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Delivering family planning services to the last mile

When Khadija Yassin (24) got the news that she has been selected to go for a training as a community based distribution agent (CBDA), she didn’t have an idea of what constituted the said role.

“Word came from the health centre to our chief saying they needed someone who is a hard worker and also of good character,” says Khadija. “The chief and other community leaders then selected me for the training. I was happy that the community had trust in me, but it was my first time to hear about a CBDA.”


Khadija has managed to convince her community to accept family planning. ©UNFPA/Malawi/Joseph Scott

The next day, Khadija received a message to go to their health centre for a briefing. That’s when she got the gist of what it entailed to be a CBDA.

The making of a CBDA

“I wasn’t alone who didn’t know what a CBDA does,” recalls Khadija, a mother of one from Chikole village in Mangochi. “In fact, the other candidates also came to learn more of the work of a CBDA during the briefing.”

A few weeks later, Khadija and her colleagues were invited for a 12 days training for CBDAs. The training, which was supported by UNFPA with funding from the Government of Iceland, drilled Khadija and her colleagues in the basics of providing non-prescriptive family planning commodities and also dissemination of information on reproductive health.

After graduation, the young cadre of volunteers were given the gargantuan task to change perceptions on how people view family planning in their communities. However, during the first days, it was difficult to convince members of her community to understand her new role and to accept the services she was offering.

Working during the Covid-19 pandemic

“I started my work when the Covid-19 pandemic was at its peak,” says Khadija. “Due to the misinformation about the disease then, people were avoiding me saying I wanted to vaccinate them. But obviously, this wasn’t the truth.”

Mangochi has a largely youthful population with 55 percent of the population below 18 years.  Almost 23 percent of women aged 15 to 24 have sexual debut before the age of 15 against a national average of 13.9 percent. The district also has poor indicators on sexual and reproductive health including low contraceptive rate (CPR), which is at 30.9 percent against the national CPR of 58 percent.


Khadija helping a couple to chose a family planning method of their choice. ©UNFPA/Malawi/Joseph Scott

“During the training, we had already been drilled of the poor family planning indicators,” says Khadija who oversees five villages. “But I didn’t anticipate such resistance.”

However, Khadija didn’t tire. She soldiered on, holding community meetings and visiting couples sharing information on the advantages of planning their families.  By and by, a few people started developing interest in her work.

“I didn’t relent,” she says. “I continued making visits to my clients every Tuesdays and Thursdays. I knew why they were thinking that way. Even myself didn’t believe in family planning. It took the CBDA training to convert me.

I kept on pushing and finally, I won a few hearts and gave them family planning commodities of their choice.”

Taking family planning to the people

Today, the people in Khadija community have completely changed their views on family planning and they now call her ‘doctor’. The prevailing myths that stopped people from accessing family planning are slowly disappearing and the numbers are backing it up.

According to data from Chikole Health Centre where Khadija reports to, after the training and deployment of CBDAs, the facility has seen a sharp increase in the accessibility and utilization of modern family planning in its catchment area.  For example, from October 2019 to March 2020 only 237 women used injectables. However, the number shot up to 928 between the period of October 2020 to March 2021, when the CBDAs were introduced into the communities.

Again during the same period, condom usage as a family planning method rose from a mere 14 to 256, pills from 13 to 228.

And Khadija is proud to be part of the team that made the achievements possible, “I am happy that my contribution is being appreciated and people are now aware of the benefits of family planning. We still have a long way to go, but we are moving in the right direction.”

By Joseph Scott, Communications Analyst