Community based distribution of contraception; review of field experience

This report presents findings which validate this thesis and addresses the issue of how the CBD approach can be most effectively and efficiently applied. First, the authors summarize the information available on 30 A.I.D. projects, including the rationale, chronology, content, and principal results of each project. Next, the paper focuses on seven substantive areas of interest identified in the initial review: efforts at demand stimulation; services mix and methods of delivery; manpower needs, development, and utilization; organizational arrangements; services support and supervision; and research and evaluation procedures. In addition, a review of commercial retail sales experience is presented because of its direct relevance to CBD projects. Finally, the findings from the first two stages of the review are interpreted and synthesized. After initial implementation obstacles were overcome, the number of CBD projects has increased annually. Thirty were begun during 1974-79 and an average of 6-8 per year are currently being initiated. As the overall CBD concept has gained wider acceptance, projects have increased in size, number, and scope. Public and private CBD programs are culturally acceptable, affordable, and effective in raising contraceptive use from the 15% to the 30-35% level. Only one of the 30 projects was terminated because of poor performance. Two questions are posed for further research: (1) How can the efficiency of CBD efforts be improved under local conditions? (2) How can the use level be increased to the 50-60% range necessary to have an impact on fertility rates? Recommended are the formalization of a periodic uniform project reporting system and budgeting format, and the development of standard data collection instruments and data analysis systems as well as guidelines for project development and administration.