Changing policy to make family planning more accessible: How it was done in Rwanda

In 2019, SHOPS Plus started working with the Association of Pharmacists and Pharmacy Owners of Rwanda (Association des Pharmaciens et Propritaires d’Officine du Rwanda [APPOR]) to advocate for policy change to allow private pharmacists to administer intramuscular injectable contraceptives.

In February 2020, those advocacy efforts resulted in the minister of health approving the policy change (read the full story).

SHOPS Plus shares their advocacy experience in Rwanda and offers insights on how other countries can advocate for similar policy change in the recently published brief, Achieving Injectable Contraceptive Task-Sharing Policy Change in Rwanda.

“This policy change was a concrete step toward aligning task shifting for injectable contraceptives [in Rwanda] to WHO recommendations for pharmacist’s administration of the same,” says Mbogo Bunyi, one of the authors of the brief.

To achieve this policy change, SHOPS Plus and APPOR worked closely with government policy makers, regulators, donors, clinicians, and pharmacy staff through a coordinated series of activities, including an advocacy plan development workshop, stakeholder meetings, and a rapid assessment of social marketing and commercial supplies of injectables.

Using the SHOPS Plus Expanding Access to Injectable Contraceptives through Pharmacies toolkit, APPOR developed an advocacy plan that was responsive to Rwanda’s needs and opportunities, prioritized shared objectives, and outlined specific actions to meet them.

“The leadership, understanding, and credibility of APPOR resulted in the development of a clear and sound user-led advocacy plan that was responsive to country context,” Bunyi states.

SHOP Plus identified four key factors that were crucial in achieving the policy change so swiftly in Rwanda:

1. Timing and the “right” enabling environment
   • The MOH was interested in increasing private sector participation to improve access to family planning.
   • Rwanda has enforceable regulation that can support task sharing of family planning responsibilities.
2. A motivated, credible private sector association or champion
   • APPOR had a history of collaborating and working with the public sector and its leadership was credible and well respected. It also had a strong network with public and private health sector actors.
3. Concise advocacy strategy
   • SHOPS Plus and APPOR developed a clear advocacy plan that presented the evidence and need for policy change.
4. Consultative process from the outset
   • APPOR conducted multiple meetings with various stakeholders to understand their interest in and concerns about policy change. Stakeholder input refined the advocacy approach and plans for implementation.

From this experience, the project offers the following recommendations to support global advocacy efforts for task sharing family planning provision and expanding access to family planning services.

• Build the capacity of a credible champion to strengthen its voice.
• Align key messages to the national development agenda.
• Identify enabling factors that can facilitate policy change.
• Understand stakeholders and speak with a unified language.
• Understand and address broader health system issues that can affect policy change for task sharing.

Click here to read the full brief.