1. Introduction of DMPA-SC injection through use of Community Based Distributors in Zambia
Gina Smith
November 2018, ICFP, Kigali, Rwanda

2. This presentation is made possible by the support of the American People through the United States Agency for International Development (USAID). The contents of this presentation are the sole responsibility of PSI/SFH Zambia and do not necessarily reflect the views of USAID or the United States Government.

3. Methodology Background Activity Objectives
To assess the feasibility of introduction of the pre-filled injectable through Community Based Distributors (CBDs)
To evaluate acceptability of the new method by the community
To share lessons learnt to inform national scale up
Pilot conducted May-July 2017 in 3 districts
161 CBDs from 29 public health facilities trained
All CBDs previously trained in DMPA-IM and other FP methods
Trained health facility staff as CBD Supervisors
To attain competency, each CBD administered 5 doses under supervision
Each facility was given buffer stock
All CBDs were given lockable wooden boxes for storing commodities
Activity Objectives
Zambia has a low modern contraceptive prevalence rate (mCPR) and high unmet need for family planning, reported at 48% and 32% respectively
The Sexual and Reproductive Health for All Initiative (SARAI) funded by USAID initiated first pilot in Zambia for DMPA-SC in 2017
SARAI has robust network for community-based voluntary family planning service provision

4. Results Family Planning Provided by CDBs (N=12,818)
Proportion of clients switching to DMPA-SC (N=2,037)
DMPA-SC Clients by Age distribution (N=2,100)
CBDs in Zambia gave more doses per month compared to similar pilots in other countries (Senegal, Niger and Uganda)
Uptake of injectable contraceptives (DMPA IM & SC) increased during pilot compared 3 months prior
Nearly half (43%) of the DMPA-SC clients were adolescents and young women < 25 years
Female CBDs gave more doses compared to male counterparts, but age and education level of CBD made no significant difference
Safety committee established and zero (0) AEs reported during pilot
Injectables (DMPA IM & SC) accounted for 48% of the all FP Methods provided by CBDs.
High switching behavior between IM and SC

5. Discussion
CBDs can safely provide DMPA-SC in Zambia, therefore strong evidence demonstrated to support national scale-up
One supervisor per facility is inadequate
Early adaptation of training manual and M&E system facilitates integration of DMPA-SC into existing FP method mix and fosters accurate reporting.
DMPA-SC using CBDs is a game changer with the potential to increase FP uptake for adolescents and young women bringing services closer to those in need.
In line with global commitments such as FP2020.
….To hear more come visit our poster abstract #1605!

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