Community-Based Access to Injectables (CBA2I)

Multiple countries are employing community-based access to injectable contraceptives (CBA2I) strategies to help achieve their Family Planning 2020 goals since CBA2I has the potential to dramatically expand access to and use of modern contraceptive methods.Three of the most common CBA2I strategies include training community health workers (CHWs) to administer injectable contraceptives, expanding access to injectable contraception through drug shops, and providing mobile services in areas where other services are limited or do not exist. Advancing Partners & Communities (APC) is supporting expansion of CBA2I services as part of a larger commitment to broadening the family planning method mix at the community level.

Below are select resources related to key issues within CBA2I.

Drug Shops

Until recently, the practice of utilizing drug shops to increase access to injectable contraceptives had not received sufficient attention in the literature. This new APC brief discusses the promising strategy. The U.S. Agency for International Development (USAID) has also developed a high-impact practice brief on family planning provision through both drug shops and pharmacies.

Managing the policy advocacy process: Drug shops’ provision of injectable contraception in Uganda
March 2017 | Case Study

Private drug shops could offer an opportunity to expand access to family planning because they are commonplace in rural areas and support a sustainable commercial market for health products.

Delivery of Injectable Contraception by Drug Shop Operators in Uganda: Research and Recommendations
October 2016 | Brief

At the London Family Planning Summit in 2012, the Government of Uganda committed to providing universal access to family planning and reducing unmet need for family planning from the current 40 percent to 10 percent by 2022. To meet this ambitious goal, all potential means of increasing accessibility to family planning must be explored.

Sale and Provision of Injectable Contraceptives in Drug Shops in Developing Countries: Conclusions from a Technical Consultation
January 2015 | Journal Article

This journal article discusses conclusions from the technical consensus meeting on injectable contraceptives in drug shops in Ghana. A subscription is required to view the full text.

A better future for injectable contraception?
November 2014 | Journal Article

This article discusses the provision of injectables though drug shops and the potential advantages of subcutaneous administration of DMPA over the current intramuscular approach.

Provision of Injectable Contraceptives within Drug Shops: A Promising Approach for Increasing Access and Method Choice
October 2012 | Publication

This brief focuses on the use of drug shops to increase access to injectable contraceptives, a strategy that had previously not received sufficient attention in the literature.

Community Health Workers Provision of Injectables

CHW provision of injectables is an important issue that should be widely expanded:

Community-based Access to Injectables in sub-Saharan Africa
March 2017 | Policy

This map illustrates the status of the provision of injectable contraception by community health workers by country in sub-Saharan Africa.

Advancing Partners & Communities: Sayana® Press Evaluation
January 2015 | Brief

This brief outlines the details of a study requested by the Malawi Ministry of Health and USAID/Malawi to assess home and self-injection of Sayana® Press in Malawi.

Sayana® Press: A Guide for Trainers of Providers
January 2015 | Training Guide

This trainer’s guide provides content for training on the progestin-only injectable contraceptive Sayana® Press. These materials were first used in 2012 to train facility- and community-based providers on use of Sayana Press (formerly depo-subQ in Uniject) in acceptability studies in Senegal and Uganda.

Building on safety, feasibility, and acceptability: the impact and cost of community health worker provision of injectable contraception
October 2013 | Journal Article

The article affirms that the provision of injectable contraceptives by CHWs is safe, acceptable, and feasible in the Zambian context, with very high rates of uptake in hard-to-reach areas.

High Impact Practices in Family Planning List
July 2013 | Brief

Updated in July 2013, this seminal brief provides a list of all the HIPs identified by the Technical Advisory Group (TAG).

CHSS

How to Introduce and Scale Up Sayana Press (DMPA-SC in Uniject)
April 2017 | Guide

This publication provides practical guidance based on results, evidence, and learning from the pilot introductions of Sayana Press in four countries in Africa.

Below you will find links to resources created by APC and other organizations.

APC Resources

Strengthening Community-based Family Planning Systems through Collaborative Improvement in Busia District, Uganda
April 2017 | Brief

In this second issue of the APC Quality Improvement Brief, APC describes the progress to date in systematic efforts to improve the quality of CBFP in Busia District and plans to scale up these efforts in two other districts in Uganda.

Community-based Access to Injectables in sub-Saharan Africa
March 2017 | Policy

This map illustrates the status of the provision of injectable contraception by community health workers by country in sub-Saharan Africa.

Managing the policy advocacy process: Drug shops’ provision of injectable contraception in Uganda
March 2017 | Case Study

Private drug shops could offer an opportunity to expand access to family planning because they are commonplace in rural areas and support a sustainable commercial market for health products.

CHW Central - A Global Resource For Community Health Workers
April 2016 | Website

CHW Central, launched in 2011, is an online community of practice managed by Initiatives Inc. that provides a forum for online discussions and exchanges with public health professionals and program managers, policy makers and CHWs in the U.S. and across the globe.

Applying a Quality Improvement Model to Strengthen Community-based Family Planning Services in Busia District, Uganda
April 2016 | Brief

In February 2015 APC, implemented by FHI 360 in Uganda, conducted a collaborative site assessment for CBFP programs with the MOH in the three pilot sites, Bulumbi, Buhehe and Buteba. The assessment identified areas for service delivery improvement, which were quantified by the QI monitoring that started in June 2015.

Projet pilote de l’accès à base communautaire des contraceptifs injectables au Bénin
May 2015 | Brief

This brief outlines the background, objectives, implementation steps & timeline, overview, and indicators of APC Benin’s community-based access to injectable contraceptives pilot project.

Benin’s Community-Based Access to Injectable Contraceptives Pilot Project
May 2015 | Brief

This brief outlines the background, objectives, implementation steps & timeline, overview, and indicators of APC Benin’s community-based access to injectable contraceptives pilot project. 

Advancing Partners & Communities: Sayana® Press Evaluation
January 2015 | Brief

This brief outlines the details of a study requested by the Malawi Ministry of Health and USAID/Malawi to assess home and self-injection of Sayana® Press in Malawi.

Sayana® Press: A Guide for Trainers of Providers
January 2015 | Training Guide

This trainer’s guide provides content for training on the progestin-only injectable contraceptive Sayana® Press. These materials were first used in 2012 to train facility- and community-based providers on use of Sayana Press (formerly depo-subQ in Uniject) in acceptability studies in Senegal and Uganda.

Community Health Worker Provision of Injectable Contraceptives: An Effective CBA2I Strategy
October 2014 | Brief

These resources are intended to be used by advocates, program managers, policymakers, donors, ministry of health staff, and other key stakeholders to craft a strategy for building support for CBA2I among key decision makers in country. Because community-based access to injectable contraceptives (CBA2I) has the potential to significantly expand access to and use of modern contraceptive methods, several countries are employing CBA2I strategies to help achieve their FP2020 goals.

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ChildFund International is a Christian organization that sponsors children in need largely through monthly donations from individual sponsors. These donations are used to support the transition from extreme poverty for these children and their communities. In addition to their sponsorship program, ChildFund receives grants and donations to provide trainings and capacity building activities, health and education programs, emergency relief, and food distribution.

Save the Children Federation, Inc. invests in children’s education, health, and protection from harm. The non-governmental organization works globally to advocate for children’s rights in order to provide economic stability, better health, and emergency aid in times of crisis.

The International Rescue Committee (IRC) provides care to Vietnamese, Cambodian, and Laotian refugees. Through the provision of essentials like food and water, medical care, and sanitation, the IRC assists approximately 140,000 Myanmar refugees as well. The organization also provides protection, legal assistance, and resettlement processing for abused women and children.

WellShare International improves the health of women, children, and their communities both locally and globally. In their efforts to develop sustainable community-based programs, WellShare applies a holistic approach that incorporates strategic partnerships, monitoring and evaluation, and sustainability efforts. The organization utilizes the transfer of simple technologies and methods to educate and transform communities.

June 02, 2017 | Blog

Jackqueline Bwire Nabwire, a community health worker trained by APC Uganda, works to bring family planning to women in her village.

March 24, 2017 | Blog

Translating research into policy and practice was key to the acceptance of CBA2I in Africa.

February 16, 2016 | Blog

Thanks to years of impassioned, and data-driven advocacy, the government of Zambia has given authority to scale up community-based distribution (CBD) of injectables to the rest of the country. APC provided the sub-grant to ChildFund Zambia, who contributed to implementing the pilot study, and provided technical assistance for the implementation of Community Based Access to Injectables (CBA2I) activities, including planning the scale-up through a community-based family planning learning site model.

April 14, 2015 | Event

Read more about two upcoming events in April and May from APC on Sayana® Press and emergency contraception.

January 26, 2015 | Event

The Global Health Mini-University (Mini-U) is an annual learning forum for professionals and students highlighting best practices and new innovations in global health. This year, the Mini-U will be held on Monday, March 2, 2015 at George Washington University's Cloyd Heck Marvin Center in Washington, DC.

July 14, 2014 | Article

An easy-to-use form of the injectable contraceptive Depo-Provera was introduced in July 2014 in Burkina Faso, the first of four African countries in which it will be rolled out this year.

Check back again for related photo galleries or videos.

Paul Mulawa is a 38-year-old Family Planning (FP) Champion and Village Health Team (VHT) member in the Iganga District, Ibalanku subcounty of Uganda. Elected by the community, Mulawa l’s VHT works within their community to promote FP, encourage individuals to immunize their children, and discuss hygiene in their homes.

Photo of Edward Basalirwa inspecting a patient's shoulder.

Edward Basalirwa is a 40-year-old Village Health Team (VHT) member and farmer from the Iganga District of Uganda. Edward was prompted to form a VHT Association in the Nsale Parish to improve the community’s well-being, and the VHT was elected in the community by the LC1 chairman, or village leader.

Photo of two women and a man meeting indoors

To respond to the unmet need for family planning (FP) in Uganda, the Salvation Army Integrating Family Planning (SAIFaP) Project organized mobile outreach activities in hard to reach areas.

Health Workers

WellShare International trained 257 village health team members in Uganda to provide adolescents with adolescent sexual and reproductive health counseling and family planning services.