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.
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 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.
The Training Resource Package (TRP) for Family Planning’s Progestin-Only Injectable module includes sessions V and VI which are focused on DMPA-SC and self-injection, as well as a number of related handouts and resources. Developed in partnership with the Access Collaborative, these materials are intended for training health care providers who offer progestin-only injectable contraception (“injectables”) in the public or private sector.
The TRP website features training information and materials for a wide range of family planning methods. This includes curriculum components and tools for trainers to design, implement, and evaluate family planning and reproductive health training.
DMPA-SC is a three-month injectable contraceptive that is easy to use and uniquely suited for self-injection. Demonstration and practice injections are a key part of training programs for both health workers and self-injection clients. Based on lessons learned in five countries, this memo summarizes PATH’s recommendations regarding devices for injection demonstration and practice, injection practice models, and waste disposal.
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
Humanitarian crises and disease outbreaks exacerbate the barriers that women face when seeking reproductive health services. They also highlight a timeless truth: women must be able to manage their own sexual and reproductive health—especially in a crisis when health systems are at their weakest.
On November 17, 2021, the PATH-JSI DMPA-SC Access Collaborative hosted this webinar on making self-care interventions available, including DMPA-SC self-injection, in humanitarian settings. Through this virtual discussion, we addressed key challenges in humanitarian settings that need to be addressed in order to leverage the potential of self-injection as an option to ease access to family planning in the context of a full method mix.
Discussion highlights included:
Programmatic or regulatory actions that need to be implemented
Country-specific cultural barriers affecting demand generation in humanitarian settings
Supply systems and processes in humanitarian settings compared to national systems
Collaboration and data sharing between agencies
This discussion was moderated by George Barigye, Regional Technical Advisor, DMPA-SC Access Collaborative, PATH, Uganda. The keynote introduction was given by Dr. Adewole Adefalu, Country Coordinator, DMPA-SC Access Collaborative, JSI, Nigeria.
Lilian Ndinda, Maternal and Child Health Coordinator, International Rescue Committee, South Sudan
Dr. Arsenia Nhancale, Program Analyst, Family Planning and HIV, United Nations Population Fund, Mozambique
Dr. Ronald Nyakoojo, Assistant Public Health Officer, Reproductive Health/HIV, United Nations High Commissioner for Refugees, Uganda
Roselline Achola, National Programme Analyst, Family Planning, United Nations Population Fund, Uganda
This discussion encouraged all stakeholders—program implementers, researchers, government officials, health providers, and members of civil society—to consider humanitarian sector perspectives when advocating for policies that advance self-care behaviors and commodities essential to improving health outcomes in crisis settings.
The DMPA-SC Access Collaborative has published a collection of briefs on countries where we have provided focused technical assistance between 2017 and 2021. This includes the Democratic Republic of the Congo, Kenya, Madagascar, Nigeria, Uganda, and Zambia. Each brief describes the country’s introduction and scale-up experiences for DMPA-SC and self-injection, including accomplishments, challenges, innovations, key lessons, factors for success, and plans for the way forward.
On September 15, 2021, the PATH-JSI DMPA-SC Access Collaborative hosted this virtual launch and walk-through of the redesigned DMPA-SC Country Data Dashboard and new monitoring, learning, and evaluation (MLE) tools.
The AC data dashboard is an interactive tool that presents available data collected during DMPA-SC self-injection (SI) introduction and scale-up. The dashboard visualizes SI uptake, tracks implementation of key policies, and integrates data use practices to support data-driven decision making. Information presented on the dashboard has changed over time to reflect shifting needs of stakeholders. After undergoing a human centered design exercise to better understand information needs surrounding SI introduction and scale-up, the Access Collaborative recently redesigned the DMPA-SC Country data dashboard. This webinar introduced new data available and demonstrated new features on the dashboard.
The webinar also included an overview of the Access Collaborative’s new MLE toolkit developed to help meet the needs of ministries of health and implementing partners. This toolkit features three tools for dynamic decision-making: a data visualization principles guide, an Excel dashboard how-to guide, and a data use and indicators guide. The tools are primers in how to create dynamic and visually compelling SI program data displays (e.g., dashboards, presentations) that facilitate comprehension and use of SI data for family planning program decision-making. While the toolkit was developed with SI in mind, many of the principles could be applied to data visualization needs across family planning programs and methods.