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WHO Consolidated Guideline on Self-Care Interventions for Health

This guidance from the World Health Organization (WHO) aims to provide a people-centred, evidence-based normative guideline that will support individuals, communities, and countries with quality health services and self-care interventions, based on PHC strategies, comprehensive essential service packages and people-centredness. The guidance includes a “strong” recommendation for self-administered injectable contraception, stating that this should be made available as an additional approach to deliver injectable contraception for individuals of reproductive age.

Institutional Author(s): World Health Organization (WHO)
Publication date: June, 2021

How self-injection contributes to contraceptive autonomy and the power of making self-injection count

This opening plenary of the Making Self-Injection Count workshop highlighted how self-injection data can help close the gender data gap by providing key information and insights on the experiences of women and adolescents. Presenters discussed how self-injection can contribute to contraceptive autonomy by enabling women and girls to make and actualize their own decisions. The session featured personal stories from a self-injection ambassador, self-injection provider, and self-injection client.

Objectives

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

  • Describe the importance of self-injection for contraceptive autonomy, and self-injection in the context of self-care.
  • Describe the landscape of self-injection data availability.
  • Understand experiences of self-injection from the lens of a provider, user, and advocate.

Key takeaways

  • While progress is being made, self-injection data availability is still limited compared to other contraceptive data sets.
  • Disaggregation by client age, district, and DMPA-SC delivery mode (self-injected vs. provider-administered DMPA-SC) is essential to DMPA-SC data tracking.
  • High-quality data systems give us insight into women’s and girls’ preferences, client access to family planning, provider training needs, and global supply management opportunities.

Presenters

  • Caitlin Corneliess, MPH, Project Director, DMPA-SC Access Collaborative
  • Fannie Kachale, Director Reproductive Health Services, Ministry of Health, Malawi
  • Briana Lucido, WHO Department of Sexual and Reproductive Health and Research
  • Dr. George Swomen, MD, Programme Officer of Special Projects, Planned Parenthood Federation of Nigeria (PPFN)
  • Fatimata Deme, President, Senegalese Women’s Network for the Promotion of Family Planning
  • Matilda, Volunteer, Kibalinga Health Centre in Uganda

Institutional Author(s): PATH, JSI, Inc.
Publication date: March, 2021

Self-injected subcutaneous DMPA: A new frontier in advancing contraceptive access and use for women

This brief details the strong body of evidence and experience with self-injection of DMPA-SC in low-resource settings, including how the practice can reduce access-related barriers, improve contraceptive continuation, and enhance women’s autonomy.

Institutional Author(s): PATH
Publication date: October, 2019

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

Insight synthesis report on DMPA-SC self-injection

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.

Institutional Author(s): Population Services International (PSI)
Publication date: September, 2021

The “why” and the “how” of routine data collection: Real world examples of using data from routine HMISs in policy and programming

In this session from the Making Self-Injection Count workshop, presenters discussed challenges to data use for decision-making and shared examples of how countries and programs have made data actionable in other health areas, specifically Malaria and immunization. The presentation included an example of an application of routine family planning data, including a new analysis of self-injection data from Senegal, and wrapped up with a panel Q&A focused on solutions.

Objectives

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

  • Understand key principles for fostering data use for decision-making.
  • Understand how countries and programs have used routine health data for decision-making.
  • Identify strategies to overcome challenges to data use.
  • Consider data quality and understand how it can be evaluated.

Key takeaways

  • Better data will lead to better decision-making and better health outcomes.
  • Data should:
    • be subjected to quality audits.
    • be delivered in a form that works for each intended audience and in alignment with their goals.
    • be shared with those who contributed the data and who have control over how services are offered.
    • include visualizations that effectively convey key details.
    • be iterative and ongoing.
  • There is a need for standardized metrics that allow for comparability among countries.

Presenters

  • Jonathan Drummey, Data Visualization Specialist, PATH
  • Fred Njobvu, Technical Advisor, Center for Digital & Data Excellence, PATH
  • Marie-Reign Rutagwera, Strategic Information Advisor, PAMO Plus, PATH
  • Jessica Williamson, Data Analyst, Track20 Project, Avenir Health

Institutional Author(s): PATH, JSI, Inc.
Publication date: March, 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 Adolescent and covert family planning users’ experiences self-injecting contraception in Uganda and Malawi: implications for waste disposal of subcutaneous depot medroxyprogesterone acetate

Costs and cost-effectiveness of subcutaneous DMPA through different delivery channels: What new evidence tells us

This brief summarizes recent evidence from African countries on the costs and cost-effectiveness of DMPA-SC. Key findings include that DMPA-SC may help reduce service delivery costs by catalyzing expansion of channels closest to women and that self-injected DMPA-SC is cost-saving as compared to clinic-administered DMPA-IM when accounting for costs to women and health systems.

Institutional Author(s): PATH
Publication date: October, 2019

Household waste disposal in DMPA-SC self-injection programs

This presentation highlights the background and resources on the appropriate method of sharps disposal. It presents country practices and evidence on disposal from DMPA-SC self-injection studies and projects, while offering disposal options and considerations for contraceptive self-injection program design and planning. It is designed for in-country stakeholders and decision -makers developing DMPA -SC self-injection programs and plans.

Institutional Author(s): PATH, JSI, Inc.
Publication date: April, 2019

DMPA-SC: an emerging option to increase women’s contraceptive choices

As countries strive to achieve the Sustainable Development Goal of universal access to sexual and reproductive health care services — including modern contraceptive methods through Universal Health Coverage (UHC) strategies, and the Family Planning 2020 goal of expanding access for an additional 120 million women and girls in 69 of the world’s poorest countries — policymakers and program managers have a heightened interest in providing contraceptive methods that better meet women’s needs. A subcutaneous formulation of the injectable depot medroxyprogesterone acetate (DMPA-SC) is one such option for broadening the spectrum of contraceptive choices. DMPA-SC combines the characteristics of an injectable contraceptive with a technology that facilitates task sharing of its delivery to community health workers (CHWs) as well as the possibility of self-injection by women. DMPA-SC is available in a prefilled, single-use injection device marketed as Sayana® Press. While DMPA-SC has many similarities to intramuscular DMPA (DMPA-IM) — it is taken every 3 months, is highly effective and has a similar side effect profile — it also has some significant differences: A lower dose of DMPA (104 mg for DMPA-SC versus 150 mg for DMPA-IM) that achieves similar systemic drug levels; Smaller needle size (2.5 cm for DMPA-SC versus 3.8 cm for DMPA-IM); Subcutaneous administration that is usually less painful than intramuscular injection, but skin reactions are more common; An all-in-one device that reduces the commodities needed and requires less skill to administer DMPA-SC is currently registered in 33 countries by government authorities or through a World Health Organization (WHO) collaborative procedure. Approximately one million doses of DMPA-SC have been used worldwide through introductory research studies, mostly in sub-Saharan Africa and South and Southeast Asia. Research to date has consistently demonstrated DMPA-SC’s safety, effectiveness and acceptability to both users and health care providers. While this consistency is encouraging, further evidence would help guide acceptable, efficient and effective ways to maximize its potential.

Institutional Author(s): World Health Organization (WHO)
Individual Author(s): Ian Askew, Elisa Wells
Publication date: August, 2018