title: Performance and measurement of a community-based distribution model of family planning services in Pakistan.
abstract: BACKGROUND
  Community-based distribution (CBD) has been successfully applied to family planning (FP) services worldwide. It forms the basis for the large lady health worker (LHW) programme in Pakistan which serves a limited number of women with contraception services. Thus, the concept has seen limited application in Pakistan. We present the outcomes of a CBD model that was implemented in 49 districts across Pakistan by a non-government organization (NGO).
  
  
  METHODS
  The Marie Stopes Society (MSS) developed a CBD model around its fixed centres and reached around half a million married women of reproductive age (MWRA) with services. The services provided included outreach, counselling, condoms, pills, injections, and referrals for intrauterine contraceptive devices (IUCDs) and other reproductive health services. Services were provided in peri-urban locations for a subsidized fee using a businesslike target setting approach. The results of the programme were assessed by triangulating inception records against a cross-sectional end-of-project survey and service delivery records.
  
  
  RESULTS
  The contraceptive prevalence rate (CPR) had increased from 38% to 51% by project-end with modern method use increasing by 50-200% and traditional method use remaining unchanged. Unmet need and self-reported pregnancy rates fell correspondingly. Approximately 73,500 new users were added to the initial user registered numbers to a total of 132,300; MSS accounted for 53,000 per year at the end of the project, which matched the commodities supplied by the NGO.
  
  
  CONCLUSIONS
  The MSS CBD model presents a viable option for scaling effective FP services that may be replicated and scaled up with either donor support or by contracting out by the government. Triangulation of multiple data sources can provide more in-depth assessment of service delivery programmes and provide inferences that can inform service delivery.
authors.affiliation: Marie Stopes Society, Karachi, Pakistan. khurram.azmat@mariestopes.org
authors.forename: Syed Khurram
authors.initials: SK
authors.lastname: Azmat
authors.affiliation: Marie Stopes Society, Karachi, Pakistan.
authors.forename: Shirin
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: Marie Stopes Society, Karachi, Pakistan.
authors.forename: Waqas
authors.initials: W
authors.lastname: Hameed
authors.affiliation: Marie Stopes Society, Karachi, Pakistan.
authors.forename: Mohsina
authors.initials: M
authors.lastname: Bilgrami
authors.affiliation: Research and Development Solutions, Islamabad, Pakistan.
authors.forename: Ayesha
authors.initials: A
authors.lastname: Khan
authors.affiliation: Research and Development Solutions, Islamabad, Pakistan.
authors.forename: Adnan Ahmad
authors.initials: AA
authors.lastname: Khan
authors.affiliation: Marie Stopes Society, Karachi, Pakistan.
authors.forename: Ghulam
authors.initials: G
authors.lastname: Mustafa
mesh_terms: D000328:Adult; D003695:Delivery of Health Care / Q000592:standards*; D005193:Family Planning Services / Q000592:standards*; D005260:Female; D006801:Humans; D008962:Models, Theoretical; D010154:Pakistan; D011247:Pregnancy; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies