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Tag: Nigeria


Balancing act: New developments and tensions in private sector access to DMPA-SC and self-injection

The Injectables Access Collaborative Learning and Action Network, in collaboration with USAID’s Frontier Health Markets Engage project, hosted this December 7, 2023 webinar on the latest innovations, policy developments, and evidence on access to DMPA-SC and self-injection through private sector channels such as pharmacies, drug shops, and private clinics.

One-third of contraceptive users in low- and middle-income countries access their method from a private sector source. Momentum is growing to ensure that contraceptive injectables, including DMPA-SC/self-injection, are among the range of methods offered through private channels. Speakers shared the latest evidence regarding pharmacy and drug shop provision of DMPA-SC/self-injection, updates on the release of a generic product, reflections on packaging for the private sector, and tensions between equity and financial sustainability in a changing landscape for contraceptive procurement financing. Speakers and participants discussed innovations to improve private sector channel economics and advance both equity and sustainability.

This event is part of series on task-sharing, along with this webinar on expanding community access to injectable contraception.

Institutional author(s): PATH, Clinton Health Access Initiative (CHAI), inSupply Health, Jhpiego, JSI, Frontier Health Markets Engage
Publication date: December, 2023

State of Self-Care Report

Progress and Potential of Self-Care: Taking Stock and Looking Ahead

The momentum around self-care is building through an array of self-care practices, policies, and interventions worldwide. This report aims to take stock of the SRH self-care field and document its progress. It is intended to provide a resource for global and national advocacy, to inform implementation of self-care guidelines, and to link the reader to evidence and learning exchanges. It includes case examples describing the process of introducing and scaling up DMPA-SC self-injection in Malawi and Nigeria.

Institutional author(s): Self-Care Trailblazer Group
Publication date: June, 2023

Measuring Scale-Up: A review of the AC sustainability tracking indicators

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.

Institutional author(s): PATH, JSI
Publication date: March, 2023

Self-injected contraceptives: does the investment reflect women’s preferences?

Subcutaneous depot medroxyprogesterone acetate (DMPA-SC) is an innovative contraceptive method aimed at meeting women’s unique circumstances and needs, largely due to its ability to be self-injected. Substantial research and advocacy investments have been made to promote roll-out of DMPA-SC across sub-Saharan Africa. To date, research on the demand for DMPA-SC as a self-injectable method has been conducted largely with healthcare providers, via qualitative research, or with highly specific subsamples that are not population based. Using three recent rounds of data from Performance Monitoring for Action, we examined population-representative trends in demand, use, and preference for self-injection among current non-users in Burkina Faso, the Democratic Republic of Congo (Kinshasa and Kongo Central regions), Kenya, and Nigeria (Lagos and Kano States). We found that while over 80.0% of women had heard of injectables across settings, few women had heard of self-injection (ranging from 13.0% in Kenya to 24.8% in Burkina Faso). Despite initial increases in DMPA-SC prevalence, DMPA-SC usage began to stagnate or even decrease in all settings in the recent three years (except in Nigeria-Kano). Few (0.0%–16.7%) current DMPA-SC users were self-injecting, and the majority instead were relying on a healthcare provider for administration of DMPA-SC. Among current contraceptive non-users wishing to use an injectable in the future, only 1.5%–11.4% preferred to self-inject. Our results show that self-injection is uncommon, and demand for self-injection is very limited across six settings, calling for further qualitative and quantitative research on women’s views on DMPA-SC and self-injection and, ultimately, their contraceptive preferences and needs.

Institutional author(s): Johns Hopkins Bloomberg School of Public Health
Individual author(s): Shannon N Wood, Sophia Magalona, Linnea A Zimmerman, Funmilola OlaOlorun, Elizabeth Omoluabi, Pierre Akilimali, Georges Guiella, Peter Gichangi, Philip Anglewicz
Publication date: July, 2022

Journal article BMJ Global Health

Training supply recommendations for DMPA-SC rollout

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.

Institutional author(s): PATH
Publication date: 2022

Self-injection in the private sector: Promoting policies for progress

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

Institutional author(s): PATH, JSI, Jhpiego, Nigeria Federal Ministry of Health, Pharmaceutical Society of Kenya, Association of Pharmacists of Madagascar
Publication date: February, 2022

DMPA-SC Access Collaborative country briefs

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.

 

Institutional author(s): PATH, JSI
Publication date: 2021

Looking back, thinking forward, and scaling up: Insights from the DMPA-SC Access Collaborative

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.

Institutional author(s): PATH, JSI
Publication date: April, 2021

Injectable Contraceptive Assessment in Uganda and Nigeria

This webinar presented key findings from a two-phased research program funded by The Bill & Melinda Gates Foundation in Nigeria and Uganda. The first phase was a qualitative exploration within Focus Group discussions (total sample n=600 in 100 Focus Groups (n=6 per FG) across 8 different FG types and split across 2 urban and 2 rural settings per country) with women and their male partners (separately). The second phase was a quantitative survey with women (total sample n=1,410 women) split across 4 regions within each country.

The research explored several central topics:

  • The various contraceptive journeys and experiences of women and their male partners, including satisfied and discontinued users of the injectable contraceptive (Depo), satisfied users of the DMPA-SC (Sayana Press), naïve users of modern contraceptive and those using traditional methods.
  • Factors which lead to discontinuation and experiences with/perception of side effects.
  • Gauged level of acceptability and preference for certain injectable attributes, in particular the impact of DMPA-SC 3 months or a potential 6 month injectable on likelihood to try. We tested 3 fully developed concepts and vary the most impactful features from phase 1 with women.
  • Developed a forecast model for Depo, DMPA-SC 3-month and a potential 6-month injectable in Nigeria and Uganda.

Institutional author(s): Reproductive Health Supplies Coalition (RHSC), Routes2Results
Publication date: November, 2019

Using Human-Centered Design to Explore Potential Users’ and Men’s Views of New Injectable Contraceptives in Kampala and Lagos

Background: Injectable contraceptives are the most used method in sub-Saharan Africa. We conducted market research to assess potential user attitudes toward 4- and 6-month injectables. We also present user suggestions for marketing these new injectables once they are available.

Methods: We implemented a 2-phase market research study from October through December 2021 in Kampala, Uganda, and Lagos, Nigeria. We conducted 11 focus group discussions (FGDs) with 51 participants in Kampala and 12 FGDs with 67 participants in Lagos. FGDs included current and potential injectable users and men stratified by marital status and age. Next, 23 women in Kampala and 24 in Lagos participated in cocreation workshops using human-centered design methods to explore marketing and communications strategies for each injectable. Data collection teams completed semistructured data extraction tables that were then analyzed thematically.

Results: Participants liked both injectable options due to the reduced number of facility visits that would save time and money and increase privacy. Primary concerns included side effects, delayed return to fertility, cost, self-efficacy to self-inject, and stock-outs. Participants in Kampala preferred a shorter reinjection window (or “grace period”) because it is easier to remember and they assumed it meant a quicker return to fertility, but participants in Lagos preferred a longer window because it provides extra time for reinjection. Citing norms around women needing to get pregnant quickly after marriage, participants in both sites felt that the 4-month injectable would benefit young people with busy lifestyles or limited access to facilities, whereas the 6-month injectable would benefit women who already had children.

Conclusions: We found that participants in Kampala and Lagos would prefer additional injectable options to meet the wide-ranging needs of users in different stages of their reproductive lives. Family planning program planners can apply the marketing insights we identified when these new injectables become available.

Institutional author(s): FHI 360
Individual author(s): Holly M Burke, Rebecca Callahan, Anna Lawton, Abigail Turinayo, Oluwatoyin Oyekenu, Sheila Niyonsaba, Oladunni Taiwo, Victor Muwonge Semaganda, Andy Awiti, Audrey Fratus, Fredrick Mubiru, Funmilola OlaOlorun
Publication date: December, 2023

Journal article Global Health: Science and Practice