Elsevier

Contraception

Volume 98, Issue 5, November 2018, Pages 389-395
Contraception

Original research article
Costs of administering injectable contraceptives through health workers and self-injection: evidence from Burkina Faso, Uganda, and Senegal,☆☆

https://doi.org/10.1016/j.contraception.2018.05.018Get rights and content
Under a Creative Commons license
open access

Abstract

Objective

To evaluate the 12-month total direct costs (medical and nonmedical) of delivering subcutaneous depot medroxyprogesterone acetate (DMPA-SC) under three strategies — facility-based administration, community-based administration and self-injection — compared to the costs of delivering intramuscular DMPA (DMPA-IM) via facility- and community-based administration.

Study design

We conducted four cross-sectional microcosting studies in three countries from December 2015 to January 2017. We estimated direct medical costs (i.e., costs to health systems) using primary data collected from 95 health facilities on the resources used for injectable contraceptive service delivery. For self-injection, we included both costs of the actual research intervention and adjusted programmatic costs reflecting a lower-cost training aid. Direct nonmedical costs (i.e., client travel and time costs) came from client interviews conducted during injectable continuation studies. All costs were estimated for one couple year of protection. One-way sensitivity analyses identified the largest cost drivers.

Results

Total costs were lowest for community-based distribution of DMPA-SC (US$7.69) and DMPA-IM ($7.71) in Uganda. Total costs for self-injection before adjustment of the training aid were $9.73 (Uganda) and $10.28 (Senegal). After adjustment, costs decreased to $7.83 (Uganda) and $8.38 (Senegal) and were lower than the costs of facility-based administration of DMPA-IM ($10.12 Uganda, $9.46 Senegal). Costs were highest for facility-based administration of DMPA-SC ($12.14) and DMPA-IM ($11.60) in Burkina Faso. Across all studies, direct nonmedical costs were lowest for self-injecting women.

Conclusions

Community-based distribution and self-injection may be promising channels for reducing injectable contraception delivery costs. We observed no major differences in costs when administering DMPA-SC and DMPA-IM under the same strategy.

Implications

Designing interventions to bring contraceptive service delivery closer to women may reduce barriers to contraceptive access. Community-based distribution of injectable contraception reduces direct costs of service delivery. Compared to facility-based health worker administration, self-injection brings economic benefits for women and health systems, especially with a lower-cost client training aid.

Keywords

Costs
DMPA-SC
Contraceptive service delivery costs
Injectable contraception
Self-injection
Community-based distribution

Cited by (0)

Acknowledgment of funding: This work was supported by the Bill & Melinda Gates Foundation, Seattle, WA, USA (grant number OPP1060986). The funder did not play a role in study design; the collection, analysis and interpretation of data; the writing of the report or the decision to submit the article for publication.

☆☆

Declaration of interest: N/A.