Abstract
Convenient, nonclinical, community-based services that use community organization, structure and institutions has emerged as the core strategy to expand access to contraceptive technologies in sub-Saharan Africa. When experimental projects in Asia revealed that this approach, collectively termed “community-based distribution” (CBD), can enhance the quality, appropriateness and impact of family planning programs, lack of convenient access to contraceptives was viewed as the primary barrier to the practice of family planning rather than societal barriers. This paper presents findings from the long term observation of a factorial trial of alternative strategies for CBD, testing the relative effects of professional nurse based strategies versus combining nurse with volunteer roles that target the needs of men. Quantitative and qualitative results attest to the importance of activities that address the needs and concerns of men. Strategies that lacked this focus had no impact, even when CBD made comprehensive family planning services fully accessible.
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Notes
- 1.
The “Integrated Management of Childhood Illness (IMCI)” approach was intended to improve health by training workers to recognize treatment needs of a wide range of health problems and engage parents and communities in improving recognition of illness and appropriate actions (see WHO (2008)).
- 2.
Community engagement components of the Zurugelu approach were designed to sustain access to basic pharmaceutical supplies. Volunteer recruitment and management procedures were adapted from the recommendations of the UNICEF sponsored “Bamako Initiative” which sought to translate social institutions into resources that organize primary healthcare (Knippenberg et al. 1990). Family planning themes and activities were added to Bamako mandated health service strategies.
- 3.
The term “durbar” refers to an event, convened by chiefs and elders, to assemble family heads for making announcements, building consensus, and gauging community reactions to some event or activity of collective interest. Employed extensively in northern Ghana as an important mechanism for community governance, durbars were utilized in the CHFP to promote health awareness and build understanding of project activities (Tindana et al. 2007).
- 4.
This approach represented the view promoted by the World Bank at the time which advocated the use of paid, professional nurses to improve the range and coverage of community health care (World Bank 2003).
- 5.
- 6.
- 7.
The High Impact Rapid Delivery program was launched in the Upper East Region of Ghana in 2003 as a follow-on to the UNICEF Accelerated Child Survival Program. Although the official aims and clinical components of both programs were similar to CHFP, these initiatives did not provide for the posting of nurses to communities and family planning was not a focus of volunteer training and deployment (Nakamura et al. 2011). Ghana Health Service progress reports on the High Impact Rapid Delivery program make no mention of family planning (see, for example, Ghana Health Service 2010).
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Acknowledgements
This research was funded by grants to the Mailman School of Public Health, Columbia University from the William and Flora Hewlett Foundation and the Doris Duke Charitable Foundation. The Navrongo Community Health and Family Planning Project was supported by grants to the Population Council from the United States Agency for International Development, the Finnish International Development Agency, and the Mellon Foundation. The Navrongo Demographic Surveillance System was supported by grants to the Ghana Health Service from the Rockefeller Foundation.
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Adongo, P.B., Phillips, J.F., Baynes, C.D. (2014). Addressing Men’s Concerns About Reproductive Health Services and Fertility Regulation in a Rural Sahelian Setting of Northern Ghana: The “Zurugelu Approach”. In: Kulczycki, A. (eds) Critical Issues in Reproductive Health. The Springer Series on Demographic Methods and Population Analysis, vol 33. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-6722-5_4
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