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Emergency Contraceptive Pills ECPs Knowledge for Health


									Community-based Distribution of
   Injectable Contraception

         Flexible Fund Partners Meeting
       "Tools and Approaches for Successful
    Community-based Family Planning Programs"
              Friday, June 20th, 2008
 Descriptionof 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
What is community-based
distribution of injectables?
Where is the innovation being used?
 • 1970s: Bangladesh
 • 1990s: Latin America
    • Guatemala
    • Bolivia
    • Mexico
    • Peru
 • 2000s: Nepal
 • 2005: Uganda
 • 2006: Madagascar
Uganda Study to Assess the Safety and
Feasibility of CBD of injectables
2004-5 study to compare two groups of new
   • CBD clients (n=449)
   • Clinic clients (n=328)
The study assessed:
   • Continuation
   • Satisfaction
   • Knowledge of side effects
   • Problems
Uganda Study Results
   Clients who received a 2nd Injection
   (6 mo. continuation)
100%                                      96%
          88%             85%


        Pilot CBD     Pilot Clinic   Scale-up CBD
          n=415          n=242          n=169
Uganda Study Results
Satisfaction with Care (“satisfied” or “very satisfied”)


 20%         95%             93%              98%
         Pilot CBD       Pilot Clinic    Scale-up CBD
           n=449            n=328           n=188
Uganda Study Results
                        Injection Site Problems

 Infections /    0.0%
 Abscesses       0.0%

Very painful     0.7%
 injection       0.0%
                                        Clinic Clients   CRHW Clients

 Temporary       0.7%
 numbness        0.3%

                0%        20%     40%           60%       80%       100%
 Uganda Study Results
         Client Knowledge of Common Side Effects
Irregular bleeding

  Heavy bleeding

                                      Pilot CBD Clients
     Amenorrhea                       Pilot Clinic Clients
                                      Scale-up CBD Clients


     Weight gain

                     0%   20%   40%      60%       80%       100%
Madagascar Study
 61 CBD workers from 13
 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
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
Madagascar Study Results
 Contraceptive History of DMPA Acceptors (n=303)

                            N ew
                           to F P
                Ever        28%
                Us e d
               DM P A
                           N ew
                          DM P A
Madagascar Study Results
       Clients' Reports of Service Quality (n=303)
 CBD worker asked if menstruating           93
 Satisfied with injection technique         100
 Received injection on buttock              99
 No problem with injection site             97
 CBD worker friendly                        97
 Trust CBD worker with privacy              96
 Client was counseled on side effects       70
 Client correctly recalled duration of      88
 pregnancy protection
Madagascar Study Results
            Clients’ Reports on Satisfaction (n=303)

    Satisfied with DMPA method

    No morbidity at injection site

 Plan to receive re-injection from
           CBD worker

   Would recommend to friends

                                     0   20    40     60     80   100
                                              % of clients
Where is there demand for the
    Kenya

    Nigeria

    Rwanda

    Zambia

    Ethiopia, Mali, Malawi, Senegal and
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
Challenges to introduction

 Sustainability of supplies
 Ongoing monitoring and evaluation
 Supportive supervision
 Health establishment
 National regulations
 Improving counseling
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
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
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:
                     CBD of DMPA Cartoon Manual
Thank You!

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