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

Abstract

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.

Knowledge translation strategies for policy and action focused on sexual, reproductive, maternal, newborn, child and adolescent health and well-being: a rapid scoping review

“…All studies were published between 2000 and 2020, with an increase in relevant publications since 2006. Just over a third (34%) were published between 2011 and 201523–53 and another 34% between 2016 and 2020 54–84. Thirty-two per cent of studies were quasi-experimental designs,23 25 26 28 31 32 34 35 44 50 51 59–61 67 68 75 76 83 85–92 with observational (22%),36 37 39 43 45 52 71 72 77 80 93–102 mixed-methods (17%),40–42 47 53 56–58 64 69 82 103–106 experimental (16%)24 27 38 62 66 74 78 79 107–112 and qualitative (11%)29 30 33 49 54 55 63 70 81 113 designs also identified.…”

“…Thirty-two per cent of studies were quasi-experimental designs,23 25 26 28 31 32 34 35 44 50 51 59–61 67 68 75 76 83 85–92 with observational (22%),36 37 39 43 45 52 71 72 77 80 93–102 mixed-methods (17%),40–42 47 53 56–58 64 69 82 103–106 experimental (16%)24 27 38 62 66 74 78 79 107–112 and qualitative (11%)29 30 33 49 54 55 63 70 81 113 designs also identified. Two editorials were also included 65 73…”

“…The majority of the studies (52%) were conducted in high-income countries,23–25 27–29 31 33–35 38 40 41 43–45 49 53 56 57 62 66–68 71 73 74 74 80 83 87 93–95 97 98 100 102–105 107 108 108 109 112 including Canada, the USA and Australia. Middle-income countries were the setting for 36% studies,26 30 32 36 39 42 46–48 50 52 63–65 75–77 81 82 85 86 88–92 96 101 110 111 113 including Nepal, Egypt and Zambia, with most middle-income countries considered low-middle income (81%) and 19% considered upper-middle income. Only 4% of included studies were located in low-income countries, such as Uganda and Madagascar 58–60 99.…”

“…Twenty-eight per cent addressed newborn health and well-being or stillbirths,23 25 26 28 31 34 50 59 60 60 64 68 81 82 86 88 90 95–97 109 111 and a quarter of studies addressed maternal health and well-being 24 37 39 44 45 52 54 55 58 63 72 73 75–77 87 92 93 103 104 112 113. Studies addressing sexual and reproductive health and rights (SRHR (12%))30 38 42 61 65 66 69–71 101 106 and adolescent health and well-being (4%)33 41 56 107 priorities were identified, but in a lower volume compared with studies addressing maternal, child and newborn or stillbirth priorities. Some studies (13%) also included multiple SRMNCAH priorities, with eight targeting both maternal and newborn health and well-being,37 46 54 81 82 84 90 92 two targeting maternal and child health and well-being52 72 and two targeting maternal, child and newborn health and well-being 75 76.…”

‘Our culture prohibits some things’: qualitative inquiry into how sociocultural context influences the scale-up of community-based injectable contraceptives in Nigeria

“…Evidence suggests that CBD of contraceptives is still needed in LMICs particularly rural or isolated communities in order to increase CPR. [15][16][17] The full potential of CBD to improve CPR has not been fully realised in sub-Saharan Africa. 18 Nigeria started its family planning policy review in 2007 and successfully piloted the CBD of injectable contraceptives through community health extension workers (CHEW) as a new innovation in the health system in 2010 in Gombe State, north-eastern region.…”