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.

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.

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.

This webinar hosted by the DMPA-SC Access Collaborative Learning and Action Networks (LAN) on July 21, 2021 highlighted important considerations for private pharmacies in data collection and reporting on self-care products such as DMPA-SC self-injection. Presenters shared their experiences and lessons from introducing DMPA-SC self-injection through private delivery channels in their respective countries.

Highlights included:

• The specific types of self-injection data collected across countries.
• Best practices for engaging and motivating private sector pharmacies and drug shops to provide data to the public sector.
• Tools used by pharmacies to collect self-injection data.

This virtual discussion encouraged all stakeholders—program implementers, researchers, government officials, health providers, and civil society members—to consider private sector perspectives on data collection and reporting practices, highlighting the importance of good private sector data to inform government policies and strategies for monitoring, regulating health products, and procurement.

In this Making Self-Injection Count workshop session, participants were engaged in a lively discussion and interactive collaboration around the important considerations for private sector data collection and reporting on self-care products such as DMPA-SC. This session began with a short presentation to set the stage on the important role of private sector and data within the context of mixed health systems. Participants joined a moderated discussion with three in-country implementers from Nigeria (DKT), Uganda (PSI) and Zambia (JSI) who shared their experiences and lessons from introducing DMPA SC self-injection and other self-care products through private delivery channels. The session concluded with a facilitated, interactive activity to identify and prioritize private sector data needs.

Objectives

By the end of the session, participants were able to:

• Characterize the private sector within the context of the total market for DMPA-SC and other self-care products.
• Describe the current landscape for provision of DMPA-SC self-injection through the private sector.
• Identify the unique considerations and feasibility for collecting private sector data within mixed health systems.

Key takeaways

• The private sector is highly diverse and fragmented, comprised of profit and non-for-profit, formal and informal, domestic and global non-state actors. A total market approach (TMA) considers all channels of service delivery–public and private–to increase equitable and sustainable access to health products and services by maximizing the comparative advantage of all sectors. TMA builds upon market segmentation, using various channels to expand the overall market and meet demand for family planning, particularly where the public sector is not meeting women’s preferences/needs.
• Aligning and harmonizing data in mixed health systems is complicated. Different types of data are needed at various levels to understand the total market. By taking a holistic perspective–one that considers both the public and private sectors–we can identify the opportunities and gaps that exist at client, provider and systems level to guide policy, program, and investment decisions. Some data is more readily available, such as public sector procurement and distribution trends. However, other data, such as consumer retail price, willingness to pay or volumes of product sold, are often less available due to a variety of reasons, and sometimes require additional research.
• It is important to engage and understand the perspectives of the private sector when it comes to data collection/reporting desires and needs of governments and other stakeholders.

Presenters

• Ariella Bock, Senior Technical Advisor, JSI
• Mika Bwembya, Health Supply Chain and Total Market Director, USAID DISCOVER Health Project
• Kimberly Cole, Private Sector Service Delivery Programs, USAID’s Global Health Bureau’s Office of Population and Reproductive Health
• Tanvi Pandit-Rajani, Private Sector & Health Markets Lead, JSI
• Christine Prefontaine, Senior Human-Centered Design Advisor, JSI
• Victoria Webbe, Regional Knowledge Manager, DKT Francophone West and Central Africa

PMA generates frequent, high-quality surveys monitoring key health indicators in nine countries in Africa and Asia. Data is available open-source for research, program planning, and policy-making. PMA family planning briefs provide a snapshot of select indicators through charts, graphs and tables. Key indicators for family planning include unmet need for family planning, modern contraceptive prevalence rate (​mCPR), and family planning access, equity, quality, and choice.

The Track20 Project, implemented by Avenir Health, monitors progress towards achieving the goals of the global FP2020 initiative, adding an additional 120 million modern method users between 2012 and 2020 in the world’s 69 poorest countries. Track20 works directly with governments in participating FP2020 countries to collect, analyze and use data to monitor progress annually in family planning and to actively use data to improve family planning strategies and plans. Track20 activities and efforts are focused on countries that chose to make a commitment to the FP2020 global initiative, referred to as Track20 Focus Countries. The remaining FP2020 countries, referred to as Additional Track20 Countries, will also receive some technical support.

The Reproductive Health Supplies Visualizer (RH Viz) is a series of public-facing dashboards designed to help the RH community see integrated and aggregated supply chain inventory, order, and shipment data.

The Global Family Planning Visibility and Analytics Network (VAN) captures data from multiple sources to improve supply chain visibility. The VAN offers a platform to assess supply needs, prioritize them, and act when supply imbalances loom.

This is an open-access collection of health market literature, featuring documents and related resources needed to understand, develop, and intervene in different global health markets.