Building on safety, feasibility, and acceptability: the impact and cost of community health worker provision of injectable contraception
Building on safety, feasibility, and acceptability: the impact and cost of community health worker provision of injectable contraception
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DOI：
10.9745/ghsp-d-13-00025
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发表时间：
2013-11-01
影响因子：
4
通讯作者：
Mbewe, Reuben Kamoto
中科院分区：
文献类型：
--
作者：
Chin-Quee, Dawn;Bratt, John;Mbewe, Reuben Kamoto
背景：在许多撒哈拉以南非洲国家，医生、护士和助产士的严重短缺阻碍了扩大获得计划生育服务的努力，特别是在农村地区。填补这一空白的一种方法是由社区卫生工作者（chw）提供注射避孕药具，这是一种越来越多的证据和国际支持的干预措施。2009年，在赞比亚政府的批准下，富力360与赞比亚儿童基金会合作，设计并实施了这一干预措施，作为其现有的CHW计划生育方案的一部分。方法：采用客户报告和21项结构化观察表对CHW提供注射用醋酸甲孕酮的安全性进行评估。可行性和可接受性是通过与chw和一部分DMPA客户的访谈来衡量的。通过2010年2月至2011年2月接受培训的卫生保健员的计划生育情况，评估在提供避孕药和避孕套时增加DMPA的影响。2009年11月至2011年2月期间使用电子表格记录费用。结果：在安全性、可行性和可接受性的所有指标上得分都很高。对51名避孕套客户，391名避孕药客户和2206名DMPA客户提供了两年的保护（CYP， 1年的妊娠保护）。在1739名初次接触计划生育的客户中，85%选择注射DMPA， 13%选择避孕药，2%选择避孕套。服药一年后的继续率也很高，为63%，而服用避孕药者为47%。如果50%的用户继续使用chw提供的DMPA，每两年的增量成本为21.24美元。结论：该研究证实，在赞比亚的情况下，卫生工作者提供的注射避孕药是安全的、可接受的和可行的，在难以到达的地区有很高的吸收率。客户的高延续率意味着，如果将干预措施加入到现有的社区分发计划中，干预措施的成本可能会很低——这一发现与计划复制（目前正在赞比亚进行）有关。
Background: A critical shortage of doctors, nurses, and midwives in many sub-Saharan African countries inhibits efforts to expand access to family planning services, especially in rural areas. One way to fill this gap is for community health workers (CHWs) to provide injectable contraceptives, an intervention for which there is growing evidence and international support. In 2009, with approval from the Government of Zambia (GoZ), FHI 360 collaborated with ChildFund Zambia to design and implement such an intervention as part of its existing CHW family planning program.Methods: The safety of CHW provision of injectable DMPA (depot medroxyprogesterone acetate) was measured by client reports and by a 21-item structured observation checklist. Feasibility and acceptability were measured by interviews with CHWs and a subset of DMPA clients. The impact of adding DMPA to pill and condom provision was assessed by family planning uptake among the clients of trained CHWs from February 2010 to February 2011. Costs were documented using spreadsheets over the period November 2009 to February 2011.Results: Scores were high on all measures of safety, feasibility, and acceptability. Couple-years of protection (CYP, protection from pregnancy for 1 year) was provided to 51 condom clients, 391 pill clients, and 2,206 DMPA clients. Of the 1,739 clients new to family planning, 85% chose injectable DMPA, while 13% chose pills and 2% chose condoms. Continuation rates were also high, at 63% after 1 year as compared with 47% for pill users. Incremental costs per coupleyear were US$21.24 if 50% of users continue with CHW-provided DMPA.Conclusion: The study affirms that the provision of injectable contraceptives by CHWs is safe, acceptable, and feasible in the Zambian context, with very high rates of uptake in hard-to-reach areas. High continuation rates among clients mean that costs of the intervention can be low when added to an existing community-based distribution program-a finding that is relevant to program replication (now underway in Zambia).