Based on evidence and experience, countries worldwide are adding the option of DMPA-SC self-injection to their contraceptive method mix.
Self-injection has the potential to reduce access-related barriers for women, increase contraceptive continuation rates, and enhance women’s autonomy. There are strong data that women, including women in low-resource settings, can self-administer DMPA-SC safely and effectively, and that they like doing so.
This Making Self-Injection Count workshop session provided an overview of self-injection indicators across countries and how those can be integrated into HMIS/LMIS systems and analyzed to answer programmatic and research questions. Stories from Uganda and Nigeria highlighted common challenges in integrating self-injection indicators into these systems. Breakout rooms at the end of the session allowed participants to discuss and receive suggestions and feedback on their own HMIS/LMIS integration efforts through peer-to-peer conversations.
By the end of this session, participants were able to:
Identify common self-injection indicators, challenges in integrating these indicators into HMIS/LMIS systems, and potential strategies for overcoming them.
Have a deeper understanding of how to match common self-injection HMIS indicators to programmatic and/or research questions and how to translate those to actionable data.
Self-injection introduction into a national family planning program can help expand contraceptive choices and options.
To continuously monitor the unique contribution of self-injection to the family planning program, routine data are necessary.
Self-injection data use helps to inform decision-making through the identification of policy and programmatic gaps, such as:
Number of units for training, approval for specific cadres of providers, need for better counseling messages and tools.
Data and indicators to integrate in HMISes must be useful and usable.
There is benefit to complementing routine data with other from additional sources, e.g., research studies or surveys.
A proactive government is vital to the success of self-injection data integration.
Competing priorities and limited funding are perennial challenges to integrating self-injection in HMIS data.
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.
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 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 has been 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.
We want to hear from you! We welcome your reflections on the Contraceptive Self-Injection Program Design Guide. Do you have feedback for consideration? By completing this short survey open through November 30, you can help us ensure these resources are meeting the needs of key stakeholders.
This policy landscape can be leveraged by applicants interested in applying to the DMPA-SC Regulatory Advocacy Catalytic Opportunity Fund (COF). The landscape was originally developed in 2020 to understand policies and regulations, including over-the-counter regulations, that impact women’s access to DMPA-SC and identify short- and long-term advocacy opportunities. In 2022, it was refreshed to understand policy shifts and additional advocacy opportunities in a subset of 12 of the original 18 countries currently eligible for the Regulatory Advocacy COF. Insights from the policy landscape have informed the design and eligibility criteria of the Regulatory Advocacy COF, proactively identified opportunities, and provided frameworks and guidance for interested applicants.
This conceptual framework articulates how social and behavior change can support sexual and reproductive health (SRH) self-care initiatives and contribute to improved health outcomes. Developed by Breakthrough Action and the Self-Care Trailblazer Group, the framework is designed for use by policymakers and government representatives, donors, and self-care program implementers. The framework was also featured in a webinar held on September 28, 2022.
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.
The desire for private sector family planning programs to have the ability to overbrand/overpackage the Pfizer Inc. DMPA-SC product, Sayana® Press, has existed since initial product introduction planning discussions among global partners in 2008–2009. The PATH-JSI DMPA-SC Access Collaborative solicited input from the team’s regional technical advisors, country coordinators, and local partners to better understand the status of overbranding, and any related advocacy, in the countries where we work.
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.
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.
The private sector holds great potential to reduce unmet need for family planning, and many countries are poised to adopt a total market approach for increasing contraceptive access through private pharmacies and drug shops. Policies supporting scale-up of family planning service provision and expanding method options such as DMPA-SC self-injection, must be prioritized in these entities.
The PATH-JSI DMPA-SC Access Collaborative and partners have gained valuable insights with relevance to private sector engagement on self-injection. This webinar held February 15, 2022 highlighted lessons learnt, challenges, recommendations, and considerations for policies supporting private sector engagement in self-injection in different country contexts. Specific topics included:
Financing and commodity production ecosystems
Procurement and supply chains
Service delivery and programming
Data reporting and monitoring
The discussion was moderated by Allen Namagembe, Deputy Project Director, Uganda DMPA-SC Access Collaborative, PATH.
Dr. Kayode Afolabi, Director and Head, Reproductive Health Division, Federal Ministry of Health, Nigeria
Dr. Daniella Munene, Member, National Executive Committee, Pharmaceutical Society of Kenya
Dr. Hortense Randrianaivo, President, Association of Pharmacists of Madagascar
Mr. Célestin Compaore, Regional Project Director, DMPA-SC, Jhpiego, Burkina Faso