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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Community-based provision of injectable contraceptives in Madagascar: 'Task shifting' to expand access to injectable contraceptives
Health Policy and Planning, Volume 27, No. 1, Year 2012
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Description
Introduction Injectable contraceptives are now the most popular contraceptive methods in sub-Saharan Africa. Injectables have not been an option for African women lacking convenient access to health facilities, however, since very few family planning programmes permit community-based distribution (CBD) of injectables by non-medically trained workers. Committed to reducing unmet contraceptive need among remote, rural populations, the Ministry of Health and Family Planning (MOHFP) of Madagascar sought evidence regarding the safety, effectiveness and acceptability of CBD of injectables.Methods The MOHFP joined implementing partners in training 61 experienced CBD agents from 13 communities in provision of injectables. Management mechanisms for injectables were added to the CBD programme's pre-existing systems for record keeping, commodity management and supervision. After 7 months of service provision, an evaluation team reviewed service records and interviewed CBD workers and their supervisors and clients.Results CBD workers demonstrated competence in injection technique, counselling and management of clients' re-injection schedule. CBD of injectables appeared to increase contraceptive use, with 1662 women accepting injectables from a CBD worker. Of these, 41 were new family planning users. All CBD agents wished to continue providing this service, and most supervisors indicated the programme should continue. Nearly all clients interviewed said they intended to return to the CBD worker for re-injection and would recommend this service to a friend.Conclusions This experience from Madagascar is among the first evidence from sub-Saharan Africa documenting the feasibility, effectiveness and acceptability of CBD services for injectable contraceptives. This evidence influenced national and global policy makers to recommend expansion of the practice. CBD of injectables is an example of effective task shifting of a clinical practice as a means of extending services to underserved populations without further burdening clinicians. © 2011 The Author; all rights reserved.
Authors & Co-Authors
Hoke, Theresa Hatzell
United States, Durham
Fhi 360
Wheeler, Stephanie B.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Lynd, Kelsey
United States, Palo Alto
Stanford University
Green, Mackenzie Kenzie S.
United States, Durham
Fhi 360
Razafindravony, Bakolisoa Harimalala
Madagascar, Antananarivo
Ministry of Health and Family Planning
Rasamihajamanana, Eugénie
Madagascar, Antananarivo
Ministry of Health and Family Planning
Blumenthal, Paul D.
United States, Palo Alto
Stanford University
Statistics
Citations: 86
Authors: 7
Affiliations: 4
Identifiers
Doi:
10.1093/heapol/czr003
e-ISSN:
14602237
Research Areas
Health System And Policy
Sexual And Reproductive Health
Study Locations
Madagascar
Participants Gender
Female