Introducing Sayana Press into Senegal Method Mix
In Senegal, the modern contraceptive prevalence rate (mCPR) doubled within a decade, rising from 10% in 2005 to 21.2% in 2015. This increase has placed Senegal at the forefront of the international family planning (FP) movement.
The country has adopted a vision for family planning based on what’s knowns as the three Ds—democratization, decentralization, and demedicalization—and has set a very ambitious goal to reach 45% mCPR by 2020.
One of the guiding principles of Senegal’s Ministry of Health and Social Action (MOHSA) is to ensure the availability of a wide range of contraceptive methods at all levels of health service. This involves introducing as many new high-quality contraceptive products as possible both in public health facilities and at the community level.
Introducing new contraceptive products isn’t simple. It takes involved, active stakeholders to first encourage the population to accept the product, then to ensure its availability within health facilities, and finally to promote the effective distribution of the product by health workers. And it really helps if the new product is easy for health workers to administer.
So the Ministry prioritized introducing Sayana Press—an easy-to-use and subcutaneously injected contraceptive.
The successful introduction of Sayana Press was the result of a rich partnership venture that made the method available in all health facilities in four regions of Senegal, including community-level facilities, within a span of two years.
Here’s why it worked:
There was commitment at the highest national level. The Reproductive Health Department developed a National Strategic Plan for Family Planning for 2012-2015, in partnership with technical and financial partners and other ministry entities. All the stakeholders involved in developing and implementing the plan pushed the minister of health to commit to an ambitious goal of achieving an mCPR of 27% by 2015 at the first Family Planning Summit in London in 2012.
It had support from the donor community. Senegal’s family planning commitment garnered significant support from the international community. In 2012, donors—including the United States Agency for International Development (USAID), the Bill & Melinda Gates Foundation, Pfizer Laboratories, and Agence Française de Développement—came together to facilitate the production of Sayana Press in Senegal. This consortium approach enabled Senegal to obtain the product at a lower cost and to mobilize resources for introducing the method.
Senegal leveraged the expertise of several partners to implement and scale up the new method. Three international non-government organizations (NGOs)—PATH, ChildFund, and IntraHealth International—joined forces to rapidly introduce and scale up Sayana Press in Senegal. PATH brought expertise in monitoring and documentation; ChildFund was in charge of introducing the method in the health huts (community-level health service sites in rural areas managed by a community health worker); and at IntraHealth, we were responsible for introducing Sayana Press into public and private health facilities and integrating the product into the national pharmaceutical supply chain.
To make sure health workers throughout all levels of the health system could effectively offer clients Sayana Press—and do so quickly—we took a cascade training approach. IntraHealth worked with the Ministry to develop and implement a sustainable training plan.
First, we developed a pool of national trainers of trainers and created and validated training and post-training tools with this group. Trainers from this pool then trained regional and district core team members as provider trainers. Regional and district management trainers—trained providers to offer the method to clients and these last one trained community health workers.
We also involved private-sector facilities by working through the private doctors’ union and the paramedical providers association to reach and train private providers.
Consortium work has been a constant at all these stages, corroborating the Senegalese saying mbolo moy doole—union is strength.