An initiative of the Advancing Injectable Markets for Sustainability (AIMS) project

AIMS will award successful proposals up to US$200,000 for a 9-month award period.

Often women are unable to access self-injectable contraception because of gaps in provider training, supply chains, medical waste management, and other issues. D-Prize is helping to address these gaps by funding aspiring entrepreneurs to expand access to DMPA-SC in low-income countries.

Each D-Prize award winner will receive up to US$20,000 to launch a nonprofit or social venture tackling a DMPA-SC access gap. Applicants should be entrepreneurial and ready to commit full-time to their venture if the pilot succeeds. Organizations that apply should be entirely new or at a very early stage (under 18 months old or raised less than US$30,000).

2026 deadlines
Early: May 17 | Regular: June 7 | Extension: June 28

There are five specific calls for new ventures addressing DMPA-SC gaps:
• Improving provider training
• Last-mile supply chain management
• Medical waste management
• Reaching underserved populations
• Propose an approach not listed above

Learn more and apply at www.d-prize.org.

The Advancing Injectable Markets for Sustainability (AIMS) project provides free data-driven technical assistance (TA), coordination, resources, and tools to ensure that women and girls have increased access to DMPA-SC and self-injection as part of an expanded range of contraceptive methods, delivered through informed choice programming.

Partners can access TA by submitting a request to the AIMS team at FPoptions@path.org.

In collaboration with the Uganda Ministry of Health, PATH is leading the Private Sector Family Planning project (2023–2026) to strengthen the private sector market for family planning, paving the way for introduction of more contraceptive methods in commercial outlets, providing clients more options for where and how to access methods of their choice.

The Injectables Access Collaborative Learning and Action Network hosted this webinar on February 28, 2024 highlighting task-sharing provision of injectable contraception—including DMPA-SC and self-injection—through support from community health workers (CHWs). At least 13 countries now authorize CHWs to support clients’ initiation of self-injection at the community level. Participants learned about the latest data on DMPA-SC provision and self-injection support by CHWs, heard from ministry of health representatives and CHWs themselves about the practice and potential of task-sharing of self-care services, and reflected on how to strengthen community health programs to improve equitable access to integrated primary health care services, including an expanded range of family planning options.

This event is part of series on task-sharing along with this webinar on private sector access to DMPA-SC.

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

On March 21, 2023, the DMPA-SC Access Collaborative hosted this webinar highlighting the strengths and gaps of monitoring scale-up in the context of efforts to institutionalize DMPA-SC and self-injection in national family planning programs. The discussion focused on findings from Madagascar, Nigeria, Uganda, and Zambia, touching upon national goals for DMPA-SC, in-country perspectives on the value proposition of DMPA-SC, and suggested indicators for use in tracking the scale-up of a new product.

The DMPA-SC Access Collaborative has produced the brief and program design guide linked below to support countries and partners that are planning and rolling out DMPA-SC self-injection as part of an expanded range of contraceptive methods delivered through informed choice programming.

The Recommendations for Contraceptive Self-Injection brief summarizes the latest key findings, insights and recommendations the AC has accumulated through six years of technical assistance to ministries and partners engaged in self-injection program introduction and scale-up. These practices should be universally considered and implemented to increase family planning program success.

The Contraceptive Self-Injection Program Design Guide is a comprehensive tool that outlines optimal program models for DMPA-SC self-injection. It was originally developed in 2020 based on the self-injection program rollout in Uganda, the first country in sub-saharan Africa to offer contraceptive self-injection outside of a research setting. The guide was updated in 2022 to reflect subsequent learnings, evidence, and data from scale-up efforts. The program design guide:

• Walks users through each step of a self-injection program, including all components related to health workers and clients.
• Highlights essential evidence on self-injection program design.
• Establishes areas where more research is needed.
• Draws attention to key moments for program design decision-making.
• Links users to additional resources and tools for program development.

Please contact FPoptions@path.org for further information or requests for assistance.

Contraceptive self-injection (SI) is a new self-care practice with potential to transform women’s family planning access by putting a popular method, injectable contraception, directly into the hands of users. Research shows that SI is feasible and acceptable; evidence regarding how to design and implement SI programs under real-world conditions is still needed. This evaluation examined women’s experiences when self-injection of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) was introduced in Uganda alongside other contraceptive options in the context of informed choice. We conducted structured survey interviews with 958 randomly selected SI clients trained in three districts in 2019. SI clients demonstrated their injection technique on a model to permit an assessment of injection proficiency. A randomly selected subset of 200 were re-interviewed 10–17 months post-training to understand resupply experiences, waste disposal practices and continuation. Finally, we conducted survey interviews with a random sample of 200 clients who participated in training but declined to self-inject. Data were analyzed using Stata IC/14.2. Differences between groups were measured using chi square and t-tests. Multivariate analyses predicting injection proficiency and SI adoption employed mixed effects logistic regression. Nearly three quarters of SI clients (73%) were able to demonstrate injection proficiency without additional instruction from a provider. Years of education, having received a complete training, practicing, and taking home a job aid were associated with higher odds of proficiency. Self-reported satisfaction and continuation were high, with 93% reinjecting independently 3 months post-training. However, a substantial share of those trained opted not to self-inject. Being single, having a partner supportive of family planning use, training with a job aid, practicing, witnessing a demonstration and exposure to a full training were associated with higher odds of becoming an SI client; conversely, those trained in a group had reduced odds of becoming an SI client. The self-care program was successful for the majority of women who became self-injectors, enabling most women to demonstrate SI proficiency. Nearly all those who opted to self-inject reinjected independently, and the majority continued self-injecting for at least 1 year. Additional research should identify strategies to facilitate adoption by women who wish to self-inject but face challenges.

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.