Challenges Faced and Solutions Implemented by the CHAK Family Planning Project, Kenya
| Challenges Faced | Solutions |
|---|---|
| By religious leaders | |
| Criticism from community members that it was inappropriate for religious leaders to talk about family planning and that they were straying from their mission to preach the word of God | Religious leaders received training to equip them as family planning educators and used relevant verses from the Bible and Quran to support their calling to educate people on health issues and promote family health through family planning. |
| Contraceptive myths and misconceptions, opposition to family planning based on religious beliefs | Religious leaders discussed facts of family planning in order to dispel myths and misconceptions, and used WHO materials as well as verses from the Bible and Quran to address opposition to family planning. |
| Technical questions from family planning clients or potential clients that religious leaders could not answer | Religious leaders referred such clients or potential clients to CHVs or health facilities, invited health facility staff or CHVs to speak about family planning during religious services and other community events. |
| Male Muslim leaders not able to reach women with family planning messages | Female Muslim religious leaders were recruited to conduct outreach to women. |
| By CHVs | |
| Stock-outs of family planning commodities (pills, condoms, and CycleBeads) | CHVs referred clients to health facilities for these commodities. |
| Hostility towards family planning, particularly the idea of not having more children (sometimes reinforced by religious leaders) | CHVs emphasized that the goal for family planning is to space births and limit family size to what the family wants and can care for, but not necessarily to stop having children. |
| Skepticism towards particular family planning methods, including beliefs that they are ineffective, harmful, or cause negative side effects | CHVs tried to combat myths and misconceptions, such as sterilization can cause cancer, family planning leads to weakness that makes women unable to work, and various methods are ineffective. |
| Referred clients not visiting the health facility due to lack of time and money or lack of support from husbands | CHVs conducted community outreach, including counseling couples about the benefits of family planning. |
| By health facilities | |
| Staff turnover, particularly of nurses trained on LARCs, such as implants and IUDs | Actions included on-the-job training and mentorship of new staff, improving work environment (such as through ensuring that commodities and supplies are available), and recognition of staff who perform well. |
| Commodity shortages and stock-outs, particularly during strikes at government facilities (3-month doctors' strike in 2016–2017 and 5-month nurses' strike in 2017), which led to increased demand for family planning services at FBO-managed facilities | Grant funds were used to purchase “buffer stock” (200 IUDs and 300 implants were purchased during Phase 2), and coordination with county health departments was undertaken to maintain adequate stock without need for project-purchased commodities (as achieved by Dophil and Namasoli). |
Abbreviations: FBO, faith-based organization; CHAK, Christian Health Association of Kenya; CHV, community health volunteer; IUD, intrauterine device; LARC, long-acting reversible contraceptive; WHO, World Health Organization.