Community-Based Access to Injectables (CBA2I)

Multiple countries are employing community-based access to injectable contraceptives (CBA2I) strategies to help achieve their Family Planning 2020 goals since CBA2I has the potential to dramatically expand access to and use of modern contraceptive methods.Three of the most common CBA2I strategies include training community health workers (CHWs) to administer injectable contraceptives, expanding access to injectable contraception through drug shops, and providing mobile services in areas where other services are limited or do not exist. Advancing Partners & Communities (APC) is supporting expansion of CBA2I services as part of a larger commitment to broadening the family planning method mix at the community level.

Below you will find links to resources created by APC and other organizations.

APC Resources

Benin’s Community-Based Access to Injectable Contraceptives Pilot Project
May 2015 | Brief

This brief outlines the background, objectives, implementation steps & timeline, overview, and indicators of APC Benin’s community-based access to injectable contraceptives pilot project. 

Advancing Partners & Communities: Sayana® Press Evaluation
January 2015 | Brief

This brief outlines the details of a study requested by the Malawi Ministry of Health and USAID/Malawi to assess home and self-injection of Sayana® Press in Malawi.

Sayana® Press: A Guide for Trainers of Providers
January 2015 | Training Guide

This trainer’s guide provides content for training on the progestin-only injectable contraceptive Sayana® Press. These materials were first used in 2012 to train facility- and community-based providers on use of Sayana Press (formerly depo-subQ in Uniject) in acceptability studies in Senegal and Uganda.

Community Health Worker Provision of Injectable Contraceptives: An Effective CBA2I Strategy
October 2014 | Brief

These resources are intended to be used by advocates, program managers, policymakers, donors, ministry of health staff, and other key stakeholders to craft a strategy for building support for CBA2I among key decision makers in country. Because community-based access to injectable contraceptives (CBA2I) has the potential to significantly expand access to and use of modern contraceptive methods, several countries are employing CBA2I strategies to help achieve their FP2020 goals.

Guidance for Integrating the Provision of Injectable Contraceptives by Community Health Workers into Family Planning/Sexual and Reproductive Health Policy
March 2014 | Brief

This brief provides guidance on writing policy to enable the provision of injectable contraceptives by non-clinical community health workers (CHWs) and is intended for use by policymakers and influencers who are interested in changing national policy to support the provision of injectable contraceptives by CHWs.

Provision of Injectable Contraceptives within Drug Shops: A Promising Approach for Increasing Access and Method Choice
October 2012 | Publication

This brief focuses on the use of drug shops to increase access to injectable contraceptives, a strategy that had previously not received sufficient attention in the literature.

External Resources

Family Planning Provision in Pharmacies and Drug Shops: an Urgent Prescription
April 2019 | Journal Article

Drug shops and pharmacies have long been recognized as the first point of contact for health care in developing countries, including family planning services. This article draws on lessons learned from the rich experience of earlier efforts to promote a variety of public health interventions in pharmacies and drug shops.

Key Facts from WHO on Family Planning and Contraception

Learn more from WHO about the benefits of family planning, who provides family planning & contraceptives, and the different contraceptive methods. 

Community-Based Access to Injectable Contraceptives (CBA2I): Select Resources
May 2018 | Guide

The following materials aim to help stakeholders effectively monitor and evaluate CBA2I, as well as advocate for buy-in and changing policy and programs, including piloting, implementing and scaling up programs.

Community Based Access to Injectable Contraceptives: Select Resources
April 2018 | Toolkit

The following materials aim to help stakeholders effectively monitor and evaluate the practice, as well as advocate for buy-in and changing policy and programs, including piloting, implementing and scaling up programs.

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Below are select resources related to key issues within CBA2I.

Drug Shops

Until recently, the practice of utilizing drug shops to increase access to injectable contraceptives had not received sufficient attention in the literature. This new APC brief discusses the promising strategy. The U.S. Agency for International Development (USAID) has also developed a high-impact practice brief on family planning provision through both drug shops and pharmacies.

Family Planning Provision in Pharmacies and Drug Shops: an Urgent Prescription
April 2019 | Journal Article

Drug shops and pharmacies have long been recognized as the first point of contact for health care in developing countries, including family planning services. This article draws on lessons learned from the rich experience of earlier efforts to promote a variety of public health interventions in pharmacies and drug shops.

Markets Matter Advocacy Guide: How advocates can strengthen markets to improve access to essential health products
October 2017 | Guide

As the latest addition to PATH’s Stronger Health Advocates Greater Health Impact series, this guide contains an overview of market actors and identifies policies and advocacy entry points for civil society.

Managing the policy advocacy process: Drug shops’ provision of injectable contraception in Uganda
March 2017 | Case Study

Private drug shops could offer an opportunity to expand access to family planning because they are commonplace in rural areas and support a sustainable commercial market for health products.

Delivery of Injectable Contraception by Drug Shop Operators in Uganda: Research and Recommendations
October 2016 | Brief

At the London Family Planning Summit in 2012, the Government of Uganda committed to providing universal access to family planning and reducing unmet need for family planning from the current 40 percent to 10 percent by 2022. To meet this ambitious goal, all potential means of increasing accessibility to family planning must be explored.

Sale and Provision of Injectable Contraceptives in Drug Shops in Developing Countries: Conclusions from a Technical Consultation
January 2015 | Journal Article

This journal article discusses conclusions from the technical consensus meeting on injectable contraceptives in drug shops in Ghana. A subscription is required to view the full text.

A better future for injectable contraception?
November 2014 | Journal Article

This article discusses the provision of injectables though drug shops and the potential advantages of subcutaneous administration of DMPA over the current intramuscular approach.

Provision of Injectable Contraceptives within Drug Shops: A Promising Approach for Increasing Access and Method Choice
October 2012 | Publication

This brief focuses on the use of drug shops to increase access to injectable contraceptives, a strategy that had previously not received sufficient attention in the literature.

Community Health Workers Provision of Injectables

CHW provision of injectables is an important issue that should be widely expanded:

Community Health Worker Provision of Injectable Contraception: An Implementation Handbook and Job Aids
July 2019 | Job Aid

Are you working on implementing CBA2I programs? Check out an implementation handbook developed by FHI 360, which is a step-by-step guide for introducing injectable contraceptives into an existing community-based distribution program. Along with three additional resources, a community health workers job aid booklet, a counseling tool, and a user guide that APC contributed to which are tools that can be adapted for country-specific needs.

Introduction of Community-Based Provision of Subcutaneous Depot Medroxyprogesterone Acetate (DMPA-SC) in Benin: Programmatic Results
June 2019 | Journal Article

Read the journal article in Global Health: Science and Practice journal by APC/Benin staff about community health workers and facility-based health care providers who were trained to administer DMPA-SC safely and effectively in 10 health zones.

Community-based Access to Injectables in sub-Saharan Africa
March 2017 | Policy

This map illustrates the status of the provision of injectable contraception by community health workers by country in sub-Saharan Africa.

Advancing Partners & Communities: Sayana® Press Evaluation
January 2015 | Brief

This brief outlines the details of a study requested by the Malawi Ministry of Health and USAID/Malawi to assess home and self-injection of Sayana® Press in Malawi.

Sayana® Press: A Guide for Trainers of Providers
January 2015 | Training Guide

This trainer’s guide provides content for training on the progestin-only injectable contraceptive Sayana® Press. These materials were first used in 2012 to train facility- and community-based providers on use of Sayana Press (formerly depo-subQ in Uniject) in acceptability studies in Senegal and Uganda.

Building on safety, feasibility, and acceptability: the impact and cost of community health worker provision of injectable contraception
October 2013 | Journal Article

The article affirms that the provision of injectable contraceptives by CHWs is safe, acceptable, and feasible in the Zambian context, with very high rates of uptake in hard-to-reach areas.

High Impact Practices in Family Planning List
July 2013 | Brief

Updated in July 2013, this seminal brief provides a list of all the HIPs identified by the Technical Advisory Group (TAG).

CHSS

How to Introduce and Scale Up Sayana Press (DMPA-SC in Uniject)
April 2017 | Guide

This publication provides practical guidance based on results, evidence, and learning from the pilot introductions of Sayana Press in four countries in Africa.

APC at the Global Health Mini-University 2015
January 26, 2015 | Event

The Global Health Mini-University (Mini-U) is an annual learning forum for professionals and students highlighting best practices and new innovations in global health. This year, the Mini-U will be held on Monday, March 2, 2015 at George Washington University's Cloyd Heck Marvin Center in Washington, DC.

New Contraceptive Shot Being Released in Africa
July 14, 2014 | Article

An easy-to-use form of the injectable contraceptive Depo-Provera was introduced in July 2014 in Burkina Faso, the first of four African countries in which it will be rolled out this year.

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