title: Reaching the poor through community-based distributors of contraceptives: experiences from Muheza district, Tanzania.
abstract: Community based distribution (CBD) programmes were introduced as a strategy to ensure access of contraceptives to the needy. The strategy is reported to increase contraceptive knowledge and use. Although CBD agents have the advantage of reaching the poor in rural areas, wealth gap does exist even in these settings. The objective of this study was to determine access to information and modern contraceptives services among people of different wealth status in a rural setting in Muheza, Tanzania. This cross-sectional study was conducted following a six year project in promotion of contraceptive using community-based agents. The study area was stratified into three socio-geographical strata from which one village was randomly selected. Through house-to-house visits, interviews were conducted using structured questionnaires until the required sample size was obtained. A community-led wealth ranking criteria was developed through consensus and used to classify respondents into wealth categories. A total of 1,420 respondents were interviewed. Contraceptive Prevalence Rate (CPR) for modern methods was 32.2%; injectables accounted for half (50.8%) followed by pills (32.7%). CBD agents accounted for one-third (34.3%) of the contraceptive use. There was no difference in the access to information (P=0.44) and to contraceptives (P=0.83) between the poorer and the less poor. Half of the respondents (49.4%; 214/431) reported paying for services, with no difference between the less poor and the poorer (P=0.75). Respondents receiving services from health facilities were more likely to pay for services (61.3%) compared to CBD agents (25.0%). However, the level of satisfaction was high (approximately 70%) in both health facilities and CBD agents. This study has shown that people in the rural settings of Muheza district were able to access information and contraceptives from CBD agents and health facilities, regardless of their wealth status. There is however, need to address the issue of informal payments lest it deters people in need from accessing the services.
authors.affiliation: Department of Community Health, Muhimbili University of Health and Allied Sciences, PO. Box 65015, Dar es Salaam, Tanzania. dsimba@muhas.ac.tz
authors.forename: Daudi
authors.initials: D
authors.lastname: Simba
authors.affiliation: Tanzania German Programme to Support Health, P.O. Box 5187, Tanga, Tanzania.
authors.forename: Cordula
authors.initials: C
authors.lastname: Schuemer
authors.forename: Kate
authors.initials: K
authors.lastname: Forrester
authors.affiliation: Tanzania German Programme to Support Health, P.O. Box 5187, Tanga, Tanzania.
authors.forename: Merriment
authors.initials: M
authors.lastname: Hiza
mesh_terms: D000293:Adolescent; D000328:Adult; D003153:Community Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data*; D003267:Contraception / Q000191:economics / Q000379:methods*; D003430:Cross-Sectional Studies; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011203:Poverty / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013636:Tanzania