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Community-based Contraception Distribution in the DRC
If Emmanuel Tshimanga is any indication, the Democratic Republic of Congo (DRC) is on its way to addressing a critical health need: unmet family planning demand. A student at the Mikalayi Medical Technical Institute, Tshimanga received training not only on how contraception works but also on how to counsel patients and distribute products at the community level.
He is one of more than 100 medical students receiving the family planning training, with a potential pipeline of hundreds more. They will provide family planning services to the quarter of families in Kasai-Central province who have an unmet need, according to UNICEF Multiple Indicator Cluster Surveys (MICS) 2017-2018. The main reasons are lack of diversified family-planning methods and the relatively low number of community providers able to offer modern contraceptive methods.
The training Tshimanga got could be a breakthrough. The traditional academic curricula for nurses and doctors covered family planning for informational purposes. Students didn’t receive training to distribute or provide counseling.
But the Abt Associates-led Integrated Health Program (IHP) supported the Ministry of Public Health, Hygiene, and Prevention as it integrated the community-based distributors (CBD) approach into the training program. The training, funded by the U.S. Agency for International Development (USAID), occurred at three medical institutes, where 132 medical and nursing students took the courses. CBD refers to non-clinical methods of family planning (e.g., distributing condoms and cycle beads). The students could distribute these non-clinical methods and learned about giving advice on clinical methods such as injectables and pills--but could not provide them. USAID IHP also organized a training-of-trainers for 21 teachers—including six women—from the technical medical institutions. The trainers then taught 623 students about clinical and non-clinical methods.
“This is a first for the education system in Kasaï-Central,” says Christophe Tshitoko, a teacher at the Mikalaii Medical Technical Institute. “We never placed the implant in clients, or even conducted an educational talk. But we managed to master the long-term methods, thanks to the training,”
Students learned how to speak to people about family planning methods and how to counsel clients on finding the right option for them and their families. After the course, students began to put their training to use. Between April and June 2022, they advised 8,657 people on modern contraceptive methods, including 5,895 women. A total of 2,598 clients benefited from oral contraceptive methods, 84 clients benefited from implantable contraceptive methods, 971 clients received injectable contraceptives, 1,095 clients received cycle necklaces, and 4,664 received condoms.
Between April and June 2022 in five other provinces, USAID IHP supported training for instructors that will serve as the basis for ongoing curricula in the institutes. We reached 15 technical medical institutes and 613 learners, including 234 women and girls. The program also provided learners with CBD kits consisting of backpacks, boots, umbrella, hats, vests, and management and delivery tools that enable them to reach community members with family planning information and products. At the end of 2022, USAID IHP further scaled up the integration of the CBD approach in these six provinces and continues to train data managers at medical technical institutes to enable them to collect data on this initiative.
If the courses have the desired impact in these provinces, it could be the start of a nationwide effort to build a cadre of new nurses and doctors with the skills to reach those most in need. With USAID IHP support, the DRC government can create an ever-growing growing pool of nurses and doctors like Tshimanga who can provide the family-planning services many communities desperately need.
Reproductive, Maternal, Newborn and Child Health in Sub-Saharan Africa