Scaling up delivery of contraceptive implants in sub-Saharan Africa: operational experiences of Marie Stopes International

Abstract

Between 2008 and 2012, Marie Stopes International (MSI) provided 1.7 million contraceptive implants in sub-Saharan Africa as part of a comprehensive method mix, primarily through mobile outreach using dedicated MSI providers and also through social franchising and MSI-run clinics. Large-scale access, quality, and informed choice were key elements of MSI's strategy.

Uptake and early removals of Implanon NXT in South Africa: Perceptions and attitudes of healthcare workers

“…[9] These efforts boosted the confidence of providers to remove implants; at follow-up, none of those trained had refused to do removals, an issue which had previously hampered the programme. [9] All the nurses expressed enthusiasm about the prospect of attending further training by qualified personnel. Opportunities for practical experience, where several insertions and removals are done under supervision, and for continued mentoring, appear to be particularly important, with nurse E saying: 'It just needs some practice.…”

“…Consistent with this, several studies on implant services in a range of settings have shown that providers' level of knowledge, especially around counselling, is a key determinant of the uptake of the implant and subsequent continuation. [9,15,18,20] Of note, a study across several sub-Saharan African countries showed the benefits of competency-based training on the implant, sideeffect management, and regular mandatory refresher courses and mentorship. [9] These efforts boosted the confidence of providers to remove implants; at follow-up, none of those trained had refused to do removals, an issue which had previously hampered the programme.…”

“…[9,15,18,20] Of note, a study across several sub-Saharan African countries showed the benefits of competency-based training on the implant, sideeffect management, and regular mandatory refresher courses and mentorship. [9] These efforts boosted the confidence of providers to remove implants; at follow-up, none of those trained had refused to do removals, an issue which had previously hampered the programme. [9] All the nurses expressed enthusiasm about the prospect of attending further training by qualified personnel.…”

“…[3,[5][6][7][8] Consistent with the 2012 Contraception Policy objectives, the National Department of Health (DoH) introduced Implanon NXT in 2014 to increase the range of contraceptive options for women, particularly long-acting methods. [9,10] Implanon NXT is a single-rod subdermal implant containing 68 mg of the progestin etonogestrel and offers 3 years of highly effective pregnancy protection (<1 pregnancy per 100 women-years). [5] Before implant roll-out, preparations such as healthcare provider training, programmatic guidelines and manual development were put in place, and >6 000 healthcare providers trained across the country, mostly using a cascade training approach -training provided by healthcare workers who have attended a training.…”

Introduction of the contraceptive implant in South Africa: Successes, challenges and the way forward

“…[22] Equally, the voices of satisfied clients, who comprise the large majority of women who insert the implant, must be allowed to shape the public discourse about the method. [23] Even though few women cited pamphlets, television or social media as direct sources of information about the implant, these media could play an important role in reinforcing the testimonies of women who are satisfied with the method, and in counteracting negative perceptions and rumours before these become entrenched. Demand-creation efforts around the time of introducing the implant in SA, successfully generated positive impressions of the method.…”