A Meeting of the Minds: More Contraceptives for Western Kenya

By Paul Kuria, Research Officer Packard Western Kenya Project

The right to health is a fundamental part of Kenya’s new constitution--part of that right to health is the right to family planning options and access to modern contraceptives APHRC’s Population Dynamics and Reproductive Health (PDRH) program has been working to increase modern contraceptive access and use among women ages 15-49 in rural districts of western parts of Kenya, through the Packard Western Kenya Project, which is a three-year demonstration Community-Based Contraceptive Distribution initiative, in Siaya and Busia counties. Through a mix of activities, the project promotes and encourages couples to have smaller families for self-reliance and prosperity, all and well captured in the project tagline ‘jamii ndogo jimudu’ (small family for self-reliance)

The project is a collaborative effort between Family Health Options Kenya (FHOK), Marie Stopes Kenya (MSK), Great Lakes University of Kisumu (GLUK), and the Ministry of Public Health and Sanitation (Division of Reproductive Health, and Division of Community Health Services). The experiences gained from this initiative were the main focus as project consortium partners met at GLUK the first weekend in May to attend the 9th Tropical Institute of Community Health (TICH) Conference.

The afternoon of the third day of this year’s conference titled ‘Innovations in Health Systems Strengthening towards MDGs’, kicked off with a two-hour round table discussion on the role of Community-Based Contraceptive (CBD) programs in improving contraceptive uptake and general health of rural communities. The discussions included short presentations on the experiences and achievements of the PWK project, as well as lessons learned during the past 24 months of implementation. Also highlighted were achievements and experiences of the intervention at the community level and the implications of the program on development and strengthening of components of the health systems in the intervention areas.

The discussions centered on whether there is enough evidence to advocate the expansion of the Community Health Workers (CHWs) roles to include administering injectables. Some participants felt that CHWs do not have enough medical expertise and training to provide such services—such as a mastery of human anatomy and physiology. Other participants felt different and argued that just like many family members of patients suffering from type 2 diabetes are trained how to administer doses of short and intermediate-acting  injectable insulin, CHWs could also be trained to provide injectable contraceptives. They argued that with adequate facilitative supervision and training in safe use and disposal of sharps, CHWs are capable of providing this most commonly used contraceptive in sub-Saharan Africa.

The discussions also focused on strategies for making rural community health programs effective in promoting healthy behaviors. Discussants also debated about motivation schemes for Community Health Workers in an era of devolved health system and called for the government to speed up the process of the development of community units and recruitment of Community Health Workers. Sustainability models of community health programs were discussed at length and future interventions were challenged to develop innovative strategies of ensuring community-based programs are sustainable. One example of innovative strategy that I thought had real potential across rural Kenya was the linking and engagement of community health workers to income-generating activities and massive enrollment of the families to the national social health insurance scheme.

One smart move by the conference planners was that they included funding in their budgets to bring community health workers and members of the district and provincial health management teams to attend the conference. These participants provided valuable input to the discussions. This type of inclusive participation is exactly the type of engagement APHRC emphasizes in our new strategic plan.

Overall I thought the conference was a great way to untangle the lessons learned from the past two years and to discuss the feasibility of scale up in 2013. After the interesting (and sometimes hotly debated) topics I feel that most of the consortium partners left the conference rejuvenated about new ideas for the scale-up and the impact this intervention could have for rural women across Kenya.