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.
The objective of this research is to assess the acceptability of the provision of subcutaneously administered depo medroxyprogesterone acetate (DMPA-SC) by nonclinically trained community health workers (CHWs) among acceptors in the rural province of Lualaba in the Democratic Republic of the Congo (DRC).In 2017, 34 CHWs received training in provision of DMPA-SC. Among other methods, DMPA-SC by CHWs was offered during household visits and at community outreach events. The initial survey included questions on acceptors’ demographic characteristics, contraceptive use history and experience with provision of DMPA-SC by a CHW. The follow-up included questions about side effects experienced and continuation of DMPA-SC by a CHW. Seventy-four percent of initial acceptors of DMPA-SC (N=252) were first-time contraception users. Almost all (96.0%) felt very comfortable with a CHW performing the injection rather than a physician or nurse, and 97.6% perceived that the CHW was very comfortable performing the injection. A total of 239 women were interviewed at follow-up. Most expressed satisfaction with the method despite some side effects experienced. Almost all acceptors (97.9%) were satisfied with the information provided by CHWs, and 93.8% were satisfied with the overall service. Most (96.4%) would choose to continue receiving DMPA-SC by a CHW rather than in a health clinic, and 95.2% would recommend DMPA-SC by a CHW to a friend. Overall, administration of DMPA-SC by CHWs is acceptable to users in Lualaba. DMPA-SC can be safely provided within the community after proper training. This study validates the use of CHWs (without clinical training) to provide DMPA-SC in a rural sub-Saharan African setting. It also represents an important step in obtaining official MOH authorization for the scale-up of this mechanism of distribution to other underserved regions in the DRC.