Communities “Starting to Know the Goodness” of Family Planning and HIV Testing and Counseling in Rural Malawi

Communities “Starting to Know the Goodness” of Family Planning and HIV Testing and Counseling in Rural Malawi

From Alima Twaibu’s village in Nhkotakota district, it is 10 km to the nearest Health Center or 16 km to the District Hospital. With more than 80% of the population living in rural areas, the majority of Malawians experience similar challenges to accessing care. People have to walk long distances to receive services when they are sick. And when time away from work or paying for transport competes with other basic expenses, the decision to seek preventive services like family planning and HIV testing and counseling (HTC) is even more difficult. Fortunately for her neighbors and surrounding communities, Alima is an experienced Community-Based Distribution Agent (CBDA).  The Community Based Family Planning and HIV and AIDS Services (CFPHS) project, funded by USAID and led by MSH, and partners Futures Group International (FGI), and Population Services International (PSI) works in collaboration with the Ministry of Health to increase access to basic health services for populations living in hard to reach areas. CBDAs, like Alima, are the driving force behind delivering family planning and HIV and AIDS services to fellow community members.

After completing the pre-service training in July 2008 and subsequent HTC and family planning trainings, Alima has worked with roughly 537 clients. The communities “get information that they wouldn’t have before,” she says. In particular, Alima emphasizes that CBDAs share the information, but that it is important to let the individual or couple decide what to do with it. With the integration of family planning and HTC services at the community level, CBDAs are not only critical to conducting HIV tests, but also to facilitating a discussion of what to do with the results. “Maybe they use a condom instead,” suggests Alima.

Local leaders have played a significant role in community mobilization and utilization of the services CBDAs offer. Of the five villages within Alima’s catchment area, three village heads have been tested with the intention to act as a role model for the community. Even when one family gets tested, others feel encouraged. She sees about 4-5 new clients a month for HTC because “now they understand the advantage.”

When asked about stigma, there have been a few tough clients. One female teenager tested HIV+ and was referred to the Health Center; she threw her referral letter in the latrine. After counseling from her mother, she returned to Alima for another letter. Another approach to deal with stigma is door-to-door testing—families are able to receive information and services in a more private and comfortable setting. A satisfied couple explained that when Alima arrived at their home with information, they wanted to take their time. After a night of discussion, they returned to her the following day for family planning and HTC. The woman had 6 children from 1992-2003; in 2009 she chose tubal ligation as her long-term method.

As 1 of 118 CBDAs in the Nhkotakota, Alima exemplifies the MSH mission. Her dedication and thoughtful approach to sharing information is leading to real action in the health of surrounding communities.

Hillary Anderson is a communications intern in the MSH Malawi office and an MPH candidate at the Boston University School of Public Health.