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.

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.

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.

This webinar held on February 23, 2022 was hosted by Expanding Effective Contraceptive Options (EECO) led by WCG Cares with PSI and the DMPA-SC Access Collaborative led by PATH in partnership with JSI. The discussion focused on the introduction and scale up of self-care family planning methods in sub-Saharan Africa, highlighting lessons and best practices from DMPA-SC scale-up and Caya® diaphragm pilot introductions in French-speaking West Africa. Presenters from Benin, Niger, and Senegal shared successes and challenges. This webinar was offered in French.

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.

Objectives: The primary objective of this study was to compare the 12-month continuation rate for women who self-injected subcutaneous depot-medroxyprogesterone acetate (DMPA-SC) with that for women receiving intramuscular depot-medroxyprogesterone acetate (DMPA-IM) from a provider. This research contributes to the broader goal of identifying solutions to support women to use contraception for their full desired duration.
Study design: Participants were clients from 13 clinics in the Dakar and Thiés regions of Senegal who had decided to use injectable contraception prior to enrollment. They chose self-injection of DMPA-SC or provider administration of DMPA-IM. Self-injectors were trained and given three units of DMPA-SC. The provider-injected group received DMPA-IM and returned to the clinics for future injections. We interviewed participants at baseline and after the second, third and fourth injections (the equivalent of 12 months of contraceptive coverage). We employed Kaplan–Meier methods to estimate continuation probabilities, with a log-rank test to compare differences between groups. A multivariate Cox regression identified factors correlated with discontinuation.
Results: The 12-month continuation rate for 650 women self-injecting DMPA-SC was 80.2%, while that for 649 women receiving DMPA-IM from a provider was 70.4% (p<.01). The difference in continuation between self-injectors and those receiving DMPA from a provider remained significant in a multivariate Cox regression model. The primary reason for discontinuation in both groups (44.7% self-injected; 44.5% provider-injected) was forgetting to reinject or reinjecting late. Fewer women reported side effects in the self-injection group than in the provider-administered group.
Conclusions: The higher 12-month continuation rate for women self-injecting DMPA-SC relative to provider-administered DMPA-IM suggests that self-injection may help prevent pregnancy more consistently and continuously.

This document was created to support ministry of health and nongovernmental partners as they develop strategies to introduce and scale up subcutaneous DMPA (DMPA-SC, brand name Sayana® Press) to increase contraceptive options and access. Available in English and French, the publication provides practical guidance based on results, evidence, and learning from the pilot introductions of DMPA-SC in four countries in Africa.

In collaboration with ministries of health, PATH and key partners launched the first pilot introductions of subcutaneous depot medroxyprogesterone acetate (DMPA-SC, brand name Sayana® Press) in Burkina Faso, Niger, Senegal, and Uganda from July 2014 through June 2016. While each country implemented a unique introduction strategy, all agreed to track a set of uniform indicators to chart the effect of introducing this new method across settings. Existing national health information systems (HIS) were unable to track new methods or delivery channels introduced for a pilot, thus were not a feasible source for project data. We successfully monitored the four-country pilot introductions by implementing a four-phase approach: 1) developing and defining global indicators, 2) integrating indicators into existing country data collection tools, 3) facilitating consistent reporting and data management, and 4) analyzing and interpreting data and sharing results. Project partners leveraged existing family planning registers to the extent possible, and introduced new or modified data collection and reporting tools to generate project-specific data where necessary. We routinely shared monitoring results with global and national stakeholders, informing decisions about future investments in the product and scale up of DMPA-SC nationwide. Our process and lessons learned may provide insights for countries planning to introduce DMPA-SC or other new contraceptive methods in settings where stakeholder expectations for measurable results for decision-making are high.