Translating Evidence into Policy Change: Advocacy for Community-Based Distribution of Injectable Contraceptives in Zambia

Abstract

Community-based distribution (CBD) of injectable contraceptives has increased access to family planning for millions of women in rural areas in resource-limited settings. Despite the evidence of the success of this contraceptive delivery method, many nations have yet to integrate CBD into their family planning policies. The aim of this paper to describe the process through which PATH spearheaded efforts to successfully advocate for policy change to authorize non-clinical personnel in Zambia to provide injectable contraceptives. We describe a four-part framework for policy advocacy: (a) evidence building and technical assistance, (b) stakeholder engagement, (c) government engagement, and (d) knowledge dissemination. Advocacy for policy change to allow CBD of injectable contraceptives was long and iterative. Evidence to support advocacy efforts was built through a Zambian delegates’ study tour to Rwanda to witness Rwanda’s robust CBD program and a rapid assessment of Zambian pilot sites where non-clinical personnel were administering injectable contraceptives. Advocacy was led by PATH in partnership with key stakeholders from the Zambia Family Planning Technical Working Group (FPWTG), key government officials, and a special task force of stakeholders focused on advocating for CBD of injectable contraceptives. This task force used evidence from the study tour and rapid site assessment in national and international forums to demonstrate the beneficial effects of allowing non-clinical personnel to administer injectable contraceptives. The Zambian government authorized the policy change in 2016. The policy advocacy efforts of PATH, FPWTG, and the special task force demonstrate the need for an ample evidence base and sustained engagement of government and stakeholder groups.