Abstract
Contraceptive implants offer promising opportunities for addressing the high and growing unmet need for modern contraceptives in sub-Saharan Africa. Marie Stopes International (MSI) offers implants as one of many family planning options. Between 2008 and 2012, MSI scaled up voluntary access to implants in 15 sub-Saharan African countries, from 80,041 implants in 2008 to 754,329 implants in 2012. This 9-fold increase amounted to more than 1.7 million implants delivered cumulatively over the 5-year period. High levels of client satisfaction were attained alongside service provision scale up by using existing MSI service delivery channels-mobile outreach, social franchising, and clinics-to implement strategies that broadened access for underserved clients and maintained service quality. Use of adaptive and context-specific service delivery models and attention to key operational components, including sufficient numbers of trained providers, strong supply chains, diverse financing mechanisms, and implant removal services, underpinned our service delivery efforts. Accounting for 70% of the implants delivered by MSI in 2012, mobile outreach services through dedicated MSI provider teams played a central role in scale-up efforts, fueled in part by the provision of free or heavily subsidized services. Social franchising also demonstrated promise for future program growth, along with MSI clinics. Continued high growth in implant provision between 2011 and 2012 in all sub-Saharan African countries indicates the region's capacity for further service delivery expansion. Meeting the expected rising demand for implants and ensuring long-term sustainable access to the method, as part of a comprehensive method mix, will require continued use of appropriate service delivery models, effective operations, and ongoing collaboration between the private, public, and nongovernmental sectors. MSI's experience can be instructive for future efforts to ensure contraceptive access and choice in sub-Saharan Africa, especially as the global health community works to achieve its Family Planning 2020 (FP2020) commitments to expand family planning access to 120 million new users.
Highlights
Global Health: Science and Practice 2014 | Volume 2 | Number 1 nearly 1 in 3 sub-Saharan African women have an unmet need for family planning, the highest proportion (31%) of any region in the world.[1]
When we consider that the number of women choosing family planning in the general population increased by 60% between 2006 and 2011 and that the proportion choosing implants expanded greatly, the role of Marie Stopes Uganda in reaching 76% of these users is significant.[8]
Developed by Marie Stopes International (MSI), this indicator measures a program’s ability to deliver services to those facing the highest barriers to access, such as the poor, young women, those who have not previously been using family planning, and users of short-acting methods who seek services at MSI to meet their desire for a long-acting and permanent methods (LAPMs)
Summary
Scaling up delivery of contraceptive implants in sub-Saharan Africa: operational experiences of Marie Stopes International. Susan Duvall,a Sarah Thurston,b Michelle Weinberger,c Olivia Nuccio,d Nomi Fuchs-Montgomeryc. Between 2008 and 2012, Marie Stopes International (MSI) provided 1.7 million contraceptive implants in sub-Saharan Africa as part of a comprehensive method mix, primarily through mobile outreach using dedicated MSI providers and through social franchising and MSI-run clinics. Large-scale access, quality, and informed choice were key elements of MSI’s strategy
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