Official websites use. Share sensitive information only on official, secure websites. This is an open-access article distributed under the terms of the Creative Commons Attribution 4. Midterm process evaluation results indicated that design and implementation failures hindered the program's success, notably: 1 the short-acting methods provided by community-based distributors CBDs offered limited choice; 2 the nominal revenue retained from selling the methods provided limited motivation for the volunteer CBDs; and 3 the model was poorly coordinated with the existing clinical service system, partly because of challenging systems issues.
In the revised model, the CBDs will also provide subcutaneous injectables and emergency contraceptive pills, retain more revenue from contraceptive sales, and have better interaction with the existing system including conducting monthly mini-campaigns to increase visibility and attract more clients.
In a context where distance, user fees, and health staff shortages constitute significant barriers to accessing facility-based family planning services, the use of community-based distributors CBDs as counseling and contraceptive providers has been tested in several resource-constrained environments to increase family planning uptake. In the capital city of the Democratic Republic of the Congo DRC , Kinshasa, a massive CBD program AcQual has been implemented since , with lackluster results measured in terms of the low volume of contraceptives provided.
A process evaluation conducted in assessed the fidelity of implementation of the program compared with the original AcQual design and analyzed gaps in provider training and motivation, contraceptive supplies, and reporting and monitoring processes.
Its objective was to identify both theory and implementation failures in order to propose midcourse corrections for the program. In addition, 10 in-depth interviews were conducted with clinical personnel, local health program managers, and project partners to identify gaps in the AcQual implementation environment.
