PROGRESS Newsletter #10

This issue of Works in PROGRESS focuses entirely on PROGRESS activities related to community-based family planning. Recent activities are summarized below, and a comprehensive view of PROGRESS activities in this area (2008–2013) is available here. In addition, a two-page summary of PROGRESS activities and their impact on community-based access to injectable contraceptives (CBA2I) is available here (PDF, 1.2 MB).

Research Shows Acceptability of Sayana Press in Senegal and Uganda

Sayana Press, a subcutaneous formulation of DMPA in the Uniject injection system.

Pilot research in Senegal and Uganda has found that community health workers, clinic-based providers and clients using injectable contraception preferred subcutaneous delivery of injectable contraceptives with the Uniject™ device over traditional intramuscular delivery. The new subcutaneous product, called Sayana® Press, delivers depot-medroxyprogesterone acetate (DMPA) in the prefilled Uniject injection device; this product had originally been called depo-subQ provera 104™ in Uniject. The research, summarized here (PDF, 665 KB), also found that trained community health workers could safely administer Sayana Press.

Costed Plan Developed after Policy Change in Nigeria's Gombe State

	Community health workers who participated in the pilot project that triggered the policy change and the costed implementation plan for Nigeria's Gombe State.

The Gombe State Ministry of Health in Nigeria has developed a costed framework for expanding family planning services for 2013–2018, following a national policy change to allow community-based provision of injectable contraceptives. The policy change followed a study in Gombe State supported by FHI 360, which found that community health extension workers safely and effectively administered injectables with minimal supervision. The new costed framework, which was developed with PROGRESS support, will both expand the focus on community services and strengthen clinical services. The framework is available here (PDF, 1.8 MB).

Research Addresses Workloads and Incentives for Community Health Workers

PROGRESS has released findings of two studies that address key challenges for volunteer community health workers. In collaboration with the Rwanda Ministry of Health, researchers found that adding re-supply of oral contraceptive pills and DMPA to standard condom, counseling and referral services did not affect the workers' perceptions of workload. In Uganda, PROGRESS conducted a study to understand the factors associated with retention and performance of volunteer community health workers in three programs spanning seven districts. Community health workers identified transport as a discouraging factor and the main challenge for performing their responsibilities. Summaries of both studies will be available soon on this page.

West Africa Meeting Prompts Action in Benin

In March 2013, health officials from nine countries attended the Francophone West Africa Community-Based Family Planning Partners' Meeting in Senegal. This landmark meeting was held to advocate and build capacity for the introduction of community-based family planning, including CBA2I, as a global standard of practice in the Ouagadougou Partnership countries. The Senegal Ministry of Health and Social Action’s Division of Reproductive Health and Child Survival hosted the meeting in collaboration with World Learning Grants Solicitation and Management (GSM) and PROGRESS. As a result of the meeting, advocacy efforts by the Benin Ministry of Health are paving the way for a CBA2I demonstration project in Benin, as described in this brief (PDF, 199 KB). The USAID-funded Advancing Partners and Communities project supported the Benin delegation attending the Senegal meeting.

Site visit during the meeting in Senegal, where officials from Benin saw how a community health worker tracks follow-up visits with community-based family planning clients.

 Number 10 • July 2013

PROGRESS Expands Scope of Community-Based Family Planning Approaches

PROGRESS has focused on two additional technical areas that include a strong component of community-based family planning: family planning within drug shops and the integration of family planning with non-health sectors. Drug shops in the private sector sell and in some cases provide contraceptives to underserved populations. Non-health development agencies reach underserved groups with empowering activities into which family planning can be integrated.

Zambia First Lady Supports Scale-up of Community-Based Access to Injectables

At the Women Deliver conference in May 2013, the First Lady of Zambia, Her Excellency Dr. Christine Kaseba-Sata, called for scaling up CBA2I. “Zambia is struggling to cope with the human resource crisis,” she said during a plenary speech. “We have done a pilot study looking at community workers providing injectable contraceptives and the results were very promising,” she added, referring to the PROGRESS-led study. “We had to really make sure that we move from the pilot to scale-up, and we’ve made commitments to do this.”

International Agencies Incorporate Community-Based Access to Injectables as Standard of Practice

PROGRESS has provided materials and technical assistance to the International Planned Parenthood Federation (IPPF), Marie Stopes International, the International Rescue Committee, the International Federation of Gynecology and Obstetrics (FIGO) and other groups to help them institutionalize CBA2I into their overall guidance to members and affiliates. For example, IPPF formally encouraged their 173 member associations to include CBA2I in their outreach and community-based activities and work plans, with links to the CBA2I Toolkit (see below).

Uganda Meeting Highlights Leadership in Community-Based Family Planning

At the March 2013 end-of-project meeting for PROGRESS in Uganda, speakers discussed the growth in access to contraception at the community level, including an emphasis on injectables as the most popular contraceptive choice among women. A summary of PROGRESS work on community-based family planning in Uganda is available here (PDF, 173 KB), with more information on all PROGRESS activities in Uganda available here.

PROGRESS Supports Toolkit on Community-Based Access to Injectables

With PROGRESS support, FHI 360 and Knowledge for Health (K4Health) developed the CBA2I Toolkit, which was launched in July 2011 and is available here. The toolkit serves as a platform to strengthen the capacity of organizations to plan, implement, evaluate, promote and scale up community-based family planning programs and to advocate for changes to national policies and service-delivery guidelines. PROGRESS has continued to update the toolkit, which now contains approximately 150 resources available for downloading, with most of the resources available in both French and English. All of the resources can be used or adapted by partners for their specific country contexts.

PROGRESS (Program Research for Strengthening Services) is a five-year project awarded to FHI 360 by the U.S. Agency for International Development (USAID) in June 2008. The project seeks to improve access to family planning among underserved populations by providing global technical leadership and working in selected countries. PROGRESS currently works in 13 countries in sub-Saharan Africa and in India.