Scaling Up Access to Implants: A Summative Evaluation of the Implants Access Program

Rebecca Braun; Annika Grever

doi:10.9745/GHSP-D-19-00383

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FIGURE 1.
Implant Procurement for FP2020 Countries, 2010–2018^a
^a These data were sourced from United Nations Population Fund Reproductive Health Interchange on July 1, 2019. Data are provided by the central procurement offices of large family planning donors, institutional buyers, and other organizations that procure contraceptives. The data reflect ∼80% of donor-provided contraceptive supplies and do not include directly procured products by governments. More information is available at: https://www.unfpaprocurement.org/rhi-home.
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FIGURE 2.
Implants Access Program Governance Structure
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FIGURE 3.
Key Insights from the Implants Access Program Evaluation

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TABLE 1.

Implants Access Program Objectives, Barriers Addressed, and Partner Approaches

Objectives	Barriers Addressed	Partner Approaches
1. Improve market dynamics	High unit price of the primary LARC demanded in FP2020 countries	Volume guarantee to lower price of implants Support for market entry of a generic implant product
2. Strengthen supply chain performance	Limited and inconsistent information on country procurement needs and supply availability Inconsistent supply availability at service delivery points	Improvements to data visibility, transparency, and coordination to better match country-level supply and demand Introduction of dashboards and job aids to strengthen and support in-country supply chain efforts
3. Improve and expand service delivery	Shortage of trained providers to insert and remove implants	Creation and expansion of innovative and cost-effective training approaches Expansion of the range of service delivery models to provide LARCs
4. Increase knowledge and awareness	Limited knowledge among women about family planning options including implants	Community awareness and sensitization activities to increase understanding of family planning and benefits of LARCs
5. Together, the strategies above contributed to a fifth objective: Improve the enabling environment for contraceptives

Abbreviation: LARC, long-acting reversible contraceptive.

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TABLE 2.

Key Events in the Global Family Planning Field, 2012–2018

Event	Year	Objective	Relevance to Implants Access Program
London Family Planning Summit	2012	This summit secured US$2.3 billion toward meeting the unmet need for contraception for 120 million women worldwide by 2020.	Countries made specific goals around raising modern contraceptive prevalence rate and reducing unmet need; donors committed funding for family planning commodities and service delivery, including implants.
FP2020 launch	2012	This global partnership of governments, donors, civil society organizations, and technical experts emerged to help meet the goals of the 2012 London summit.	FP2020 connected countries committed to LARCs with financial and technical resources as needed.
UN Commodities Commission report	2012	This report listed 13 lifesaving commodities that could save over 6 million lives and avert maternal deaths via improved access to family planning.	Implants were named as a lifesaving commodity and this report identified recommendations to improve financing, utilization, supply, and demand for implants.
UNICEF RMNCH Trust Fund	2013	This fund was established by UNICEF, UNFPA, and WHO to finance high-impact interventions in RMNCH based on recommendations of the UN Commodities Commission report.	The RMNCH trust fund supported eight countries as they expanded the availability of implants and other lifesaving commodities.
WHO task shifting recommendations	2013	The WHO published updated, evidence-based recommendations on the provision of RMNCH interventions by different cadres of health workers.	The updated task shifting recommendations specified that auxiliary nurses and auxiliary nurse midwives should be permitted to insert and remove implants with targeted monitoring and evaluation.
WHO expansion of implants eligibility criteria	2015	The fifth edition of WHO’s Medical Eligibility Criteria reduced restrictions around the use of implants and other hormonal contraceptives for adolescents and breastfeeding women less than 6 weeks’ postpartum.	Postpartum women had more options for hormonal contraceptives, which enabled the opportunity to provide LARCs to women shortly after birth. Adolescents were cleared to access implants.
Youth statement on LARCs	2015	This statement provided evidence that LARCs were safe for youth and adolescents and was signed by over 50 endorsing organizations.	The document provided guidance for programs and service providers that all adolescents and youth deserved access to a full range of methods, including implants.
2017 Family Planning Summit	2017	Donors, policymakers, and advocates convened to assess efforts toward reaching FP2020 goals and accelerate progress.	Countries, donors, civil society organizations, and private sector partners recommitted to LARCs. More than 2 dozen FP2020 countries committed to expanding their method mix.

Abbreviations: LARC, long-acting reversible contraceptive; RMNCH, reproductive, maternal, newborn, and child health; UN, United Nations; UNICEF, United Nations Children’s Fund; UNFPA, United Nations Population Fund; WHO, World Health Organization.