and IMR in
Malawi .
• The project works through a network of CBDAs and
HSAs to provide FP and HIV & AIDS services in the
hard to reach underserved areas.

3. Project Geographic Scope
Karonga (11): CFPHS
= Project Head Office Kasungu (3): BASICS & CFPHS
Nkhotakota (6): CFPHS
Mangochi (21): BASICS, CFPHS, &
TBCAP Salima (9): BASICS & CFPHS
Balaka (16): BASICS & CFPHS
Phalombe (26): BASICS &
CFPHS
Chikwawa (18): BASICS & CFPHS

4. CFPHS Approaches
• Define and develop the supply and capacity of
service providers at district, health center and
community levels
• Create demand for FP and HIV & AIDS services
through BCC, community networks and outreach
• Review current policies and advocate for supportive
policies

5. FFSDP MODEL
DELIVERY OF QUALITY, INTEGRATED SERVICES
for FP and Prevention & Treatment of HIV/AIDS/STIs
FULLY COMMUNITY
MANAGEMENT& SUPPORT SYSTEMS
LEADERSHIP SUPPORT FUNCTIONAL
DISTRICTS Engaged traditional &
at Zonal & National Levels elected leaders
Technical &
Operational Support FULLY Social marketing &
Clear policies & guidelines BCC activities
SUPPORTIVE
Adequate norms & protocols Community
Trained & motivated COMMUNITIES
Effective strategies & involvement
approaches for different staff
Sufficient equipment, PROVIDERS Positive social
groups RH/FP
(incl. CBDAs Local FBOs/NGOs
Planning & mgt tools drugs, & supplies CLIENTS atmosphere (stigma
Adequate /HSAs) motivated and engaged
Human resource mgt reduction, reduction
infrastructure Community structures
Financial mgt systems & tools •Proven FP capacity with •Well informed of GBV) involved: women’s &
Supply mgt system Functional referral Attention to
performance improvement •Aware of FP benefits men’s groups, youth
Mgt information system system
opportunities •Able to freely chose underserved & high- associations
Quality assurance system Functional MIS
•Regular formative preferred FP method risk groups Local governments
supervision •Understand their rights Affordable services involved in all activities
•Adapted info. system •Continue use of chosen Informed choice
•Incentives method and adhere to
•Respect for clients’ indications for use
Political rights
Support, •Understanding of
Social
needs of both genders
Dialogue, & Support &
Advocacy Sustainable use of
quality, integrated
Local
FP/RH services Ownership
Enabling policy and social environment
5

6. Family Planning Services
6

7. FP service Accomplishments
• 1003 CBDAs trained
• 293 Supervisors trained;
• 361 HSAs trained in DMPA
• 96 Nurses and Clinical officers trained in LTPM
• 15 TOTs and 205 providers trained in Standard Days
Method.
• SDM provision started January 2010
7

8. FP Service Provision
CFPHS Trained Provider inserting Jadelle DMPA Practicum 8

9. FP Results
• About 90,046 DMPA doses given by HSAs Jan-Dec
09
• 271,799 people counseled on FP and HIV messages
9

10. Results:
New and Old Clients By HSAs and CBDAs Yr 09
CBDAs made 3,007 referrals for other FP
methods. Thus likely drop in new users

11. Results Continued

12. 12

13. FP service delivery Challenges
• Retention of CBDAs vs incentives
• Reporting
• Proper disposal of hazardous waste
• Drop out of service providers.
13

14. HIV TESTING AND
COUNSELING SERVICES
14

15. Accomplishments
• 76 CBDAs trained in Door to Door provision of HTC.
• 15 HSAs trained in HTC
• 13 HSAs trained in HTC Supervision
15

16. HTC SERVICE RESULTS
• 83, 220 people learned their HIV status between Sept
08 and Dec 09 through door to door integrated HTC
and FP services by the 76 trained CBDAs
16

17. People Counseled & Tested for HIV – by Quarter
Dec 08

18. HTC Service Delivery Challenges
• Proper disposal of hazardous waste
• Availability of Test Kits
18

19. DEMAND CREATION
19

20. Activities:
Increase demand for contraceptives and HIV testing
• Message design workshop conducted
• Communication strategy document developed
• Branded BCC campaign launched
page 20

21. Listening Club activities
• 25 FP Listerners clubs (already existing) per district
were trained.
• Trained 2 members from each club to lead the
listening activity.
• Listerners clubs meeting conducted every
Wednesday
• Discussion guides developed to assist during
listening activity.
page 21

22. Community drama performances
• A script based on the radio drama series was
developed for community drama performances
• Three community drama troupes per district identified
and trained.
• Troupes asked to perform regularly in their
communities.
page 22

23. Community Sensitization/ Open days
• CBDAs, HAS and HTC Counselors showcase the
services they provide.
• As of December 2009, 13 open days were held
throughout the project districts.
page 23

24. Integration of Gender Based Violence into all
activities
• Developed GBV modules with the help of a GBV
consultant.
• Ensured that GBV was incorporated in the training of
CBDAs and private sector providers
• Ensured that all materials developed for the BCC
campaign were gender sensitive
page 24

25. Increased accessibility to oral and injectable
contraceptives
• Initiated family planning provision through private
clinics, pharmacies and drug stores
• Trained 292 private sector providers in FP service
provision
• Distributed 12 813 cycles of oral contraceptives and
99 285 vials of injectable contraceptives.
page 25

26. Results:
• 32 525 people reached through community drama
• 56 034 people (26 676 male and 29 358 female)
reached with family planning and HIV and AIDS
services through open days.
26

27. Demand creation and increasing access: Open Day
27

28. POLICY AND ADVOCACY
28

29. Policy Landscape analysis
Activities
• Consultative meetings
• Document review
• Disseminated findings at FP sub committee
29

30. Results
• 9 policy areas identified
• Policy on CBD of DMPA included in SRHR policy
• Oral pills de regulated
• Policy language on social marketing included in
SRHR policy
30

31. CBD of DMPA
Activities Results
• Several debates • MoH decision on HSAs March
• HPI feasibility Study 2007 2008
• Operational barriers study • Consensus to pilot HSA..
• DMPA initiative
Madagascar study tour in
June 2008 • Policy statement on CBD of
• DMPA
Stakeholder’s dissemination
meeting July 2008 • guidelines and training
• materials developed and
SRHR policy review
approved Oct. 2008
• Guidelines development
• Guidelines disseminated June
Workshop
2009
31

32. Integration of FP and HIV/AIDS Survey
• Objectives: meaning, purpose, challenges,
lessons
• Data collected in Sept. 2009
• Report submitted to MSH home office
• Dissemination and consensus building
workshop in May 2010.
• Results expected to guide policy and guidelines
development
32

33. Social Marketing Guidelines
• Literature review
• Consultations
• Interviewed CBDAs in two districts
• Lessons learnt from other countries presented to RHU and options
for Malawi discussed
• RHU prefers to pilot in urban or semi urban using a private sector
organisation
• Government’s policy of free health services
• Working with PSI to pilot
33

34. Advocacy with
Faith Based Organizations
• Consultative meetings with Muslim clerics on FP and
HIV/AIDS services and Islam
• Conducted high level advocacy conference in August
2009
• Resolutions a guide to Muslims on FP and HIV/AIDS
issues; and future programmes
• FP and HIV/AIDS presentations at women’s
gatherings
34

35. Advocacy with regulatory bodies
• Pharmacy, Medicines and Poisons Board of Malawi
• Medical Council of Malawi
• Nurses and Midwives Council of Malawi
35

36. Policy Challenges
• Conflict between policy, practice and regulation.
• Policy on free health service affecting community
based social marketing efforts and private sector
involvement.
• HSA provision of other contraceptive methods.
• Ministry’s view regarding CBDA
administration/provision of DMPA at the community
level
• Sustainability and scale-up of CBD program
• Integration of FP and HIV/AIDS services
36

37. MONITORING AND
EVALUATION
37

38. Monitoring and Evaluation
• CFPHS Project falls under USAID SO 8
• SO 8 has 4 Intermediate results as follows:
o Increased use of improved health behaviours
and services
o Improvement of quality services
o Increased access to services
o Strengthening health sector capacity.

39. Monitoring and Evaluation
• 3 Indicators chosen to monitor SO8 as follows:
o Percentage of under-five children sleeping
under insecticide-treated bed nets
o Contraceptive prevalence rate
o Use of condoms during risky sex
• Only last two relate to the CFPHS Project

40. Monitoring and Evaluation
• Contribute to Goal Level indicators
• Total fertility rate
• Prevalence of HIV among 15 to 49 year olds
40

41. Critical Assumptions
• Facilities are adequately staffed.
• Political and professional support is available for
CBDAs to deliver FP and HIV/AIDS services.
• Policies have been approved by MOH enabling
CBDAs to provide injectable contraceptives.
• Contraceptives, STI medicines, and HIV test kits are
available.

42. Monitoring and Evaluation:
Main Outputs for Project Monitoring – Program Inception
• Detailed Implementation Plan (DIP)
• Performance Management and Evaluation Plan
(PMEP)
 Indicator definitions
 Work plan
 Data Quality Assessment checklist
• Baseline Survey
» Conducted April 2008
» Report released January 2009

43. Life of Project Outputs
• Monthly reports
• Quarterly Reports
• Bi-annual Reports
• Annual Reports

44. Challenges
• Staff turnover high
• Data collection difficult by design (work in hard to
reach areas)
• Data management

45. Looking forward
• Improve data management
• Use of modern communication systems for data
reporting – Associated challenges of expenses
involved
• Staff and Volunteer (CBDA) motivation

46. OVERALL
LESSONS LEARNT
46

47. Major Lessons Learned
• Well trained non-medical workers can effectively provide
selected FP methods.
• Community based services reduces workload at health
facilities.
• SDM has created a lot of interest among the catholic
community in FP;
• Increased training of LTPM providers has increased
demand for Jadelle;

48. Major Lessons learned cont…
• Demand Creation activities improves service uptake
• Integrated community based FP and HTC services
reduce stigma
• High level advocacy improves political will.
48

49. Capacity gaps in FP and HIV&AIDS issues A sustainable advocacy strategy is
exist among the Muslim community important
49

50. Conclusion
• Scaling up integrated CFPHS can accelerate
meeting the FP and HIV & AIDS demands of the
underserved rural communities.
50