Successes and challenges in promoting the contraceptive implant in Zambia

The contraceptive implant, a five-year family planning method, is particularly suitable to the Zambian situation in which a majority of the population lives in rural areas and has difficulty accessing medical care due to long distances and poor road and transport networks. Additionally, Zambia faces reoccurring stock-outs of family planning commodities, such as oral contraceptives and the injectable – a situation to which women with the implant become immune for the duration of their use of the method. In 2005, the Zambia Ministry of Health and Health Services and Systems Program (HSSP) thus initiated a program to train various cadres of healthcare providers in the insertion and removal of contraceptive implants. Since the program began, a total of 325 healthcare providers from urban and rural health facilities across Zambia have been trained. Follow-up assessments with providers six weeks post-training have shown that acceptance of implants among clients has been high with a majority of rural clinics maintaining wait lists in order to meet demand. The same factors that make the implant an ideal family planning method for many Zambian women also, however, pose challenges to the implementation of the training and service delivery program. Inconsistent commodity supply chains delay delivery of the implants and infection prevention commodities and the human resource crisis limits the ability of facilities to keep pace with women's needs. This paper examines what factors have led to the successful rollout of the contraceptive implant in Zambia and lessons learnt in addressing the challenges that remain.