University of California at Berkeley, School of Public Health, Bixby Center for Population Health and Sustainability, Berkeley, CA, USA.
Mekelle University College of Health Sciences, Mekelle, Ethiopia.
Glob Health Sci Pract. 2017 Mar 28;5(1):44-56. doi: 10.9745/GHSP-D-16-00344. Print 2017 Mar 24.
Ethiopia has made notable progress in increasing awareness and knowledge of family planning and is considered a success story among funders and program planners. Yet unmet need among rural women (28.6%) is almost double that of urban women (15.5%), with a wide gap in total fertility rate depending on urban (2.6) or rural (5.5) residence. This study investigates the impact of a service delivery model that combines community-based distribution (CBD) of contraception with social marketing in Tigray, Ethiopia, to create a more sustainable approach to CBD. Between September 2011 and October 2013, 626 volunteer CHWs were recruited and trained to administer depot medroxyprogesterone acetate (DMPA) injections and provide counseling and referrals to the health post for other methods; the project implementation period ended in June 2014. The CHWs received a supply of DMPA injections in the form of a microloan from a drug revolving fund; the CHWs charged women a minimal fee (5 birr, or US$0.29), determined based on willingness-to-pay data, for each DMPA injection; and the CHWs returned part of the fee (3 birr) to the drug revolving fund while keeping the remaining portion (2 birr). The CHWs also promoted demand for family planning through door-to-door outreach and community meetings. Existing health extension workers (HEWs) provided regular supervision of the CHWs, supplemented by in-depth supervision visits from study coordinators. Baseline and endline representative surveys of women of reproductive age, as well as of participating CHWs, were conducted. In addition, DMPA provision data from the CHWs were collected. Between October 2011 and June 2014, the CHWs served in total 8,604 women and administered an estimated 15,410 DMPA injections, equivalent to providing 3,853 couple-years of protection. There was a 25% significant increase in contraceptive use among surveyed women, from 30.1% at baseline to 37.7% at endline, with DMPA use largely responsible for this increase. Changes in quality of family planning markers from baseline suggested services improved between baseline and endline: nearly 50% more women reported being told about side effects and what to do if they experience side effects, and 25% more women said they were told about other methods of contraception. The results from household surveys at baseline and endline suggest that CHWs in this model made a significant contribution to family planning in the region.
埃塞俄比亚在提高计划生育意识和知识方面取得了显著进展，被资助者和项目规划者视为成功典范。然而，农村妇女未满足的需求（28.6%）几乎是城市妇女的两倍（15.5%），城市（2.6）和农村（5.5）的总生育率差距很大。本研究调查了一种服务提供模式的影响，该模式将社区为基础的避孕品分销（CBD）与社会营销相结合，以创造一种更可持续的 CBD 方法。在 2011 年 9 月至 2013 年 10 月期间，招募了 626 名志愿者 CHW 进行培训，以管理 depot 醋酸甲羟孕酮（DMPA）注射，并为卫生所提供咨询和转诊服务；该项目实施期于 2014 年 6 月结束。CHW 从药物循环基金获得 DMPA 注射的微贷款；CHW 向每位接受 DMPA 注射的妇女收取最低费用（5 比尔，或 0.29 美元），费用根据支付意愿数据确定；CHW 将部分费用（3 比尔）退还给药物循环基金，同时保留其余部分（2 比尔）。CHW 还通过上门宣传和社区会议来促进计划生育需求。现有卫生推广工作者（HEW）对 CHW 进行定期监督，并由研究协调员进行深入监督访问。对育龄妇女和参与 CHW 进行了基线和期末代表性调查。此外，还收集了 CHW 的 DMPA 提供数据。在 2011 年 10 月至 2014 年 6 月期间，CHW 共为 8604 名妇女提供服务，并估计注射了 15410 次 DMPA，相当于提供了 3853 对夫妇年的保护。接受调查的妇女的避孕使用率显著增加了 25%，从基线时的 30.1%增加到期末时的 37.7%，而 DMPA 的使用在很大程度上导致了这一增长。从基线到期末，计划生育指标的质量变化表明服务有所改善：近 50%的妇女报告说被告知了副作用以及如果出现副作用该怎么办，25%的妇女表示被告知了其他避孕方法。基线和期末家庭调查的结果表明，该模式中的 CHW 为该地区的计划生育做出了重大贡献。
