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.

An in-depth look at DMPA-SC and self-injection introduction in Zambia

The DMPA-SC Access Collaborative (AC) hosted this virtual discussion on February 16, 2023 to explore the challenges of introducing new contraceptive methods in the context of informed choice programming. This webinar focused on findings from a recent study conducted in Zambia which aimed to determine:

• The barriers to clients’ ability to exercise autonomy in their choice of family planning methods and modes of administration.
• The extent to which provider perceptions and method bias affect access to self-injection as a new contraceptive option.

This research was conducted as part of the AC’s broader learning agenda and focused on the potential risks to informed choice that could arise as new products or service innovations are integrated in family planning programs. While a new intervention is intended to expand contraceptive access and options, its introduction may inadvertently convey to providers that it is inherently better than existing products or practices. In the case of DMPA-SC, providers may promote self-injection over provider administration. Alternatively, providers may feel hesitant about a new method and withhold information. In either case, the client’s right to receive accurate information about a variety of methods and to make an informed choice about her reproductive health care is compromised. To explore these questions, the AC conducted a literature review and study interviewing both clients and providers to understand how DMPA-SC and self-injection are being offered in Zambia’s Copperbelt Province.

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 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.

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.

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.

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.

In 2018, Zambia initiated a strategy development process to introduce and scale up DMPA-SC, which called for private sector engagement. The purpose of this activity was to generate
experience from a DMPA-SC self-injection pilot in the private sector to inform country and global learning, and to provide the Zambian MOH with operational recommendations for policy and program planning. In partnership with the Zambian Ministry of Health (MOH), we designed and applied a client centered approach that reflected the specific needs and desires of private health sector clients and providers. We adapted and tailored globally available DMPA-SC training materials and methodologies designed largely for a public sector context to a private sector setting. The private sector pilot demonstrated that a shorter training format, that incorporated an e-learning video and individual consultation, was effective for training clients in DMPA-SC self-injection. Based on stakeholder interviews and a highly participatory HCD workshop, we developed and provided the Zambian MOH with recommendations for a phased, targeted DMPA-SC self-injection scale-up based on a total market approach. This activity demonstrated that a shorter DMPA-SC training format was effective for training private providers and their clients in self-injection, and that most women who participated in the pilot are willing to pay a price similar to or higher than the negotiated donor price of $.85 per unit. With only one DMPA-SC product available in the global market, the authors strongly encourage Zambia and other countries committed to engaging the private sector to consider a phased, targeted approach using market segmentation to strengthen public and private sector coordination, minimize product leakage, and ensure quality standardization across all service delivery channels.