Abstract
Background
Community-based distribution (CBD) of injectable contraceptives has increased access to family planning for millions of women in rural areas in resource-limited settings. Despite the evidence of the success of this contraceptive delivery method, many nations have yet to integrate CBD into their family planning policies. The aim of this paper to describe the process through which PATH spearheaded efforts to successfully advocate for policy change to authorize non-clinical personnel in Zambia to provide injectable contraceptives.
Methods
We describe a four-part framework for policy advocacy: (a) evidence building and technical assistance, (b) stakeholder engagement, (c) government engagement, and (d) knowledge dissemination.
Results
Advocacy for policy change to allow CBD of injectable contraceptives was long and iterative. Evidence to support advocacy efforts was built through a Zambian delegates’ study tour to Rwanda to witness Rwanda’s robust CBD program and a rapid assessment of Zambian pilot sites where non-clinical personnel were administering injectable contraceptives. Advocacy was led by PATH in partnership with key stakeholders from the Zambia Family Planning Technical Working Group (FPWTG), key government officials, and a special task force of stakeholders focused on advocating for CBD of injectable contraceptives. This task force used evidence from the study tour and rapid site assessment in national and international forums to demonstrate the beneficial effects of allowing non-clinical personnel to administer injectable contraceptives. The Zambian government authorized the policy change in 2016.
Conclusion
The policy advocacy efforts of PATH, FPWTG, and the special task force demonstrate the need for an ample evidence base and sustained engagement of government and stakeholder groups.
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References
Abdul-hadi, R. A., Abass, M. M., Aiyenigba, B. O., Oseni, L. O., Odafe, S., Chabikuli, O. N., et al. (2013). The effectiveness of community based distribution of injectable contraceptives using community health extension workers in Gombe State, Northern Nigeria. African Journal of Reproductive Health, 17(2), 80–88 Retrieved from https://www.ajrh.info/index.php/ajrh/article/view/273.
Ahmed, S., Li, Q., Liu, L., & Tsui, A. O. (2012). Maternal deaths averted by contraceptive use: an analysis of 172 countries. Lancet, 380(9837), 111–125. https://doi.org/10.1016/s0140-6736(12)60478-4.
Belohlav, K., & Karra, M. (2013). Household decision-making and contraceptive use in Zambia. Washington: Population Reference Bureau Retrieved from http://www.prb.org/Publications/Reports/2013/poppov-household-decisionmaking-zambia.aspx.
Central Statistical Office (Zambia), Ministry of Health (Zambia), & ICF International. (2014). Zambia demographic and health survey 2013–14. Rockville: DHS Program, ICF International Retrieved from https://www.dhsprogram.com/pubs/pdf/FR304/FR304.pdf.
Chanda, D. M. M. (2016). CBDS to offer Depo-Provera. Times of Zambia. Retrieved from http://www.times.co.zm/?p=91035.
Chin-Quee, D., Bratt, J., Malkin, M., Nduna, M. M., Otterness, C., Jumbe, L., & Mbewe, R. K. (2013). Building on safety, feasibility, and acceptability: the impact and cost of community health worker provision of injectable contraception. Global Health: Science and Practice, 1(3), 316–327. https://doi.org/10.9745/GHSP-D-13-00025.
Curry, L., Taylor, L., Pallas, S. W., Cherlin, E., Pérez-Escamilla, R., & Bradley, E. H. (2013). Scaling up depot medroxyprogesterone acetate (DMPA): a systematic literature review illustrating the AIDED model. Reproductive Health, 10(1), 39.
FHI 360. (2008). Promoting community-based distribution /community reproductive health worker provision of DMPA: educational visit to Uganda—summary report. Retrieved from http://pdf.usaid.gov/pdf_docs/Pdacl827.pdf
FHI 360. (2018). Status of CBA2I in Africa [Map]. Retrieved from https://www.k4health.org/sites/default/files/cba2i_africa_2017_20march2017_0.pdf.
Government of Zambia. (2018). Family planning 2020 commitment. Retrieved from http://www.familyplanning2020.org/zambia.
Hoke, T., Brunie, A., Krueger, K., Dreisbach, C., Akol, A., Rabenja, N. L., et al. (2012a). Community-based distribution of injectable contraceptives: introduction strategies in four sub-Saharan African countries. International Perspectives on Sexual and Reproductive Health, 38(4), 214–219. https://doi.org/10.1363/3821412.
Hoke, T. H., Wheeler, S. B., Lynd, K., Green, M. S., Razafindravony, B. H., Rasamihajamanana, E., & Blumenthal, P. D. (2012b). Community-based provision of injectable contraceptives in Madagascar: ‘task shifting’ to expand access to injectable contraceptives. Health Policy and Planning, 27(1), 52–59. https://doi.org/10.1093/heapol/czr003.
Jacinto, A., Mobaracaly, M. R., Ustáb, M. B., Bique, C., Blazer, C., Weidert, K., & Prata, N. (2016). Safety and acceptability of community-based distribution of injectable contraceptives: a pilot project in Mozambique. Global Health: Science and Practice, 4(3), 410–421. https://doi.org/10.9745/GHSP-D-16-00133.
Krueger, K., Akol, A., Wamala, P., & Brunie, A. (2011). Scaling up community provision of injectables through the public sector in Uganda. Studies in Family Planning, 42(2), 117–124.
MacQueen, K. M., Harlan, S. V., Slevin, K. W., Hannah, S., Bass, E., & Moffett, J. (2012). The stakeholder engagement toolkit for HIV prevention trials. Durham: FHI 360.
Malarcher, S., Meirik, O., Lebetkin, E., Shah, I., Spieler, J., & Stanback, J. (2011). Provision of DMPA by community health workers: what the evidence shows. Contraception, 83(6), 495–503. https://doi.org/10.1016/j.contraception.2010.08.013.
Ministry of Community Development Maternal and Child Health (Zambia). (2013). Family planning services: Integrated Family Planning Scale-up Plan 2013–2020. Lusaka, Zambia: Author. Retrieved from http://www.familyplanning2020.org/resources/4185.
PATH (n.d.). Map your advocacy impact strategy. Retrieved from http://www.path.org/publications/files/APP_10-part_info.pdf.
Petta, C. A., Faúndes, A., Dunson, T. R., Ramos, M., DeLucio, M., Faúndes, D., & Bahamondes, L. (1998). Timing of onset of contraceptive effectiveness in Depo-Provera users. II. Effects on ovarian function. Fertility and Sterility, 70(5), 817–820. https://doi.org/10.1016/S0015-0282(98)00309-4.
Prata, N., Gessessew, A., Cartwright, A., & Fraser, A. (2011). Provision of injectable contraceptives in Ethiopia through community-based reproductive health agents. Bulletin of the World Health Organization, 89(8), 556–564. https://doi.org/10.2471/BLT.11.086710.
Prata, N., Vahidnia, F., Potts, M., & Dries-Daffner, I. (2005). Revisiting community-based distribution programs: are they still needed? Contraception, 72(6), 402–407. https://doi.org/10.1016/j.contraception.2005.06.059.
Singh, S., Darroch, J. E., Ashford, L. S., & Vlassoff, M. (2009). Adding it up: the costs and benefits of investing in family planning and maternal and new born health. New York: Guttmacher Institute and United Nations Population Fund Retrieved from https://www.guttmacher.org/report/adding-it-costs-and-benefits-investing-family-planning-and-maternal-and-newborn-health.
Solo, J., Luhanga, M., & Wohlfahrt, D. (2005). Zambia case study: ready for change. New York: The ACQUIRE Project/EngenderHealth Retrieved from http://www.acquireproject.org/archive/files/3.0_program_effectively/3.2_resources/3.2.2_studies/zambia_case_study.pdf.
Stanback, J., Mbonye, A., & Bekiita, M. (2007). Contraceptive injections by community health workers in Uganda: a nonrandomized community trial. Bulletin of the World Health Organization, 85(10), 768–773. https://doi.org/10.2471/blt.07.040162.
Stanback, J., Spieler, J., Shah, I., Finger, W. R., & Expanding Access to Injectable Contraceptives Technical Consultation Participants. (2010). Community-based health workers can safely and effectively administer injectable contraceptives: conclusions from a technical consultation. Contraception, 81(3), 181–184. https://doi.org/10.1016/j.contraception.2009.10.006.
United Nations, Department of Economic and Social Affairs, Population Division. (2015). Trends in contraceptive use worldwide 2015 (UN Publication ST/ESA/SER.A/349). Retrived from http://www.un.org/en/development/desa/population/publications/pdf/family/trendsContraceptiveUse2015Report.pdf.
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Gichane, M.W., Mutesa, M. & Chowa, G. Translating Evidence into Policy Change: Advocacy for Community-Based Distribution of Injectable Contraceptives in Zambia. Glob Soc Welf 6, 41–47 (2019). https://doi.org/10.1007/s40609-018-0115-y
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DOI: https://doi.org/10.1007/s40609-018-0115-y