Consequences of the Shift from Domiciliary Distribution To Site-Based Family Planning Services in Bangladesh

spectors) within the government program and 1,500 supervisors (mostly female) in programs operated by nongovernmental organizations.1 The domiciliary distribution of family planning services has been widely recognized as a key factor in the success of the Bangladesh program.2 However, in recent years, this approach faced several challenges. First, because of increasing numbers of women in the reproductive agegroups, family planning coverage will have to expand from 27 million couples in 1995 to 40 million in 2005, and during the same period the number of contraceptive users will have to increase from 12 million to 28 million, if the national goal of replacement fertility is to be achieved by 2005.3 In addition, the program depends heavily upon donor contributions, which cover 63% of total costs.4 Fieldworkers’ salaries account for approximately 60–65% of these costs.5 With donor funding expectSubrata Routh is team leader, Health Financing and Sustainability Team, and is senior project coordinator, Operations Research Project, Health and Population Extension Division, International Center for Diarrhoeal Disease Research, Bangladesh (ICDDR,B): Centre for Health and Population Research, Dhaka, Bangladesh. Ali Ashraf is senior operations researcher, Operations Research Project, Health and Population Extension Division, ICDDR,B: Centre for Health and Population Research, Dhaka. John Stoeckel is health and population consultant, Bangkok, Thailand. Barkat-e-Khuda is chief of party, Operations Research Project, and is division director, Health and Population Extension Division, ICDDR,B: Centre for Health and Population Research, Dhaka. Consequences of the Shift from Domiciliary Distribution To Site-Based Family Planning Services in Bangladesh