Search

While community-based interventions are a proven high-impact strategy to increase contraceptive uptake in low-income countries, their capacity to support women’s contraceptive choices (including continued use, switching and discontinuation) in the long run remains insufficiently discussed. This cohort study follows 883 women 3 and 6 months after they received a modern method during community campaigns organized in Kinshasa (D.R. Congo), to analyze their contraceptive trajectories and the factors associated with ever discontinuing contraceptive use in the first 6 months following a campaign. In the community-based distribution (CBD) model currently institutionalized in DRC, campaign clients are not provided with additional doses or support, besides baseline counseling, to (dis-)continue using the method they received, but must rely on Family Planning resources within the existing local health system. Almost a third (28.9%) of all women discontinued modern contraception during the study period, with much higher discontinuation rates for short-acting methods (38.7% for pills and up to 68.9% for DMPA-SC). Variables previously associated with high discontinuation (marital status, fertility intentions and side-effects) led to higher odds of “ever discontinuing”. However, these variables became non-significant when controlling for resupply issues. Women’s self-reported reasons for discontinuation confirmed the multivariate regression results. Detailed sub-analysis of resupply issues for pills, injectables and Cyclebeads pointed to the role of cost, unreliable campaign schedules and weak integration of community-based strategies into the formal health system. Extremely low rates of implants removal suggest similar access to FP services issues. The study highlights the need to identify CBD strategies best suited to support women’s choices and preferences towards successful contraceptive trajectories in fragile health systems.

Background: Male partner’s approval is a key determinant of contraceptive use for women living in Sub-Saharan Africa and improving men’s support and couple communication is a cornerstone of family planning programs. However, approval is often only measured through the women’s perception of their partner’s opinion.Methods: This study conducted in Kinshasa compares contraceptive approval variables from matched male and female partners to establish the frequency of (in)accurate perceptions by the woman, then test their association with modern contraceptive use. Additional regressions estimate individual and couple variables associated with (in)correct perceptions. Results: Results confirm women are poorly aware of their partner’s opinion but indicate that perceived approval or disapproval by the woman is a much stronger determinant of modern contraceptive use than her partner’s actual opinion. Higher educational achievement from the woman is the strongest driver of misunderstanding her partner’s approval. Conclusions: Women’s perceptions of partner’s approval are much stronger determinant of contraceptive use than the latter’s actual opinion, and stereotyping men’s opinion of family planning is a common error of appreciation. However, findings also suggest these misunderstandings might serve women’s capacity to negotiate contraceptive use.

In Kinshasa, Democratic Republic of the Congo (DRC), modern contraceptive prevalence is low by international standards: 29.6% as of 2020. A 2015 pilot study demonstrated the feasibility and acceptability of using medical and nursing students to administer DMPA-SC (the subcutaneous injection) among other methods at the community level. The more far-reaching discovery was the potential of clinically trained students to increase access to low-cost contraception in the short-run, while improving the quality of service delivery for future generations of healthcare providers. Scale-up involved integrating the family planning curriculum into the training of nursing students, including classroom instruction in contraceptive technology and service delivery, coupled with a year-long field practicum in which students offered a range of contraceptive methods during intermittent outreach events, door-to-door distribution or sales from their homes. Starting in 2015, a multi-agency team consisting of an international non-governmental organizations (NGO), several Ministry of Health directorates and a local NGO used the ExpandNet/WHO framework to guide this scale-up. This article details the nine steps in the scale-up process. It presents results on increases in contraceptive uptake, feedback from participating nursing school personnel and the employment experience of the graduates from this programme. Between 2015 and 2019, the family planning curriculum was incorporated into 30.8% of the 477 nursing schools in 7 of the 26 provinces in the DRC. Students delivered 461 769 couple-years of protection (the key output indicator for family planning programmes). Nursing school personnel were strongly favourable to the approach, although they needed continued support to adequately implement a set of additional interventions related to the service delivery components of the new training approach. Post-graduation, only 40.1% of graduates had paid employment (reflecting the staggering unemployment in the DRC); among those, over 90% used their family planning training in their work. We describe the multiple challenges faced during the scale-up process and in planning for expansion to additional schools.

Background Clients must recall information from contraceptive counseling sessions to properly use their chosen method. Client recall in community-based settings is challenging given the public nature of these events and the presence of many potential distractions. Understanding the factors that influence client recall during community-based distribution events can guide future training of providers to improve proper use of contraceptive methods and client satisfaction. Methods This cross-sectional study employed a convenience sample of 957 women ages 15–49 old who sought contraceptive services from community-based contraceptive distribution events in Kinshasa, Democratic Republic of the Congo, known as Lelo PF. Recall scores were developed by matching direct observations with client exit interviews. The association between recall and client characteristics, provider characteristics and an index for the quality of the provider-client interaction were tested using multivariate linear regression. Results The average recall score was 67.6%. Recall scores were higher among clients who accepted methods with simpler administration procedures, such as CycleBeads (81.3%), compared to methods requiring more medically advanced administration procedures, such as DMPA-SC (56.6%) and Implanon-NXT (62.1%). This relationship held even after controlling for amount of information each client received. Status as a first-time user was associated with a 5.8 percentage point decrease in recall score (p = 0.002). Time since the provider’s initial family planning training and clients’ perception of the provider-client interaction were associated with higher client recall scores. Conclusion Results of this study suggest that to improve client recall at Lelo PF events, future provider training should focus on how to deliver clear, specific information to clients, making sure clients feel at ease during the counseling session, and treating clients with respect. First-time family planning users and clients who select methods with more medically advanced administration procedures may require extra attention during the consultation to ensure they are able understand and remember the information. Results suggest that providers who have been offering services longer may be more effective in conveying information in a way that clients can remember. Program managers should consider requesting input from experienced providers to improve training sessions.

In a context where distance, user fees, and health staff shortages constitute significant barriers to accessing facility-based family planning services, the use of community-based distributors (CBDs) as counseling and contraceptive providers has been tested in several resource-constrained environments to increase family planning uptake. In the capital city of the Democratic Republic of the Congo (DRC), Kinshasa, a massive CBD program (AcQual) has been implemented since 2014, with lackluster results measured in terms of the low volume of contraceptives provided. A process evaluation conducted in 2017 assessed the fidelity of implementation of the program compared with the original AcQual design and analyzed gaps in provider training and motivation, contraceptive supplies, and reporting and monitoring processes. Its objective was to identify both theory and implementation failures in order to propose midcourse corrections for the program. The mixed-method data collection focused on the CBDs as a pivotal component of the AcQual program with 700 active CBDs interviewed. In addition, 10 in-depth interviews were conducted with clinical personnel, local health program managers, and project partners to identify gaps in the AcQual implementation environment. Issues with CBDs' performance, knowledge retention, and commitment to program activities, as well as gaps in contraceptive supply chains and insufficient monitoring and supervision processes, were the main implementation failures identified. Inappropriate method mix offered by the CBDs (condoms, pills, and CycleBeads only) and chronic overburdening of health care staff at the local level compounded these issues and explained the low volume of contraceptives provided through AcQual. Midcourse corrections included a more structured schedule of activities, stronger integration of CBDs with clinical providers and health zone managers, expansion of the mix of contraceptives offered to include subcutaneous injectables and emergency contraceptive pills, and clarifying reporting and monitoring responsibilities among all partners. Findings from this process evaluation contribute to the limited knowledge base regarding "unwelcome results" by examining all the intervention components and their relationships to highlight areas of potential failures, both in design and implementation, for similar CBD programs.

Background: Spatial access has a direct effect on health service utilization in many settings. While, all elements of access are usually affected by service delivery points and client characteristics. Distance to facility has proven to affect family planning service use in many Sub-Saharan countries. Studies show that women who reside closer to facilities offering family planning services are more likely to use modern contraceptives. However, researchers often test the theory of distance decay to observe any association between an increased distance of health facilities and health service utilization. This study to analyze the significance of proximity to family planning (FP) services, as well as service availability and quality of family planning services in Kinshasa. Methods: We used a pool of four rounds of facility- and population-based survey data in Kinshasa. We tested if women who live closer to service delivery points with higher level of availability and quality are more likely to use modern contraceptives or less likely to have unmet need for contraceptive services. Results: Our findings show that living closer to an SDP is not a determinant of modern contraceptive use or having unmet need for FP services. Discussion: Lack of cognitive access, economic barriers, bypassing the closest facility, and sociocultural norms are among the strong barriers for women in Kinshasa not to use modern contraceptives. Our analysis shows that proximity to quality services does not necessarily result in increased FP use among women of reproductive age living in Kinshasa, thus suggesting that a bypass phenomenon may occur when obtaining modern contraceptive services. Conclusion: This study indicates that proximity to facilities does not necessarily equate proximity to methods, nor does it necessarily enable current users or women with an unmet need (potential contraceptive users) to easily obtain services for their method of choice. This study notes that other barriers to access may be substantial determinants of contraceptive use or unmet need. More research should be conducted that directly measures multidimensional components of access in order to interpret women’s contraceptive seeking behaviors in urban areas of Sub-Saharan Africa.

BackgroundEvidence suggests that the single-disease paradigm does not accurately reflect the individual experience, with increasing prevalence of chronic disease multimorbidity, and subtle yet important differences in types of co-occurring diseases. Knowledge of multimorbidity patterns can aid clarification of individual-level burden and needs, to inform prevention and treatment strategies. This study aimed to estimate the prevalence of multimorbidity in Jamaica, identify population subgroups with similar and distinct disease profiles, and examine consistency in patterns identified across statistical techniques.MethodsLatent class analysis (LCA) was used to examine multimorbidity patterns in a sample of 2,551 respondents aged 15-74 years, based on data from the nationally representative Jamaica Health and Lifestyle Survey 2007/2008 and self-reported presence/absence of 11 chronic conditions. Secondary analyses compared results with patterns identified using exploratory factor analysis (EFA).ResultsNearly one-quarter of the sample (24.1%) were multimorbid (i.e. had ≥2 diseases), with significantly higher burden in females compared to males (31.6% vs. 16.1%; pConclusionThis first study of multimorbidity in the Caribbean has revealed a high burden of co-existing conditions in the Jamaican population, that is predominantly borne by females. Consistency across methods supports the validity of patterns identified. Future research into the causes and consequences of multimorbidity patterns can guide development of clinical and public health strategies that allow for targeted prevention and intervention.

Background Kinshasa is Africa's third largest city and one of the continent’s most rapidly growing urban areas. PMA2020 data showed that Kinshasa has a modern contraceptive prevalence of 26.5% among married women in 2018. In Kinshasa’s method mix, the contraceptive implant recently became the dominant method among contraceptive users married and in union. This study provides insight into patterns of implant use in a high-fertility setting by evaluating the 24-month continuation rate for Implanon NXT and identifying the characteristics associated with discontinuation. Methodology This community-based, prospective cohort study followed 531 Implanon users aged 18–49 years at 6, 12 and 24 months. The following information was collected: socio-demographic characteristics, Method Information Index (MII) and contraceptive history. The main outcome variable for this study was implant discontinuation. The incidence rate of discontinuation is presented as events per 1000 person/months (p-m), from the date of enrolment. The Cox proportional hazards modelling was used to measure predictors of discontinuation. Results A total of 9158.13 p-m were available for analysis, with an overall incidence rate of 9.06 (95% CI: 9.04–9.08) removals per 1000 p-m. Of nine possible co-variates tested, the likelihood of discontinuation was higher among women who lived in military camps, had less than three children, never used injectables or implants in the past, had experienced heavy/prolonged bleeding, and whose MII score was less than 3. Conclusion In addition to four client characteristics that predicted discontinuation, we identified one programmatic factor: quality of counseling as measured by the Method Information Index. Community providers in similar contexts should pay more attention to clients having less than three children, new adopters, and to clients living military camps as underserved population, where clients have less access to health facilities. More targeted counselling and follow-up is needed, especially on bleeding patterns.

Methods for the evaluation and comparison of the structure of numerous honeybee colonies are needed for the development of applied and fundamental field research, as well as to evaluate how the structure and activity of honeybee colonies evolve over time. ColEval complements existing methods, as it uses an online reference image bank for (human) learning and training purposes. ColEval is based on the evaluation of the surface area percentage occupied by different components of a honeybee colony: adult worker bees, open and capped brood, honey, nectar, and pollen. This method is an essential tool for the description of the evolution in the size of honeybee colonies. The procedure makes allowances for tendencies between different observers and uses them to calculate accurate measurements of honeybee colony evaluation. ColEval thus allows for a posteriori comparison of under- or over-evaluation made by different observers working on the same project, it is thus possible to eliminate observer bias in the measurements and to conduct large surveys.

Expanding access to family planning (FP) is a principal objective of global family planning efforts and has been a driving force of national family planning programs in recent years. Many country programs are working alongside with the international family planning community to expand access to modern contraceptives. However, there is a challenging need for measuring all aspects of access. Measuring access usually requires linking information from multiple sources (e.g., individual women and facilities). To assess the influence of access to family planning services on modern contraceptive use among women, we link four rounds of individual women and service delivery points survey data from PMA2020 in Kinshasa. Multilevel logistics regression on pooled data is performed to test the influence of facility-level access factors on individual-level contraceptive use. We add variables tailored from a conceptual framework to cover elements of access to family planning: administrative access, geographic or physical access, economic access or affordability, cognitive access, service quality, and psychological access. We find that the effect of community and facility-level access factors varies extensively but having fewer stocked-out facilities and more facilities with long-acting permanent methods (LAPM) increases the odds of using modern contraceptives among women in Kinshasa. Our study shows that reliable supply chain with a broad array of method mix will increase the odds of modern contraceptive use at community level among women in Kinshasa. Using to community-oriented practices and service delivery along with empowering women to make health-related decisions should become a priority of family planning programs and international stakeholders in the country.

Despite the commitment of the Democratic Republic of the Congo (DRC) to expand the family planning method mix and increase access to services, awareness of emergency contraception is low among women, and the method remains underused and poorly integrated in family planning programming.Data from 15 focus group discussions conducted in 2016 among women aged 15-35 were used to examine awareness and perceptions of, and attitudes toward, emergency contraceptives. After facilitators explained emergency contraceptive pills' mechanism of action and other characteristics, participants were asked about the potential benefits and risks of making the method more widely available. Transcripts were analyzed using an iterative approach.Women reported employing a wide range of postcoital contraceptive behaviors, albeit often using inappropriate products, and generally agreed that emergency contraceptive pills seemed to be a potentially effective solution to their family planning needs. Perceived benefits and limitations of the method were almost always framed in reference to other, better-known contraceptives, and women expressed strong preferences for pharmacy-based provision that aligned with their usual behaviors for obtaining contraceptives. Participants were reluctant to see the method available for free.Emergency contraceptive pills have the potential to address gaps in the family planning method mix in the DRC. Assessing whether women have incomplete or erroneous information about family planning methods can provide better understanding of women's contraceptive choices in low-income countries.Contexto: A pesar del compromiso de la República Democrática del Congo (RDC) de expandir la mezcla de métodos de planificación familiar y aumentar el acceso a los servicios, el conocimiento sobre la anticoncepción de emergencia es bajo entre las mujeres, y el método continúa siendo subutilizado y deficientemente integrado a los programas de planificación familiar. Métodos: Se usaron datos provenientes de debates en 15 grupos focales conducidos en 2016 con mujeres en edades de 15–35 años, para examinar conocimientos, percepciones y actitudes en relación con los anticonceptivos de emergencia. Después de que los facilitadores explicaron el mecanismo de acción de las píldoras anticonceptivas de emergencia y otras características, se preguntó a las participantes sobre los beneficios y riesgos potenciales de aumentar la disponibilidad del método. Las transcripciones se analizaron utilizando un enfoque iterativo. Resultados: Las mujeres reportaron estar usando una amplia variedad de conductas anticonceptivas posteriores al coito, aunque con frecuencia utilizando productos inapropiados, y en general, estuvieron de acuerdo en que las píldoras de anticoncepción de emergencia parecían ser una solución potencialmente efectiva para sus necesidades de planificación familiar. Las percepciones acerca de los beneficios y limitaciones del método estuvieron casi siempre enmarcadas con referencia a otros métodos más conocidos, y las mujeres expresaron fuertes preferencias por la provisión a través de farmacias, lo cual coincide con sus conductas usuales en la obtención de anticonceptivos. Las participantes mostraron dudas respecto a que el método estuviera disponible de forma gratuita. Conclusión: Las píldoras de anticoncepción de emergencia tienen el potencial de dar respuesta a las brechas en la mezcla de métodos de planificación familiar en la RDC. Evaluar si las mujeres tienen información incompleta o errónea sobre los métodos de planificación familiar puede proporcionar una mejor comprensión acerca de sus preferencias en materia de anticonceptivos en los países de bajos ingresos.Contexte: Malgré l'engagement pris par la République démocratique du Congo (RDC) d'élargir son éventail de méthodes de planification familiale et d'accroître l'accès aux services, la sensibilisation à la contraception d'urgence est faible parmi les femmes et la méthode reste sous-utilisée et mal intégrée dans la programmation de la planification familiale. Méthodes: Les données obtenues de 15 discussions de groupe menées en 2016 parmi des femmes âgées de 15 à 35 ans ont servi à l'examen de la sensibilisation aux contraceptifs d'urgence, ainsi que des perceptions et des attitudes à leur égard. Après leur avoir expliqué le mode d'action et d'autres caractéristiques de la pilule contraceptive d'urgence, les animateurs ont invité les participantes à parler des avantages et des risques potentiels d'un accès plus large à la méthode. Les transcriptions ont été analysées selon une approche itérative. Résultats: Les femmes ont fait état de divers comportements contraceptifs post-coïtaux, utilisant cependant souvent des produits inappropriés. Elles ont généralement convenu que la pilule contraceptive d'urgence semble offrir une solution potentiellement efficace à leurs besoins de planification familiale. Les avantages et inconvénients perçus de la méthode sont presque toujours comparés en référence à d'autres contraceptifs mieux connus et les femmes ont exprimé de nettes préférences pour une prestation en pharmacie, conforme à leurs comportements habituels d'obtention de la contraception. Les participantes se sont montrées réticentes à l'idée d'une disponibilité gratuite de la méthode.La pilule contraceptive d'urgence offre le potentiel de combler les lacunes de l'éventail de méthodes de planification familiale en RDC. Il est possible de mieux comprendre les choix contraceptifs des femmes dans les pays à faible revenu en évaluant si elles sont informées de manière incomplète ou erronée sur les méthodes de planification familiale.

Despite the prominence of informal drug shops as sources of contraceptives in Kinshasa, Democratic Republic of the Congo, evidence on the quality of services they provide is scant. Given efforts to leverage the private sector to increase contraceptive access, evaluating the contraceptive knowledge, attitudes and practices of these providers is warranted.In April-May 2018, a mystery client study on the provision of emergency contraception (EC) was conducted in 854 informal drug shops in Kinshasa. Twelve mystery clients, presenting as younger or older than 18 and married or unmarried, visited the outlets to request something to "avoid getting pregnant" after unprotected sex, and to purchase the recommended medicine. Frequencies of key outcomes were calculated, and chi-square testing assessed associations between client age and marital status and the methods and counseling received.Overall, providers recommended EC in 77% of visits, and in 54% of visits, clients left with the method. In 62% of the visits in which providers recommended EC, they specified a time frame for taking the pill; the correct window of efficacy was indicated in 75% of these visits. In 18% of visits, other (noncontraceptive) drugs were provided, and in 7% of visits, providers did not help the client. Regardless of the visit outcome, providers were nearly always deemed respectful (96%).Leveraging informal outlets to increase contraceptive provision will require identifying quality outlets, strengthening supply chains and advocating for policy changes that recognize them as effective contraceptive providers without decreasing their perceived advantages for women.RESUMEN Contexto: A pesar de la importancia de las farmacias informales como fuente para obtener anticonceptivos en Kinshasa, República Democrática del Congo, la evidencia sobre la calidad de los servicios que prestan es escasa. Ante los esfuerzos para aprovechar al sector privado con el fin de aumentar el acceso a los anticonceptivos, se justifica evaluar los conocimientos, las actitudes y las prácticas anticonceptivas de esos proveedores. Métodos: Entre abril y mayo de 2018, se realizó un estudio de cliente simulado acerca de la provisión de anticoncepción de emergencia (AE) en 854 farmacias informales en Kinshasa. Doce clientas simuladas que se presentaron como menores o mayores de 18 años y como casadas o solteras, visitaron los puntos de venta para solicitar algo para “evitar quedar embarazadas” después de haber tenido relaciones sexuales sin protección y para comprar el medicamento recomendado. Se calcularon las frecuencias de los resultados clave, y las pruebas de chi-cuadrado evaluaron las asociaciones entre la edad de la clienta, el estado conyugal, los métodos y el asesoramiento recibido. Resultados: En general, los proveedores recomendaron AE en el 77% de las visitas; y, en el 54% de las visitas, las clientas llevaron el método. En el 62% de las visitas en las cuales los proveedores recomendaron AE, especificaron el tiempo adecuado para tomar la píldora; el 75% indicó la ventana correcta de eficacia en esas visitas. En el 18% de las visitas, se proporcionaron otros medicamentos (no anticonceptivos) y en el 7% de las visitas, los proveedores no ayudaron a la clienta. Independientemente del resultado de la visita, se consideró que los proveedores casi siempre fueron respetuosos (96%). Conclusiones: Aprovechar los puntos de venta informales para aumentar la provisión de anticonceptivos requerirá identificar puntos de venta de calidad, fortalecer las cadenas de suministro y abogar por cambios en las políticas que los reconozcan como proveedores efectivos de anticonceptivos sin disminuir sus ventajas percibidas para las mujeres.RÉSUMÉ Contexte: Malgré l'importance des dépôts de vente de médicaments informels en tant que sources de contraceptifs à Kinshasa (République démocratique du Congo), il n'existe guère de données sur la qualité de leurs services. Étant donné les efforts déployés pour mettre le secteur privé à contribution dans l‘élargissement de l'accès à la contraception, l‘évaluation de la connaissance, des attitudes et des pratiques de ces prestataires à son égard est justifiée. Méthodes: En avril-mai 2018, une étude par clientes fictives sur la fourniture de la contraception d'urgence (CU) a été menée dans 854 dépôts de vente de médicaments informels kinois. Douze clientes fictives, se présentant comme ayant moins ou plus de 18 ans et comme mariées ou célibataires, se sont rendues dans les dépôts pour y demander quelque chose qui leur permette de « ne pas tomber enceintes « après un rapport sexuel non protégé et pour acheter le médicament recommandé. Les fréquences des principaux résultats ont été calculées et les associations entre l'âge et la situation matrimoniale de la cliente et les méthodes et le conseil reçus ont été évaluées par tests chi carré. Résultats: Globalement, les prestataires ont recommandé la CU dans 77% des cas et, dans 54%, les clientes ont obtenu la méthode. Dans 62% des cas où les prestataires avaient recommandé la CU, ils ont spécifié un délai de prise de la pilule. La période correcte d'efficacité a été indiquée dans 75% de ces cas. Dans 18% des cas, d'autres médicaments (non contraceptifs) ont été fournis et dans 7%, les prestataires n'ont pas aidé la cliente. Indépendamment du résultat de la visite, les prestataires ont presque toujours été qualifiés de respectueux (96%). Conclusions: La mise à contribution des dépôts informels pour l'accroissement de l'offre contraceptive nécessitera l'identification des dépôts de qualité, le renforcement des chaînes d'approvisionnement et le plaidoyer en faveur de changements de politique qui reconnaissent ces dépôts comme prestataires efficaces de la contraception sans réduire leurs avantages perçus pour les femmes.

The DRC’s National Program for Reproductive Health—the government office charged with coordinating and overseeing family planning—has lacked the human and financial resources to effectively carry out its role. As of 2011, at least 10 local and international nongovernmental organizations (NGOs) were providing some type of family planning service delivery in Kinshasa; however, each tended to work in isolation. Although these groups have worked diligently to attain their own project objectives, there was no coordinated effort to collectively increase contraceptive prevalence in Kinshasa. This special report presents a case study of a promising model for increasing contraceptive availability in Kinshasa, which could be replicated in other large cities in the DRC and elsewhere in the region.

Objectives Recent programmatic and research efforts on addressing gaps in health systems of low-income countries increasingly see task shifting, i.e. the provision of healthcare by non-medically trained personnel, as a possible solution to increase the availability of specific services and commodities. In Kinshasa, private-sector pharmacies are the primary and preferred provider of family planning (FP) methods, and thus constitute a potential resource for expanding access to specific contraceptives. The objective of this study is to explore selected pharmacies' readiness to serve women seeking emergency contraception (EC). Study design This study used a mystery client (MC) methodology to visit 73 pharmacies in Kinshasa, Democratic Republic of Congo (DRC). Trained interviewers posed as novice EC users and asked specific questions to evaluate the pharmacy staff's technical knowledge of EC and their attitudes towards EC clients. The results of the MC visit were recorded immediately after the MC left the pharmacy. Results Findings indicate that more than two-thirds of EC providers were knowledgeable about EC dosage, timeframe, and side effects, and 90% were deemed helpful towards novice EC users. Rare but glaring misconceptions about EC timeframe (20% of providers) and long-term side effects (4% of providers), as well as frequent stock-out (22%) and cost issues highlight priorities for programmatic improvements. Conclusions As new service delivery strategies are explored to complement the uneven network of health structures in DRC, this study suggests that, given proper training and integration in FP programming, private-sector pharmacies have the potential to meet specific contraceptive needs for women living in Kinshasa. Implication statement Private pharmacies included in study sample in Kinshasa (DRC) have adequate family planning (FP) service skills to provide clients with emergency contraceptive pills. These higher-end outlets constitute an opportunity for expanding access to FP, although, under total market approaches, a more diverse range of drugs shops should be investigated.

A series of facility-based surveys that mapped all sites providing family planning services and that assessed readiness to provide services, using mobile phones, was feasible in a low-resource setting, contributing to mobilization of partners and increased donor support. Between 2012 and 2013, readiness to provide services increased from 44% of sites to 63%. Three factors most associated with productivity: type of facility (clinics more than hospitals or health centers), more years in operation, and number of methods available., Background: Modern contraceptive prevalence was 14.1% in 2007 in Kinshasa, the capital city of the Democratic Republic of the Congo (DRC). Yet virtually nothing was known about the family planning supply environment. Methods: Three surveys of health facilities were conducted in 2012, 2013, and 2014 to determine the number, spatial distribution, and attributes of sites providing family planning services. The 2012 and 2013 surveys aimed to identify the universe of family planning facilities while obtaining a limited set of data on “readiness” to provide family planning services (defined as having at least 3 modern methods, at least 1 person training in family planning in the last 3 years, and an information system to track distribution of products to clients) and output (measured by couple-years of protection, or CYP). In contrast, the 2014 survey, conducted under the umbrella of the Performance Monitoring and Accountability 2020 (PMA2020) project, was based on 2-stage cluster sampling. This article provides detailed analysis of the 2012 and 2013 surveys, including bivariate and multivariate analysis of correlates of readiness to provide services and of output. Results: We identified 184 health facilities that reported providing at least 1 contraceptive method in 2012 and 395 facilities in 2013. The percentage of sites defined as “ready” to provide services increased from 44.1% in 2012 to 63.3% in 2013. For the 3-month period between January and March 2013, facilities distributed between 0 and 879.2 CYP (mean, 39.7). Nearly half (49%) of the CYP was attributable to implants, followed by IUDs (24%), CycleBeads (11%), and injectables (8%). In 2013, facilities supported by PEPFAR (n = 121) were more likely than other facilities to be rated as ready to provide services (P