Introducing DISC 2.0 – Scaling Self-Inject Contraception
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By Robin Swearingen, SRH Program Manager, PSI, and Julia Kenney, Senior Associate, Communications, PSI
Since 2020, the Delivering Innovation for Self-Care (DISC) project has designed, tested, and scaled provider- and user-facing interventions to strengthen access to self-inject (SI) contraception and support women’s contraceptive choices. Welcome to DISC 2.0 – the next wave of scaling access to SI for women in LMICs.
Over the next three years, with the support of the Children’s Investment Fund Foundation, DISC will focus on building sustainable SI markets to ensure women have access and agency to choose Self-inject if it works for their bodies, lives, and futures. While DISC will continue working in Malawi, Nigeria, and Uganda, we are also introducing DISC programming in Zambia.
DISC’s demand generation, provider capacity building and health system strengthening interventions for Self-Inject have resulted in over one million SI client visits delivered through collaborations with partners and Ministries of Health in Nigeria, Uganda, and Malawi. Under DISC’s first phase, we leveraged client and provider insights to design, test, and begin to scale up a set of user- and provider-facing interventions, combined with cross-cutting health system strengthening. Through DISC 2.0 we will continue to:
- Amplify women’s voice, choice, and agency – Women’s voices are at the core of every decision we make. After delivering over one million SI visits, we will continue to center women’s experiences as we scale access to contraceptive self-care.
- Community-level research on the barriers to contraceptive self-care was the foundation for DISC’s first phase, with a specific focus on overcoming obstacles to uptake such as fear of the needle and lack of agency to self-inject.
- Strengthen provider capacity for empathy and self-care – Many providers are hesitant to offer DMPA-SC self-inject because they do not have sufficient training or capacity and instead offer provider-administered injectables. We developed an empathy-based SI counseling module that we are scaling through implementing partners. These training materials are also being integrated into pre and post training curriculums and counseling guides to ensure providers are well-equipped to support clients in building confidence to inject themselves.
- Reduce stress on health systems – We strengthen data reporting and supply chain management to make SI a more reliably available product for providers and users.
Under DISC 2.0, our mantra is ‘scaling through partnerships’ to make high quality contraceptive self-care services easily accessible to as many women as possible within our four DISC countries. By integrating our activities within routine Ministry of Health operations, we will make sure contraceptive self-care is here to stay. In DISC’s new phase, we will focus on:
- Scaling self-care contraception to new geographies – DISC 2.0 will continue to work in Malawi, Nigeria, and Uganda and will expand into Zambia. In Zambia, provider-administered injectables are already part of the healthcare system’s contraceptive method mix and our community and provider interventions can improve awareness of and access to SI. We are also moving into new geographic areas within Malawi, Uganda, and Nigeria by integrating DISC interventions with partner programs in each country.
- Supporting women beyond the urban centers – Since the beginning, DISC has largely focused on designing, testing, and scaling SI interventions for ‘early adopters’ who live in urban and peri-urban communities. While we continue work in these populations, DISC’s first phase has built the foundation within each country’s health system for DISC 2.0 to focus on supporting women in a wider range of communities with self-care contraception.
- Sustaining SI interventions through strategic partnerships – Access to self-care contraception is only sustainable if it is fully integrated into health systems. That is why DISC 2.0 is focused on sustaining SI through strategic partnerships. We have partnered with Family Health Services (FHS), Amref Health Africa, and the Family Planning Association of Malawi (FPAM), SFH-Nigeria, MSI Reproductive Choices, and Jhpiego, FHI-360 and the Ministries of Health of all DISC countries. Through our strategic partners’ expertise in provider training, community engagement, advocacy, and health systems strengthening, SI access will remain long after DISC’s interventions end.
Where DISC 2.0 is Scaling SI
With DISC 2.0, we will expand to increase access to Self-inject for more women.
- In Malawi, we will continue our broad geographic focus, with operations in 24 out of the country’s 28 districts, in close partnership with Family Health Services (FHS), Amref Health Africa, and the Family Planning Association of Malawi (FPAM).
- In Nigeria, we will work in 15 out of the 36 states, with potential for further expansion, through our consortium partners SFH-Nigeria, MSI Reproductive Choices, and Jhpiego.
- In Uganda, we plan to work in 46 districts, more than doubling the 21 districts that DISC 1 supported. This expansion is made possible through PSI Uganda’s partnership with the USAID Uganda Health Activity (UHA) project implemented by FHI-360.
- In Zambia, we will work in 6 of the 10 provinces in close partnership with Jhpiego, who are implementing the USAID Family Health & Nutrition and Momentum MCGL projects.
Sustaining progress at all levels of the health system
We are scaling SI interventions at every level of the health system through strategic partnerships to ensure self-care contraception is here to stay. DISC 2.0 will build upon the foundational learnings of our first phase so that all women have the agency to choose contraception that works for their bodies, lives, and futures.
