MAVERICK BEAT | PROJECT HIGHLIGHT

TRANSFORMING THE DELIVERY OF INJECTABLE CONTRACEPTIVES IN MOZAMBIQUE

PROJECT DESCRIPTION

Creating a Cost-Recoverable Model for the Distribution of Sayana Press in Mozambique

With the goal of reducing unmet need for family planning, PSI Mozambique began this project in September 2016 to develop a cost-recoverable model to improve access to modern contraceptive methods in peri-urban and rural areas through a community-based distribution (CBD) approach. One method that would be introduced for the first time in Mozambique was the injectable contraceptive, DMPA-SC, administered at the village level by community health promoters to women of reproductive age and adolescent girls.

Through a fee-based system of community-based distribution, the project leveraged entrepreneurship among community health promoters (CHP) and used technology to connect clients with CHP in order to bring access to modern contraceptives closer to Sara. This project was viewed as a first step in getting the government and Sara comfortable with the ultimate goal of self-administration of the injectable, which was successfully approved by Mozambique in February 2021

PROJECT TEAM

MICAELA RODRIGUES
Marketing Director
PSI Mozambique

Micaela Rodrigues has a background in Marketing with 15 years experience working in social impact and behavior change. As PSI Mozambique’s Marketing Director for the past 5 years, Micaela has brought a consumer perspective to the platform’s programs–delivering innovative and creative solutions to meet the consumer needs at the center of everything PSI does. She believes that only with a deep understanding of the consumer do we have the ability to develop the right solutions and leverage new opportunities.

Working in Social Impact is a key driver for Micaela, bringing her the highest motivation. Her focus, within the marketing area, is to bring a sustainable approach to everything she does to make an effective and lasting impact. She loves traveling, learning about new cultures, meeting new people, and spending time with her kids!

Nicolau Nhantumbo is the Digital Health Systems officer at PSI Mozambique with 4 years working with Health Systems. During the Maverick Collective Community Based Distribution project he was the field operations coordinator. Today, Nicolau is the interface between the Mozambique Program team and the Digital Health Solutions team to ensure that the apps developed meet the country needs and that they are implemented according to the different projects. 

Working in projects that impact communities and the country is Nicolau’s daily motivation. His dream is to see self-referrals to family planning really work in Mozambique.

NICOLAU NHANTUMBO
Digital Health Systems Officer
PSI Mozambique

STASIA OBREMSKEY
Maverick Collective Member

Stasia Obremskey is the Managing Director of RH Capital Funds the impact investing venture fund of Rhia Ventures where she is responsible for investing in innovations in women’s reproductive health. She joined Rhia Ventures at its founding in 2018 after more than twenty-five years of experience as an interim CFO for non-profit organizations and start-up companies and an impact investor and philanthropist in women’s reproductive health. 

Stasia holds a bachelor’s degree in Business Administration with a concentration in Finance from the University of Notre Dame and an MBA from the Harvard Graduate School of Business. She has extensive experience as a member of several nonprofit boards where she has held a number of leadership positions. 

Stasia is a founding member of The Maverick Collective. As the proud mother of three young adults, she is working with scientists and entrepreneurs to find the next generation of hormone-free contraceptives to meet their sexual health needs.nj

MArta's STORY

Excerpt from “There’s No Place Like Home (For Receiving Healthcare)”
By Stasia Obremskey

That day, Grace and I tagged along with Ilda, a community health worker, as she made her rounds to several villages. All of the clients she saw that day had first been counseled and screened by a nurse at a Tem Mais clinic in a nearby village. Tem Mais clinics are private-sector family planning clinics where clients pay a subsidized price for health care. After counseling on various family planning methods, the clients I visited that day had selected Sayana Press as their choice of method.

As Grace and I watched the toddler dart back and forth between the two rooms, Ilda and Marta talked about her next injection of Sayana Press. Ilda underlined that this method did not protect against HIV transmission. Marta asked for and received both male and female condoms and Ilda demonstrated the proper use of the female condom. Once the counseling session was over, Ilda washed her hands, swabbed Marta’s upper arm with an alcohol pad and injected the small needle into Marta’s arm, pushing down on the drug-filled well for five seconds.

After safely disposing of the spent cartridge. Ilda picked up her phone and sent an SMS message to the network to record her visit, noting the date and Marta’s telephone number. In a few moments, Marta’s phone buzzed and the network sent back a 4-digit code. With this code, Ilda confirmed the visit and the network automatically recorded when she would need to return to the village to administer the next dose.

This SMS network, called Movercado, sends reminders to Marta about when to expect her next visit and allows for Marta and Ilda to communicate between visits if questions come up. Finally, as we were preparing to leave, Marta paid Ilda 30 Metical (20 Metical for Sayana Press and 10 Metical for the home visit). This is the equivalent of about fifty cents in US dollars.
As we departed the little boy ran to his mother and once safely in her arms, waved goodbye to us. During that home visit, Grace and I had seen the three innovative elements of our project in action: administration of Sayana Press by the CHW, payment for a home visit, and the Movercado network recording the transaction.

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Stasia's JOURNAL

An unexpected moment

My daughter Grace and I arrived in Mozambique over the weekend and wanted to have a few days to explore Maputo and the beautiful beaches in the area before we met our project team. We spent a day touring Maputo and then took a boat out to the peninsula to enjoy a day on the beach.

We were sitting on beach chairs by the ocean reading and dozing when a freak wave rolled in and washed us and all our belongings out into the sea! 

Luckily, the hotel staff was nearby and managed to rescue my bag which had washed out to sea with our passports, money, telephones and jewelry in it. We were washed into bushes along the shore—shocked, but otherwise OK. The hotel had a beach camera which recorded the entire event, so we got to watch it over and over! 

We recounted our adventure to the country project team the following day and they were also on the beach near Maputo and experienced the rogue wave as well. Several phones and beach towels were also washed out to sea.

A memorable meeting with Sara

When we visited Mozambique, our project was using community health promoters to educate women about various methods and, if selected, inject a 3-month contraceptive, DMPA-SC, to women in their home. 

The health worker would return every three months for a subsequent injection. We had the opportunity to accompany one of the health workers on her visits to re-inject a woman. This allowed us to meet and see where “Marietta” (Sara in Mozambique) lived and gain a better understanding of her needs and environment. 

It was a privilege to be welcomed into her home to observe this interaction between the health worker and Marietta and see the health service provided where Marietta needed them. We literally met Marietta where she was!

Grace’s reflections after a visit to a school in Maputo

Monday, March 13; Visited Noroeste 1 Secondary School in Maputo, the capital city of Mozambique. 

The school enrolls about 6,000 boys and girls from grades 8 to 12, who attend classes in morning, noon and night shifts. Situated in the corner of the common area was a Tem Mais clinic, a small, square room where a trained nurse administers several different types of family planning methods to female students throughout their school day. Wearing distinct green T shirts, identifying them as trained Peer Educators, graduates of the school, mill around outside the clinic while teenage girls in groups of two or three approach them with questions about sex, relationships, and birth control. 

We sat down with a group of twenty or so girls to talk about family planning, relationships, parental guidance- or lack thereof- and menstruation. The school has no integrated Sex Education curriculum, but students seek information from their biology textbooks, parents, peers, the internet, and the HIV and STI workshops conducted on campus by outside experts. The girls- all roughly around my own age- all had varying levels of knowledge about their own reproductive health. One girl mentioned that she was on birth control at her mother’s request, while a younger student told me, when she started her period, her mother’s sole words of wisdom were: “from this day on, all men are snakes”. Many of the students were well-versed in the different methods and effectiveness of birth control. 

Compared to the two high schools I’ve attended, I was amazed that the on-campus clinic in Maputo offers everything from emergency contraceptive pills to long-term hormonal implants with the full support of school administrators and parents! 

Despite the varying levels of information surrounding reproductive health, the girls unanimously agreed on one thing- no one was interested in getting pregnant anytime soon. As one girl put it, they all had “too much in front of them” to get sidelined by an unplanned pregnancy.

More from mozambique

Listen: Women Choose Contraception To Reach Their Full Potential

The BBC World Service program Business Daily traveled to Mozambique to learn how PSI’s community health workers distribute Sayana Press ™ door to door, allowing women access to a choice of contraception they may not have previously had. Presenter Manuela Saragosa also interviewed Faustina Fynn-Nyame, the director of PSI’s Women’s Health Project, to discuss how women across sub-Saharan Africa are choosing to access contraception for themselves and for their families.

LISTEN HERE

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