BENGUET STATE UNIVERSITY

COLLEGE OF NURSING

ACADEMIC JOURNAL:
Repositioning Family Planning
Through Community Based
Distribution Agents in Malawi By
Boniface Kalanda

Submitted by: BOSANG, Shylla Klaren L. 3F2

Due to its low reproductive health indices and consistently high rates of maternal death,
Malawi has serious challenges in the area of maternal health. In spite of the relative calm, the
nation's high maternal death rate—which stands at 984 per 100,000 live births—nearly
doubled between 1992 and 2000. High fertility rates, regional variations, and the low
adoption of contemporary family planning techniques are all contributing causes. With a
16.4% infection incidence among women of reproductive age, the HIV/AIDS epidemic
exacerbates pre-existing health problems, especially in young people who are less likely to
receive voluntary counseling and testing (VCT). Implementing family planning initiatives,
such as the Population and Family Planning Project, which sought to increase contraceptive
prevalence rates through community-based distribution, is one way to try to solve these
issues.However, the impact and effectiveness of such initiatives need further evaluation.

Between 1999 and 2003, the Population and Family Planning Project in Malawi was carried
out with the aim of improving family planning services by means of community-based
distribution agents (CBDAs). About 100 CBDAs were educated as part of the project, with
the goal of keeping 80% of them on staff. On average, each CBDA sought out 200 clients.
The study employed baseline and endline surveys to evaluate its results. The surveys covered
factors such as the prevalence of contraception, the sources of contraceptive techniques, the
acceptance of family planning, fertility desires, knowledge about contraception, and
knowledge of HIV/AIDS prevention measures. The project's goal was to raise the prevalence
of contraception, but its effectiveness and impact have not yet been evaluated. This raises
concerns about the more comprehensive approaches required to address Malawi's intricate
maternal and reproductive health issues, especially in light of regional disparities and the
HIV/AIDS pandemic.

The purpose of the study carried out in Malawi was to assess the effects of providing family
planning services through the Population and Family Planning Project using a district-wide
community-based distribution (CBD) approach. The results show promising trends, with
significant gains in family planning-related knowledge, attitudes, and practices. When
compared to control districts, the project's pilot districts had a marked increase in the
approval of family planning, indicating that Community-Based Distribution Agents (CBDAs)
were successful in influencing public opinion. The project was successful in encouraging
safer sexual practices and modern contraceptive technologies, as seen by the significant
increase in condom use and the contraceptive prevalence rate (CPR).

Furthermore, with a significant growth in their involvement in pilot districts, the report
emphasizes the critical role that CBDAs play as a public supply source for family planning
services. The trend toward using CBDAs as a practical family planning resource indicates
that they are important in influencing family planning-related attitudes and behaviors. The
study ends by highlighting the potential advantages of using CBDAs for family planning
services, especially in areas without adequate facilities within a reasonable distance from
residents, and concluding that a comprehensive CBD approach can contribute to increased
family planning approval, knowledge, CPR, and condom use.

In summary, the study suggests that CBDAs be used going forward to provide family
planning services throughout the district, especially in places where traditional facilities are
difficult to get to. The study promotes the use of data from businesses working with CBDAs,
like Banja La Mtsogolo (BLM) and Family Planning Services of Malawi (FPAM), in a
cost-benefit analysis. The aforementioned strategy is consistent with the overarching
objective of realigning Malawi's family planning program and highlights the potential
significance of community-based techniques in tackling reproductive health issues in settings
with limited resources.

II.​ NURSING IMPLICATIONS

A. Nursing Practice

The study's conclusions have a big impact on nursing practice, especially when it comes to
family planning and reproductive health. First off, the study's findings about the rising
acceptance of family planning, awareness of contemporary contraceptive techniques, and use
of family planning services highlight the critical role that nurses play as educators and
advocates. In order to ensure that people and communities are well-informed to make
decisions regarding their reproductive health, nurses can play a critical role in providing
accurate information on family planning methods. This emphasizes how important it is for
nurses to have continuing education and training so they can be equipped with the know-how
to meet the changing requirements of their communities.

The report also highlights the important role that Community-Based Distribution Agents
(CBDAs) play in providing family planning services. As members of the larger healthcare
team, nurses can work with CBDAs to increase access to family planning services in places
where facilities are not readily available. In line with the tenets of community-based care, this
cooperative approach enables nurses to interact with community health workers and promotes
the more thorough and easily accessible provision of reproductive health services. This could
entail organizing outreach initiatives, providing training and support for CBDAs, and
guaranteeing that official healthcare facilities and community-based agencies provide care
concurrently.

Finally, the study indicates that a community-based distribution (CBD) strategy used
district-wide may result in a rise in the use of public family planning resources. In order to
improve the integration of family planning services into public health frameworks and to
promote community-based initiatives, nurses can actively participate in the creation and
implementation of policies. Additionally, in order to guarantee that these community-driven
treatments are long-lasting and successfully incorporated into the larger healthcare system,
nurses can push for better infrastructure and resources to support CBDAs. To put it simply,
the study emphasizes how collaborative nursing practice is and calls for nurses to actively
participate in community-based initiatives that improve reproductive health outcomes.

B. Nursing Education

The study's conclusions have a big impact on nursing education because they show how
important it is to have a more comprehensive curriculum that takes into account how
reproductive health is changing. Comprehensive family planning modules, including the most
recent data on contemporary contraceptive techniques and community-based distribution
tactics, should be incorporated into nursing curricula. The development of the abilities
necessary for efficient reproductive health advocacy, counseling, and education should be
prioritized. Educational institutions may prepare future nurses to play a critical role in
enhancing family planning outcomes and general reproductive health in varied community
contexts by providing them with up-to-date information and communication skills.

Programs for nursing education should also think about including opportunities for students
to participate in community-based activities through hands-on training. Students'
comprehension of community-based care and the incorporation of family planning services
into public health frameworks can be improved by exposure to the cooperative efforts
exhibited in this study, especially the participation of Community-Based Distribution Agents
(CBDAs). Practical experiences, like field placements or community health rotations, can
give nursing students the knowledge and insights they need to successfully negotiate the
potential and difficulties of reproductive health education in a variety of socioeconomic and
cultural situations. Future nurses can be more effectively equipped to make a significant
contribution to the improvement of the health outcomes of the communities they serve by
ensuring that nursing education is in line with the reality of community-based reproductive
health interventions.

C. Nursing Research

The study's conclusions have significant ramifications for nursing research and point to
directions that warrant more study and inquiry. Nursing researchers can investigate the
efficacy of community-based approaches, like the one this study investigated, in a range of
healthcare settings and patient demographics. This can entail testing the model's applicability
to various socioeconomic settings, cultural contexts, and healthcare infrastructures. Future
studies may examine how long-term behavioral changes, community involvement, and the
incorporation of family planning services into larger healthcare systems can all contribute to
the sustainability of community-based interventions. Solid research in these fields may
provide insightful information that helps guide evidence-based nursing policy and practices.

Nursing researchers can also investigate how nurses participate in community-based projects
by training and collaborating with Community-Based Distribution Agents (CBDAs). It would
be insightful to look into how such cooperative efforts affect reproductive health indicators
and family planning utilization, among other community health outcomes. The results of this
study may aid in the creation of recommendations and best practices for incorporating
nursing knowledge into community-based healthcare delivery systems. In order to optimize
healthcare methods and shape policy recommendations for better reproductive health
outcomes, nursing research may make a significant contribution to the body of knowledge
about the efficacy and sustainability of nurse-led interventions in community-based settings.

I.​ PERSONAL INSIGHT

Upon reflecting on the content of the journal and its nursing implications, it becomes clear
that community-based approaches, particularly involving Community-Based Distribution
Agents (CBDAs), offer a promising avenue for enhancing reproductive health outcomes in
resource-limited settings like Malawi. This study suggests that these approaches can
positively influence family planning approval, knowledge, and utilization. Personally, I see
this as a powerful affirmation of the potential impact when nursing professionals work
collaboratively with community health workers. It not only broadens access to reproductive
health services but also addresses the intricate factors shaping attitudes and behaviors
surrounding family planning.

My key takeaway is the recognition of the pivotal role nurses can play in this collaborative
framework. The implications for nursing practice emphasize the importance of ongoing
education, ensuring that nurses are well-prepared to serve as knowledgeable advocates in the
realm of reproductive health. This insight highlights the need for nursing education programs
to adapt, integrating modules that align with the evolving landscape of family planning and
community-based care. The study further underscores the significance of nurses collaborating
with CBDAs and other community health workers. By actively engaging in these community
health initiatives, nurses can contribute to positive changes in knowledge, attitudes, and
practices related to family planning, championing better health outcomes for individuals and
communities alike.

In summary, my personal insight is that nursing professionals possess a crucial role in

REFERENCE:

Kalanda, B. (2023). Repositioning family planning through community based distribution

agents in Malawi. Malawi Medical Journal, 22(3). https://doi.org/10.4314/mmj.v22i3.62191