Trained community-based distributors successfully provide injectable contraceptives, Madagascar.
Article Type: Brief article
Subject: Contraceptive drugs, Injectable (Distribution)
Community health aides (Practice)
Pub Date: 05/01/2012
Publication: Name: Reproductive Health Matters Publisher: Elsevier Science Publishers Audience: General Format: Magazine/Journal Subject: Family and marriage; Health; Women's issues/gender studies Copyright: COPYRIGHT 2012 Reproductive Health Matters ISSN: 0968-8080
Issue: Date: May, 2012 Source Volume: 20 Source Issue: 39
Topic: Event Code: 690 Goods & services distribution; 200 Management dynamics Advertising Code: 59 Channels of Distribution Computer Subject: Company distribution practices
Product: Product Code: 2834128 Injectable Contraceptives NAICS Code: 325412 Pharmaceutical Preparation Manufacturing SIC Code: 2834 Pharmaceutical preparations
Geographic: Geographic Scope: Madagascar Geographic Name: Madagascar Geographic Code: 6MADA Madagascar
Accession Number: 296571596
Full Text: Madagascar's Ministry of Health and Family Planning sought evidence regarding the safety, effectiveness and acceptability of community-based distribution (CBD) of injectable contraceptives. 62 experienced CBD agents from 13 very poor communities with low service provision and low contraceptive usage were trained in provision of injectables in 2006. Management mechanisms for injectables were added to the existing CBD systems for record keeping, commodity management and supervision. After seven months of service provision, service records were reviewed and CBD workers and their supervisors and service users were interviewed. CBD workers demonstrated competence in injection technique, counselling and management of re-injection schedules, with nearly half the agents scoring the maximum possible points. Community-based distribution of injectables appeared to increase contraceptive use, with 1,662 women accepting injectables from a CBD worker. Of these, 41% were new family planning users. Ali CBD agents wished to continue providing this service, and most supervisors indicated the programme should continue. Nearly all women interviewed intended to return to the CBD worker for re-injection and would recommend this service to a friend. Two gaps needing improvement were counselling on possible side effects and use of a checklist to rule out pregnancy for non-menstruating women, which called for enhanced training and supervision. This intervention shows the feasibility, effectiveness and acceptability of CBD services for injectable contraceptives. It is an example of effective task shifting as a means of extending services to underserved populations. (1)

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(1.) Hoke T, Wheeler SB, Lynd K, et al. Community-based provision of injectable contraceptives in Madagascar: 'task shifting' to expand access to injectable contraceptives. Health Policy and Planning 2011;1-8. Doi:10.1093/ heapol/cz003.

Doi: 10.1016/S0968-8080(12)39628-6
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