Injectable contraceptives are popular among women, especially in sub-Saharan Africa. Health officials and providers in a growing number of countries seek to make injectable contraceptives more widely available at the community level through trained paraprofessionals. Studies and field observations have found that community health workers (CHWs) can provide injectables safely and that community access to injectables attracts new contraceptive users.

This guide is designed to assist the many health professionals and advocates who are interested in making injectable contraceptives more widely available, especially for women with little or no access to health facilities. It will also be useful to donors, family planning/reproductive health professionals, and others who may not be directly involved in advocacy but need to understand the process and the rationale for community access to injectable contraceptives.

The guide describes six steps that advocates can take to support policy change to permit CHWs to provide injectables:

1. Form a working group and assess feasibility
2. Collect data and information
3. Plan your strategy
4. Develop advocacy messages and talking points
5. Plan to monitor and evaluate progress
6. Implement the advocacy plan

In most countries, the decision to change health service delivery guidelines is the responsibility of the Ministry of Health (MOH), with advice from professional societies that set medical standards and the drug regulatory authority. Accordingly, advocacy work regarding injectables often consists of informing health professionals, engaging them in dialogue, explaining the importance of community provision, and showing them that it can work. The process is likely to evolve to include new tasks, such as reaching out to additional stakeholders, recruiting policy champions, initiating a demonstration project, and organizing site visits.

Based on experiences in several countries, this guide emphasizes the need to analyze the local setting and policy climate carefully, to focus advocacy work on the key decisionmakers and influential stakeholders, and to be patient and persistent in addressing challenges and delays. At the same time, advocates must be flexible to adapt to changes in the policy environment, such as turnover in key MOH personnel, a new controversy that becomes a topic of public debate, statements by politicians and opinion leaders, and changes in government priorities. When a new opportunity arises, advocates have to be prepared to move quickly to take advantage of the situation.

With its focus on advocacy and policy change, this guide is designed to complement the comprehensive reference materials available to lead program managers and health providers through the implementation process. Implementation of community-based access to injectables begins with determining the feasibility and need for such services and then proceeds to setting them up, including establishing service delivery guidelines, identifying and training community-based distributors, creating supervision and logistics systems, and providing community education.