Repositioning in Action E-Bulletin
September 2007
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Toolkit to Extend Reach of Popular Family Planning Method
While the injectable contraceptive depot-medroxyprogesterone acetate (DMPA or Depo-Provera) is widely used in Africa, few women in rural areas have access to clinics for provisions. To remedy this, several pilot programs in community-based distribution (CBD) methods were launched in Africa, Asia, and Latin America. To date, results are showing great success.
Uganda: Successes in CBD Distribution of Injectable Contraception
A pilot study in Uganda [PDF, 125KB] demonstrated that well-trained community health workers can safely and efficiently provide injectable contraceptives. Conducted by Family Health International and Save the Children USA in 2004 and 2005, the study found no significant differences in client satisfaction, side effects, or contraceptive continuation at six months between DMPA users who received their injections from CBD workers and those who received them at local clinics. Additionally, contraceptive prevalence in the district where the pilot study was conducted increased by about five percentage points after CBD of DMPA was introduced.
The success of the pilot study convinced skeptics that their fears that paramedical personnel cannot safely provide DMPA were unfounded. A similar pilot project began in Madagascar in late 2006, and Kenya is one of several countries where health officials are considering CBD of DMPA.
Many Factors Contribute to CBD Programs
Those involved in the Uganda study recommend that family planning programs in sub-Saharan Africa consider establishing CBD of an injectable method where there is high unmet need combined with poor access to family planning methods and services. Experience indicates that the best approach is to add injectable contraception to a strong, stable CBD program that is already well integrated into Ministry of Health structures.
Other factors that contribute to the success include government support; a strong service delivery organization; state-of–the art service guidelines; properly trained and supervised frontline service providers; an effective commodity logistics system; and planning for scale-up from the outset.
From Research to Practice: An Advocacy Toolkit
The newly released kit, Improving Access to Family Planning: Community-based Distribution of Injectable Contraceptives, draws upon the lessons from these experiences to provide information and tools with which decision-makers can advocate for and initiate CBD of DMPA. It discusses best practices in training, counseling, and ensuring supply. The kit also provides overviews of resources, steps for initiating provision within existing reproductive health programs, and a checklist for screening clients based on the World Health Organization's Medical Eligibility Criteria for Contraceptive Use.
The new advocacy toolkit includes the following resources:
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Brief 1: Expanding Access to Injectable Contraception
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Brief 2: Safety of Community-based Distribution of DMPA
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Brief 3: Effectiveness of Community-based Distribution of DMPA
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Brief 4: Integrating Community-based Distribution of DMPA into Existing Health Systems
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Brief 5: Community-based Distribution of DMPA: The Nakasongola Project, Uganda
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Brief 6: Community-based Distribution of DMPA: The APROFAM Project, Guatemala
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Brief 7: Community-based Distribution of DMPA: The Matlab Project, Bangladesh
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Steps to Begin Providing DMPA through Community-based Services
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Selected CBD of DMPA Resources
Access the toolkit by visiting USAID's Repositioning
Family Planning web page
Have You Seen?
Virtual Family Planning Conference Connects Francophone African Countries
The first of two virtual conferences to heighten attention to family planning, held July 17-19, 2007, attracted 254 people from 19 African countries. The presentations focused on successes and challenges in obtaining government commitment; contextual factors that affect the success of a family planning program, including policies and regulations; and potential modalities for financing services and commodities. Most of the participants were health professionals working in ministries of health, nongovernmental organizations, and other family planning institutions.
The second conference, which will be held November 6-8, 2007, will look at the importance of family planning program capacity, contraceptive security and communications. Details on Part Two of the virtual conference will be sent out in October. For more information, please email Alexandra Todd at atodd@usaid.gov.
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We Want to Tell Your Repositioning Story
Please contact Kim Ocheltree at kocheltree@usaid.gov with your successes in family planning programming.
For more information on Repositioning Family Planning, please contact Alexandra Todd at atodd@usaid.gov.
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