Community-based Distribution of Injectable Contraception

1. Community-based Distribution of Injectable Contraception Flexible Fund Partners Meeting "Tools and Approaches for Successful Community-based Family Planning Programs" Friday, June 20th, 2008

2. Outline Description of the innovation Where this innovation is in use Data from FHI’s studies What should be in place before introduction Challenges to introduction How NGOs can implement the strategy Resources for implementation and advocacy

3. What is community-based distribution of injectables?

4. Where is the innovation being used? • 1970s: Bangladesh • 1990s: Latin America • Guatemala • Bolivia • Mexico • Peru • 2000s: Nepal • 2005: Uganda • 2006: Madagascar

5. 2004-5 study to compare two groups of new clients • CBD clients (n=449) • Clinic clients (n=328) • The study assessed: • Continuation • Satisfaction • Knowledge of side effects • Problems Uganda Study to Assess the Safety and Feasibility of CBD of injectables

6. Uganda

7. Uganda Study Results Clients who received a 2nd Injection (6 mo. continuation)

8. Uganda Study Results Satisfaction with Care (“satisfied” or “very satisfied”) 95% 93% 98%

9. Uganda Study Results Injection Site Problems

10. Uganda Study Results Client Knowledge of Common Side Effects

11. 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 system’s ability to support the innovation • Acceptability

12. 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

13. Madagascar Study Results Contraceptive History of DMPA Acceptors (n=303)

14. Madagascar Study Results Clients' Reports of Service Quality (n=303)

15. Madagascar Study Results Clients’ Reports on Satisfaction (n=303)

16. Kenya • Nigeria • Rwanda • Zambia • Ethiopia, Mali, Malawi, Senegal and Ecuador Where is there demand for the innovation?

17. What should be in place? • Government support is essential • An active, strong CBD program • Existing demand for DMPA • State-of–the art service guidelines • Effective commodity logistics system

18. Challenges to introduction • Sustainability of supplies • Ongoing monitoring and evaluation • Supportive supervision • Health establishment • National regulations • Improving counseling

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

20. FHI’s 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 • M&E and supervision systems

21. CBD of DMPA Cartoon Manual 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/CBD+of+DMPA.htm

22. Thank You!