Evolution of a Large-Scale Community-Based Contraceptive Distribution Program in Kinshasa, DRC Based on Process...

Area of Science:

• Public Health
• Reproductive Health
• Health Systems Strengthening

Background:

• Community-based distributors (CBDs) are utilized in resource-constrained settings to improve family planning (FP) access.
• A large-scale CBD program (AcQual) in Kinshasa, Democratic Republic of the Congo (DRC), yielded suboptimal contraceptive delivery volumes.
• Significant barriers to facility-based FP services include distance, user fees, and health staff shortages.

Purpose of the Study:

• To conduct a process evaluation of the AcQual CBD program in Kinshasa.
• To identify implementation fidelity gaps and theory failures in the CBD program.
• To propose midcourse corrections to enhance family planning uptake.

Main Methods:

• Mixed-methods approach focusing on CBDs as the core program component.
• Interviews with 700 active CBDs.
• In-depth interviews with 10 clinical personnel, program managers, and project partners.

Main Results:

• Identified implementation failures included issues with CBD performance, knowledge retention, commitment, supply chain gaps, and inadequate monitoring/supervision.
• Limited contraceptive method mix (condoms, pills, CycleBeads) and overburdened healthcare staff contributed to low service volume.
• Program design and implementation failures were evident, impacting overall effectiveness.

Conclusions:

• Midcourse corrections proposed include structured activity schedules, enhanced CBD integration with clinical providers and managers, expanded contraceptive methods (injectables, emergency pills), and clarified reporting responsibilities.
• Addressing provider training, motivation, supply chain management, and supervision is crucial for successful CBD programs.
• Findings offer insights into potential failures in similar CBD programs aiming to improve family planning services.