Developed by the PSI Delivering Innovation in Self-Care (DISC) project, this training package is intended to guide ministries of health, family planning/reproductive health projects, and any implementing organization that is interested in integrating an empathy-based approach to improve health providers’ quality of care.

The training content addresses risks of preventable client “drop-off” during the initiation stage of women’s self-injection journey by using empathetic counseling to instill client confidence and address common concerns such as fear of the needle. In addition to supporting providers’ service delivery, the training modules can support improved health system functioning by putting the client’s experience front and center and by bringing more structure and guidance to the supportive supervision process, enabling providers to build their competencies after the training sessions.

For more information on integrating this training curriculum in your family planning program, please contact the PSI DISC project at disc.info@psi.org.

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.

This webinar held on February 23, 2022 was hosted by Expanding Effective Contraceptive Options (EECO) led by WCG Cares with PSI and the DMPA-SC Access Collaborative led by PATH in partnership with JSI. The discussion focused on the introduction and scale up of self-care family planning methods in sub-Saharan Africa, highlighting lessons and best practices from DMPA-SC scale-up and Caya® diaphragm pilot introductions in French-speaking West Africa. Presenters from Benin, Niger, and Senegal shared successes and challenges. This webinar was offered in French.

This guide provides direction to programs that want to forecast for new and underused methods (NUMs) of family planning. It supports program managers and others involved in forecasting as they plan to introduce a contraceptive technology for the first time in a country and/or position an underused method for scale-up.

PSI’s Delivering Innovation in Self-Care (DISC) project began a formal evaluation of DISC’s DMPA-SC self-injection service delivery impact in 36 participating health facilities in Niger, Lagos, and Oyo states of Nigeria in July 2022, with ongoing data gathering intervals through May 2023. The evaluation sought to measure and understand trends in service delivery of specific contraceptive methods as well as assess the impact of DISC interventions on DMPA-SC self-injection service provision and uptake.

DISC’s empathy training model—which extends beyond self-injection training and also encompasses community mobilization, follow-up supervision and mentoring, and capacity building for data reporting—has been shown to be highly effective at delivering provider and consumer behavior change to overcome fears around self-injection. In close collaboration with the national and local governing bodies and partners, DISC has rolled out this model in three countries (Nigeria, Uganda, and Malawi) where it has been associated with DMPA-SC self-injection market growth at the national level.

To facilitate decision-making around the introduction and scale-up of contraceptive technologies, the Expanding Effective Contraceptive Options (EECO) project, led by WCG Cares in partnership with PSI, and USAID’s Center for Innovation and Impact teamed up to create the Contraceptive Innovation Index. On January 25, 2023, EECO and USAID hosted a webinar on the development and use of this tool; the webinar slides and recording are linked below.

Insights gained through evidence-based design

This report distills more than a year of programmatic research findings, looking at self-injection from a user journey perspective to analyze what drives consumer and provider decisions and attitudes. It reflects the unique perspectives of DMPA-SC self-injection early adopters and prospective users across Uganda and Nigeria. The report outlines how women perceive their own power, what makes self-injection convenient for them, who they trust as partners in their de-medicalized contraceptive experience, and more.

Counseling for Choice (C4C) is an evidence-based approach to contraceptive counseling that supports clients to decide which method is right for them. By addressing many of the root causes of unmet need for contraception and discontinuation, C4C aims to change how providers and clients participate in voluntary family planning counseling discussions. The approach comprises a thorough training in C4C techniques and use of the Choice Book for Providers, a job aid and visual tool providers can use with clients during counseling sessions.

Quality of family planning counseling is likely associated with whether or not women continue to use the same contraceptive method over time. The Method Information Index (MII) is a widely available measure of contraceptive counseling quality but little is known about its association with rates of method continuation. Using data from a prospective cohort study of 1,998 social franchise clients in Pakistan and Uganda, we investigated the relationship between reported baseline MII and the risk of method continuation over 12 months using survival analysis and Cox proportional hazard models. Higher scores on the 3-question Method Information Index (MII)—measuring client-reported receipt of contraceptive information—was associated with continued use of family planning over 12 months. We recommend incorporating use of the MII in routine assessments of family planning service quality.

Global Health: Science and Practice. March 2019, 7(1):87-102. https://doi.org/10.9745/GHSP-D-18-00407

These tools contain guidance for health care workers to counsel family planning clients on bleeding changes associated with the use of hormonal contraception and the copper intrauterine device (IUD). Fears and misconceptions about menstrual bleeding often contribute to discontinuation and non-use of contraception. Although amenorrhea or reduced bleeding can have important noncontraceptive health and lifestyle advantages, these potential benefits are often not emphasized in counseling sessions.

To fill a gap in counseling tools that address women’s concerns about bleeding changes, FHI 360 co-developed these tools with PSI and with funding from the U.S. Agency for International Development.

The job aids are available in Dholuo, English, French, Luhya, Spanish, and Swahili.

• Facility-based tool: For use by health care providers in clinics and other health care facilities
• Community-based tool: For use by community health workers and volunteers to counsel low-literacy clients
• Training slides: For use by health care workers with family planning training experience to train other providers on the use of the facility-based and community-based tools