Communitybased Distribution of Injectable Contraception

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Community-based Distribution of Injectable
Contraception

• Flexible Fund Partners Meeting
• "Tools and Approaches for Successful
• Community-based Family Planning Programs"
• Friday, June 20th, 2008

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Outline

• Description of the innovation
• Where this innovation is in use
• Data from FHIs studies
• What should be in place before introduction
• Challenges to introduction
• How NGOs can implement the strategy
• Resources for implementation and advocacy

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What is community-based distribution of
injectables?
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Where is the innovation being used?

• 1970s Bangladesh
• 1990s Latin America
• Guatemala
• Bolivia
• Mexico
• Peru
• 2000s Nepal
• 2005 Uganda
• 2006 Madagascar

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Uganda Study to Assess the Safety and Feasibility
of CBD of injectables

• 2004-5 study to compare two groups of new
  clients
  
• CBD clients (n449)
• Clinic clients (n328)
• The study assessed
• Continuation
• Satisfaction
• Knowledge of side effects
• Problems

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Uganda
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Uganda Study Results
Clients who received a 2nd Injection
(6 mo. continuation)
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Uganda Study Results
Satisfaction with Care (satisfied or very
satisfied)
95
93
98
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Injection Site Problems
Uganda Study Results
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Client Knowledge of Common Side Effects
Uganda Study Results
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Madagascar Study

• 61 CBD workers from 13 communes
• Collaboration of 3 NGOs supported by SanteNet
• The study assessed
• Quality of services
• Effect on uptake of FP
• The systems ability to support the innovation
• Acceptability

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Madagascar Study Results

• High levels of competency were demonstrated
• Increased uptake of FP in communities
• Management systems sustained the innovation
• Overall the innovation was acceptable

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Madagascar Study Results
Contraceptive History of DMPA Acceptors (n303)
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Clients' Reports of Service Quality (n303)
Madagascar Study Results
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Madagascar Study Results
Clients Reports on Satisfaction (n303)
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Where is there demand for the innovation?

• Kenya
• Nigeria
• Rwanda
• Zambia
• Ethiopia, Mali, Malawi, Senegal and Ecuador

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What should be in place?

• Government support is essential
• An active, strong CBD program
• Existing demand for DMPA
• State-ofthe art service guidelines
• Effective commodity logistics system

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Challenges to introduction

• Sustainability of supplies
• Ongoing monitoring and evaluation
• Supportive supervision
• Health establishment
• National regulations
• Improving counseling

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NGO Implementation

• There is guidance for implementers
• All contexts are unique and will need
  individualized planning
  
• FHI and partners can provide TA in advocacy and
  implementation

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FHIs Technical Assistance

• Varies widely depending on the context, needs of
  partners, and resources.
  
• South-to-south learning exchanges
• In-country advocacy strategies
• Coordination of a stakeholder input
• Training of trainers
• ME and supervision systems

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Resources and Tools

• Advocacy strategy and briefs
• The Implementation Handbook
• DMPA Screening Checklists
• Key Factors for Replication Checklist
• Rapid assessment of CBD program
• Training tools
• Available at http//www.fhi.org/en/Topics/CBDof
  DMPA.htm

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Thank You!