1. Task-shifting for DMPA-SC: Lessons for advocates from training, policy guidance, and service delivery
Roy Jacobstein, MD, MPH
Senior Medical Advisor
IntraHealth International
Next Generation of Injectables mtg
Dakar, Senegal
February 3, 2017

2. “We ask the village health worker to do everything but brain surgery.”
Task-shifting is a longstanding & effective practice for increasing FP access
“We ask the village health worker to do everything but brain surgery.”
—Health Economics Professor Carl Stevens,
on FP field trip to village in Bangladesh, 1986

3. Clients themselves (home care & self care)
The arc of task-shifting to more cadres to increase access to FP services
Ob-Gyns
Clients themselves (home care & self care)
Task-shifting
& task sharing

4. There is always resistance to task-shifting, but it can – and has been – overcome
Health systems are hierarchical and ‘conserve-ative’
Have well-established policies and routine practices
Very slow pace of change (example from U.S.: it took 13 years for 1/2 of all cardiologists to treat heart attacks the evidence-proven best way)
Need evidence that it can be done safely and skillfully (but that alone is not enough)
Need appropriate guidelines (does not automatically lead to changes in service policies & practices)
Need champions, at all levels, & repetition of effort (one-off interventions do not lead to changes in practice)
Need advocacy, with good messaging
“Change takes time”

5. Different terminology, different normative bodies, same practice, in health and FP programs
En 2009, une consultation technique de l’OMS a revu l’évidence et l’expérience des programmes, et a conclu: “L’administration à base communautaire des contraceptifs injectables aux progestatifs-seuls par des agents de santé convenablement formés à la tâche est sans danger, efficace et acceptable’’ pour les clients.

6. WHO task-sharing recommendations: By health worker cadre and FP methods

7. WHO Recommendations for workers with “limited clinical judgment”
DMPA and DMPA-SC are Category 1
Both Category 1 & Category 2 are “yes”/”oui” for frontline and community workers
Category 2 is sometimes mistakenly, erroneously implemented as “no”

8. How are we doing with implementation
How are we doing with implementation?: Examples from East Africa and West Africa
Burkina Faso
Kenya

9. Thank you
Merci
Asante sana
Jërëjef