PPMVs should be trained before providing injectable services. Additional research is needed on the benefits of job aids for screening and counseling.

BackgroundTo increase access to voluntary family planning (FP) services, Nigerian policymakers are debating how to task share injectable contraceptive services to drug shop owners known as Patent and Proprietary Medicine Vendors (PPMVs). Task sharing FP services to drug shops is a promising practice, but information is needed on how to ensure high quality FP services. This analysis assesses the effects of job aids on PPMVs’ knowledge of injectable contraceptives 9 months after receiving a standardized training.MethodsOne hundred ninety-four PPMVs were trained on FP counseling and administration of injectable contraceptives in Bauchi, Cross River, Ebonyi and Kaduna states. PPMVs were interviewed before, after, and 9 months after the training. Three variables were used to assess injectable contraceptive knowledge: 1) intramuscular depot-medroxyprogesterone acetate (DMPA-IM) knowledge: a combination of three questions related to device type, injection location, and reinjection frequency; 2) subcutaneous DMPA (DMPA-SC) knowledge: a combination of the same three questions but for DMPA-SC; and 3) knowledge of at least 4 of the 7 common injectable side effects. Three separate adjusted logistic regression models were conducted to determine the factors that influence PPMV knowledge of injectable contraceptives 9 months after the training.ResultsOver half of PPMVs (56%) reported using at least two job aids at 9 months. PPMVs’ knowledge of DMPA-IM, DMPA-SC and side effects were low before the training but increased immediately after. Nine months later, knowledge remained higher than pre-test levels but generally reduced compared to posttest levels. PPMVs who reported using at least two FP job aids were 2.6 (95% CI: 1.4–5.1) times more likely to have DMPA-IM knowledge 9 months after the training compared to those who used one or no job aids, while adjusting for PPMV characteristics. Similar results were observed for knowledge of DMPA-SC (AOR: 2.5; 95% CI: 1.2–4.6) and side effects (AOR: 2.5; 95% CI: 1.3–4.8).ConclusionPPMVs who used at least two FP job aids were more likely to correctly answer key injectable contraceptive questions 9 months after training. Incorporating proven job aids into routine trainings is a low-cost strategy that can reinforce knowledge and help PPMVs to retain information.

Background The low utilisation of modern contraceptives in many low- and middle-income countries remains a challenge. Patent medicine vendors (PMVs) that operate in the informal health sector, have the potential to address this challenge. Between 2015 and 2018, the Population Council, in collaboration with the Federal and State Ministries of Health and the Pharmacy Council of Nigeria, trained PMVs in six states to deliver injectable contraceptive services. Outcome evaluation demonstrated increased client uptake of injectable contraceptive services; however, there is limited information on how and why the intervention influenced outcomes. This study was conducted to elucidate the processes and mechanism through which the previous intervention influenced women’s utilisation of injectable contraceptive services. Methods The study utilised a mixed methods, convergent parallel design guided by the UK Medical Research Council framework. Quantitative data were obtained from 140 trained PMVs and 145 of their clients in three states and 27 in-depth interviews were conducted among relevant stakeholders. The quantitative data were analysed descriptively, while the qualitative data were analysed thematically. Results The results revealed that even after the completion of the PMV study which had a time-bound government waiver for injectable contraceptive service provision by PMVs, they continued to stock and provide injectables in response to the needs of their clients contrary to the current legislation which prohibits this. The causal mechanism that influenced women’s utilisation of injectable contraceptives were the initial training that the PMV received; the favourable regulatory environment as demonstrated in the approval provided by government for PMVs to provide injectable contraceptives for the duration of the study; and the satisfaction and the confidence the female clients had developed in the ability of the PMVs to serve them. However, there were gaps with regards to the consistent supply of quality injectable contraceptive commodities and in PMVs use of job aids. Referral and linkages to government or private-owned facilities were also sub-optimal. Conclusion PMVs continue to play important roles in family planning service provision; this underscores the need to formalize and scale-up this intervention to aid their integral roles coupled with multi-faceted initiatives to enhance the quality of their services.

Background: To increase access to voluntary family planning (FP) services, policymakers in Nigeria are debating how to task share the provision of injectable contraceptives to drug shop owners known as Patent and Proprietary Medicine Vendors (PPMVs). Globally, task sharing FP services to drug shops is a promising practice, but more information is needed on how to support PPMVs in providing high quality FP, including injectable services. Methods: 194 PPMVs were trained to provide FP counseling and administration of injectable contraceptive services in Bauchi, Cross River, Ebonyi and Kaduna states. PPMVs were interviewed immediately before, immediately after, and 9 months after the training. Three variables were used to assess injectable contraceptive knowledge: 1) intramuscular depot-medroxyprogesterone acetate (DMPA-IM) knowledge: a combination of three questions related to device type, injection location, and reinjection frequency; 2) subcutaneous DMPA (DMPA-SC) knowledge: a combination of the same three questions but for DMPA-SC; and 3) knowledge of at least 4 of the 7 common side effects of progestin-only injectables. Three separate adjusted logistic regression models were conducted to determine the factors that influence PPMV knowledge of injectable contraceptives 9 months after the training. Results: A little over half of PPMVs (56%) reported using at least two job aids at 9 months. PPMVs’ knowledge of DMPA-IM, DMPA-SC and side effects were low before the training but increased immediately after. Nine months later, knowledge levels remained higher than pre-test levels but generally reduced compared to post-test levels. PPMVs who reported using at least 2 FP job aids were 2.6 (95% CI: 1.4-5.1) times more likely to have complete DMPA-IM knowledge 9 months after the training compared to those who did not use job aids or only used one, while adjusting for PPMV characteristics. Similar results were observed for knowledge of DMPA-SC (AOR: 2.5; 95% CI: 1.2-4.6) and side effects (AOR: 2.5; 95% CI: 1.3-4.8). Conclusion: Training PPMVs to use proven FP job aids should be incorporated into routine trainings, as they reinforce knowledge months after a training and can help PPMVs to retain information. When designing scale-up programs, jobs aids are a good investment for larger capacity-building strategies.

Background: To increase access to voluntary family planning (FP) services, policymakers in Nigeria are debating how to task share the provision of injectable contraceptives to drug shop owners known as Patent and Proprietary Medicine Vendors (PPMVs). Globally, task sharing FP services to drug shops is a promising practice, but more information is needed on how to support PPMVs in providing high quality FP, including injectable services. Methods: 194 PPMVs were trained to provide FP counseling and administration of injectable contraceptive services in Bauchi, Cross River, Ebonyi and Kaduna states. PPMVs were interviewed immediately before, immediately after, and 9 months after the training. Three variables were used to assess injectable contraceptive knowledge: 1) intramuscular depot-medroxyprogesterone acetate (DMPA-IM) knowledge: a combination of three questions related to device type, injection location, and reinjection frequency; 2) subcutaneous DMPA (DMPA-SC) knowledge: a combination of the same three questions but for DMPA-SC; and 3) knowledge of at least 4 of the 7 common side effects of progestin-only injectables. Three separate adjusted logistic regression models were conducted to determine the factors that influence PPMV knowledge of injectable contraceptives 9 months after the training. Results: A little over half of PPMVs (56%) reported using at least two job aids at 9 months. PPMVs’ knowledge of DMPA-IM, DMPA-SC and side effects were low before the training but increased immediately after. Nine months later, knowledge levels remained higher than pre-test levels but generally reduced compared to post-test levels. PPMVs who reported using at least 2 FP job aids were 2.6 (95% CI: 1.4-5.1) times more likely to have complete DMPA-IM knowledge 9 months after the training compared to those who did not use job aids or only used one, while adjusting for PPMV characteristics. Similar results were observed for knowledge of DMPA-SC (AOR: 2.5; 95% CI: 1.2-4.6) and side effects (AOR: 2.5; 95% CI: 1.3-4.8). Conclusion: Training PPMVs to use proven FP job aids should be incorporated into routine trainings, as they reinforce knowledge months after a training and can help PPMVs to retain information. When designing scale-up programs, jobs aids are a good investment for larger capacity-building strategies.