Towards achieving the family planning targets in the African region: a rapid review of task sharing policies

Abstract

Background Expanding access and use of effective contraception is important in achieving universal access to reproductive healthcare services, especially in low- and middle-income countries (LMICs), such as those in sub-Saharan Africa (SSA). Shortage of trained healthcare providers is an important contributor to increased unmet need for contraception in SSA. The World Health Organization (WHO) recommends task sharing as an important strategy to improve access to sexual and reproductive healthcare services by addressing shortage of healthcare providers. This study explores the status, successes, challenges and impacts of the implementation of task sharing for family planning in five SSA countries. This evidence is aimed at promoting the implementation and scale-up of task sharing programmes in SSA countries by WHO. Methodology and findings We employed a rapid programme review (RPR) methodology to generate evidence on task sharing for family planning programmes from five SSA countries namely, Burkina Faso, Cote d’Ivoire, Ethiopia, Ghana, and Nigeria. This involved a desk review of country task sharing policy documents, implementation plans and guidelines, annual sexual and reproductive health programme reports, WHO regional meeting reports on task sharing for family planning; and information from key informants on country background, intervention packages, impact, enablers, challenges and ways forward on task sharing for family planning. The findings indicate mainly the involvement of community health workers, midwives and nurses in the task sharing programmes with training in provision of contraceptive pills and long-acting reversible contraceptives (LARC). Results indicate an increase in family planning indicators during the task shifting implementation period. For instance, injectable contraceptive use increased more than threefold within six months in Burkina Faso; contraceptive prevalence rate doubled with declines in total fertility and unmet need for contraception in Ethiopia; and uptake of LARC increased in Ghana and Nigeria. Some barriers to successful implementation include poor retention of lower cadre providers, inadequate documentation, and poor data systems. Conclusions Task sharing plays a role in increasing contraceptive uptake and holds promise in promoting universal access to family planning in the SSA region. Evidence from this RPR is helpful in elaborating country policies and scale-up of task sharing for family planning programmes.

Facility readiness to remove subdermal contraceptive implants in 6 sub-Saharan African countries

“…As part of a broader movement to promote the use of long-acting reversible contraceptive (LARC) methods, scholars and advocates have been eager to expand access to and use of the contraceptive implant, citing the implant's 5-year duration, high effectiveness, and low levels of user error. 1 , 2 , 3 , 4 Recent work on contraceptive implants has described the past few years as a period of “liftoff” and “blossoming” for implants in sub-Saharan Africa in particular, with population-based survey data showing considerable growth in implant use across an array of sociodemographic groups in that region. 3 In Kenya, for example, implant use grew from 1.7% of married women in 2003 to 18.1% in 2016.…”

Long-Acting Reversible Contraceptive Use by Rural–Urban Residence among Women in Nigeria, 2016–2018

“…While the total fertility rate (TFR) in rural areas is estimated to be about 1.3 times compared to urban areas, the modern contraceptive use, on the other hand, is higher in urban areas compared to rural areas (18.2% vs. 7.8%, respectively) [ 16 , 17 ], thus highlighting a higher unmet need for modern contraception for women in rural areas. With task shifting in contraceptive service provision for women in resource-constrained settings evolving, it is expected that many lower cadre staff will be trained and deployed to rural areas to scale LARC provision [ 16 , 18 , 19 ]. This likely explains the increased uptake of LARCs among women in rural areas in our study.…”

Removal of a well-palpable one-rod subdermal contraceptive implant using a dedicated hand-held device or standard technique: a randomized, open-label, non-inferiority trial

“…The insertion technology enables lower-level health workers in many regions of the world to provide services; an easy-to-use removal device can do the same. These paired technologies can help expand access to long-acting reversible contraception ( Shelton and Burke, 2016 ) through task sharing ( Ouedraogo et al , 2021 ) to help achieve the ambitious goals of providing family planning information, services and supplies to an additional 120 million women and girls in 69 of the world’s poorest countries ( FP2020, 2021 ).…”