1. INTRODUCTION OF DMPA-SC THROUGH USE OF COMMUNITY BASED DISTRIBUTORS IN ZAMBIA
Authors: John Phiri2; Gina Smith1,2; Felix Tembo2; Gertrude Silungwe 2; Doris Ngosa Mwape 2; George Kateteye2; Loyce Muthali3; Namuunda Mutombo2; and Namwinga Chintu1, 2
Affiliations: 1Population Services International; 2Society for Family Health-Zambia; 3USAID
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-vs. 5,284 DMPA IM (Feb-April 2017).
Similar pilot in other countries showed that each provider administered 3 doses/month.
Abstract ID:1605
1. BACKGROUND
FIG 1- FAMILY PLANNING PROVIDED BY CBD’S (N = 12,818)
DMPA-SC
16%
Pill 9%
DMPA-IM
32%
Male Condom
37%
Female Condom
Zambia has a relatively low modern contraceptive prevalence rate (mCPR) and high unmet need for family planning, reported at 48% and 32% respectively[1]. In response to this, Society for Family Health (SFH) launched the Sexual and Reproductive Health for All Initiative (SARAI) in 2015, a five-year USAID-funded project that aims to increase the mCPR by 2% annually through increased access to quality voluntary family planning and reproductive health services.  The project has a robust community-based network for family planning service provision and was thus selected to initiate the roll-out of DMPA-SC in 2017 in collaboration with the Government of the Republic of Zambia.   
34%
66%
DMPA-SC
DMPA-IM
FIG 2- DMPA-SC AS A PROPORTION ALL INJECTABLES PROVIDED
(N = 6,190)
2. PROGRAM
To assess the feasibility of introduction of pre-filled injectable DMPA-SC by the Community Based Distributors (CBDs) in community.
To evaluate acceptability of the new method by the community.
To share lessons learnt to inform national scale up.
Revisit
97%
New DMPA SC Acceptors 3%
FIG 3- CLIENT TYPE (N = 2,100)
FIG 4- PROPORTION OF CLIENTS SWITCHING TO DMPA-SC
80%
20%
From other methods to DMPA–SC
From DMPA IM to DMPA–SC
3. METHODS
Three-month pilot (May-July 2017) study across 29 public health facilities in Kalulushi, Mafinga and Kawambe districts.
161 CBDs received 3-day training in DMPA SC in April 2017; 59% Male, 77% > age 35 years, 87% attained secondary education.
Supervisors trained included facility in-charges, pharmacists & MCH coordinators.
Waste management integrated into training
Proficiency required at least 5 DMPA-SC injections under qualified clinical supervision prior to providing service using checklist
Each CBDs given 10 doses of DMPA SC post-training based on 3-months prior average of DMPA-IM stock and each facility given 30 units buffer stock.
All CBDs supplied with stock tracking forms and lockable wooden boxes for storing commodities.
All CBDs were previously trained in DMPA-IM and other FP methods
National DMPA-SC safety committee established
FIG 5-DMPA-SC Clients by Age Distribution (N = 2,100)
11%
32%
53% 4%
668
231 91
15-19 Yrs
20-24 Yrs
25-49 Yrs
Above 49 Yrs
110
5. CONCLUSION
This study represents an important contribution to the literature on task-shifting and scale up of cost-effective voluntary FP innovations, particularly in low resource settings. The pilot demonstrated:
CBDs can safely provide DMPA-SC at the community level with appropriate public sector coordination and oversight.
Community-level distribution of DMPA-SC has the potential to improve access to voluntary family planning among adolescents and young women
Adequate human resources at each health facility are needed to provide optimal quality supportive supervision.
Availability of a buffer stock at the district and facility is useful to reducing stock-outs.
Well defined training curriculum and supervision systems are key to the successful scale up of DMPA SC into the existing FP distribution methods at community level.
4. RESULTS
12,818 voluntary family planning methods provided during pilot.
6,190 injectables (DMPA IM & SC) were provided (48.2%).
2,100 DMPA-SC doses administered (May-July) with DMPA-SC accounting for 34% of the total injectables administered.
Each CBD gave an average of 5 DMPA-SC doses per month.
On average, female CBDs gave 18 DMPA-SC doses vs. 11 doses administered by male CBDs.
Zero (0) Adverse Events reported during pilot
[1] Zambia Demographic Health Survey 2013/14
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