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Tag: public sector


Adolescent and Youth Experiences With Contraceptive Self-Injection in Uganda

Results From the Uganda Self-Injection Best Practices Project

Purpose
We used qualitative and quantitative data to evaluate the differing experiences of adolescents and adult women in the contraceptive self-injection program in primary care settings in Uganda. From these results, we assessed barriers to adolescent DMPA-SC self-injection access and continuation and provide recommendations to address them.

Methods
The Self-Injection Best Practices project (2017–2019) in four districts trained clinic-based providers and Village Health Teams to provide self-injection training in clinics, community settings, and small group meetings for adolescent girls and young women. More than 12,000 women of reproductive age received self-injection services through the program, including 2,215 under 20 years. Structured surveys (n = 1,060) and in-depth interviews (n = 36) were conducted with randomly selected adolescent participants between July and November 2018. Mixed-effects logistic regression was used to assess quantitative differences in outcomes of interest between age groups.

Results
The study found no significant difference in self-injection proficiency or continuation between adolescents and adult women; 92.6% of adolescents self-injected independently when due for reinjection. Adolescents were significantly less likely than adults to report first hearing about self-injection from a community health worker. More adolescents expressed concern over discovery when seeking contraception at a clinic and fear of their DMPA-SC units being discovered at home. Adolescents were significantly less likely than adult women to mention convenience as a rationale for self-injecting, and more likely to mention wanting to learn a new skill and/or that friends recommended self-injection.

Discussion
Self-injection is a promising method of contraception for adolescents in Uganda, given comparable proficiency and continuation relative to adult women. Policies and programs should ensure rights-based access to a range of methods, including self-injection for this age group.

Institutional author(s): PATH
Individual author(s): Caitlin Corneliess, Jane Cover, Andrew Secor, Allen Namagembe, Fiona Walugembe
Publication date: October, 2022

Journal Article Journal of Adolescent Health article

Contraceptive self-injection through routine service delivery: Health worker perspectives from Uganda

Self-care reproductive health innovations are increasingly valued as practices that enable women to manage their fertility with greater autonomy. While self-care, by definition, takes place beyond the clinic walls, many self-care practices nonetheless require initial or follow up visits to a health worker. Access to self-care hinges on the extent to which health care workers who serve as gatekeepers find the innovation appropriate and practical. Self-injection of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) is being introduced and scaled in many countries. In late 2018, health workers in Uganda began offering self-injection of DMPA-SC in the public sector, and this study examines health workers’ views on the acceptability and feasibility of training women to self-inject. We conducted in-person interviews with 120 health workers active in the self-injection program to better understand provider practices, program satisfaction, and their views on feasibility. A subset of 77 health workers participated in in-depth interviews. Quantitative data was analyzed using Stata (v14) software, and chi square and student t tests used to measure between group differences. Qualitative data was analyzed using Atlas.ti, employing an iterative coding process, to identify key themes that resonated. The majority of health workers were very satisfied with the self-injection program and reported it was moderately easy to integrate self-injection training into routine service delivery. They identified lack of time to train clients in the clinic setting, lack of materials among community health workers, and client fear of self-injection as key challenges. Community health workers were less likely to report time challenges and indicated higher levels of satisfaction and greater ease in offering self-injection services. The relatively high acceptability of the self-injection program among health workers is promising; however, strategies to overcome feasibility challenges, such as workload constraints that limit the ability to offer self-injection training, are needed to expand service delivery to more women interested in this new self-care innovation. As self-injection programs are introduced and scaled across settings, there is a need for evidence regarding how self-care innovations can be designed and implemented in ways that are practical for health workers, while optimizing women’s successful adoption and use.

Institutional author(s): PATH
Individual author(s): Chloe Morozoff, Jane Cover, Allen Namagembe, Damalie Nsangi, Justine Tumusiime, Aurora Anna Stout, Jennifer Kidwell Drake
Publication date: September, 2022

Contraceptive self-injection through routine service delivery: Experiences of Ugandan women in the public health system

Contraceptive self-injection (SI) is a new self-care practice with potential to transform women’s family planning access by putting a popular method, injectable contraception, directly into the hands of users. Research shows that SI is feasible and acceptable; evidence regarding how to design and implement SI programs under real-world conditions is still needed. This evaluation examined women’s experiences when self-injection of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) was introduced in Uganda alongside other contraceptive options in the context of informed choice. We conducted structured survey interviews with 958 randomly selected SI clients trained in three districts in 2019. SI clients demonstrated their injection technique on a model to permit an assessment of injection proficiency. A randomly selected subset of 200 were re-interviewed 10–17 months post-training to understand resupply experiences, waste disposal practices and continuation. Finally, we conducted survey interviews with a random sample of 200 clients who participated in training but declined to self-inject. Data were analyzed using Stata IC/14.2. Differences between groups were measured using chi square and t-tests. Multivariate analyses predicting injection proficiency and SI adoption employed mixed effects logistic regression. Nearly three quarters of SI clients (73%) were able to demonstrate injection proficiency without additional instruction from a provider. Years of education, having received a complete training, practicing, and taking home a job aid were associated with higher odds of proficiency. Self-reported satisfaction and continuation were high, with 93% reinjecting independently 3 months post-training. However, a substantial share of those trained opted not to self-inject. Being single, having a partner supportive of family planning use, training with a job aid, practicing, witnessing a demonstration and exposure to a full training were associated with higher odds of becoming an SI client; conversely, those trained in a group had reduced odds of becoming an SI client. The self-care program was successful for the majority of women who became self-injectors, enabling most women to demonstrate SI proficiency. Nearly all those who opted to self-inject reinjected independently, and the majority continued self-injecting for at least 1 year. Additional research should identify strategies to facilitate adoption by women who wish to self-inject but face challenges.

Institutional author(s): PATH
Individual author(s): Jane Cover, Allen Namagembe, Chloe Morozoff, Justine Tumusiime, Damalie Nsangi, Jennifer Kidwell Drake
Publication date: August, 2022

Access Collaborative technical assistance (TA) resource menu

The DMPA-SC Access Collaborative provides data-driven technical assistance (TA), resources, and tools that countries need for designing, implementing, and monitoring the introduction and scale up of DMPA-SC self-injection as part of an expanded range of contraceptive methods, delivered through informed choice programming.

In addition to general information and evidence on DMPA-SC, partners can access the support outlined in the menu below by submitting a request through the technical assistance request form, also linked below. Your request can be submitted by emailing the completed form to FPoptions@path.org.

Institutional author(s): PATH, JSI
Publication date: 2022

The Catalytic Opportunity Fund for Scale-Up of DMPA-SC: Learning from high-impact, short-term funding opportunities

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.

Institutional author(s): PATH, Clinton Health Access Initiative (CHAI), JSI, Society for Family Health, Pathfinder International, MSI Reproductive Choices, Jhpiego
Publication date: May, 2021

Track20 Project

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.

Institutional author(s): Avenir Health
Publication date: 2021

Tool Web page

Performance Monitoring for Action (PMA): Family Planning

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.

Institutional author(s): Johns Hopkins Bloomberg School of Public Health
Publication date: 2021

Tool Web page

Reproductive Health Supplies Visualizer (RH Viz)

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.

Institutional author(s): Reproductive Health Supplies Coalition (RHSC)
Publication date: December, 2020

Tool Web page

Global Family Planning Visibility and Analytics Network (VAN)

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.

Institutional author(s): Reproductive Health Supplies Coalition (RHSC)
Publication date: December, 2020

Tool Web page

Market Bookshelf

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.

Institutional author(s): Reproductive Health Supplies Coalition (RHSC), USAID, William Davidson Institute
Publication date: December, 2020

Tool Web page