Contributors: Deepak Tiwari and Mukesh Sharma
After the Government of India introduced Antara, an injectable contraceptive, Urban Primary Health Centers (UPHCs) were not able to provide this method choice to their urban family planning clients because it was only offered at district hospitals.
The Challenge Initiative for Healthy Cities (TCIHC) in India saw an opportunity to make injectables widely available to the urban poor by getting nurses and medical officers at UPHCs trained and certified to provide them. TCIHC then sought the support of Chief Medical Officers (CMO) for cities in Uttar Pradesh and the trainings took place. Afterwards, UPHCs in Varanasi and Saharanpur started providing injectables but they were still unavailable in Firozabad’s UPHCs even though they had trained staff.
During a visit with other high-level stakeholders earlier this year, Jose “Oying” Rimon – director of The Challenge Initiative (TCI) and the Bill & Melinda Gates Institute for Population and Reproductive Health – presented Firozabad’s CMO, Dr. Shiv Kumar Dikshit, with a challenge.
“Can you get injectables to your UPHCs so when we come back again in June, we will see progress?” Rimon asked.
Other members of the TCIHC team supported his request, arguing that Firozabad was ready as all the nurses were trained. In addition, Firozabad’s UPHCs all had medical officers on site to ensure compliance with the guidelines that state the first dose of an injectable must be administered by trained medical doctors.
Even though Firozabad offered fixed day static (FDS) services (a TCI best practice approach that provides quality family planning services on a fixed day every week to encourage the uptake of family planning methods), the mix of contraceptive methods would be incomplete without injectables.
Before that day ended, Dr. Dikshit issues two letters, one to the logistics management department of the Directorate Family Welfare for supplying Antara (injectable) vials to meet stockouts at the district hospital in Firozabad and another to the Directorate General Family Welfare for authorizing district combined hospital Shikohabad and community health center (CHC) Tunla to provide injectable contraceptive to family planning clients.
Rimon was not surprised at the speed in which Dr. Dikshit made this contraceptive choice available because when governments are in charge, it instills the confidence and pride needed to make things happen. He noted that the hallmark of TCI’s “business unusual” platform is to let local governments lead because they know how to get things done for their communities.
Since then, two more UPHCs – Ram Nagar and Nanglabari – have started offering injectable contraceptives.
The TCIHC team is thankful to Dr. Shiv Kumar Dikshit, CMO Firozabad, for supporting urban family planning in UPHCs, and also giving his extensive inputs for this story.