Insights from Ethiopia’s Learning Visit to Nigeria on DMPA-SC Self-Injection

In January 2024, a delegation of Ethiopian health specialists, including representatives from the Ministry of Health, Population Services International (PSI) Ethiopia, and the Ethiopian Society of Obstetricians and Gynecologists (ESOG), visited Nigeria to learn about the implementation and scale-up of DMPA-SC self-injection (SI). The visit aimed to gather insights and best practices that could inform Ethiopia's own efforts to introduce and expand the use of DMPA-SC for self-injection, an initiative that has been in the exploratory phase since early 2020.

Depot medroxyprogesterone acetate subcutaneous (DMPA-SC) is a contraceptive injection administered under the skin. It is a lower-dose alternative to the traditional intramuscular (IM) DMPA injection, with 104 mg compared to 150 mg. DMPA-SC is delivered through a prefilled, ready-to-inject system, making it convenient for self-administration and community-based distribution. This method is not only safe and highly effective in preventing pregnancy but also has the potential to significantly improve contraceptive access and method choice for women, especially in underserved areas.

Nigeria's successful integration of DMPA-SC SI into their national family planning program offers valuable lessons for Ethiopia. Nigeria, like Ethiopia, faces challenges such as diverse populations, natural disasters, internal conflicts, and disease outbreaks. Despite these challenges, Nigeria has made significant progress in expanding contraceptive options and improving access to sexual and reproductive health care by adopting and implementing WHO’s Self-Care Guidelines.

During the visit, the Ethiopian delegation observed the practical application of DMPA-SC SI in various settings, including policy formulation, stakeholder engagement, training, and service delivery. The key takeaways from the visit include:

Nigeria’s success underscores the importance of a favorable policy environment and strong advocacy efforts. The development and endorsement of national self-care guidelines and task-shifting policies were critical to the scale-up of DMPA-SC SI. Engaging a wide range of stakeholders, including government agencies, NGOs, and professional associations, was essential for coordinated efforts and sustained progress.

Nigeria implemented standardized training curricula and low-cost training approaches, training over 29,000 providers across various states. Integrating DMPA-SC into national family planning training curricula ensured that providers were well-equipped to support self-injection. DMPA-SC was integrated into routine forecasting and quantification processes, and distributed to all state stores. Effective service delivery was supported by robust monitoring systems, including data collection and analysis through national health information systems.

Tailored social and behavior change communication materials were developed to increase awareness and acceptance of DMPA-SC. These efforts were crucial in driving demand and ensuring high continuation rates among users. Proper disposal of used DMPA-SC units was emphasized, with recommendations for puncture-proof containers and appropriate disposal methods to ensure safety and environmental protection.

Ethiopia is poised to benefit greatly from the insights gained during the learning visit to Nigeria. By adopting similar strategies, Ethiopia can enhance its family planning services, particularly through the introduction and scale-up of DMPA-SC SI. The Ethiopian Ministry of Health, in collaboration with partners like PSI and ESOG, is committed to creating a supportive policy environment, building provider capacity, engaging stakeholders, and developing effective monitoring and demand generation strategies.

The Ethiopian Society of Obstetricians and Gynecologists (ESOG) is committed to playing a pivotal role in the introduction and scale-up of DMPA-SC SI in Ethiopia. ESOG will focus on advocacy efforts to ensure a favorable policy environment, provide training and capacity-building support to healthcare providers, and contribute to the development of tailored educational materials. By leveraging its expertise and networks, ESOG aims to promote the adoption of self-care practices and improve access to contraceptive options for women across Ethiopia.

The learning visit to Nigeria provided invaluable insights that will guide Ethiopia in enhancing its family planning services through the introduction of DMPA-SC self-injection. With the collaborative efforts of the Ministry of Health, PSI, ESOG, and other stakeholders, Ethiopia is well-positioned to expand access to contraception, improve health outcomes, and empower women to take charge of their reproductive health.

The Transformative Power of Self-Care for Women's Health in Ethiopia

We are thrilled to see the recent approval of the national self-care guideline by the Ministry of Health. This landmark policy has the potential to revolutionize how women engage with and manage their health. Self-care empowers women to take charge of their wellbeing, leading to improved health outcomes and stronger health systems.

Self-care encompasses a wide range of health-related activities that individuals can perform for themselves, with or without the support of a health worker. For women, self-care can include practices such as self-monitoring, self-testing, and self-medication. By providing women with the knowledge, tools, and confidence to manage their own health, self-care promotes gender equity and enables women to become active agents in their healthcare.

One of the key benefits of self-care is its ability to improve access to essential health services, especially for women in rural and underserved areas. By reducing the need for frequent visits to healthcare facilities, self-care frees up resources and allows health workers to focus on more complex cases. This is particularly important in Ethiopia, where the healthcare system faces challenges in reaching all segments of the population.

Recent studies have shown that targeted interventions can significantly improve self-care practices among women with chronic conditions like diabetes and hypertension. Factors such as social support, access to information, and self-care education play a crucial role in promoting healthy behaviors. By addressing these factors and empowering women with the necessary knowledge and skills, we can help them better manage their health and prevent complications.

To fully realize the benefits of self-care, it is essential to integrate it seamlessly into the existing health system. This requires collaboration between healthcare providers, policymakers, and women themselves. Healthcare providers must be trained to support and guide women in their self-care practices, while policymakers need to ensure that self-care solutions are affordable, accessible, and aligned with national health priorities.

The approval of the national self-care guideline in Ethiopia marks a significant step towards empowering women and improving their health outcomes. By embracing self-care, we can help women take control of their health, reduce the burden on the healthcare system, and work towards achieving universal health coverage. As women's health specialists, it is our responsibility to champion self-care and ensure that every woman in Ethiopia has access to the knowledge, tools, and support she needs to thrive.

ESOG's planned contribution in this endeavor is multi-faceted. We are committed to continuing our advocacy efforts to ensure that self-care remains a central component of women's healthcare policies and programs in Ethiopia. Additionally, we will work closely with healthcare providers and partners to strengthen their capacity to support and guide women in adopting self-care practices. Through our training programs, community outreach initiatives, and collaboration with stakeholders, ESOG will strive to empower women across Ethiopia with the knowledge, tools, and resources they need to embrace self-care and lead healthier lives. Together, we can make self-care a cornerstone of women's health empowerment in Ethiopia.