Making Family Planning Acceptable, Accessible, and Affordable: The Experience of Malawi

"Key informants noted that perhaps the greatest contribution to the growth in FP [family planning] use is the culture of acceptance for FP at the community level."

This project brief on FP in Malawi highlights key policy and programme achievements, conveys the story behind the programme's success, and looks to the future for sustaining and building on its progress. The brief synthesises findings from a Fall 2011 review conducted by the RESPOND Project, in collaboration with the United States Agency for International Development (USAID) and Malawian health ministry partners.

In the “Transforming FP service delivery section” of the report, strategies to realise the goal of making FP accessible and affordable include the following:

• Investing in human resources and training - A core component of efforts to establish culturally appropriate and effective modes of service delivery in Malawi has been training health surveillance assistants (the lowest level cadre of full-time salaried workers in the Ministry of Health) and volunteer community-based distribution (CBD) agents to provide FP information and supply specific contraceptives at the community level.
• Deploying lower cadres of health professionals (clinical officers, midwives, nurses, and health surveillance assistants) and volunteers to provide services at the community level -  Health surveillance assistants and CBD agents educate clients about different FP methods and inform them that long-acting and permanent methods (LA/PMs) are available at the district hospital for a small fee (and many workers will accompany the clients to the facility). They announce mobile outreach provider visits. "Some key informants referred to this community-based approach as representing the ‘demedicalization’ of FP. One CBD agent interviewed for this study remarked: 'We can’t have a medical approach to a social need.'"
• Expanding outreach and mobile services through public-private partnerships, including  bringing services closer to communities and task-shifting of service delivery to more cadres and sites.
• Creating a culture of acceptance - The Government of Malawi made concerted efforts to disseminate information about the benefits of modern FP to all communities, with an emphasis on the idea that “modern contraception can help mothers avoid pregnancies that may be too early, too frequent, too many, and too late.”