Task-shifting the provision of DMPA-SC in the DR Congo: Perspectives from two different groups of providers

Julie H Hernandez,Pierre Akilimali,Annie Glover,Rebecca Emel,Albert Mwembo,Jane Bertrand

doi:10.1016/j.contraception.2018.07.002

Julie H Hernandez, Pierre Akilimali + Show 4 more

Open Access

https://doi.org/10.1016/j.contraception.2018.07.002

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Abstract

ObjectivesTo document the experience of three groups of Family Planning service providers participating in task-shifting for the provision of subcutaneous depot-medroxyprogesterone acetate (DMPA-SC) at the community level in the DRC. Study designThis article compares results from interviews with DMPA-SC providers in two separate pilot studies: 1) 53 medical and nursing school students teaching women how to self-inject (2016–2017); and 2) 34 lay community health workers providing DMPA-SC in rural areas of Lualaba (2017). All providers gave information on socio-demographic characteristics, recruitment,) training, supervision, experience and satisfaction with the provision of DMPA-SC. The paper examines variations in responses from the different provider cadres. ResultsDespite substantive variations in provider profiles in terms of age, educational and marital status, reported levels of satisfaction with offering DMPA-SC in the community were consistently high. Over 90% of all providers declared being comfortable or very comfortable interacting with FP clients, and more than three quarters of them were very comfortable performing an injection. Over 90% of Lualaba providers and over 80% of student providers gave correct responses to DMPA-SC protocol questions regarding referral of clients to facilities and side-effects management. The vast majority declared being (very) satisfied with their experience providing DMPA-SC. ConclusionsProviders with and without a clinical background, when properly trained and supervised, can provide DMPA-SC at the community level in both urban and rural settings of the DRC. Support strategies from the Family Planning environment (continuous contraceptive supplies and adequate referral system to fixed facilities) are key to engaging community health workers and sustainably leveraging task-shifting opportunities. Implication statementThis study provides additional evidence on the acceptability and feasibility of task-shifting in relation to DMCP-SC and supports further scale-up efforts.

Highlights

In the Democratic Republic of Congo, the task-shifting of family planning (FP) services is not a new idea [1], but the commitment of the country to the FP2020 initiative since 2012 has boosted the interest for community-based provision of contraceptives as a way to decrease unmet need1 for FP
Following on efforts to compare acceptability of community-based DMPA-SC provision by different cadres of clinical and non-clinical personnel in Uganda and Senegal [7], the objective of this paper is to evaluate the experience of two different groups of providers, as they remain a key component for the success of any task-shifting program
The providers were recruited by faculty in large, governmentaccredited medical and nursing schools among students who had completed clinical modules on injection, volunteered to participate and successfully completed a 6 days training on providing the full range of contraceptives authorized for community-based provision, referring women to facilities for additional FP services and training interested clients to self-inject DMPA-SC

Summary

Objectives

To document the experience of three groups of Family Planning service providers participating in taskshifting for the provision of subcutaneous depot-medroxyprogesterone acetate (DMPA-SC) at the community level in the DRC. All providers gave information on socio-demographic characteristics, recruitment,) training, supervision, experience and satisfaction with the provision of DMPA-SC. Results: Despite substantive variations in provider profiles in terms of age, educational and marital status, reported levels of satisfaction with offering DMPA-SC in the community were consistently high. Over 90% of Lualaba providers and over 80% of student providers gave correct responses to DMPA-SC protocol questions regarding referral of clients to facilities and side-effects management. Support strategies from the Family Planning environment (continuous contraceptive supplies and adequate referral system to fixed facilities) are key to engaging community health workers and sustainably leveraging task-shifting opportunities. Implication statement: This study provides additional evidence on the acceptability and feasibility of task-shifting in relation to DMCP-SC and supports further scale-up efforts

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