Project Dates: 2007-2009
After the advent of the Health Extension Program in 2004 by the government of Ethiopia, Health Extension Workers (HEWs) were the main providers of injectable contraceptives to rural women in Tigray, providing DMPA injections for free at the government health posts and health centers, and occasionally in the communities during vaccination campaigns. Though community based reproductive health agents (CBRHAs) were mobilized to provide basic family planning services and referrals in the past, as lay health workers, they were only trained to distribute oral contraceptives and condoms.
However, given both the demand for injectable contraceptives and the distance many women resided from a health post, inclusion of CBRHAs is a valuable resource for distributing injectable contraceptives in rural communities. Consequently, from 2007 to 2009, the Bixby Center, and the Tigray Regional Health Bureau (TRHB) conducted a prospective non-randomized community intervention trial in four village sites in two woredas of Tigray to determine if CBRHAs could administer injectable contraceptives to women in a rural region of Ethiopia with the same effectiveness, safety and acceptability as HEWs.
Working with Venture Strategies the Bixby Center is researching the safety of community based distributions and administration of Depo Provera.The pilot study demonstrated that CBRHAs could deliver injectable contraceptives to women safely, with high quality, acceptability and continuation rates. In fact, CBRHA clients were significantly less likely to have used injectable contraceptives in the past as compared to HEW clients, suggesting the role of CBRHAs in increasing injectable contraceptive prevalence. A 2009 World Health Organization technical consultation reviewed evidence on community-based provision of injectable contraceptives from 16 studies, including this pilot study in Tigray. The conclusions of the WHO supported the inclusion of community health workers in distributing injectable contraceptives.
The findings of this pilot study were published in the WHO Bulletin in April 2011.