Three Questions with Erin McGinn: Advocating for Task Sharing and Self-Care for Family Planning

Three Questions with Erin McGinn: Advocating for Task Sharing and Self-Care for Family Planning

Erin McGinn, M.A., has worked in international family planning and reproductive health for over 20 years, translating innovations and best practices into policies and programs. At Palladium, a program partner in the HRH2030 consortium, she is a director in the Health Practice, where she contributes to both the HRH2030 and HP+ projects. Ms. McGinn is passionate about women’s rights, positive youth development, expanding the contraceptive method mix, and translating evidence into action. Her diverse areas of work include publications on the Supply, Enabling Environment, Demand (SEED) model for family planning programming, social accountability in family planning/reproductive health, and provider-initiated family planning within HIV services.

Erin and her colleague, Sara Stratton, are the authors of a new HRH2030 Technical Report, National Family Planning Guidelines in 10 Countries: How they align with current evidence and WHO recommendations on task sharing and self-care.

 Question 1: The global Family Planning 2020 initiative (FP2020) sets a goal of having 120 million additional women using modern contraceptives by this year—a goal that will likely be hard to attain. Can you provide some context to the obstacles in reaching this goal, particularly in the role that the health workforce plays in access to family planning?

We are not going to reach our FP2020 goals without reducing barriers women face in accessing contraception. These barriers can be social, financial, environmental, or related to the health system. One of the most unnecessary, and perhaps easiest to address, of the health system barriers, is when policies limit who can provide which method, because this constricts access. We already have an intense health worker shortage in most places, and specialized providers are usually concentrated in urban areas, leaving many women, particularly in rural areas, without routine access to doctors, and sometimes even nurses or midwives.

The good news is that decades of research and international global guidance confirms that providing most family planning methods, particularly some of the most commonly used ones (such as pills, injectables, and implants), is not that complicated and extremely safe. As such, countries should be adopting policies, regulations, and service delivery strategies that expand the types of health care workers who can provide family planning methods, particularly those with less training, such as auxiliaries and community health workers; this expansion is called task sharing. Likewise, there is increased focus on self-care in health – supporting the ability of individuals, families, and communities to promote and maintain their own health. In the field of family planning, examples of self-care include self-injection of the contraceptive called Sayana Press (DMPA-SC), and advance provision of oral contraceptive pills and emergency contraceptive pills or having these methods accessible on demand through pharmacies. Self-care can remove health systems barriers and ensure women have safe and effective access to FP methods when they need and want it. 

Adopting task sharing and self-care approaches within a national family planning program has the potential to increase access and convenience, support method continuation, and save money – these are essential program approaches to help us meet our FP2020 goals.

Question 2: The new report looked at how 10 different countries have adopted—or have lagged behind in adopting—policies, service delivery guidelines, or other government guidance in line with scientific evidence and WHO guidelines on task sharing and self-care. Tell us about one country that’s doing well in this area and one country that is lagging behind, what your research shows, and the impact on the delivery of family planning services in each of these countries.

The report is based on national policies and guidelines that were obtained through a web search and informal inquiries and as such, one limitation is that we could only analyze the documents we were able to obtain. It is possible an in-country assessment would have different results. In the next phase of this work, we plan to do a deeper dive with an in-country assessments in two countries.

For this study, we found that most countries were progressing towards task sharing and self-care, and in particular, newer policies and guidelines were, for the most part, in-line with international guidance. Some countries had uneven approaches to task sharing or self-care. For instance, Uganda is piloting self-injection of Sayana Press (DMPA-SC), but it doesn’t permit auxiliary nurses to provide implants – so for some methods Uganda is a leader, and in others, a laggard. Malawi has also been a leader in adopting task sharing and self-care, but we could only document this through informal sources – their family planning guidelines and related documents reviewed did not clearly address which health cadres can provide which family planning methods.

The West African countries we looked at, Burkina Faso, Côte d’Ivoire, and Mali, have made great strides in adopting international guidelines on task sharing and self-care, likely due to task sharing being a cornerstone commitment of the Ouagadougou Partnership in francophone West Africa, where historically, family planning has been highly medicalized.

Philippines seems to be the outlier, in that task sharing didn’t seem to be part of its strategy for family planning service delivery. It relies heavily on their midwife cadre and so there is room for Philippines to consider more task sharing and self-care options in its family planning program.

Question 3: One of the recommendations in the report is that countries could strengthen their national family planning guidelines by integrating pharmacies and drug shops within the guidance documents. Why is this important and how would this make a difference?

There are many reasons why we should be working with pharmacies and drug shops more to increase access to family planning. In many places, a drug shop or pharmacy is the first point of access for people accessing health care, and depending on the country, they may be more abundant or in more remote areas than health facilities.

Many family planning methods (condoms, pills, emergency contraception, injectables, diaphragms, standard days method beads) can be easily stocked and sold through pharmacies and drug shops, and require minimal training to counsel and provide, particularly for re-supply. As such, these service delivery outlets have the potential to increase convenience and access for clients, potentially freeing up health facilities to focus on providing the more clinical family planning methods such as IUDs, implants, tubal ligation, or vasectomy.

In many places, women and men are already accessing these short-acting methods from pharmacies and drug shops, but our paper found these outlets are not really being leveraged as part of national family planning guidelines. Integrating pharmacies and drug shops more purposefully into national family planning strategies and guidelines will help a country maximize all available resources to meeting the contraceptive needs of its people and increase access for clients.

Photo: Erin McGinn is a director in Palladium’s Health Practice, where she contributes to the HRH2030 program.