Please find below a message from our colleagues at WHO, with a comment from me.
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Dear Colleagues,
I am pleased to share with you a recent publication developed in collaboration with our Brazilian team.
“Ali M, Tavares AB, Modesto LBM and Kiarie J (2026) Scaling up long-acting reversible contraception through task sharing and capacity building: an implementation science approach in Balsas, Brazil. Front. Glob. Women’s Health 7:1673405”.
doi: https://doi.org/10.3389/fgwh.2026.1673405
This research project used a structured, EPIS-framework-guided approach to scale up contraceptive service delivery in a resource-limited setting. Scaling up was achieved by transforming a single municipal hospital into a center of excellence, then systematically extending training, task sharing, and mentoring to all 26 primary care facilities in Balsas and four neighboring municipalities (80 health care providers). This expanded service coverage from one specialist-led site to a regional network of general practitioners and nurses, resulting in a dramatic increase in voluntary IUD insertions, from only eight over five years to 1,468 in a single year.
Key lessons for scaling up include:
Task sharing (shifting IUD procedures from specialists to GPs and nurses) significantly expands service capacity and access.
Cascade training plus ongoing mentoring ensures competency and confidence across a large provider base (80 providers trained).
A phased, systematic implementation process (Exploration–Preparation–Implementation–Sustainment) enables structured, replicable scale-up.
Strengthened health information systems and continuous capacity building are essential to sustain improvements beyond the initial scale-up phase.
I would greatly appreciate it if you could circulate this publication within your respective networks.
With best regards,
Moazzam
Moazzam Ali MD,PhD, MPH
Medical officer/ Epidemiologist
Geneva, Switzerland
E.mail: alimoa@who.int
Telephone: +41227913442 (CET Time zone)
ORCID: Moazzam’s ORCID X/Twitter : @Moazzam2000
www.who.int/hrp
Department of Sexual, Reproductive, Maternal, Child and Adolescent Health and Ageing
and HRP, the UN's Special Programme in Human Reproduction
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COMMENT (NPW): The paper notes: 'Several barriers hinder LARC uptake, including provider training gaps, limited service availability outside urban centers, and widespread misconceptions among potential users. In Brazil, copper IUDs can only be inserted or removed by trained gynecologists, further restricting access in lower-level facilities'. This emphasises the importance of meeting the healthcare information needs of women and health workers.
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org