Nursing student training as a novel approach to increasing community-based access to contraception in the Democratic Republic of the Congo: evaluation of outcomes

This study evaluated the scale-up of an innovative approach to increasing modern contraceptive use in the Democratic Republic of the Congo (DRC) on multiple outcomes: fidelity to design, acceptability, sustainability, satisfaction, adoption by other organizations, and penetration. The intervention consisted of incorporating a family planning (FP) module into the training of third-year nursing students, who then counseled and delivered services during community outreach events as their practicum several times annually in selected provinces. In late 2023, eight different stakeholder groups were interviewed (national-level health authorities, provincial-level health authorities, program managers replicating the model, chief district medical officers, nursing school focal points, nursing students, FP clients, and a parent association), for a total of 1238 persons. It consisted of telephone interviews (for three stakeholder groups), in-depth interviews (for three other groups), in-person interviews (one group), and focus group (one group). Data were triangulated across stakeholder groups for each outcome. The scale-up of the nursing school model achieved many of its desired outcomes regarding fidelity to design, acceptability, satisfaction, penetration, and adoption. Unresolved issues included pervasive contraceptive stockouts, difficulties in accurately capturing data on contraceptive distribution in the national health information system, and sustainability. The DRC model originated from a scarcity of government or donor resources to pay community health workers but has proven to be a promising means of increasing access to contraception. The results of this research will inform the further expansion of the model within the DRC and possibly to other countries facing similar challenges.