Year 8 Annual Performance Monitoring Report: Expanding Effective Contraceptive Options (EECO)

The project focuses on four products: modern fertility awareness method (mFAM) apps, the hormonal intrauterine device (hormonal IUD), the Dual Prevention Pill (DPP), and the SILCS Diaphragm, also known as Caya. The project dates from October 2013 to September 2023, with Year 8 covering the period from October 1, 2020 to September 30, 2021. In Zambia, the EECO project worked to introduce the hormonal IUD, including Avibela from Medicines360. The project team selected MSI Reproductive Choices - Zambia as the new Local Technical Representative (LTR) for Avibela in Zambia. The post-approval variations for Avibela were submitted to the Zambia Medicines Regulatory Authority (ZAMRA) in March 2021, including changes to the Marketing Authorization Holder (MAH) and indication for prevention of pregnancy for up to 6 years. ZAMRA approved the post-approval variation for the MAH change in June 2021, but requested additional information on the indication for prevention of pregnancy for up to 6 years in August 2021. EECO-supported sites in Zambia received a final donation of unbranded hormonal IUD units from the International Contraceptive Access (ICA) Foundation in early 2020. SFH distributed all of the units to public sector facilities, and for the remainder of the project in Zambia, these EECO-supported facilities provided both Avibela and ICA Foundation products to clients. In preparation for national scale-up of the hormonal IUD in the public sector, SFH oriented provincial maternal and child health coordinators and provincial pharmacists on monthly and quarterly reporting on the supply chain, stock, and service delivery. By the end of the project activities in Zambia, 2,073 women had received voluntary hormonal IUD insertions since EECO-supported services began in mid-2017. Public sector community health workers will continue to educate communities on the full range of available FP methods, including the hormonal IUD, without EECO funding. However, these community activities were paused in response to the COVID-19 pandemic. In Madagascar, the EECO project worked to introduce the hormonal IUD, including Avibela. The post-approval variations for Avibela were submitted to the Direction de l'Agence du Médicament de Madagascar (DAMM) in March 2021, including changes to the shelf-life extension and indication for prevention of pregnancy for up to 6 years. DAMM requested that these variations be submitted as a new Marketing Authorization (MA) application, and the resubmission took place in July 2021. Supplemental paperwork requested by DAMM was submitted in September 2021. During this reporting period, 47 providers continued to offer Avibela in 37 private and public clinics throughout five regions of Madagascar. EECO/PSI Madagascar continued to generate demand, distribute stock, monitor service quality, and provide supportive supervision to Avibela providers while maintaining COVID-19 mitigation measures. A total of 7,396 interpersonal communication (IPC) sessions were conducted by 11 Brand Ambassadors in 5 regions, with most of these sessions being with individual women rather than groups. Brand Ambassadors also continued to use online discussion forums to generate interest and make referrals for counseling and service delivery. The EECO project also conducted learning activities, including a study on the hormonal IUD in four countries, including Zambia, Madagascar, and Nigeria. The study was initially rejected by the journal Contraception, but was revised and resubmitted to BMC Reproductive Health, where it is currently under peer review.