PMID- 23874767
OWN - NLM
STAT- MEDLINE
DCOM- 20140218
LR  - 20220311
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 8
IP  - 7
DP  - 2013
TI  - Meeting rural demand: a case for combining community-based distribution and 
      social marketing of injectable contraceptives in Tigray, Ethiopia.
PG  - e68794
LID - 10.1371/journal.pone.0068794 [doi]
LID - e68794
AB  - BACKGROUND: In Sub-Saharan Africa, policy changes have begun to pave the way for 
      community distribution of injectable contraceptives but sustaining such efforts 
      remains challenging. Combining social marketing with community-based distribution 
      provides an opportunity to recover some program costs and compensate workers with 
      proceeds from contraceptive sales. This paper proposes a model for increasing 
      access to injectable contraceptives in rural settings by using community-based 
      distributers as social marketing agents and incorporating financing systems to 
      improve sustainability. METHODS: This intervention was implemented in three 
      districts of the Central Zone of Tigray, Ethiopia and program data has been 
      collected from November 2011 through October 2012. A total of 137 Community Based 
      Reproductive Health Agents (CBRHAs) were trained to provide injectable 
      contraceptives and were provided with a loan of 25 injectable contraceptives from 
      a drug revolving fund, created with project funds. The price of a single dose 
      credited to a CBRHA was 3 birr ($0.17) and they provide injections to women for 5 
      birr ($0.29), determined with willingness-to-pay data. Social marketing was used 
      to create awareness and generate demand. Both quantitative and qualitative 
      methods were used to examine important feasibility aspects of the intervention. 
      RESULTS: Forty-four percent of CBRHAs were providing family planning methods at 
      the time of the training and 96% believed providing injectable contraceptives 
      would improve their services. By October 2012, 137 CBRHAs had successfully 
      completed training and provided 2541 injections. Of total injections, 47% were 
      provided to new users of injectable contraceptives. Approximately 31% of 
      injections were given for free to the poorest women, including adolescents. 
      CONCLUSIONS: Insights gained from the first year of implementation of the model 
      provide a framework for further expansion in Tigray, Ethiopia. Our experience 
      highlights how program planners can tailor interventions to match family planning 
      preferences and create more sustainable contraceptive service provision with 
      greater impact.
FAU - Prata, Ndola
AU  - Prata N
AD  - Bixby Center for Population, Health and Sustainability, School of Public Health, 
      University of California at Berkeley, Berkeley, California, USA. 
      ndola@berkeley.edu
FAU - Weidert, Karen
AU  - Weidert K
FAU - Fraser, Ashley
AU  - Fraser A
FAU - Gessessew, Amanuel
AU  - Gessessew A
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20130712
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Contraceptive Agents)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Contraceptive Agents/*economics/*supply & distribution
MH  - Demography
MH  - Ethiopia
MH  - Female
MH  - Health Services Needs and Demand/*economics
MH  - Humans
MH  - Injections
MH  - Middle Aged
MH  - Reproduction
MH  - *Residence Characteristics
MH  - *Rural Population
MH  - *Social Marketing
MH  - Young Adult
PMC - PMC3709906
COIS- Competing Interests: The authors have declared that no competing interests exist.
EDAT- 2013/07/23 06:00
MHDA- 2014/02/19 06:00
PMCR- 2013/07/12
CRDT- 2013/07/23 06:00
PHST- 2012/10/25 00:00 [received]
PHST- 2013/06/03 00:00 [accepted]
PHST- 2013/07/23 06:00 [entrez]
PHST- 2013/07/23 06:00 [pubmed]
PHST- 2014/02/19 06:00 [medline]
PHST- 2013/07/12 00:00 [pmc-release]
AID - PONE-D-12-33481 [pii]
AID - 10.1371/journal.pone.0068794 [doi]
PST - epublish
SO  - PLoS One. 2013 Jul 12;8(7):e68794. doi: 10.1371/journal.pone.0068794. Print 2013.