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Lasway Cb Dof Dmpa(Jan28 09)
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  • Hello everyone, my name is Christine Lasway, and I’m very pleased to be able to talk to you about FHI’s work in moving data to impact. I will be using the example of community-based distribution of injectable contraceptives to demonstrate that FHI’s work builds off of field experiences and data that has existed since the 1970s. I hope to demonstrate that moving evidence into practice requires not only supportive data but also a supportive process that requires local leadership and advocacy.

Lasway Cb Dof Dmpa(Jan28 09) Presentation Transcript

  • 1. Using Local Data to Move 30 years of Evidence into Practical Solutions: The Case of Community-based Distribution of Injectable Contraceptives in Africa Presented by Christine Lasway, FHI
  • 2. Outline
    • The Problem and the 30Yr Old Solution
    • Moving Evidence into Practical Solutions in Africa Settings
    • Programmatic/policy improvements
    • Challenges and Facilitating factors
    • Where we are now?
  • 3. The Data, The Problem Preferred Method for future use Unmet Need for FP Services
      • How to bridge the gap between high demand and high unmet need?
      • How do we get DMPA closer to more people who need it?
  • 4. The 30Yr Old Solution Community-based distribution of injectable contraceptives!
    • Existing Supportive Data
    • Bangladesh (1970s), Latin America (1990s), Nepal (2000s)
    • Attributes of innovation
    • Administration of the injection is carried out by a community member with limited (or no) clinical training
    • Provision is in the client’s home or close by
    • Applicability in the African Context
    • CBD of Family Planning already exists for Pills and Condoms
    • Clients’ Privacy is afforded by DMPA and with CBD
  • 5. Moving Evidence into Practice in African Settings
    • The Challenges:
    • Non-clinical health workers are not trained to give safe injections
    • Regulations restrict paramedicals from giving injections
    • Concern that CBDs will give “other kinds” of injections to earn income
  • 6. Moving Evidence into Practice in African Settings
    • The Process:
    • Utilized existing 30 yr data/information to garner interest of the intervention in Africa.
    • Generated local data to answer key questions:
      • Is it feasible for a non-clinical/CBD to safely and effectively administer DMPA?
      • Would access ( defined as increased use ) be improved?
    • Used local data to inform policy and programmatic change
    • Used local data to guide new research questions to strengthen evidence base
  • 7. 1. Utilized Existing Data to Garner Interest
    • Consulted with several MoHs on the intervention
    • Uganda selected as study site
      • Joint design of the research study and intervention with partners and MoH
      • Engaged those who opposed the innovation
      • Established a guiding body or national core team
      • Sensitized and engaged community members
  • 8. Study Area Characteristics
    • Nakasongola District
    • T FR > National Average
    • CPR is 3%-5%
    • Served by a sub-district hospital, 6 health centers, and 11 health posts
    • Over 50% of residents walk over 1 hour to a health clinic
  • 9. 2. Generating Local Data
    • Safety and Feasibility Study, Nakasongola, Uganda (2004-2005)
    • Study Design:
    • Post-intervention Comparison of new CBD and Health Clinic Clients on:
      • Continuation (2nd Injection at 6 months),
      • User Satisfaction
      • Knowledge
      • Incidence of injection-site morbidities
    • Intervention:
    • Training on Safe injection practices
    • Waste disposal practices
    • Enhanced Supervision
  • 10. Uganda - Key Study Findings No difference found between CBD and Clinic administration of DMPA 0.3% 0% 85% Clinic n=328 0% Infection/Abscess 0.7% Temporary Numbness 88% Continuation (2 nd Injection at 6 months) CBD n=449 Item Assessed
  • 11.
    • Tailored and targeted communication of results to a variety of audiences/venues.
    • Advocacy at global and country levels
    • Educational Tours/Field Visits
    • Created implementation guide with detailed steps for introducing the intervention in a program
    • Assessed scalability of the intervention
    • Conducted further research studies to strengthen local evidence base
    3. Using Data to Inform Policy & Programmatic Change
  • 12. Programmatic and Policy Improvements:
    • Uganda:
    • Scaled-up – new areas & groups
    • Sustained momentum & awareness
    • New funds secured in-country
    • Policy to come?
    • Madagascar:
    • Supportive policy change enacted
    • The Madagascar Study (2006-2007)
      • Results: the practice was acceptable, safe, and increased CPR
    • National scale up underway
  • 13. Programmatic / Policy Improvements:
    • Global:
    • Kenya identified & launching
    • Momentum in other countries
    • Strengthened Evidence-base
    TUNISIA MOROCCO SAHARA ALGERIA MAURITANIA MALI NIGER LIBYA CHAD EGYPT SUDAN ETHIOPIA DJIBOUTI ERITREA SOMALIA KENYA TANZANIA DEMOCRATIC CENTRAL RWANDA GABON EQUATORIAL ANGOLA CONGO NIGERIA BENIN DTVOIRE SIERRA SENEGA L GHANA THE GUINEA LIBERIA CAMEROON MALAWI ZAMBI A MOZAMBIQUE MADAGASCAR ZIMBABWE BOTSWANA SWAZILAND LESOTHO NAMIBIA ANGOLA WESTERN UGANDA OF THE CONGO REPUBLIC BURUNDI GUINEA REP. OF TOGO COTE BURKINA FASO GUINEA LEONE GAMBIA BISSAU SOUTH REPUBLIC AFRICAN THE AFRICA Implementing Policies changed Interested
  • 14. 4. New Research Questions – Same Goal, Different Approaches
    • Exploring feasibility of other non-clinical health workers to safely inject, e.g.: Drug shop dispensers
    • Self-Injection of DMPA
  • 15. Challenges:
    • Differing requirements for “sufficient” data amongst countries to facilitate changes in policy and practice
    • Gaining trust on the utility of the data
    • Requests for introductory trials in individual countries amid limited resources
    • Sustainability issues with CBD programs
  • 16. Factors that facilitated data use…
    • Sustained advocacy efforts.
    • Creation of implementation guide to facilitate adoption of innovation by other programs/organizations.
    • All levels understand utility of data and evidence-based decision making.
    • Consistent funding to support research utilization.
    • Understanding of the local decision-making process.
  • 17. With Local Data, Change is Happening in Africa 2004 TUNISIA MOROCCO SAHARA ALGERIA MAURITANIA MALI NIGER LIBYA CHAD EGYPT SUDAN ETHIOPIA DJIBOUTI ERITREA SOMALIA KENYA TANZANIA DEMOCRATIC CENTRAL RWANDA GABON EQUATORIAL ANGOLA CONGO NIGERIA BENIN DTVOIRE SIERRA SENEGA L GHANA THE GUINEA LIBERIA CAMEROON MALAWI ZAMBI A MOZAMBIQUE MADAGASCAR ZIMBABWE BOTSWANA SWAZILAND LESOTHO NAMIBIA ANGOLA WESTERN UGANDA OF THE CONGO REPUBLIC BURUNDI GUINEA REP. OF TOGO COTE BURKINA FASO GUINEA LEONE GAMBIA BISSAU SOUTH REPUBLIC AFRICAN THE AFRICA 2009