Task Sharing of Injectable Contraception Services in Pakistan: A Randomized Controlled Trial

Area of Science:

• Reproductive Health
• Public Health
• Health Services Research

Background:

• Injectable contraceptives are crucial for family planning.
• Lay health workers (LHWs) are increasingly involved in delivering health services.
• Ensuring quality of care by LHWs for injectable contraceptives requires rigorous evaluation.

Purpose of the Study:

• To compare the performance of LHWs and clinically trained family welfare workers (FWWs) in providing depot medroxyprogesterone acetate (DMPA) services.
• To assess appropriate screening, counseling, and injection techniques for DMPA administration by different provider types.
• To evaluate the impact of service delivery context (urban vs. rural) on provider performance.

Main Methods:

• A randomized controlled trial was conducted comparing LHWs and FWWs.
• Data collected on screening, counseling, and injection techniques for DMPA.
• Urban (n=355) and rural (n=105) samples of providers and clients were included.
• Noninferiority tests were used to compare provider performance.

Main Results:

• In urban settings, FWWs screened clients more appropriately (88%) than LHWs (77%).
• In rural settings, both provider types achieved over 90% appropriate screening.
• LHWs demonstrated noninferiority to FWWs in appropriate counseling (p=0.003).
• LHWs exhibited superior injection technique compared to FWWs.

Conclusions:

• LHWs can effectively provide DMPA services, particularly in counseling and injection technique.
• The effectiveness of LHWs in screening may be influenced by the service delivery context.
• Further research is needed to optimize LHW training and support for screening processes.