Community-Based Distribution of Injectable Contraceptives: Introduction Strategies in Four Sub-Saharan African Countries

Hoke, Theresa; Brunie, Aurélie; Krueger, Kirsten; Dreisbach, Crystal; Akol, Angela; Rabenja, Ny Lovaniaina; Olawo, Alice; Stanback, John

doi:10.1363/3821412

Cited by 33 publications

(56 citation statements)

References 12 publications

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“…Also notable was that 74% of DMPA users switched from receiving their injections from clinics to CHWs, supporting another aim of task sharing -reduction of the burden on understaffed rural health facilities. As a result of this study and extensive advocacy efforts, Kenya enacted a policy change in 2012 to permit CHW provision of injectable contraception in hard-to-reach areas [1].…”

Section: Pilot Studiesmentioning

confidence: 99%

“…A subsequent analysis by Hoke et al [1] examined the aforementioned experiences in Madagascar, Nigeria, Kenya, and the 2004-2005 pilot study in Uganda. The review highlighted lessons learned, with implications for future research and programming.…”

Section: Pilot Studiesmentioning

confidence: 99%

“…Since the mid-2000s, there has been a resurgence of global attention on the role of community health workers (CHWs) in increasing access to health serviceswith particular emphasis on family planning. Definitions of CHWs vary, but those providing family planning are trained to do so without formal clinical credentials [1]. Although attached to health facilities for necessities, such as commodities and supervision, they work outside the facilities, in the communities where they live.…”

Section: Introductionmentioning

confidence: 99%

“…Although attached to health facilities for necessities, such as commodities and supervision, they work outside the facilities, in the communities where they live. They generally provide education, selected contraceptive methods, and referrals to clinics for higher level services [1]. The importance of CHWs is rising largely because of the acknowledgement by the global health community that the health workforce and related resources are limited and inequitably distributed, the critical shortage of health workers in Africa and Asia, and global commitments to accelerate progress towards improved maternal, newborn, and child health outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Community-based provision of family planning in the developing world

Malkin

Stanback²

2015

Current Opinion in Obstetrics &Amp; Gynecology

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Decades of previous research on community-based family planning has focused on the traditional community health worker. Yet, recent developments in this field have expanded many areas that have been studied previously. A major emphasis of recent research has dealt with broadening the community-based locations from which clients can obtain injectable contraception. Drug shops in developing countries are promising locations for family planning services. They are ubiquitous, frequently accessed, and generally sustainable businesses. Also, a new formulation of injectable contraception in an easy-to-use delivery device is garnering global attention for its potential benefits in community-level use. Additional research and programmatic interventions are needed to better understand the training, policy, regulatory, and logistical needs to ensure quality service delivery.

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Section: Pilot Studiesmentioning

confidence: 99%

Section: Pilot Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Community-based provision of family planning in the developing world

Malkin

Stanback²

2015

Current Opinion in Obstetrics &Amp; Gynecology

Self Cite

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“…Different paths were followed, as some governments changed policy first and then conducted pilot studies and scale up, while others began with pilots before considering scale up and policy change 7 . The impact of CHW-provided injectable contraception has been measured in countries such as Kenya, Madagascar, Malawi, Nigeria, and Uganda, where these programs reported expanded access to family planning services, increased uptake of family planning methods, reduced workload in clinics, and improved method continuation rates among DMPA users 8 , 9 …”

Section: Introductionmentioning

confidence: 99%

Building on safety, feasibility, and acceptability: the impact and cost of community health worker provision of injectable contraception

Chin-Quee

Bratt

Malkin

et al. 2013

Glob Health Sci Pract

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This project in Zambia contributes to our understanding of the impact of community-based provision of injectables on method choice and uptake and of the costs of adding DMPA to an established community-based family planning program. The project also illustrates the importance of involving stakeholders from the outset, analyzing costs relevant to scale up, and engaging in policy change dialogue not at the end, but rather throughout project implementation.

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Translating Evidence into Policy Change: Advocacy for Community-Based Distribution of Injectable Contraceptives in Zambia

Gichane

Mutesa²,

Chowa

2018

Glob Soc Welf

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Background Community-based distribution (CBD) of injectable contraceptives has increased access to family planning for millions of women in rural areas in resource-limited settings. Despite the evidence of the success of this contraceptive delivery method, many nations have yet to integrate CBD into their family planning policies. The aim of this paper to describe the process through which PATH spearheaded efforts to successfully advocate for policy change to authorize non-clinical personnel in Zambia to provide injectable contraceptives. Methods We describe a four-part framework for policy advocacy: (a) evidence building and technical assistance, (b) stakeholder engagement, (c) government engagement, and (d) knowledge dissemination.Results Advocacy for policy change to allow CBD of injectable contraceptives was long and iterative. Evidence to support advocacy efforts was built through a Zambian delegates' study tour to Rwanda to witness Rwanda's robust CBD program and a rapid assessment of Zambian pilot sites where non-clinical personnel were administering injectable contraceptives. Advocacy was led by PATH in partnership with key stakeholders from the Zambia Family Planning Technical Working Group (FPWTG), key government officials, and a special task force of stakeholders focused on advocating for CBD of injectable contraceptives. This task force used evidence from the study tour and rapid site assessment in national and international forums to demonstrate the beneficial effects of allowing non-clinical personnel to administer injectable contraceptives. The Zambian government authorized the policy change in 2016. ConclusionThe policy advocacy efforts of PATH, FPWTG, and the special task force demonstrate the need for an ample evidence base and sustained engagement of government and stakeholder groups.

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Community-Based Distribution of Injectable Contraceptives: Introduction Strategies in Four Sub-Saharan African Countries

Cited by 33 publications

References 12 publications

Community-based provision of family planning in the developing world

Community-based provision of family planning in the developing world

Building on safety, feasibility, and acceptability: the impact and cost of community health worker provision of injectable contraception

Translating Evidence into Policy Change: Advocacy for Community-Based Distribution of Injectable Contraceptives in Zambia

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