Lessons learned from training and support for health workers in the public and private sectors

Malawi has made significant progress in scaling up DMPA-SC and self-injection in the public sector with 100% of service delivery points activated. The country has also learned valuable lessons through private sector pilots and is in the process of finalizing new guidelines to authorize pharmacies and drugstores to provide self-injection training to clients. The country’s approach is widely appreciated as an example of effective government-led and partner-supported scale-up involving both the public and private sector.

This webinar hosted by the PATH-JSI DMPA-SC Access Collaborative Learning and Action Network on August 3, 2022 featured public and private partners’ insights on national scale-up of DMPA-SC and self-injection, with a focus on provider training and supportive supervision as well as strong cross-sectoral partnerships. Speakers included representatives from the Malawi Ministry of Health Reproductive Health Directorate, Clinton Health Access Initiative, FHI 360, and Population Services International.

Drawing from program data and research, panelists discussed practical lessons learned from Malawi’s national scale-up of public-sector provider training, public provider reflections on integrating self-injection, and experiences from a private sector provider training pilot. These lessons may benefit governments and public and private partners in other contexts who are in the process of introducing or scaling up DMPA-SC for self-injection.

Over the past two years, a number of implementing partners have leveraged the Catalytic Opportunity Fund (COF) to support the scale-up of DMPA-SC in focal countries. The COF is a rapid funding mechanism administered by Clinton Health Access Initiative (CHAI) and managed by the DMPA-SC Operations Group, a group that responds to operational and service delivery issues in DMPA-SC and self-injection introduction and scale-up. The fund aims to support short-term DMPA-SC scale-up activities that unlock or generate additional resources. COF grantees carry out a diverse range of activities with short-term, small grants that make significant contributions to the national introduction and scale-up of DMPA-SC in their countries.

During this DMPA-SC Learning and Action Network (LAN) knowledge-sharing webinar held on May 19, 2021, successful COF grantees representing the Society for Family Health, Pathfinder International, Marie Stopes, and Jhpiego shared about the fund’s impact on their work and key lessons learned. The virtual discussion encouraged all stakeholders—program implementers, researchers, government officials, health providers, and members of civil society—to consider applicable strategies and mechanisms for efficient, sustainable, and scalable product introduction.

For more information, please contact the Access Collaborative LAN at dmpa-sc-lan@path.org or the CHAI COF at COF@clintonhealthaccess.org.

This session of the Making Self-Injection Count workshop took an advocacy lens to highlight the importance of self-injection data. Representatives from the Government of Malawi—which has included self-injection in their HMIS since 2019—shared an overview of their self-injection program, highlighting the process for updating their HMIS including success and challenges. They also highlighted how self-injection data has been used at the national and district program levels. Participants had an opportunity to ask questions during the question and answer session.

Objectives

By the end of this session, participants were able to:

• Describe the value of integrating self-care methods, including self-injection, into an HMIS.
• Understand the challenges and success factors for HMIS integration.
• Describe how data has been used in countries where this integration has already happened.

Key takeaways

• Inclusion of SI indicators in the Malawi national health management information system (HMIS) involved a collaborative effort among the reproductive health directorate, the central M&E division, MoH district teams, and DMPA-SC task force partners.
• In Malawi, key lessons learned were:
  • all relevant stakeholders should be involved from the beginning to minimize back-and-forth process flow.
  • high-quality data and services are dependent on routine mentorship, supervision, SI counseling, and process-review meetings.
• Visibility on self-injection uptake in Malawi has improved efficiency of targeted support, implementation adjustments, and supply chain management. Being able to track DMPA-SC visits stratified by self-injection versus provider administration has helped with supply management and reduction of waste, and findings on reasons for discontinuation at the facility level have informed support needs and service delivery.

Presenters

• Gracious Ali, Program Associate, Clinton Health Access Initiative (CHAI)
• Jessie Chirwa, Family Planning Program Officer, Malawi Ministry of Health Reproductive Health Directorate
• Philemon Moses, CHAD Monitoring and Evaluation Officer
• Regina Mponya, Family Planning Coordinator, Malawi Ministry of Health Reproductive Health Directorate

This policy landscape can be leveraged by applicants interested in applying to the DMPA-SC Regulatory Advocacy Catalytic Opportunity Fund (COF). The landscape was originally developed in 2020 to understand policies and regulations, including over-the-counter regulations, that impact women’s access to DMPA-SC and identify short- and long-term advocacy opportunities. In 2022, it was refreshed to understand policy shifts and additional advocacy opportunities in a subset of 12 of the original 18 countries currently eligible for the Regulatory Advocacy COF. Insights from the policy landscape have informed the design and eligibility criteria of the Regulatory Advocacy COF, proactively identified opportunities, and provided frameworks and guidance for interested applicants.

As part of the Global Health Science and Practice (GHTechX) conference, CHAI, FHI 360, PATH, the Population Council, PSI, and WCG hosted an April 22, 2021 session to synthesize lessons learned across contraceptive introduction of implants, DMPA-SC self-injection, hormonal IUS and other methods. During the session, experts from Kenya, Madagascar, Uganda, and the United States outlined essential steps for the process of contraceptive product introduction, described common challenges, and shared tools and approaches based on experiences with the three methods. Session slides are available below. To watch the recording of this and many other sessions, register for free on the GHTechX website.