Key Points
- The CBD of DMPA appears to be as safe as provision by clinic-based providers.
- Women who receive DMPA from CBD workers are as satisfied as women who receive DMPA at a clinic.
- Fears that paramedical personnel cannot safely provide DMPA are unfounded.
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The results of an intervention study of the community-based distribution (CBD) of depot-medroxyprogesterone acetate (DMPA) in Uganda confirm that well-trained community health workers can safely provide injectable contraceptives.
Conducted by FHI and Save the Children USA in 2004 and 2005, the study assessed the safety, quality, and feasibility of CBD of DMPA by comparing the clients of CBD workers with those of clinic-based providers in Uganda's Nakasongola District.
A rural district, Nakasongola had a contraceptive prevalence rate of 3 to 4 percent in 2000, compared to the national average of 17 percent. Since the late 1990s, almost 100 CBD workers have been providing free family planning services, including condoms and oral contraceptives, to the women of the district.
The study involved 449 clients of CBD workers and 328 clients from local clinics. Differences between the women in the two groups suggest that the CBD workers recruited clients who had limited access to clinics or were not typical clinic users.
Read or download the full study report here.
The Intervention …
- CBD workers received a week of intensive classroom training before participating in a two-week clinic practicum including supervised client screenings and DMPA injections.
- To ensure safety, CBD workers used only nonreusable syringes. They were given special containers for disposal of used injection equipment and were trained in the proper use and disposal of these "sharps" containers.
- Save the Children staff continued to supervise all CBD workers, who also maintained regular contact with staff from nearby health centers.
... And its Effects on Family Planning Services
- Contraceptive prevalence in Nakasongola increased by about five percentage points after the CBD of DMPA was introduced.
- DMPA clients of CBD workers were as satisfied with their choice of method and the quality of care they received as were clinic-based clients.
- The study had difficulty recruiting clinic-based clients, suggesting that many women prefer the CBD of DMPA to clinic-based provision.
- Women receiving DMPA from CBD workers continued using the method just as long as their clinic-going counterparts did.
- Clients in both groups reported few problems resulting from the DMPA injections and no accidental needle sticks.
- Based on the results of the study, Ugandan health officials decided to continue the CBD of DMPA in Nakasongola and expand it to two other districts.
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Photo credit: John Stanback/FHI |
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A CBD worker uses a tomato to practice her injection technique at a training session in Uganda's Nakasongola District. | |
