Acceptability of the community-level provision of Sayana® Press by medical and nursing students in Kinshasa, Democratic Republic of the Congo

Abstract

ObjectivesThe objectives were to assess acceptors' attitudes toward Sayana® Press as a method and toward the mechanism of community-based distribution by medical and nursing (M/N) students, known locally as “DBCs,” in Kinshasa, Democratic Republic of the Congo, and to evaluate the experience of these DBCs.Study designIn 2015, surveys were conducted among (1) acceptors of Sayana® Press on the day of the initial injection, (2) these same acceptors 3 months later and (3) the DBCs providing community-based services. The analysis was descriptive and involved no significance testing.ResultsAcceptors of Sayana® Press expressed high levels of satisfaction with the method, despite some pain experienced at injection and subsequent side effects. Although most were satisfied with the counseling and services received from the DBCs, less than one third realized that the providers were M/N students. The DBCs expressed satisfaction in serving as community-based distributors; more than 95% would recommend it to others. Their primary complaints were lack of remuneration, stockouts and need for greater supervision.ConclusionsConsistent with results from previous pilot introductions of Sayana® Press in three African countries, clients were highly satisfied with Sayana® Press as a method. The reported preference for resupply at health centers may reflect a lack of client awareness that the DBCs administering methods near the health center were not in fact staff from the health center. The pilot served to gain acceptance for the use of M/N students in community-based distribution, paving the way for additional task-shifting pilots in Kinshasa.ImplicationsSayana® Press represents a promising new method for increasing access to modern contraception in low-income countries. The Kinshasa experience is the first to test the use of medical and nursing students as providers at the community level. The study reports high levels of satisfaction on three counts: acceptors of the contraceptive method, acceptors of the mode of service delivery, and DBCs in their role as providers of contraception at the community level. However, many clients were not aware that the DBCs were students. The study represents an important contribution to the literature on task-shifting, especially in a country with chronic shortages of healthcare personnel.

An observational study to test the acceptability and feasibility of using medical and nursing students to instruct clients in DMPA-SC self-injection at the community level in Kinshasa

“…Our findings on the acceptability of DMPA-SC as a method are consistent with the results of the pilot introduction of the method in Burkina Faso, Niger, Senegal and Uganda from 2014 to 2016 [17] , as well as our 2015 pilot in Kinshasa [16] . Our findings on high client satisfaction with self-injection concur with results from studies in Malawi and Uganda [18] , [19] ; clients who self-injected had higher continuation rates than those who received DMPA-SC from providers.…”

“…A 2015 pilot study in Kinshasa used medical and nursing (M/N) students to deliver DMPA-SC and other methods at the community level. It showed that women were highly satisfied with the method and service received from these providers [15] , [16] . Local Ministry of Health (MOH) officials encouraged further testing of innovative strategies.…”

Client and provider experiences with self-administration of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) in Malawi

“…Specifically, we found that clients in Malawi had similar positive experiences with self-injection as those who participated in studies in Uganda and Senegal; like the women in Malawi, they also felt that self-injecting DMPA-SC was easy and preferable compared to DMPA IM [5,6]. Experiencing fewer side effects has been previously documented as a reason women prefer DMPA-SC compared to DMPA-IM [4,11]. In our study, almost half of clients spontaneously mentioned experiencing no or fewer side effects using DMPA-SC compared to DMPA-IM.…”

Contraceptive use among adolescent and young women in North and South Kivu, Democratic Republic of the Congo: A cross-sectional population-based survey

“…Investments in quality, combined with free care, can therefore improve equity. For short-acting method users, community-level provision may improve their access and use of contraception, although results from such pilots in DRC have thus far been mixed [26,27]. It is, however, important to note that 20-24-year-olds were more likely to receive contraceptive information from health workers or CHWs than 15-19-yearolds.…”