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Author: Tulane School of Public Health and Tropical Medicine


Increasing DMPA-SC self-injection access through retail outlets and last-mile service delivery

In recent years, Ministries of Health and organizations have leveraged the Catalytic Opportunity Fund (COF) to make significant contributions to the national introduction and scale-up of DMPA-SC and self-injection. A rapid funding mechanism that supports short-term DMPA-SC scale-up activities that unlock or generate additional resources, the COF is administered by the Clinton Health Access Initiative (CHAI) and managed by the DMPA-SC Operations Group.*

This DMPA-SC Learning and Action Network (LAN) webinar held on July 7, 2022 featured successful COF grantees in the DRC, Rwanda, and Zambia. Speakers highlighted considerations for pharmacy and drug shop introduction, recommendations, and lessons from the DMPA-SC Access Collaborative’s experience in Zambia, inroads made by Pathfinder and Tulane university in the DRC, and early insights from Kasha’s last-mile family planning services delivery in Rwanda.

*The DMPA-SC Operations Group, convened by the Access Collaborative under the oversight of the DMPA-SC Donor Consortium, is a coordinating mechanism to proactively manage and reactively respond to both operational and service delivery issues arising from efforts to introduce, scale up, and ultimately increase access to DMPA-SC and self-injection.

Institutional author(s): PATH, JSI, Pathfinder International, Tulane School of Public Health and Tropical Medicine, Kasha
Publication date: July, 2022

Task-shifting the provision of DMPA-SC in the DR Congo: Perspectives from two different groups of providers

This article compares results from interviews with DMPA-SC providers in two separate pilot studies: 1) 53 medical and nursing school students teaching women how to self-inject (2016–2017); and 2) 34 lay community health workers providing DMPA-SC in rural areas of Lualaba (2017). All providers gave information on socio-demographic characteristics, recruitment,) training, supervision, experience and satisfaction with the provision of DMPA-SC. The paper examines variations in responses from the different provider cadres.

Institutional author(s): Tulane School of Public Health and Tropical Medicine, Kinshasa University School of Public Health, École de Santé Publique de Lubumbashi
Individual author(s): Julie Hernandez, Pierre Akilimali, Annie Glover, Rebecca Emel, Albert Mwembo, Jane T Bertrand
Publication date: July, 2018

Journal article Link to Journal Article

Contraception: DMPA-SC supplement

This special DMPA-SC supplement of the journal Contraception includes 13 articles authored by several organizations on topics including task-sharing, contraceptive continuation, cost and cost-effectiveness, acceptability and feasibility, storage and disposal, and private sector provision across six countries.

Institutional author(s): World Health Organization (WHO), PATH, FHI 360, Tulane School of Public Health and Tropical Medicine, University of Washington, Institut de Recherche en Sciences et de la Santé, College of Medicine, University of Malawi, Institut Supérieur de Statistiques, Makerere University, Institut Africain de Santé Publique (IASP), University of California San Francisco, École de Santé Publique de Lubumbashi, Population Council
Publication date: 2018

Acceptability of the distribution of DMPA-SC by community health workers among acceptors in the rural province of Lualaba in the Democratic Republic of the Congo: a pilot study

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.

Institutional author(s): École de Santé Publique de Lubumbashi, Tulane School of Public Health and Tropical Medicine, l'Univers Santé Plus, Pathfinder International
Individual author(s): Albert Mwembo, Rebecca Emel, Tesky Koba, Jacqueline Bapura Sankoko, Aben Ngay, Rianne Gay, Jane T Bertrand
Publication date: August, 2018

Journal article Link to Journal Article

Acceptability of the community-level provision of Sayana® Press by medical and nursing students in Kinshasa, Democratic Republic of the Congo

In the Democratic Republic of the Congo (DRC), the Ministry of Health authorizes only physicians and nurses to give injections, with one exception-medical and nursing students may also give injections if supervised by a clinical instructor. The emergence of the injectable contraceptive Sayana Press in some African countries prompted the DRC to test the acceptability and feasibility of distributing Sayana Press and other contraceptive methods at the community level through medical and nursing students. Sayana Press is similar in formulation to the injectable contraceptive Depo-Provera but contains a lower dose and is administered subcutaneously using a single-use syringe with a short needle called the Uniject system. The Uniject system allows Sayana Press to be administered by community health workers without clinical training or by self-injection. In this pilot, the advocacy objective was to obtain approval from the Ministry of Health to allow medical and nursing students to inject Sayana Press, as a first step toward authorization for community health workers to provide the method. The pilot described in this article documents a process whereby an innovative approach moved from concept to implementation to replication in less than 2 years. It also paved the way for testing additional progressive strategies to increase access to contraception at the community level. Because the pilot project included a research component designed to assess benefits and challenges, it provided the means to introduce the new task-shifting approach, which might not have been approved otherwise. Key pilot activities included: (1) increasing awareness of Sayana Press among family planning stakeholders at a national conference on family planning, (2) enlisting the support of key decision makers in designing the pilot, (3) obtaining marketing authorization to distribute Sayana Press in the DRC, (4) implementing the pilot from July to December 2015, (5) conducting quantitative and qualitative studies to assess acceptability and feasibility, and (6) disseminating the findings to family planning stakeholders. Before the pilot, Sayana Press was relatively unknown in the DRC, and there was no precedent for medical and nursing students providing family planning methods or giving injections at the community level. In less than 12 months, the approach gained legitimacy and acceptance. The key Ministry of Health decision maker orchestrated the closing session of the dissemination meeting on next steps, paving the way for pilot tests of 3 new task-shifting approaches: insertion of Implanon NXT by medical and nursing students, self-injection for Sayana Press with supervision by students, and injection of Sayana Press by community health workers with no formal clinical training.

Institutional author(s): Tulane School of Public Health and Tropical Medicine, Action Santé et Dévéloppement, Kinshasa University School of Public Health, Institut Supérieur de Statistiques
Individual author(s): Jane T Bertrand, Paul Bukutuvwidi Makani, Julie Hernandez, Pierre Akilimali, Bitshi Mukengeshayi, Saleh Babazadeh, Arsene Binanga
Publication date: September, 2017

Journal article Link to Journal Article

Pilot Research as Advocacy: The Case of Sayana Press in Kinshasa, Democratic Republic of the Congo

In the Democratic Republic of the Congo (DRC), the Ministry of Health authorizes only physicians and nurses to give injections, with one exception-medical and nursing students may also give injections if supervised by a clinical instructor. The emergence of the injectable contraceptive Sayana Press in some African countries prompted the DRC to test the acceptability and feasibility of distributing Sayana Press and other contraceptive methods at the community level through medical and nursing students. Sayana Press is similar in formulation to the injectable contraceptive Depo-Provera but contains a lower dose and is administered subcutaneously using a single-use syringe with a short needle called the Uniject system. The Uniject system allows Sayana Press to be administered by community health workers without clinical training or by self-injection. In this pilot, the advocacy objective was to obtain approval from the Ministry of Health to allow medical and nursing students to inject Sayana Press, as a first step toward authorization for community health workers to provide the method. The pilot described in this article documents a process whereby an innovative approach moved from concept to implementation to replication in less than 2 years. It also paved the way for testing additional progressive strategies to increase access to contraception at the community level. Because the pilot project included a research component designed to assess benefits and challenges, it provided the means to introduce the new task-shifting approach, which might not have been approved otherwise. Key pilot activities included: (1) increasing awareness of Sayana Press among family planning stakeholders at a national conference on family planning, (2) enlisting the support of key decision makers in designing the pilot, (3) obtaining marketing authorization to distribute Sayana Press in the DRC, (4) implementing the pilot from July to December 2015, (5) conducting quantitative and qualitative studies to assess acceptability and feasibility, and (6) disseminating the findings to family planning stakeholders. Before the pilot, Sayana Press was relatively unknown in the DRC, and there was no precedent for medical and nursing students providing family planning methods or giving injections at the community level. In less than 12 months, the approach gained legitimacy and acceptance. The key Ministry of Health decision maker orchestrated the closing session of the dissemination meeting on next steps, paving the way for pilot tests of 3 new task-shifting approaches: insertion of Implanon NXT by medical and nursing students, self-injection for Sayana Press with supervision by students, and injection of Sayana Press by community health workers with no formal clinical training.

Institutional author(s): Tulane School of Public Health and Tropical Medicine
Individual author(s): Arsene Binanga, Jane T Bertrand
Publication date: December, 2016

Journal article Link to Journal Article