Lessons from the scale-up of provider-administered and self-injection of DMPA-SC in Nigeria: a landscape assessment.

Background: Nigeria is the seventh-most populous country in the world. Its high fertility rate and unmet need for family planning contribute to the increasing population size. To reduce this gap, the Federal Government of Nigeria, in collaboration with Injectables Access Collaborative and other public and private sector players, introduced the subcutaneous depot medroxyprogesterone acetate (DMPA-SC) to the contraceptive method mix in 2017. We conducted an assessment to document the implementation experiences and best practices from the introduction of provider-administered and self-injection (SI) of DMPA-SC from the perspective of the government and implementing partners across states and federal governments levels from the supply-side. This is meant to serve as a learning resource to provide empirical evidence to help inform the DMPA-SC programming.

Methods: A cross-sectional study design that employed a mixed-method approach to data collection was used for this assessment. Our methods included desk review of existing DMPA-SC implementation documents and key informant interviews conducted on 13 government and implementing partners across states and federal levels. Narrative summarization and graphical trend analysis were used for the presentation of information obtained from document review while Nvivo software (version 12) was used for the analysis of transcripts of the KIIs.

Results: This assessment revealed a positive trend in the use of provider-administered and self-injection DMPA-SC from 2020 to 2023. This was supported by functional policies and guidelines. Implementing the Task Shifting and Task Sharing policy continuously; strengthening referral systems for provider-administered and self-injection DMPA-SC programme; and decentralising family planning services were suggested mechanisms for strengthening DMPA-SC programme implementation in Nigeria. However, funding gaps, human resource constraints, and weak coordination mechanisms impeded DMPA-SC implementation scale up.

Conclusion: This assessment illustrates the influence of an enabling environment and stakeholder commitment on the positive trend in provider-administered and self-injection DMPA-SC uptake in Nigeria. Training service providers and improving funding through the use of innovative financing were recommended as levers for DMPA-SC programme sustainability and service scale-up.