|
In 1993, the Philippines Department of Health decided to introduce DMPA nationwide. An
FHI and Pathfinder International team working with the health department developed a draft
strategy covering pricing, information, training, commodities, logistics, evaluation,
suggested service delivery guidelines, and other elements.1
DMPA (depot-medroxyprogesterone acetate) is an easy to use, highly effective three-month
injectable suitable for most women, but may cause menstrual irregularities and may result
in a delayed return to fertility. Good counseling can prepare women for these side effects
and improves user acceptance and continuation rates. "We knew that a staged
introduction in selected areas was very important, so that any problems with supplies or
training could be addressed before the program got over-extended," says Susan
McIntyre of FHI, who worked on the strategy.
The introduction strategy involved the government's nationwide network of public clinics,
a social marketing campaign coordinated by The Futures Group's SOMARC project, and private
providers, which worked directly with the manufacturer. In the clinics, the first phase
involved 10 pilot areas where logistics, trained personnel, information and education, and
local support were strong. "It gave us time to get all the pieces of the puzzle into
place," says Patrick Coleman, senior resident adviser of Johns Hopkins
University/Population Communication Services (JHU/PCS) and coordinator for information
materials in the introduction.
In the next phase, the project expanded into more districts. Getting enough people trained
and having sufficient information materials in a timely fashion were important concerns.
DMPA stocks had to be readily available, and an information packet went to each clinic,
including a book for record keeping and materials for clients.
The Philippines experience offers valuable lessons. "Any country planning to
introduce or expand DMPA use should consider having a DMPA task force to ensure
availability of most, if not all, of the things that are needed to have a successful
campaign," says Dr. Rebecca Infantado, head of the Philippine Family Planning
Service.
An important but often overlooked part of an introduction strategy is research on how the
effort is working. About 35,000 women started using DMPA between April 1994 and February
1995, and continuation rates have been very high. An expansion that will offer DMPA
nationwide began this summer. "DMPA might equal pill acceptance," says Dr.
Infantado. "We believe the biggest challenges ahead include managing of perceived and
real side effects and supply and distribution of the contraceptive."
-- William R. Finger and Sarah Keller
Footnote
- Hardee K, Huber D, McIntyre S, et al. Proposed strategy
for the introduction of DMPA into the Philippine family planning program: Prepared for the
Department of Health and USAID/Manila. Unpublished paper. Durham: Family Health
International, 1993.
For more information, visit Family Health International's Website at www.fhi.org
Go to FHI's Network |
Copyright