To advance progress towards Zambia's Family Planning Scale Up Plan (2016-2020), which aims to increase the national contraceptive prevalence from 33% to 58% and reduce unmet need for Family Planning from 22% to 14% by the year 2020, the Government of Zambia with support from UNFPA and other partners, has invested in key strategies to expand access to family planning services through “task shifting” delivered through community-based distributors (CBDs) among other strategies.
Task shifting, or task sharing, is a strategy where high-level medical skills are delegated to or provided by lower level cadres, to widen access and overcome barriers to access and use. In 2018, the Government of Zambia approved a national plan to support provision of injectable contraceptives by CBDs (2018 to 2021), developed with technical and financial support from UNFPA and other partners.
CBDs are ordinary community members, trained to provide family planning services as well as sexual and reproductive health information in their communities. To ensure confidentiality, they either work at their homes or travel to clients’ homes. Each CBD is affiliated with a health facility that provides them with family planning commodities and technical support for adherence to safety and high quality service standards.
Enelesi's Story
Enelesi Ndesa, aged 46, is one of six CBDs providing family planning services in Chisangwa village of Kalulushi district, Copperbelt Province. Known by community members as “mama CBD”, Enelesi provides family planning services at her home, with an average of 12 clients per month. Most of her clients receive subcutaneous depot medroxyprogesterone acetate (DMPA-SC), while others choose condoms or oral contraceptives.
"Before I was selected to be a CBD, I was a member of our neighborhood health committee, where I had the opportunity to be trained on various sexual and reproductive health issues. When the CBD program was introduced in our village, I was approached by community members and the headman, asking me to become a CBD. I did not hesitate to say yes! I was very excited to hear that I would be providing family planning services to my fellow women" says Enelesi.
A subsistence farmer, Enelesi dropped out of school in 7th grade because her family did not have enough resources to pay for her secondary school education. She can, however, read English as well as Bemba, her mother tongue. Through the SARAI project, she is trained to provide condoms, injectable and oral contraceptives, as well as HIV testing using a rapid HIV test kit. Using a bicycle he received from the project, takes a 30 km ride to Chati rural health center to deliver her reports and replenish the family planning FP commodities. Although she does not receive financial incentives, Enelesi is committed to her work.
"My motivation comes from seeing women happy and accessing services close to their homes. I really feel good when women come to say thank you for the help I give to them. They call me ‘mama CBD’ or ‘ba nurse’—which also motivates me! Our village is very far from the nearest health center and so many women used to have a lot of children - not because they wanted to, but because they couldn’t manage to walk the long distance to the health facility to access family planning. But now they just come to my home within the village any time they want" says Enelesi with a big smile.
Akufuna's Story
Akufuna Kashweka has spent the last 8 years of his life as a dedicated CBD of family planning services in the rural part of Senanga District in Western Province of Zambia. After attending a training at Litambya Rural Health Center that supported to enhance his capacity for this role, Akufuna’s motivation was significantly increased to scale up his efforts in reaching the unreached communities to provide family planning information and services. Today he attends to an average of 8 clients each day in his catchment area covering distances of over 10 kilometers.
As a result of this, there has been an evident increase in the demand and uptake of family planning services within his community.
“I have observed that due to the work we do as CBDs, there has been an increase in the level of knowledge within the community resulting in improved uptake of family planning services. Additionally, teenage pregnancies and early marriages have greatly reduced.” He states.
Akufuna is one of the few male distributors in his area and he narrates that in the beginning, it made him feel uncomfortable but today he is free to engage with his clients most of whom are women and they have equally become open to work with him.
“I am committed to raise awareness on family planning in my community working together with other members because I have seen the great benefit it is adding to our people.” He adds.
Due to long distances to health facilities, many people depend on CBDs like Akufuna to provide family planning information, counselling and distribute contraceptives. Akufuna also now serves as a role model for more male community based distributors.
Bringing Vital Family Planning Services to Zambia's Rural Women
In 2019, results of the 2018 Zambia Demographic and Health Survey revealed significant improvements in family planning indicators. Unmet need for family planning reduced from 21% to 20% and the use of modern methods of contraception increased from 45% to 48%. Despite progress made, key challenges remain that limit women’s access to family planning services.
With continued efforts of CBDs like Enelesi and Akufuna, alongside sustained commitments by the Government of Zambia and partners, Zambia is on the right path towards meeting the goals of its National Family Planning Scale Up Plan (2013 to 2020), which aims to increase the national contraceptive prevalence from 33% to 58% and reduce unmet need for Family Planning from 22% to 14% by the year 2020.
