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

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.

Apporter la planification familiale au niveau des communautes
March 2019 | Infographic

La Republique du Benin est confrontee a des taux eleves de mortalite maternelle, neonatale et infantile et a un foible taux d'utilisation de la contraception moderne. En 2013, le gouvernement du Benin s'est engage a ameliorer la sante reproductive et a elargir l'acces aux services.

Bringing Family Planning to the Community in Benin
March 2019 | Infographic

APC is working in Benin to bring family planning to the community through the introduction of the easy-to-use injectable contraceptive, DMPA-SC (Sayana Press). Download the infographic to learn more about the results of the introduction.

Strengthening Community-based Family Planning Systems through Collaborative Improvement in Busia District, Uganda
April 2017 | Brief

In this second issue of the APC Quality Improvement Brief, APC describes the progress to date in systematic efforts to improve the quality of CBFP in Busia District and plans to scale up these efforts in two other districts in Uganda.

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.

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.

CHW Central - A Global Resource For Community Health Workers
April 2016 | Website

CHW Central, launched in 2011, is an online community of practice managed by Initiatives Inc. that provides a forum for online discussions and exchanges with public health professionals and program managers, policy makers and CHWs in the U.S. and across the globe.

Applying a Quality Improvement Model to Strengthen Community-based Family Planning Services in Busia District, Uganda
April 2016 | Brief

In February 2015 APC, implemented by FHI 360 in Uganda, conducted a collaborative site assessment for CBFP programs with the MOH in the three pilot sites, Bulumbi, Buhehe and Buteba. The assessment identified areas for service delivery improvement, which were quantified by the QI monitoring that started in June 2015.

Projet pilote de l’accès à base communautaire des contraceptifs injectables au Bénin
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.

Pages

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.

ChildFund International is a Christian organization that sponsors children in need largely through monthly donations from individual sponsors. These donations are used to support the transition from extreme poverty for these children and their communities. In addition to their sponsorship program, ChildFund receives grants and donations to provide trainings and capacity building activities, health and education programs, emergency relief, and food distribution.

PATH is the leader in global health innovation. An international nonprofit organization, we save lives and improve health, especially among women and children. We accelerate innovation across five platforms—vaccines, drugs, diagnostics, devices, and system and service innovations—that harness our entrepreneurial insight, scientific and public health expertise, and passion for health equity. By mobilizing partners around the world, we take innovation to scale, working alongside countries primarily in Africa and Asia to tackle their greatest health needs.

Save the Children Federation, Inc. invests in children’s education, health, and protection from harm. The non-governmental organization works globally to advocate for children’s rights in order to provide economic stability, better health, and emergency aid in times of crisis.

The International Rescue Committee (IRC) provides care to Vietnamese, Cambodian, and Laotian refugees. Through the provision of essentials like food and water, medical care, and sanitation, the IRC assists approximately 140,000 Myanmar refugees as well. The organization also provides protection, legal assistance, and resettlement processing for abused women and children.

WellShare International, founded in 1979, has a mission to advance sustainable community health around the world. WellShare applies a holistic approach that builds effective partnerships, engages community health workers to bridge the gap between communities and the formal health sector, rigorously evaluates outcomes, and promotes long-term sustainability. WellShare reaches its goal of healthy people through a focus on health education, transfer of simple technologies, and connecting people to timely and appropriate health resources.

June 10, 2019 | Blog

After nearly seven years in partnership with the Beninese government to strengthen community health systems and advance policies to support family planning, the APC project closing event on Thursday, May 23, was a time to showcase its successes and share challenges and lessons.

April 09, 2019 | Blog

APC grantee, WellShare International, is piloting an important contraception initiative in six sub-counties of Iganga and Bugweri Districts, Uganda. In July 2018, 70 village health team members and 12 health workers were trained to teach clients to self-inject subcutaneously administered depot medroxyprogesterone acetate (DMPA-SC).

March 12, 2018 | Announcement

Advancing Partners & Communities (APC) recently conducted research to show that self-injected contraceptives increase the continued use of contraception among women in low-resource settings, where the availability of high-quality contraceptives is limited. The full results of this research have now been published in The Lancet Global Health.

October 12, 2017 | Webinar

The Advancing Partners & Communities project, in collaboration with Family Planning 2020, the Implementing Best Practices initiative and USAID’s Office of Population and Reproductive Health, hosted the first webinar in a webinar series designed to share information about various family planning methods on Thursday, October 12th, 2017. View the webinar recording and presentations.

June 02, 2017 | Blog

Jackqueline Bwire Nabwire, a community health worker trained by APC Uganda, works to bring family planning to women in her village.

March 24, 2017 | Blog

Translating research into policy and practice was key to the acceptance of CBA2I in Africa.

February 16, 2016 | Blog

Thanks to years of impassioned, and data-driven advocacy, the government of Zambia has given authority to scale up community-based distribution (CBD) of injectables to the rest of the country. APC provided the sub-grant to ChildFund Zambia, who contributed to implementing the pilot study, and provided technical assistance for the implementation of Community Based Access to Injectables (CBA2I) activities, including planning the scale-up through a community-based family planning learning site model.

April 14, 2015 | Event

Read more about two upcoming events in April and May from APC on Sayana® Press and emergency contraception.

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.

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.

Check back again for related photo galleries or videos.

WellShare International is integrating DMPA SC self-injection in six sub-counties of Iganga and Bugweri Districts, Uganda in the context of a full and informed choice family planning program. Community Health Workers, known as Village Health Team (VHT) members in Uganda, and health workersoffered injectable contraceptives within youth-friendly community-based family planning services.

Paul Mulawa is a 38-year-old Family Planning (FP) Champion and Village Health Team (VHT) member in the Iganga District, Ibalanku subcounty of Uganda. Elected by the community, Mulawa l’s VHT works within their community to promote FP, encourage individuals to immunize their children, and discuss hygiene in their homes.

Photo of Edward Basalirwa inspecting a patient's shoulder.

Edward Basalirwa is a 40-year-old Village Health Team (VHT) member and farmer from the Iganga District of Uganda. Edward was prompted to form a VHT Association in the Nsale Parish to improve the community’s well-being, and the VHT was elected in the community by the LC1 chairman, or village leader.

Photo of two women and a man meeting indoors

To respond to the unmet need for family planning (FP) in Uganda, the Salvation Army Integrating Family Planning (SAIFaP) Project organized mobile outreach activities in hard to reach areas.

Health Workers

WellShare International trained 257 village health team members in Uganda to provide adolescents with adolescent sexual and reproductive health counseling and family planning services.