Academic journal article International Family Planning Perspectives

The Impact of a Regional Family Planning Service Promotion Initiative in Sub-Saharan Africa: Evidence from Cameroon. (ARTICLES)

Academic journal article International Family Planning Perspectives

The Impact of a Regional Family Planning Service Promotion Initiative in Sub-Saharan Africa: Evidence from Cameroon. (ARTICLES)

Article excerpt

Context: Sub-Saharan Africa has a considerable unmet need for contraception, in 1998-1999, the Gold Circle campaign--a regional initiative to promote and improve family planning service delivery sites--was launched in Cameroon.

Methods: During the last quarter of 1999, 571 women who had been interviewed during the 1998 Cameroon Demographic and Health Survey were reinterviewed regarding their exposure to the Gold Circle campaign and their perceptions on and use of contraceptives. The impact of the campaign was evaluated by assessing the panel data and by using an ideation model of behavior change. In addition, service statistics from Gold Circle and non-Gold Circle family planning delivery sites were contrasted to assess the effects of the campaign on clinic performance.

Results: More than one-third of the women surveyed reported exposure to the Gold Circle campaign, 52% of whom mentioned being exposed to the campaign through television. Those with primary or postprimary education were four and six times as likely, respectively, as those with no education to have been exposed to the campaign. Exposure was associated with a significant increase in the level of family planning ideation, as well as with an increased likelihood of using a modern contraceptive method (80%). The service statistics indicate that the campaign led to a significant increase in the demand for family planning services at Gold Circle clinics, with the number of new clients more than doubling immediately after the campaign launch.

Conclusions: The Gold Circle campaign had appreciable success in promoting family planning in Cameroon. The campaign had a considerable positive influence on both family planning ideation and contraceptive use.

Although there is some evidence that contraceptive use in Sub-Saharan Africa has increased in recent years, the region is still characterized by high levels of fertility and by considerable unmet need for contraception. In response, the U.S. Agency for International Development (USAID) initiated a regional reproductive and child health project in 1995. The project, Sante Familiale et Prevention du SIDA (SFPS), is currently being implemented in four French-speaking countries in the subregion: Burkina Faso, Cameroon, Cote d'Ivoire and Togo. Overall, the SFPS project seeks to contribute to the establishment and maintenance of quality reproductive health services in the target countries. (*)

As part of its quality improvement efforts, in 1998-1999 SFPS implemented the first phase of a family planning quality-promotion initiative. Called Gold Circle (GO), the initiative was designed and implemented with technical assistance from the Johns Hopkins University Center for Communication Programs. It sought to reward and promote family planning quality improvements in the four target countries. Through a certification process and by using a quality-of-care diagnostic tool to determine the current quality level of services provided, 10 or more SFPS sites were selected and designated as GO sites in each country. This article documents the impact of the campaign in Cameroon, using results of a panel study supplemented with service statistics.

Cameroon, located in Central Africa, has a population of approximately 15.4 million people, 44% of whom are younger than 15. (1) Fertility is high, with a total fertility rate of approximately 5.2 lifetime births per woman. A 1998 census of health facilities in the country identified 1,471 health facilities, ranging from hospitals to health centers, about three-quarters of which were public. In addition, there were some 230 registered pharmacies. (2)

Although family planning services are available in most of these health facilities, the contraceptive prevalence rate is only 8% for modern methods and 24% for all methods. (3) Pharmacies and public hospitals are the predominant sources of contraceptives, while kiosks and other commercial outlets are also important sources. …

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