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Author: FHI 360


Scaling self-injection across sectors in Malawi

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.

Institutional author(s): PATH, JSI, Malawi Ministry of Health, Clinton Health Access Initiative (CHAI), FHI 360, Population Services International (PSI)
Publication date: August, 2022

Contraceptive Technology Innovation (CTI) Exchange

The Contraceptive Technology Innovation (CTI) Exchange is a platform for increasing global access to resources on contraceptive research, development, registration, and introduction through collaboration and knowledge sharing. The site features Calliope, the Contraceptive Pipeline Database, which provides information on new and future contraceptive products, including long-acting and novel products currently only available in limited markets.

Institutional author(s): FHI 360
Publication date: 2021

Tool Web page

Checklist for Screening Clients Who Want to Initiate DMPA (or NET-EN)

The DMPA/NET-EN checklist consists of questions designed to identify medical conditions that would prevent safe DMPA/NET-EN use or require further screening and assess whether a client might be pregnant. It also provides guidance and directions based on clients’ responses.

Institutional author(s): FHI 360
Publication date: June, 2017

Provision of Injectable Contraceptives within Drug Shops: A Promising Approach for Increasing Access and Method Choice

This 4-page brief is focused on the use of drug shops to increase access to injectable contraceptives.

Institutional author(s): FHI 360, JSI, USAID
Publication date: June, 2014

Brief Web page

Key Indicators for Community-based Access to Injectable Contraception Pilot Studies

An indicator is a measure of program performance that is tracked over time. This document presents potential process and outcome indicators organized according to the phase of the community-based access to injectables (CBA2I) pilot along with the related evaluation questions, data sources and measurement tools. The list can be adapted to local contexts and program goals to assess a pilot’s progress toward intended outputs and achievement of goals.

Institutional author(s): FHI 360
Publication date: July, 2011

Community-Based Health Workers Can Safely and Effectively Administer Injectable Contraceptives: Conclusions from a Technical Consultation

This brief presents the conclusions of a technical consultation of experts that reviewed extensive evidence and recommended that community-based provision of injectable contraceptives by trained community health workers is safe and effective. The document highlights program guidance and operational issues as well as priorities for new research.

Institutional author(s): FHI 360
Publication date: June, 2010

Report Community-Based Health Workers Can Safely and Effectively Administer Injectable Contraceptives: Conclusions from a Technical Consultation

The Highs, Lows, and Squishy Middle of Contraceptive Product Introduction

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.

Institutional author(s): Clinton Health Access Initiative (CHAI), FHI 360, PATH, Population Council
Publication date: April, 2021

Adolescent and covert family planning users’ experiences self-injecting contraception in Uganda and Malawi: implications for waste disposal of subcutaneous depot medroxyprogesterone acetate

Self-administered subcutaneous depot medroxyprogesterone acetate (DMPA-SC) is poised to increase access to contraception; however, governments are concerned about the waste management of used units. Self-injectors in Malawi and Uganda are currently instructed to store used units in containers and return them to health workers for disposal. However, this may not be feasible in low-resource settings, especially for younger or covert self-injectors. We describe adolescent (15–19 years) and adult (20–49 years) self-injectors’ disposal experiences in Uganda and Malawi. When possible, we compare covert and overt users’ experiences.

Institutional author(s): FHI 360
Individual author(s): Holly M Burke, Catherine Packer, Laura Wando, Symon Peter Wandiembe, Nelson Muwereza, Subarna Pradhan, Akuzike Zingani, Bagrey Ngwira
Publication date: August, 2020

Journal article Reproductive Health journal

Family planning provision in pharmacies and drug shops: an urgent prescription

Drug shops and pharmacies have long been recognized as the first point of contact for health care in developing countries, including family planning (FP) services. Drug shop operators and pharmacists should not be viewed as mere merchants of short-acting contraceptive methods, as this ignores their capacity for increasing uptake of FP services and methods in a systematic and collaborative way with the public sector, social marketing groups and product distributors. We draw on lessons learned from the rich experience of earlier efforts to promote a variety of public health interventions in pharmacies and drug shops. To integrate this setting that provides convenience, confidentiality, access to user-controlled contraceptive methods (i.e., pills, condoms and potentially Sayana Press®) and a gateway to clinic-based FP services, we propose three promising practices that should be encouraged in future interventions to increase access to quality FP services.

Institutional author(s): FHI 360
Individual author(s): Dawn S. Chin-Quee, John Stanback, Tracy Orr
Publication date: August, 2018

Journal article Link to Journal Article

Continuation of subcutaneous or intramuscular injectable contraception when administered by facility-based and community health workers: findings from a prospective cohort study in Burkina Faso and Uganda

The aim of this study was to examine continuation of subcutaneous and intramuscular depot medroxyprogesterone acetate (DMPA-SC and DMPA-IM) when administered by facility-based health workers in Burkina Faso and Village Health Teams (VHTs) in Uganda. Participants were family planning clients of health centers (Burkina Faso) or VHTs (Uganda) who had decided to initiate injectable use. Women selected DMPA-SC or DMPA-IM and study staff followed them for up to four injections (providing 12 months of pregnancy protection) to determine contraceptive continuation. Study staff interviewed women at their first injection (baseline), second injection, fourth injection and if they discontinued either product.

Institutional author(s): PATH, Makerere University, Institut Africain de Santé Publique (IASP), Institut Supérieur des Sciences de la Population, Centre MURAZ, FHI 360, Institut de Recherche en Sciences de la Santé (IRSS)
Individual author(s): Ellen MacLachlan, Lynn Atuyambe, Tieba Millogo, Georges Guiella, Seydou Yaro, Simon Kasasa, Justine Bukenya, Agnes Nyabigambo, Fredrick Mubiru, Justine Tumusiime, Yentéma Onadja, Lonkila Moussa Zan, Clarisse Goeum/Sanon, Seni Kouanda, Allen Namagembe
Publication date: August, 2018

Journal article Link to Journal Article