This resource provides a high-level summary of the current state of self-injection policy development, implementation, and monitoring in each of the Injectables Access Collaborative’s 11 focus countries: Benin, DRC, Ghana, Kenya, Madagascar, Malawi, Mozambique, Nigeria, Togo, Uganda, and Zambia. The policy cycle landscape (i.e., policy development, implementation, and monitoring) features an overview of the enabling environment for self-injection in each country, including general self-injection and self-care policies, as well as local authorizations for task-sharing/task-shifting. The information is current as of Quarter 2, 2025.

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 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
• Advocacy
• Demand generation

The discussion was moderated by Allen Namagembe, Deputy Project Director, Uganda DMPA-SC Access Collaborative, PATH.

Panelists:

• 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

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.

The DMPA-SC Access Collaborative hosted this April 21, 2021 webinar highlighting lessons learned to date through four years of data-driven technical assistance and coordination to ensure that women have increased access to self-injection as a contraceptive option, delivered through informed choice programming. The discussion focused on key topics for the introduction and scale-up of self-injection—and self-care interventions more broadly—at the country level including:

• Policy and advocacy for new product introduction.
• How to coordinate scale-up of a new product.
• Using data to inform program introduction and scale-up.
• Effective innovations and adaptations in provider training.

This discussion was moderated by Monica Mutesa, Zambia Country Coordinator, DMPA-SC Access Collaborative, PATH. Speakers included:

• Caitlin Corneliess, Project Director, DMPA-SC Access Collaborative, PATH
• Adewole Adefalu, Nigeria Country Coordinator, DMPA-SC Access Collaborative, JSI
• Allen Namagembe, Uganda Deputy Director, DMPA-SC Access Collaborative, PATH
• Avotiana Rakotomanga, Madagascar Country Coordinator, DMPA-SC Access Collaborative, JSI
• Alain Kabore, Regional Technical Advisor, DMPA-SC Access Collaborative, PATH

For more information, please contact FPoptions@path.org.

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.

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.

As part of the Global Health Science and Practice (GHTechX) conference, CHAI, FHI 360, PATH, the Population Council, PSI, and WCG hosted an April 22, 2021 session to synthesize lessons learned across contraceptive introduction of implants, DMPA-SC self-injection, hormonal IUS and other methods. During the session, experts from Kenya, Madagascar, Uganda, and the United States outlined essential steps for the process of contraceptive product introduction, described common challenges, and shared tools and approaches based on experiences with the three methods. Session slides are available below. To watch the recording of this and many other sessions, register for free on the GHTechX website.

With funding from the Catalytic Opportunity Fund (COF), JSI, Inc. evaluated the feasibility of using a low-cost training mechanism, known as OAS or “Orientation, Aide par Fiche Technique (job aid)”, to facilitate DMPA-SC scale-up among injection-experienced providers. It was piloted in four pilot districts in Madagascar, covering 76 basic health facilities.

Respondents had a very positive view of the OAS strategy and agreed it was a good alternative to more traditional training that can be scaled up in areas with injection experienced providers. The most significant impact of the OAS strategy has been correcting errors to ensure proper administration of DMPA-SC, thereby eliminating rumors and previous complaints.

This report covers the background, pilot and evaluation, results, and next steps relating to the OAS strategy in Madagascar.

The country dashboard is a visual presentation of key data for a select list of priority countries; it provides a snapshot of the state and stage of DMPA-SC introduction/scale-up, allowing stakeholders to assess progress, identify roadblocks, guide course corrections, and inform decisions.