TABLE.

Challenges and Lessons Learned

What Was the Challenge?Why Was This a Challenge?How Was the Challenge Addressed? (Lesson Learned)
RC certification process took longer than anticipatedThe process may take longer than expected for several reasons, including low client uptake for the new method, which prevents RCs from demonstrating competence. In addition, RCs may need additional support after initial training to manage their new duties (counseling and filling out data collection tools).Build in “extra” time for RC certification because several factors can affect the process. Invite health zone coordinating doctors to attend supportive supervision visits to oversee health center staff who supervise RCs. (Note that current global guidance states that in countries where CHWs already administer injectables, certification can be granted with 3 injections)
Community awareness about DMPA-SC was low in regions where introduction occurredCommunication campaign was not launched simultaneously with the introduction of DMPA-SC.Introduce a targeted communication campaign in regions where DMPA-SC is introduced to garner interest and create awareness about the method.
Stockouts of DMPA-SC at the facility and community level were frequent at the beginning of introductionHealth facility staff incorrectly assumed that the APC project was responsible for reordering DMPA-SC stock.Clearly outline health facility manager responsibilities during training and encourage staff to take ownership for ordering commodities. At the national level, it is critical to ensure that the method appears on the national resupply order form as soon as the new method becomes available.
RC family planning counseling skills were lowRCs previously had been trained on family planning through MOH PIHI curriculum and initially APC only provided a short counseling skills session during the DMPA-SC training.Include a half-day refresher training session on counseling skills so that all RCs have an opportunity to practice and enhance their counseling skills. A counseling job aid was also added to guide RCs through the counseling process and ensure informed choice and voluntarism.
Data collection was not standardized across RCs or health facilitiesDuring the first few months of DMPA-SC introduction, RCs did not receive family planning registers (which were to be provided by their linked NGO) and therefore did not collect data in a systematic way.During subsequent RC trainings, the importance of using the appropriate forms to collect client data was emphasized. Additionally, time was allotted for RCs to practice filling in the client family planning registers. At the health facility level, technical assistance is provided to providers during routine supervision visits to ensure that they are correctly collecting and reporting family planning data.
  • Abbreviations: APC, Advancing Partners & Communities; CHW, community health worker; DMPA-SC, subcutaneous depot medroxyprogesterone acetate; MOH, Ministry of Health; PIHI, paquet d'interventions à haut impact (package of high-impact health services); RC, relais communautaires (lay community health workers).