Many countries, developed and developing alike, have a mix of services. In some countries - Mexico and Colombia, for instance - private family planning organizations pioneered nation-wide programmes built up from community-based delivery systems. In others, such as Indonesia and Thailand, high level political support and adequate funding enabled both countries to launch effective, national programmes with sizeable government involvement in a relatively short period of time.
Over the past three decades, government-sponsored maternal and child health care (MCH) and family planning efforts have evolved away from vertical, self-contained programmes. A number of countries are in the process of broadening their services to include all aspects of reproductive health care. More efforts are being made to link family planning with primary health care networks.
A consensus has emerged within the national and international communities that involvement of the health sector in population programmes is important for the following reasons: as a vehicle for the involvement of women in decision-making and in the provision of maternal and child health care and family planning services; to upgrade the technical and communication skills of midlevel female health workers and community-based workers; to ensure training, supervision and medical backup to non-medical delivery systems; to provide those medical services which cannot be delivered by family planning programmes alone; and to promote family planning.
Four types of service delivery for reproductive health and family planning services have evolved in both public and private programmes. Elements of all of these are generally used:
1. Clinic-based services offer a wide range of family planning services, including examinations by qualified doctors and the provision of information and appropriate contraceptives. In most cases these services are based around an established government supported or NGO clinic. Normally, family planning acceptors must come to the facility in order to get access to services, but some countries (eg. Thailand, Tunisia) provide mobile clinics which service remote villages. In addition, some countries offer services on a regular basis in places of work, such as factories and offices.
2. Community-based delivery provides contraceptives to persons not easily served by established clinics or other service units. Community-based delivery programmes provide simple family planning services at the local level and may also assist with the supply of oral rehydration salts and oversee infant and child vaccinations.
3. Social marketing programmes provide contraceptives at very low prices (often below market price) by subsidizing the cost. Normally, services are easily available to urban residents through the use of work places, barber and beauty shops, pharmacies, local food stores, nonprofit family planning associations, or specially created local sales outlets.
4. Regular commercial distribution through direct sales to family planning acceptors. Usually commercial distribution is done through private sector retailers (pharmacies, drugstores, grocery stores), or private medical providers (physicians, hospitals, clinics, midwives and traditional healers).
Despite the trend towards integrated services, the debate around which kinds of services should be combined continues among national and international policy-makers. The ideal solution will involve some combination of approaches that would contain elements of clinic-based, community-based, social marketing and the commercial sector, based on local conditions and needs. Involving local communities - particularly women's groups - in their design, implementation and assessment is crucial.