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Implant Introduction and Scale-Up: lessons learned, best practices, and opportunities to scale through PSE

Interactive Filing Cabinet

Explore our filling cabinet of resources on programmatic learnings, tips, best practices, and challenges on contraceptive implant introduction and scale-up. Scroll through the different tabs (Implants, LARCs, Implants Task Sharing and Private Sector Engagement) to learn more about these topics and what global and national initiatives have taken place over the years to increase access to implants and other contraceptives.

IMPLANTS

Association between contraceptive implant knowledge and intent with implant uptake among postpartum Malawian women: a prospective cohort study

This cohort study aims to understand the LARC use among postpartum Malawian women, and whether LARC knowledge and intent to use LARC were associated with LARC uptake. The study found that more women reported using implants than intrauterine contraception, with correct implant knowledge and intent to use the implant associated with implant uptake.

Scaling Up Access to Implants: A Summative Evaluation of the Implants Access Program

This article speaks to the Implants Access Program, which increased access to implants for women in low-income countries by addressing price barriers, enhancing supply chain visibility and coordination to limit stock-outs, capacity building in targeted areas and coordination among global and country partners. The program led with 2 volume guarantee agreements that reduced the price of implants by 50% and led to a 10-fold growth in implant procurement from 2010 to 2019 across the world’s 69 poorest countries.

Factors associated with removal difficulties of etonogestrel-containing contraceptive implants (Nexplanon ®)

This study aims to identify risk factors associated with difficult removals. Factors included weight gain among users, placements conducted in private facilities and the duration of the Nexplanon placement. The study concluded that awareness of these risk factors can help physicians identify “at risk patients” and inform safe removals.

Scaling up delivery of contraceptive implants in sub-Saharan Africa: operational experiences of Marie Stopes International

This article touches on the successful scale-up of implants in Sub-Saharan Africa, pointing to key implementation strategies for scale up, such as, focusing on clients with unmet family planning need, demand generation and multi-service delivery channels, high quality service delivery and leverage public and private partnerships. It also touches on provider supply (including leveraging task-sharing); commodity supply chain (to ensure a steady stream of reliable stocks) ; program financing mechanisms and capacity to support implant removal services.

Removing cost and access barriers to contraceptive implants 

This audio clip speaks to the introduction of Sinoplant II, which was registered in 20 countries at a third of the price compared to competitor implants. The price competition allowed for a price drop among other branded implants, allowing for more affordable scale-up.

Expanding Choice & Building Capacity:

Scaling up Implant Services through dedicated providers 

This source shares experiences of scaling up implant services through dedicated providers, specifically midwives in Mali and Zambia, employed by Population Services International. These providers expanded access to services at busy public facilities, through both demand generation and service delivery.

Final Report: Access to Contraceptive Implant Removal
in Ghana 

This final report shares the collaborative work between the Ghana Health Services, Marie Stopes International in Ghana and USAID/Ghana Health team, which assessed the state of accessing removal services for women who received implants through the public sector in Ghana. The study found that although majority of women were able to access removal services within a week of first attempt, social and structural factors act as barriers for some in accessing removal services. The study recommends expanding training on implant provision, to include removal procedures, counselling and management of side effects and sufficient and cost-effective supplies at facilities to conduct removals.

A Mixed-Methods Study of Factors Associated with Implanon Removal in Ethiopia: Final Report

This study reports on barriers that women faced in removing implants. Key barriers included: the absence of service providers and distance to travel to a facility; stock outs; or women forgetting removal date or not having the time to get it removed in a timely manner. Service providers recommend regular/refresher trainings; expanding capacity for HEWs to provide removals; maintenance of Implanon supplies and community awareness to support uptake.

User perspectives on Implanon NXT in South Africa: A survey of 12 public-sector facilities 

This article aims to understand periods of use, reasons for use and early removal f the Implant Implanon NXT after being introduced in South Africa in 2014. The study found that the convenience of using the method was highly linked to continuation among users.

Liftoff: The Blossoming of Contraceptive Implant Use in Africa 

This article shared data from 12 Sub-Saharan African countries, comparing data across three variables, modern contraceptive prevalence rate (mCPR), method-specific prevalence and a method’s share of the current method mix. The article notes a continued effort for quality insertion and removal services, as well as addressing concerns around financing and sustainability.

Strengthening implant provision and acceptance in South Africa with the ‘Any woman, any place, any time’ approach: An essential step towards reducing unintended pregnancies

This article speaks to the any woman, any place, any time approach, which encourages improving service delivery points for better access to LARCs in a range of complementary settings, such as HIV and TB clinics, school health services, existing mobile outreach services, and sex-worker programmes.

Closing the Gap: Ensuring Access to and Quality of Contraceptive Implant Removal Services is Essential to Rights-based Contraceptive Care 

This article notes a decline in uptake of contraceptive implants in South Africa, since its introduction in 2014, suggesting policy and provider interventions that use a “LARC-first approach” to improve uptake.

Implants for HIV prevention in young women: Provider perceptions and lessons learned from contraceptive implant provision

This article shares perceptions of the benefits of pre-exposure prophylaxis (PrEP) and potential misalignment with potential users, impacting the acceptability and uptake of PrEP implants. The article notes the importance of sustained and multi-pronged approaches to training health care workers and in introducing new health technologies.

Introduction of the contraceptive implant in South Africa: Successes, challenges and the way forward 

This article shares research on women’s motivations for using an implant and healthcare providers’ competencies and experiences with service provision in South Africa.

Perceptions matter: Narratives of contraceptive implant robbery in Cape Town, South Africa

This article notes how perceptions of new products can affect uptake of implants and offers important lessons for implementers to reflect on the planning and roll out of health technologies.

Lessons learnt from the introduction of the contraceptive implant in South Africa

This article details the lessons learnt from introducing the subdermal contraceptive implant in South Africa, categorizing lessons learned using WHO’s conceptual framework for the introduction of new contraceptive methods.

​Factors Associated With Delayed Contraceptive Implant Removal
in Ethiopia

This article speaks to Ethiopia’s implant scale-up initiative, implemented in 2009, where implant insertion services were expanded to health extension workers for provision. In Ethiopia, health extension workers cannot perform removals, leaving removals to be referred to higher level facilities. The study aimed to understand whether women were getting their implants removed within the recommended 3-year post insertion date and the barriers to removals that exist. The study found that women who received their implants from health extension workers were more likely to keep their implants for longer than the 3-year post-insertion duration, and faced barriers to removal such as distance to the facility or transportation.

Accessible Contraceptive Implant Removal Services: An Essential Element of Quality Service Delivery and Scale-Up 

This article highlights the importance of preparing for implant removals given the rapid scale-up of implant insertions. The article notes promising efforts that have been taken to support removal, however notes areas of implant removal concerns, such as capacity building and service delivery, data and monitoring and difficult removals.

Implementation science: Scaling a training intervention to include IUDs and implants in contraceptive services in primary care 

This article looks at the scale-up of implants and IUDs using an intervention which consisted of a training course to enhance the skills of members to allow for task-sharing, and increase patient autonomy to access a full range of contraceptives. Training entailed contraceptive ethics- patient-centered counselling of all methods, patient preferences and method removal request, alongside a practicum to address implicit bias and health equity.

Cost per insertion and couple year of protection for postpartum intrauterine devices and implants provided during service scale-up in Kigali, Rwanda

This article details the cost per post-partum (PP) implant insertion (including labour, supplies and promotional activities) and couple years of protection, to help inform the cost of scaling up implant services and activities.

Burkina Faso:

Elargir le choix des méthodes de planification familiale à travers l’amélioration de la qualité des services de retrait des implants contraceptive (FR)

This brief shares the experience of Burkina Faso with expanding family planning method choice through improved implant removals.

Nigeria:

Expanding Family Planning Method Choice through Improved Implant Removals

This brief shares the experience of Nigeria with expanding family planning method choice through improved implant removals.

République Démocratique du Congo:

Elargir le choix des méthodes de planification familiale à travers l’amélioration de la qualité des services de retrait des implants contraceptive (FR)

This brief shares the experience of the Democratic Republic of Congo with expanding family planning method choice through improved implant removals.

Tanzania:

Expanding Family Planning Method Choice through Improved Implant Removals

This brief shares the experience of Tanzania with expanding family planning method choice through improved implant removals.

Peer-reviewed journals

Grey Literature