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

External Resources

Markets Matter Advocacy Guide: How advocates can strengthen markets to improve access to essential health products
October 2017 | Guide

As the latest addition to PATH’s Stronger Health Advocates Greater Health Impact series, this guide contains an overview of market actors and identifies policies and advocacy entry points for civil society.

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.

Sale and provision of injectable contraceptives in drug shops in developing countries: conclusions from a technical consultation
March 2015 | Journal Article

In September 2013, a technical consultation held in Research Triangle Park, NC, USA, concluded that, in the developing world, drug shops have the potential to play a much greater role in helping women and couples achieve their family planning intentions. The group of 15 researchers and program experts found that sale of depot medroxyprogesterone acetate (DMPA) is common in drug shops in some countries and that training, policy, research and advocacy interventions should be prioritized by funders and the family planning community.

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.

Getting closer to people: family planning provision by drug shops in Uganda
November 2014 | Journal Article

This article affirms that private drug shops can effectively provide contraceptive methods, especially injectables, complementing government services in Uganda. 

CBA2I Toolkit on K4Health
August 2014 | Toolkit

This toolkit is a platform for strengthening the capacity of agencies and organizations to plan, implement, evaluate, promote, and scale up community-based access to injectables (CBA2I) programs and to advocate for changes to national policy and service delivery guidelines.

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).

WHO Recommendations for Task Sharing
December 2012 | Guide

This guide was developed to share the WHO recommendation of a progressive and evidence-based distribution of family planning tasks between health workers to improve access to maternal and newborn health services. These recommendations include task-sharing to allow CHWs to provide injectables in the context of targeted supervision.

Pages

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.

Family Planning Provision in Pharmacies and Drug Shops: an Urgent Prescription
April 2019 | Journal Article

Drug shops and pharmacies have long been recognized as the first point of contact for health care in developing countries, including family planning services. This article draws on lessons learned from the rich experience of earlier efforts to promote a variety of public health interventions in pharmacies and drug shops.

Markets Matter Advocacy Guide: How advocates can strengthen markets to improve access to essential health products
October 2017 | Guide

As the latest addition to PATH’s Stronger Health Advocates Greater Health Impact series, this guide contains an overview of market actors and identifies policies and advocacy entry points for civil society.

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 Health Worker Provision of Injectable Contraception: An Implementation Handbook and Job Aids
July 2019 | Job Aid

Are you working on implementing CBA2I programs? Check out an implementation handbook developed by FHI 360, which is a step-by-step guide for introducing injectable contraceptives into an existing community-based distribution program. Along with three additional resources, a community health workers job aid booklet, a counseling tool, and a user guide that APC contributed to which are tools that can be adapted for country-specific needs.

Introduction of Community-Based Provision of Subcutaneous Depot Medroxyprogesterone Acetate (DMPA-SC) in Benin: Programmatic Results
June 2019 | Journal Article

Read the journal article in Global Health: Science and Practice journal by APC/Benin staff about community health workers and facility-based health care providers who were trained to administer DMPA-SC safely and effectively in 10 health zones.

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.

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