Background/Objectives: About half of Nigeria's population resides in rural areas, where only 8% of women use modern family planning (FP), and gender norms restrict women's movement. This pilot aimed to increase rural access to FP and provide a sustainable model for the rural distribution of health commodities by testing two female-led health commodity distribution models in rural Kaduna, Kano, and Katsina.
Materials and Methods: Model 1 engaged 236 women as community-based distribution agents (CBDAs) to provide health information and sell approved commodities. Model 2 engaged 58 women to become Patent Proprietary Medicine Vendors (PPMVs). Both models were provided seed stock of commodities to sell (including condoms to CBDAs/PPMVs and oral contraceptives to PPMVs) and received training on FP, commodities, health promotion, referrals, and business. FP service registers, referral slips, and a business management tool, completed by participants, were used to assess the extent to which women accessed FP information and services and the financial sustainability of the models.
Results: From Dec 2019–Jul 2021, 294 CBDAs and PPMVs counseled 148,966 clients on FP: 498 mean clients per CBDA and 542 mean clients per PPMV. 40% were new users and 38% purchased an FP method. 53% were referred to a health facility for FP and 46% (36,318) of referred clients completed referrals with an FP method. At endline, PPMVs' median monthly balance (₦4,395/$11) nearly doubled CBDAs (₦2,358/$6). Median monthly FP sales (PPMV: ₦198/$.50 and CBDA: ₦200/$.50) made up only a fraction of PPMV and CBDA median monthly recorded sales revenue.
Conclusions: CBDAs and PPMVs increased tens of thousands of rural women's access to FP, including new users. PPMVs were slightly more successful at reaching women compared to CBDAs. Most participants earned a small profit by endline. However, they didn't make much money from FP, and cultural barriers hindered CBDAs' attempts to sell condoms.
