Provision of DMPA by community health workers: what the evidence shows

• Published in: Contraception (Stoneham) Vol. 83; no. 6; pp. 495 - 503
• Main Authors: Malarcher, Shawn, Meirik, Olav, Lebetkin, Elena, Shah, Iqbal, Spieler, Jeff, Stanback, John
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2011; Elsevier
• Subjects: Biological and medical sciences; Community Health Workers; Community-health worker; Contraceptive Agents, Female - administration & dosage; Contraceptive Agents, Female - adverse effects; DMPA; Family planning; Genital system. Reproduction; Gynecology. Andrology. Obstetrics; Humans; Injectable contraception; Injections, Intramuscular - adverse effects; Medical sciences; Medroxyprogesterone Acetate - administration & dosage; Medroxyprogesterone Acetate - adverse effects; Obstetrics and Gynecology; Patient Acceptance of Health Care; Pharmacology. Drug treatments; Systematic review; Community-health worker; Systematic review; Family planning; DMPA; Injectable contraception; Injectable form; Controlled release form; Health staff; Contraception; Drug dispensation; Review; Intramuscular administration; Progestagen; Dosage form; Medroxyprogesterone; Community health; Contraceptive; Occupational training
• ISSN: 0010-7824; 1879-0518
• DOI: 10.1016/j.contraception.2010.08.013

Abstract Background To reduce a large unmet need for family planning in many developing countries, governments are increasingly looking to community health workers (CHWs) as an effective service delivery option for health care and as a feasible option to increase access to family planning services. This article synthesizes evidence on the feasibility, safety and effectiveness of community-based delivery of the injectable contraceptive depot-medroxyprogesterone acetate (DMPA). Study Design Manual and electronic search and systematic review of published and unpublished documents on delivery of contraceptive injectables by CHWs. Results Of 600 identified documents, 19 had adequate information on injectables, almost exclusively intramuscular DMPA, provided by CHWs. The data showed that appropriately trained CHW demonstrate competency in screening clients, providing DMPA injections safely and counseling on side effects, although counseling appears equally suboptimal in both clinic and community settings. Clients and CHWs report high rates of satisfaction with community-based provision of DMPA. Provision of DMPA in community-based programs using CHWs expanded access to underserved clients and led to increased uptake of family planning services. Conclusions We conclude that DMPA can be provided safely by appropriately trained and supervised CHWs. The benefits of community-based provision of DMPA by CHWs outweigh any potential risks, and past experiences support increasing investments in and expansion of these programs.