From January 30 to February 2, 2017, 150 researchers, health professionals, advocates, and donors from 19 countries met in Dakar, Senegal for three days to strategize how best to strategize advocacy and policy approaches for introducing and increasing access to subcutaneous depo provera via Uniject, also known as DMPA-SC or Sayana® Press. The Advance Family Planning (AFP) initiative co-organized the meeting in collaboration with PATH and IntraHealth, along with a global steering group of international nongovernmental organizations (INGOs) and in-country partners. Each of the African and Asian countries represented left the meeting with evidence-based objectives specific to policy changes needed to increase access to DMPA-SC. They also developed a preliminary plan for engaging decision-makers, donors, and other stakeholders. Subsequent to the meeting, participants ensured that advocacy action plans were discussed, refined, and implemented to increase access to this method in their countries. See the AFP website for meeting presentations.
Reflecting the aim of the meeting, then Senegal Minister of Health, Awa Coll-Seck, highlighted her country’s efforts to expand access to DMPA-SC within a broader method mix. Although the participants came from very diverse countries, all saw DMPA-SC’s potential to overcome barriers to contraceptive access and relieve the health system through alternative channels of provision, including self-injection. Donors stood ready to support country-led efforts. Initial support for the meeting was matched two to one by cost-sharing from other organizations and donors. One hundred and twenty-four of the 150 participants funded (in full or in part) their own travel costs.
A session featuring World Health Organization (WHO) and experts in HIV acquisition and hormonal contraception helped countries anticipate guidance issued in March and provided WHO with greater insight into potential implications for introduction and scale-up of DMPA-SC. Within a week following the meeting, Kenya and Nigeria convened policymakers and others in their countries to chart a course for increasing access to DMPA-SC. Other countries created taskforces and used connections made to organize policymaker visits to learn first-hand about the realities of increased access and self-injection. Two participants published pieces related to the meeting. Participant evaluations confirmed the meeting’s utility and importance. A survey of participants in September2017 found that nearly all had applied the evidence shared at the meeting to improve access to DMPA-SC following the meeting.
Co-organizers supported meeting outcomes in three important ways:
• Planning and advocacy. Along with PATH, AFP reached out to INGOs and in-country partners to assess how ready countries were to introduce and increase access to DMPA-SC. IntraHealth contributed to the program and helped manage on-the-ground logistics. AFP’s advocacy partners facilitated use of the AFP SMART approach to set priorities and implement advocacy strategies after the meeting.
• Policy-relevant evidence. PATH used its own resources and independent funding to prepare a suite of advocacy materials summarizing the current state of knowledge. These materials ensured that all participants shared a basic understanding of the method and the policy issues amenable to evidence-based advocacy. In addition, PMA2020 data helped inform objective setting for Burkina Faso, the Democratic Republic of the Congo, and Nigeria.
• Subsequent financial and technical support. Four countries—Benin, Guinea, Mauritania, and Togo—have applied for funding for DMPA-SC advocacy through the Opportunity Fund, AFP’s small grants program managed by PAI. Malawi, Mozambique, Nigeria, and Senegal also expressed interest but could act on plans made in Dakar with existing resources. All participants shared in-kind support to carry forward the ideas for action generated during the meeting. For example, partners in the Support for International Family Planning Organizations (SIFPO) project were able to build on the Dakar meeting outcomes; working with PATH and other partners in Uganda, they convened sub-Saharan African stakeholders in Uganda in July 2017 to observe DMPA-SC delivery there and to review the program and policy opportunities for taking availability of the method to scale. All AFP focus countries represented have included DMPA-SC advocacy in their current work plans and PATH and John Snow, Inc. continue to provide technical support through the Subcutaneous DMPA Access Collaborative, launched in September 2017.