title: Scaling up community provision of injectables through the public sector in Uganda.
abstract: This case study presents service monitoring data and programmatic lessons from scaling up Uganda's community-based distribution of depot medroxyprogesterone acetate (DMPA, marketed as Depo-Provera) to the public sector in two districts. We describe the process and identify implementation opportunities and challenges, including modifications to the service model. Analysis of monitoring data indicates that the number of women initiating DMPA with a community health worker (CHW) was 56 percent higher than the number of new DMPA acceptors served by clinics. Including continuing DMPA users, about three of every four DMPA clients chose CHWs as their service delivery point. CHW provision appears to be the preferred method of delivery for new DMPA users in this study, and may appeal even more to continuing clients. Lessons from scaling up in Uganda's public sector include recognizing the needs for ongoing assessment of support, a process to gain community "ownership," and spontaneous innovations to supplement CHW supervision.
authors.affiliation: FHI, P.O. Box 13950, Research Triangle Park, NC 27709, USA. kkrueger@fhi.org
authors.forename: Kirsten
authors.initials: K
authors.lastname: Krueger
authors.forename: Angela
authors.initials: A
authors.lastname: Akol
authors.forename: Patricia
authors.initials: P
authors.lastname: Wamala
authors.forename: Aurélie
authors.initials: A
authors.lastname: Brunie
mesh_terms: D003151:Community Health Centers / Q000706:statistics & numerical data*; D003150:Community Health Workers / Q000706:statistics & numerical data*; D003271:Contraceptive Agents, Female / Q000600:supply & distribution*; D006801:Humans; D017258:Medroxyprogesterone Acetate / Q000600:supply & distribution*; D017150:Public Sector / Q000458:organization & administration*; D012189:Retrospective Studies; D017751:Safety Management; D014454:Uganda
chemical_list: D003271:Contraceptive Agents, Female; D017258:Medroxyprogesterone Acetate