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Tag: Uganda


Task-sharing: Expanding community access to injectable contraception

The Injectables Access Collaborative Learning and Action Network hosted this webinar on February 28, 2024 highlighting task-sharing provision of injectable contraception—including DMPA-SC and self-injection—through support from community health workers (CHWs). At least 13 countries now authorize CHWs to support clients’ initiation of self-injection at the community level. Participants learned about the latest data on DMPA-SC provision and self-injection support by CHWs, heard from ministry of health representatives and CHWs themselves about the practice and potential of task-sharing of self-care services, and reflected on how to strengthen community health programs to improve equitable access to integrated primary health care services, including an expanded range of family planning options.

This event is part of series on task-sharing along with this webinar on private sector access to DMPA-SC.

Institutional author(s): PATH, Clinton Health Access Initiative (CHAI), inSupply Health, Jhpiego, JSI, Community Health Impact Coalition
Publication date: February, 2024

Increasing access to DMPA-SC in Uganda: An advocacy case study

This DMPA-SC Advocacy Pack brief describes key evidence-building efforts, advocacy actions, and policy changes in Uganda brought about by key partners to increase access to injectable contraception, including DMPA-SC. You can draw on lessons learned from Uganda to inform your policy goals and advocacy strategy for increasing method choice and access with DMPA-SC and self-injection in your country.

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

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

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

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

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

Can DMPA-SC Self-injection Bridge a Family Planning Access Gap in Humanitarian Settings?

Humanitarian crises and disease outbreaks exacerbate the barriers that women face when seeking reproductive health services. They also highlight a timeless truth: women must be able to manage their own sexual and reproductive health—especially in a crisis when health systems are at their weakest.

On November 17, 2021, the PATH-JSI DMPA-SC Access Collaborative hosted this webinar on making self-care interventions available, including DMPA-SC self-injection, in humanitarian settings. Through this virtual discussion, we addressed key challenges in humanitarian settings that need to be addressed in order to leverage the potential of self-injection as an option to ease access to family planning in the context of a full method mix.

Discussion highlights included:

  • Programmatic or regulatory actions that need to be implemented
  • Country-specific cultural barriers affecting demand generation in humanitarian settings
  • Supply systems and processes in humanitarian settings compared to national systems
  • Collaboration and data sharing between agencies

This discussion was moderated by George Barigye, Regional Technical Advisor, DMPA-SC Access Collaborative, PATH, Uganda. The keynote introduction was given by Dr. Adewole Adefalu, Country Coordinator, DMPA-SC Access Collaborative, JSI, Nigeria.

Featured panelists:

  • Lilian Ndinda, Maternal and Child Health Coordinator, International Rescue Committee, South Sudan
  • Dr. Arsenia Nhancale, Program Analyst, Family Planning and HIV, United Nations Population Fund, Mozambique
  • Dr. Ronald Nyakoojo, Assistant Public Health Officer, Reproductive Health/HIV, United Nations High Commissioner for Refugees, Uganda
  • Roselline Achola, National Programme Analyst, Family Planning, United Nations Population Fund, Uganda

This discussion encouraged all stakeholders—program implementers, researchers, government officials, health providers, and members of civil society—to consider humanitarian sector perspectives when advocating for policies that advance self-care behaviors and commodities essential to improving health outcomes in crisis settings.

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