Reviewer’s report
Title: 
Scale-up of the DMPA-SC in Nigeria: Why policy matters
Version: 
2 
Date: 
28 May 2022
Reviewer's report:
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General comment:
Thanks for the opportunity to review this manuscript. Authors present an
interesting study on the Scale-up of the DMPA-SC in Nigeria: Why policy
matters. The study is based on 3 datasets: rapid literature review, interviews (KII
and IDIs) and FP programme data set from Nigeria's National Electronic
Logistic Management Information System (Elmis). While this work adds value
to the field of DMPS-SC scale up, several changes would significantly improve
the manuscript. First, the introduction needs to be succinct on the context of FP
in Nigeria in terms of policies, method mix, and the value addition in terms of
knowledge. I recommend the authors to provide more nuanced details about the
desk review. Lastly, the results section would benefit from a more nuanced and
detailed presentation. 
Introduction 
The introduction is scanty and does not succinctly provide the justification why
the current study is important, that is, what is known about the family planning
policy environment in the Nigerian context, past achievements and challenges,
the method mix and what new knowledge the current study is contributing. 
The current study appears to be conducted in a vacuum, the authors should
provide some theory or framework underpinning the study. 
Line 22-27: Authors wrote ´Like in other Sub-Saharan African countries,
injectable contraceptives are a very popular method in Nigeria, accounting for
22% of the modern family planning method mix (1, 3). In addition, there has
been a rising trend in their popularity over the past two decades (4)." The two
sentences are hanging without stating some of the factors why injectables are
popular in the referred context. What known factors are driving this popularity
and does the policy environment play a role? Providing these details would be
important in highlighting the context. 
Line 37-38, the authors wrote "Enabling policies are essential to the successful
introduction and scale-up of health innovations" what does 'enabling policy'
mean? And can the authors cite examples? 
Line 38-39: authors wrote "In Nigeria, there have been several policies aimed at
advancing the scale-up of DMPA-SC and self-injection in the country". Again,
this is left hanging, it would be important for authors to highlight some of the
policies they refer to. What are the government commitments to addressing FP
needs? Authors could refer to some of the FP2030 & FP2020 Commitments 
Methods:
The study is based on 3 datasets: rapid literature review, interviews (KII and
IDIs) and FP programme data set from Nigeria's National Electronic Logistic
Management Information System (eLMIS)- Authors should provide more
information on ElMIS with regard to data quality issues. The result should also
be organized based on these sources. 
Line 58: Authors mention a desk review of policy documents as one of the
methods employed. Surprisingly, there is no detail on exactly how this was done,
or how many documents were reviewed. It would also be useful to add the broad
questions that the policy review analysis sought to answer? Authors should also
indicate which methodologies and designs they used to conduct the FP policy
review. Authors can refer to Gill et la., 2008 framework for some guidance.
Line 38-43: authors wrote "The IDIs, however, pursue profound information and
knowledge through the exploration of key themes that emerged from KIIs or
have already been reported in the literature with health workers involved in the
implementation of the program" Give examples of such issues explored. 
An ethics section detailing ethical approval is missing
Results:
Line 14-21 should be moved to the method section.
Table 1 and lines 23-31, the results are presented in a quantitative survey format
while these are interviews. Instead, authors should provide a table indicating the
number and type of interviews i.e., IDI/KII- 
The result section should be presented for the different data sources to bring out
the nuances. Currently, there is a mix up of what various policies are in terms of
goals and objectives while the views of respondents just repeat what the policies
are. Start by presenting the result from the desk review of policies- rather than
listing the policies, present a summary of the current state and environment
concerning DMPA-SC vis a vis other methods. We need to see the views of Key
informants and IDI participants regarding how these policies enabled DMPA-SC
to scale up, what were the catalysts and some of the challenges since it cannot
just be a straight-line affair. How do the views of policymakers compare to those
of health providers?
Line 47: We expect to see more nuanced results for the perceived success levers
for scale-up-provide. Currently, authors just mention collaborations and having
clear policies and a
bottom-up approach and guidelines, without delving into details. 
Discussion: 
The discussion should have an introductory statement preparing readers on what
to expect. 
Line xx: Authors wrote "According to researchers, successful policies are those
that are evidence-based, specific, and have clear goals" please cite these
researchers you are referring to.
Authors should discuss their findings compared with literature from other
settings, that is, how does the DMPA-SC scale-up in Nigeria compares with
scale-up in other countries considering the policy environment. 
The study limitations are too generic. 
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
No
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
No