Scaling up long-acting reversible contraception through task sharing and capacity building: an implementation science approach in Balsas, Brazil

Introduction: The 2015 Zika outbreak crises in Brazil, exposed major challenges in access to contraception services. This report examines outcomes of project aimed at strengthening and studying family planning services in Balsas, Maranhão, an area severely affected by ZIKV. Methods: The project was guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. It followed a structured, four-phase process to systematically design, implement, and sustain evidence-based interventions aimed at enhancing contraceptive service delivery. Key activities included stakeholder engagement, health system assessments, capacity building, cascade training and task sharing from specialists to general practitioners and nurses. Results: The intervention led to significant improvements in utilization of family planning services. The transformation of the Women's Health Program, based at the Dr. Rosy Kury Municipal Hospital in Balsas, into a center of excellence, enabled the introduction and scale-up of previously unavailable services such as IUD insertion and removal. This resulted in approximately 1,468 voluntary IUD insertions within 1 year, a dramatic increase from only eight in the previous 5 years. Task sharing IUD procedures with general practitioners and nurses significantly expanded service coverage. Comprehensive training and mentoring were extended to all 26 primary care facilities in Balsas and to providers in four neighboring municipalities, with a total of 80 providers trained, contributing to increased contraceptive uptake across the region. Conclusion: The structured implementation approach effectively addressed systemic barriers to contraceptive access in a resource-limited setting. By empowering general practitioners and nurses to deliver a broader range of contraceptive methods, the intervention significantly enhanced service delivery. The success of this model highlights its potential for replication in similar contexts and underscores the importance of ongoing capacity building and strengthened health information systems to sustain long-term improvements.