Updating family planning and reproductive health preservice training is an important approach to make an impact on the health workforce and foster successful programs. In 2021, the DMPA-SC Access Collaborative, in collaboration with Uganda’s Ministry of Health and Ministry of Education and Sports, conducted a regional training for clinical and health training institutions on the topic of DMPA-SC including self-injection. This training integrated DMPA-SC content into the health provider preservice curriculum, trained tutors, and helped advance national scale-up of self-injection. As a result, 92 Ugandan health training institutions included self-injection content in their preservice curriculum for nurses, midwives, and clinical officers, and 190 tutors were trained—which will help ensure training of many more providers in the future.

During this process, the Access Collaborative gained valuable insights with relevance to other country contexts. This webinar held on January 27, 2022 highlighted lessons learnt, challenges, recommendations, and considerations for the inclusion of self-injection content in provider preservice training. In the Ugandan context, these include:

• How inclusion of self-injection in preservice training can help reach FP2030 country commitments.
• Virtual preservice training approaches during the COVID-19 pandemic.
• Costs for the inclusion of self-injection in preservice training.
• The role of regulators and the Ministry of Health in ensuring availability of DMPA-SC for preservice training.

Using eLearning to train health workers on family planning counseling can be an effective training approach, particularly when carefully planned and coordinated to maximize the benefits. On August 26, 2021, the DMPA-SC Access Collaborative hosted this webinar on eLearning for health workers learning to counsel clients on DMPA-SC including self-injection in Senegal and Uganda. During 2019-2020, this approach was launched and evaluated in four regions of Senegal and four districts in Uganda.

The findings and recommendations from the experiences in Senegal and Uganda may offer lessons for other countries wishing to implement digital learning approaches. The webinar presenters raised important considerations about stakeholder coordination, internet and technology access, eLearning platforms, establishing training targets, training content, and the important role of post-training supervision.

Over the past two years, a number of implementing partners have leveraged the Catalytic Opportunity Fund (COF) to support the scale-up of DMPA-SC in focal countries. The COF is a rapid funding mechanism administered by Clinton Health Access Initiative (CHAI) and managed by the DMPA-SC Operations Group, a group that responds to operational and service delivery issues in DMPA-SC and self-injection introduction and scale-up. The fund aims to support short-term DMPA-SC scale-up activities that unlock or generate additional resources. COF grantees carry out a diverse range of activities with short-term, small grants that make significant contributions to the national introduction and scale-up of DMPA-SC in their countries.

During this DMPA-SC Learning and Action Network (LAN) knowledge-sharing webinar held on May 19, 2021, successful COF grantees representing the Society for Family Health, Pathfinder International, Marie Stopes, and Jhpiego shared about the fund’s impact on their work and key lessons learned. The virtual discussion encouraged all stakeholders—program implementers, researchers, government officials, health providers, and members of civil society—to consider applicable strategies and mechanisms for efficient, sustainable, and scalable product introduction.

For more information, please contact the Access Collaborative LAN at dmpa-sc-lan@path.org or the CHAI COF at COF@clintonhealthaccess.org.

By leveraging digital training tools, family planning programs can integrate new approaches that help reduce the costs, time, and inconvenience associated with traditional classroom training. The PATH-JSI Access Collaborative has recently developed digital training resources for health workers and clients learning to administer DMPA-SC.

A 10-lesson DMPA-SC eLearning course for health workers is available for free in English and French and can be taken on computer or mobile device with internet access. Content includes an emphasis on informed choice counseling, new lessons on calculating the injection date and conducting follow-up visits, and updated information on training clients to self-inject.

In addition to the eLearning course, PATH and JSI have developed short 5- to 7-minute DMPA-SC training videos for both self-injection clients and health workers. Available in English and French, the videos can be translated or adapted to fit in program contexts.

If you are interested in introducing DMPA-SC digital training approaches in your program, please contact the Access Collaborative at FPoptions@path.org.

These short training videos are intended for both self-injection clients and health workers learning to administer the contraceptive DMPA-SC. The 5-minute self-injection training video is intended for women who have made the decision to self-inject DMPA-SC in the context of informed choice counseling. The 7-minute training video is for health workers who are giving injections to women who have chosen to use DMPA-SC in the context of informed choice counseling.

If you are interested in customizing these videos for your family planning program, we can make the voiceover scripts and video files available. To request these files please email FPoptions@path.org.

This training module is part of a World Health Organization series of modules on immunization training. Supportive supervision involves supervisors and health workers working together to solve problems and improve performance. The module outlines key steps and practical implementation strategies.

The Training Resource Package (TRP) for Family Planning offers curriculum components and tools for trainers to design, implement, and evaluate family planning and reproductive health training. The TRP website includes training information and materials for a wide range of family planning methods.

The TRP’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. The module was developed for training physicians, nurses, and midwives and other health care providers who offer Progestin-Only Injectable Contraception (“injectables”).

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.

These training videos from Global Health Media cover a variety of family planning and other health topics. In addition to DMPA-SC (referred to as Depo SubQ), topics include: contraceptive methods, family planning learning aids, contraceptive method skills (“how-to” films), counseling, reproductive health, and clinic-based infection prevention and control. Videos are tailored for health workers, women, or their partners, and many are available in English, French, Spanish and other languages.

The videos for health workers are also available in the Family Planning Videos app which can be downloaded from Google Play or the App store. Videos for women and partners are available in the Birth & Beyond app, also on Google Play and the App store. If you would like to narrate any videos in your local language, please contact Global Health Media.

In 2018, Zambia initiated a strategy development process to introduce and scale up DMPA-SC, which called for private sector engagement. The purpose of this activity was to generate
experience from a DMPA-SC self-injection pilot in the private sector to inform country and global learning, and to provide the Zambian MOH with operational recommendations for policy and program planning. In partnership with the Zambian Ministry of Health (MOH), we designed and applied a client centered approach that reflected the specific needs and desires of private health sector clients and providers. We adapted and tailored globally available DMPA-SC training materials and methodologies designed largely for a public sector context to a private sector setting. The private sector pilot demonstrated that a shorter training format, that incorporated an e-learning video and individual consultation, was effective for training clients in DMPA-SC self-injection. Based on stakeholder interviews and a highly participatory HCD workshop, we developed and provided the Zambian MOH with recommendations for a phased, targeted DMPA-SC self-injection scale-up based on a total market approach. This activity demonstrated that a shorter DMPA-SC training format was effective for training private providers and their clients in self-injection, and that most women who participated in the pilot are willing to pay a price similar to or higher than the negotiated donor price of $.85 per unit. With only one DMPA-SC product available in the global market, the authors strongly encourage Zambia and other countries committed to engaging the private sector to consider a phased, targeted approach using market segmentation to strengthen public and private sector coordination, minimize product leakage, and ensure quality standardization across all service delivery channels.