Community-Based Project Brings Preferred Contraceptive Method to Rural Malawians

A Malawian woman receives a Depo-Provera injection through the CFPHS project. {Photo credit: MSH.}Photo credit: MSH.

Since 2007, the USAID-funded Community-based Family Planning and HIV & AIDS Services (CFPHS) project has partnered with the ministry of health and local organizations in Malawi to expand access to integrated family planning and HIV & AIDS services in rural areas through a network of community health workers.

The CFPHS project, led by Management Sciences for Health (MSH), has had marked success, increasing contraceptive use from 20,000 to 39,000 couples in two years.

A 2004 health survey in Malawi showed that the contraceptive method of choice for about 60 percent of married women was the Depo-Provera injection (Depo). At the time, the Malawian Ministry of Health only allowed Depo to be administered in health centers, even though 80 percent of the country’s population had little access to these centers. Women in Malawi said they prefer Depo for its convenience—one shot every three months as opposed to a pill every day or a condom each time they have intercourse—and for its discretion.

In late 2008, after extensive debate with the CFPHS project, the ministry approved Depo as part of the project’s community outreach services. Since March 2010, when the project began rolling out the initiative nationwide, CFPHS has trained 1,400 community-based providers who in turn have reached more than 193,000 clients.

The CFPHS project has also helped health facilities procure 20,000 doses of the Depo, responding to what has been the initiative’s biggest challenge: stock-outs.

Depo supplies come from either the government’s medical stores or donor projects. Donor projects are able to provide the contraceptive more cheaply than the government, but they have not been able to provide a steady supply. As a result, when donor projects run out of Depo, facilities often run out as well, choosing to dedicate their limited funds to curative medicines rather than contraceptives. CFPHS is currently involved in advocating for facilities to include a line in their budgets for reproductive health commodities.

The CFPHS project seeks to substantially increase contraceptive coverage in Malawi with the ongoing introduction of Depo in community-based services.

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