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      Building on safety, feasibility, and acceptability: the impact and cost of community health worker provision of injectable contraception.

      Global Health, Science and Practice
      Johns Hopkins School Bloomberg School of Public Health, Center for Communication Programs

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          Abstract

          A critical shortage of doctors, nurses, and midwives in many sub-Saharan African countries inhibits efforts to expand access to family planning services, especially in rural areas. One way to fill this gap is for community health workers (CHWs) to provide injectable contraceptives, an intervention for which there is growing evidence and international support. In 2009, with approval from the Government of Zambia (GoZ), FHI 360 collaborated with ChildFund Zambia to design and implement such an intervention as part of its existing CHW family planning program.

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

          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). Manual and electronic search and systematic review of published and unpublished documents on delivery of contraceptive injectables by CHWs. 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. 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. Published by Elsevier Inc.
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            Community-based health workers can safely and effectively administer injectable contraceptives: conclusions from a technical consultation.

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              Community-based distribution of injectable contraceptives: introduction strategies in four sub-Saharan African countries.

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                Author and article information

                Journal
                25276547
                4168589
                10.9745/GHSP-D-13-00025

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