2.1.2  Service delivery modes

Door-to-door service delivery

A door-to-door service providing family planning packages at household level is carried out by Health Extension Practitioners. The service includes education, counselling and the provision of contraceptive methods, such as oral pills, condoms and injectables. This approach started with the establishment of the Health Extension Programme and has been cost-effective, and the preferred way to reach the majority of people in their homes.

Facility-based service delivery

A facility-based service delivery approach provides family planning services in Ethiopia through public health centres and hospitals. The major advantage of using this approach is that it can provide medically complex methods, such as IUCDs, hormonal implants and sterilisation. This approach works well for those living close to any of these health facilities.

Community-based distribution (CBD)

In areas that do not have any type of health facility nearby, family planning services may be made available through community-based distribution or CBD programmes. In this approach, CBD workers, usually village women, are trained to educate their neighbours about family planning and to distribute certain contraceptives.

In their training, the CBD workers learn the basic concepts of family planning, how each method must be used, what the precautions and side effects are for each method, and how to keep simple records and report the information to their supervisors. CBD programmes usually distribute condoms; some also provide pills and spermicides. In Ethiopia, this programme has now been replaced by the Health Extension Programme.

Commercial retail sales

In both urban and rural areas, if people are willing to obtain contraceptives from sources outside the healthcare system, commercial retail sales (sometimes called social marketing) can make some contraceptive methods very accessible. In these approaches, contraceptives, such as oral contraceptive pills, condoms and injectables, are sold at reduced, subsidised prices in pharmacies, from market stalls, and so on.

A good example of this is DKT-Ethiopia. When a commercial retail sales approach is used, the retailers are often the customers’ only source of information about the products. These retailers should be given training in basic information about the products, and how to refer people who have problems with a contraceptive.

Other delivery methods

A number of other service delivery methods have been used. Some companies provide family planning services during certain hours at the workplace. Although generally at a higher cost, family planning services are often available from private for-profit healthcare providers. Other approaches involve training paramedics, pharmacists, traditional birth attendants, midwives, traditional healers and outreach workers to provide family planning services.