Promoting confidence: a case for training CHWs to become social marketers of injectable contraceptives in Ethiopia

Ndola Prata, University of California, Berkeley
Karen Weidert, University of California, Berkeley
Amanuel Guessessew, Tigrai Health Bureau

Incorporating private sector strategies such as willingness-to-pay, social marketing, and drug revolving fund, we designed and tested a sustainable contraceptive service delivery model that used community health workers (CHWs) as rural social marketing agents to distribute injectable contraceptives. Long term availability of commodities, supply and distribution of injectables and reducing CHW attrition were key factors in designing the model. A total of 8,604 women were reached and an estimated 15,410 injectables were administered by CHWs. Using baseline and endline data we found a 25% increase in contraceptive prevalence, with injectable contraceptive use largely responsible for this increase. The majority (87%) of the injectables were paid for at the time of provision, which suggests the drug revolving fund is in a position to sustain itself with partial recovery. The paper addresses unanswered questions regarding affordability and sustainability of supply and distribution mechanisms for increasing access to injectables to remote, resource-poor areas.