Community-based distribution of injectable contraceptives in Nigeria: Does the innovation delivery fit stakeholders' preferences?

Background: This study explored the fit between the design and delivery of community-based distribution of injectable contraceptive innovation and stakeholders' preferences. Furthermore, it assessed whether and how program implementers engaged potential user groups and community members in the design of innovation delivery. Methods: This qualitative study was part of a more extensive cross-sectional study on the scale up of the community-based distribution of injectable contraceptives in Gombe, Northeast Nigeria. The authors conducted fifteen in-depth interviews (IDIs), seven key informant interviews (KIIs), and ten focus group discussions (FGDs) between September and November 2016 to obtain data from health workers, religious and traditional leaders, and community members, including users of injectable contraceptives. Additionally, the transcripts were analyzed using thematic analysis for important topics about delivery design and stakeholder preference. Results: Although the innovation was community-based, only a narrow fit was identified between the innovation's design and stakeholders' preferences. However, by continuously engaging with stakeholders, even after the implementation, the delivery of the innovation was modified to consider cultural, religious, and programmatic factors, thereby improving the 'fit.' Modifications included the use of markets as mobile posts to distribute the injectables and to provide healthcare for women, dissemination outreach at women's gatherings, and distribution of contraceptives from community health extension workers' homes. Other modifications involved recruiting young female community volunteers as peer educators, partnering with patent medicine vendors, and social marketing using mobile phones to improve compliance. In addition, community participation through community-based organizations and community gatekeepers took place from the outset, across the planning stages to scale up. Conclusion: Most of the modifications to the delivery of this innovation resulted from sociocultural, religious, and programmatic considerations. Therefore, innovation delivery should be context-relevant and cost-effective. Also, there might be a need to combine strategies for synergy and integrate community-based distribution with existing programs and infrastructures.