Issues in the selection and field implementation of family planning and health interventions in community-based distribution projects.

This issue paper 1 of a series of five which focus on community based distribution (CBD) program design and implementation discusses issues concerning the selection and field adaptation of family planning and selected health services. A major focus is on the question of "mix" that is the number and type of interventions chosen from both the family planning and health areas for any 1 project and how this mix might affect the impact and acceptability of both the family planning and health efforts. The discussion considers the philosophy and advisability of integration of family planning and health in CBD projects. The debate over types of programming--horizontal versus vertical of integrated versus unifunctional--has not been conclusive. This is necessary to ensure fit between these resources and the demands on manpower supervision and logistics imposed by the service in question. In a CBD project the choice of health priorities can in part be based on disease prevalence rates morbidity and mortality ease of control cost of the intervention and its potential to confer health problems yet one must further consider the following points: decreased project reliance on clinics; timing and frequencey of cotact between CBD workers and clients; educational level and training of workers the prevalence of the conditions logistics and rapid impact. Each of these considerations becomes much more complex once one considers implementing multiple interventions--the component "mix." Dosage schedules physical support systems workers ability to remember and to prioritize a number of ideas and skills. Additionally interventions need to be chosen in a way that ensures some balance between the time and energy spent on each one in the field. There are no comprehensive sets of guildelines or studies to assist in the selection of CBD components. To produce this paper a number of major CBD donor agencies were contacted visits to CBD field projects were made and documentation was reviewed to search for existing guidelines elaborated by other agencies working in this field. Although not definitive this report offers some direction for program planners and outlines research needs in the selection and delivery of CBD components in family planning and health.