A Next Generation Approach Introducing DMPA-SC Self-Injection Through Private Providers in Zambia

In 2018, Zambia initiated a strategy development process to introduce and scale up DMPA-SC, which called for private sector engagement. The purpose of this activity was to generate
experience from a DMPA-SC self-injection pilot in the private sector to inform country and global learning, and to provide the Zambian MOH with operational recommendations for policy and program planning. In partnership with the Zambian Ministry of Health (MOH), we designed and applied a client centered approach that reflected the specific needs and desires of private health sector clients and providers. We adapted and tailored globally available DMPA-SC training materials and methodologies designed largely for a public sector context to a private sector setting. The private sector pilot demonstrated that a shorter training format, that incorporated an e-learning video and individual consultation, was effective for training clients in DMPA-SC self-injection. Based on stakeholder interviews and a highly participatory HCD workshop, we developed and provided the Zambian MOH with recommendations for a phased, targeted DMPA-SC self-injection scale-up based on a total market approach. This activity demonstrated that a shorter DMPA-SC training format was effective for training private providers and their clients in self-injection, and that most women who participated in the pilot are willing to pay a price similar to or higher than the negotiated donor price of $.85 per unit. With only one DMPA-SC product available in the global market, the authors strongly encourage Zambia and other countries committed to engaging the private sector to consider a phased, targeted approach using market segmentation to strengthen public and private sector coordination, minimize product leakage, and ensure quality standardization across all service delivery channels.