Building on Safety, Feasibility and Acceptability of Community-Based Distribution of DMPA and Implications for Youth, Jessica Izquierdo - Community Based Services Panel

Family Planning Integration and Depo-Provera Projects

• To assess safety, acceptability, feasibility, costs and CYP of DMPA

• To review national scale-up strategies

• To highlight key stakeholders and advocacy for policy change

Family Planning Integration Project

• FP users increased from 25% at baseline to 68% • Community knowledge of available FP methods rose 92%-97%• Spousal communication about FP increased from 31% to 66%• Birth spacing rose from 29% to 48%

Family Planning Integration Project (FPIP) began June 2006

FPIP II began in April of 2010, expanding upon Phase I

DMPA pilot study introduced in 2009 in collaboration with FHI360

Introduction of DMPA

• Safety of CBD agents’ provision of DMPA injections

• Acceptability and client satisfaction

• Changes in workload with CBD agent delivery of DMPA

• Impact of adding DMPA provision by CBD agents

• Incremental cost per couple-years of protection (CYP)

With approval from the GoZ and in collaboration with FHI 360

• Theory- and practice-based training

• Checklists to determine medical eligibility

• Links with health clinics• On-the-job training and

mentorship• Waste management,

procurement, reporting

Community-based Distributors of DMPA

1 2

Client reported problem at injection site

No: 98%Yes: 2%

Acceptability and Client Satisfaction• 94 percent of CBD clients (February and April 2010)

received a second DMPA injection • 93 percent wanted to get another DMPA injection • 98 percent were satisfied with the way CBD agent gave

them their injection • 98 percent would recommend receiving a DMPA injection

from their CBD agent to a friend

Feasibility and Costs

• More than 50% of DHOs reported a decrease in DMPA and FP clients at clinics

• About 35% of the women reported their first DMPA injection as their first use of a FP method

• Client Continuation rates for Injectables 63%• Cost per CYP for combined FP methodology of pills and

DMPA ranged from about US$11-$61

Advancing the Road Map for National Scale-up Plan

Key Stops on the Road to Success• Zambian Ministry of Health• Ministry of Community

Development, Mother & Child Health

• Family Planning Technical Working Group

Study Tour to Sustain Momentum• Worked to orient new leadership to the project• Improved country-level ownership • Provided regional learning for professional bodies, donors, implementers and ministries • Motivated plans for moving ahead with CHW-provision of DMPA in Zambia

Thank You!