My first stop when I arrived in Nakasongola, Uganda, on a hot day in 2004 was the small hospital that served this rural district north of Kampala. I was paying a courtesy call to the District Medical Officer, Dr. Gerald Ssekito. He looked tired when I arrived, explaining that he and other hospital staff had not slept the night before. A pregnant woman had been brought in on the back of a motorbike in the middle of the night. She had delivered the first of her two twins the day before in her remote village, but continued laboring at home unable to birth the second. Finally, after 24 hours, her family put her on a motorbike for the long journey to the hospital, but she bled heavily and died on the way to the hospital.
Maternal death is largely preventable, and there were doubtless many opportunities to avoid this woman’s unnecessary death. I could not help thinking that her pregnancy might have been unintended and that, almost certainly, she had not been offered a contraceptive method in her remote village.
These thoughts were top of mind that day because, as an FHI 360 researcher, I had traveled to Uganda to help the Ministry of Health and local partner Save the Children conduct the first pilot study in Africa on task sharing of injectable contraception – that is, allowing lay health workers to provide contraceptive injections, a practice previously limited to clinically trained nurses and midwives. Discreet and long-lasting, injectable contraceptives have long been the most popular family planning method on the continent. But in 2004, they were not an option for women seeking services from local community health workers.
Nearly 15 years later, that stark equation has changed in many places. Family planning, including community provision of injectables, has been a success story throughout sub-Saharan Africa, with contraceptive prevalence in countries like Uganda more than doubling since 2004. I’m proud to say that FHI 360 has been a part of this success, contributing to the evidence base, promoting policy change and helping to implement local programs.
But progress has not been uniform. And for women in rural areas, access to life-saving contraception often remains tenuous. In some countries, family planning programs are still hampered by outdated local policies that prevent lay health workers from providing the methods that women need. These countries risk falling further behind in key health indicators if they ignore exciting new evidence confirming the benefits of task sharing in family planning.
What kind of evidence? We now know that well-trained lay health workers can provide not only pills and injectables, but even contraceptive implants. Further, small, locally owned drug shops — often the first stop for health care in many countries — can safely furnish a much wider range of contraceptives than regulations in many countries now allow. In Uganda, FHI 360’s research and advocacy efforts recently led to a significant policy change, allowing licensed and accredited private drug shops to stock and administer injectable contraception in 20 districts.
Finally, with the advent of the single-use, all-in-one contraceptive injectable DMPA-SC, FHI 360 research has shown that community health workers can teach women to self-administer injectables in their homes — safely, conveniently and with less risk of early discontinuation.
At the 2018 International Conference on Family Planning in Kigali, my FHI 360 colleagues and I will share important new research on the many benefits of task sharing and community-based family planning services. We also hope to engage our partners in envisioning #NextGenFP — the next generation of family planning programs, policies and contraceptive innovations. I’m confident that the next generation will see more African countries act on the evidence by making task sharing and community-based family planning services a standard of practice. Bold leadership in this area will have a real impact in decreasing maternal mortality and strengthening women’s health across the continent.