FPAK [Family Planning Association, Kenya] CBD [community-based distribution] program evaluation

The evaluation covers the period 1990-9/92. Phase II of the CBD project was launched in 1990 in 19 sites. By 1992, FPAK had recruited 734 CBD agents and 51 field workers as supervisors in an effort to expand family planning services to reach over 170,000 new clients. Within 2 years FPAK surpassed the latter target. CBD agents provide short-term family planning methods and refer clients to clinics for long term or clinical methods. Their standard services include: supply of contraceptives, referrals for examinations and clinical methods, and family planning counseling. Upon selection for the program, CBD agents receive a comprehensive two-week training course. Agents are assigned to locations covering anywhere from 300 to 800 households. They meet each month as a group with their supervisor to discuss problems in the field, receive refresher training, and be re- supplied. CBD agents collect and record a significant amount of information regarding the services they provide. CBD agents seem to be involved in more than family planning services; they also participate in and/or lead activities such as health and nutrition education and civil registration. FPAK's most significant achievements in developing the CBD program can be summarized as follows: the program's operational goals have been met; it is well established in the communities; structures and systems are in place and functioning appropriately. The implementation of CBD activities at the local level has benefited significantly from a well-managed supply system, and FPAK headquarters relies on a simple and well- designed management information system which produces service information on a regular basis. Additionally, in every site visited by the team, FPAK has been successful in engaging the support of the community. Communities showed positive perceptions of the benefits of the CBD program, and the team found significant community involvement in the launching of the program and in the recruitment of agents. Also, the program has strengthened area-level family planning programs by complementing clinic services. Moreover, the program has gained legitimacy within the local health system, both at MOH and NGO levels. Perhaps of greatest importance is the fact that enough empirical evidence exists to indicate that the CBD program is expanding family planning availability and acceptance. The evaluation team found eight primary areas of concern that should be addressed in the planning for Phase III, and made recommendations in those areas. These areas are (1) method mix expansion, (2) community willingness to share costs, (3) CBD agent's workload, (4) honoraria and other compensation for agents, (5) planning and coverage, (6) CBD management information system, (7) supervision and training, and (8) future expansion and phase out.