Zambia Family Planning Services Project

• Partners
• Components

Partners

Components

Strengthening Service Delivery and Training

John Snow, Inc.

Services were strengthened through:

• Health center refurbishment, including equipping.
• Training of service personnel with revised and upgraded curricula to increase knowledge so that more people can be served with a broader method mix.
• Recruiting and training of employer-based and community-based distribution agents.
• Attention to support systems, such as supervision, referral network development and monitoring and evaluation.

Information, Education and Communication (IEC)

The Information, Education and Communication (IEC) component of the Zambia Family Planning Services Project was implemented by JHU/PCS. Approximately 2.2 million dollars was allocated to this component to assist the government and non-governmental organizations to encourage the 350,000 married Zambian women of reproductive age who indicated a desire to practice a modern family planning method (Intenders) to link up with these better trained and equipped service providers. A secondary focus of this component was to assist young men and women (aged 15-25) to gain access to reproductive health information and services. The objectives of the component were to:

• Empower Women with method-specific knowledge (know your options; know where to go for advice).
• Enlighten Men to become supportive partners for reproductive and family health, starting with Family Planning (teamwork) and educate them so that they can intelligently discuss family planning with their wives.
• Enlist Community Leaders, influentials and elders to support efforts to link women who want to use family planning with service providers who can help them to make healthy choices.
• Enable Providers to provide confidential and caring advice and services. And,
• Educate program Managers, such as District Health Management Teams and key Zambian counterpart organizations to see Family Planning as a priority activity where appropriate, and to understand the importance of following a research-based step-by-step process for developing and implementing an IEC strategy for any family health issue.

Selected activities and results were:

• Launching of the National Family Planning Logo
• Production of the National Family Planning Policy Framework, Standards and Guidelines
• Clinic-based counselling materials
• Print materials
• Broadcast materials
• Youth Activities
• Literature Review of existing Family Planning knowledge in Zambia
• Baseline IEC Survey
• Formative qualitative research, including a Perceptual Mapping Study.
• National IEC Consensus building workshop with various Zambian organizations
• Message Design and Materials Development Workshop

The ZFPSP-IEC Component contributed to achieving these objectives by following certain operating principles, including:

• Responding to the Ministry of Health/Central Board of Health request to create highly visible activities as quickly as possible while maintaining quality of output,
• Collaborating closely with governmental and non-governmental organizdations,
• Encouraging all agencies working in IEC to adopt common fundamental principles and processes for health communication programme planning and implementation,
• Demonstrating innovative approaches to IEC that can be used for all health issues,
• Promoting cost-effective materials development,
• Promoting cost-sharing among agencies involved in similar IEC efforts, and
• Using a Push/Pull approach to encouraging women Intenders: that is, building clinic IEC capacity, as well as community mobilization and mass media promotion.

The Zambia Social Marketing Project

The prevalence of AIDS in Zambia remains alarming. Since most of the deaths occur among the young adults during their most productive years, the economic and social impacts of the epidemic on the family, the local community, and the national economy are severe.

The Zambia Social Marketing Project (ZSMP) was part of the government's effort to combat the spread of sexually transmitted diseases (STDs) including HIV, and expand the contraceptive prevalence rate. The project, which is funded by the United States Agency for International Development (USAID), is a collaborative effort between Population Services International (PSI), an international non-profit organization, and the Pharmaceutical Society of Zambia (PSZ).

How does social marketing fit into the health system in Zambia?
One of the predominant health problems in Zambia today is how to get needed health products and services to lower income people. ZSMP is at the forefront of the effort to solve this dilemma through social marketing. Through the marketing of health products through retail and wholesale outlets, institutional networks and community-based sales networks, social marketing ensures their wider distribution and access.

Further, by the use of attractive packaging, persuasive communication and the promise of high quality health products at an affordable price, social marketing encourages usage of these health products. Hence, social marketing both creates awareness and demand for health products while ensuring their constant availability and easy accessability at affordable prices.

The activities carried out by ZSMP complement the programs of the Ministry of Health (MOH). Social marketing reduces the burden on the government hospitals by encouraging clients who can afford to pay small amounts to obtain health products from nearby chemists, private clinics and other outlets. In this manner, health products can be accessed at thousands of outlets and not just in clinics and hospitals.

The success of MAXIMUM Condoms
On World AIDS Day, December 1st, 1992, ZSMP launched MAXIMUM, a high-quality, low-priced condom in Zambia. The social marketing of condoms has played a significant role in making people more comfortable about discussing the dangers of STD's including AIDS and condom usage. Through mass media advertising, community based education and the distribution of promotional items, high awareness of MAXIMUM condoms has been achieved. In just over four years, MAXIMUM has become a household name in Zambia with 25 millions condoms sold in this period.

Further, the IEC campaigns and extensive promotional activities have played an important role in reducing the stigma attached to all condoms. Market research has shown that the introduction of MAXIMUM has encouraged increased condom use among the sexually active population.

Expanding Contraceptive Choice with SafePlan
While knowledge of contraception is very high in Zambia (over 90% of married women know at least one method of contraception), only 14% of them report using any modern method. Recognizing the suitability of social marketing to support the existing efforts to increase the contraceptive prevalence rate, the MOH requested USAID to support the social marketing of oral contraceptives and vaginal foaming tablets as part of the Family Planning Services Project.

The oral contraceptive pill is the most popular method of contraception in Zambia. However, the widespread use of the pill has been hampered by the widespread misconceptions, erratic supply and poorly informed providers. The social marketing of SafePlan oral contraceptive pills which began in December 1996 will go a long way in ensuring that a high quality low dose oral contraceptive pill is widely and constantly available across the country at an affordable price of K500 ($0.39) for two months supply. A series of intensive workshops and training sessions for private sector health care providers on better understanding and dispensing contraceptives are being conducted as part of the contraceptive social marketing programme.

The future of social marketing in Zambia
Social marketing is now clearly recognized as an important component of the health delivery system in Zambia. Social marketing will become further institutionalized in Zambia when the project is registered as the Society of Family Health, a local nongovernmental trust. The trust is expected to be created in the first half of 1997. In the year ahead, the project/trust aims to begin socially marketing the following health products and services in Zambia:

• Vaginal Foaming Tablets: As part of the Family Planning Services Project, ZSMP will begin socially marketing a VFT starting April 1997.
• Female Condoms: The project has recently completed a test marketing exercise of the female condom "Reality." The study demonstrated that there is a considerable demand for the product in Zambia. The project hopes to expand the contraceptive and safer sex choices in Zambia by socially marketing Reality on a nation wide scale in the near future.
• Impregnated Mosquito Nets: To respond to the acute need for effective malaria prevention programmes, the project is pursuing funding opportunities to socially market chemically treated mosquito nets and retreatement services.
• Franchising Health Clinics: PSI has completed a feasibility study on using franchising to develop a network of private sector based primary health care clinics offering reproductive and preventive basic curative services to low-income target groups. The project is looking for funding to support this venture.
• Vitamin Supplements for Pregnant Women

Population Services International (PSI), with social marketing health programmes in 46 countries worldwide, also has the expertise to socially market the following products which are suitable for Zambia:

• Other family planning products, including injectable contraceptives and IUDs.
• Oral rehydration salts (ORS) for treating childhood diarrhoeal diseases.
• Vitamin A and other nutrients.
• Clean birth kits.
• Communication services for health programs.