Figures & Tables
Figures
- FIGURE 1
Total Client Visitsa by Family Planning Method at Dophil and Namasoli Health Facilities, Kenya, Phase 1
Abbreviation: IUD, intrauterine device.
aIncludes new and returning client visits.
- FIGURE 2
Number of Client Visits by New and Returning Visit and Family Planning Method for All 6 Health Facilities, Kenya, Phase 2
Abbreviations: IUD, intrauterine device; LAM, Lactational Amenorrhea Method.
- FIGURE 3
Number of Client Visits by New and Returning Visit and, Family Planning Method, and Facility, Kenya, Phase 2
Abbreviation: IUD, intrauterine device.
Note: “Other” includes CycleBeads, Lactational Amenorrhea Method (LAM), and female sterilization.
- FIGURE 4
Number of Client Visits by New and Returning Visit and Facility, Kenya, Phase 2
Tables
- TABLE 1.
Family Planning and Reproductive Health in Kakamega, Siaya, and Vihiga Counties, Kenya
Kakamega County Siaya County Vihiga County Kenya (national) Estimated population (2009 census) 1,660,651 842,304 554,622 38,609,223 Total fertility rate 4.4 4.2 4.5 3.9 Age at first birth, years, median 19.8 18.7 20.3 20.3 Knowledge of contraceptive methods, % 100 100 100 99 Use of modern contraceptive methods, % 60 51 57 58 Use of any contraceptive method, % 62 55 60 63 Source: Kenya Demographic and Health Survey 2015,4 except for estimated population data taken from the 2009 Kenya Population and Housing Census.15
Project Objective Project Activities 1. Build capacity of FBO-managed health facilities and community-based providers of voluntary family planning services CHAK built capacity through consultative meetings with participating health facilities and community stakeholder groups and developed capacity-building action plans.
Health care workers and CHVs from each health facility were trained on provision of family planning services.
CHAK provided technical assistance to family planning focal point persons through regular consultations and site visits, and CCIH provided long-distance technical assistance.
2. Sensitize religious leaders Religious leaders were trained and given tools in support of referring clients and educating parishioners about family planning in churches, women's groups, and men's group, using materials developed by CHAK.
Religious leaders participated in monthly meetings to support their family planning work.
3. Mobilize communities Religious leaders and CHVs engaged in monthly dialogue days aimed at educating communities about family planning, dispelling myths, presenting family planning as consistent with Biblical principles, and explaining the benefits of family planning.
CHVs distributed information, education, and communication materials to health facilities.
CHVs and religious leaders engaged in ongoing community education and information sharing (often presenting together at the same event), including sensitization meetings in churches and communities.
4. Improve family planning access and referrals from communities to health facilities Health facilities carried out quarterly outreach events to offer voluntary family planning services.
CHVs carried out monthly community-based distribution of pills, condoms, and Cycle Beads.
Religious leaders and CHVs referred clients to health facilities for family planning services.
5. Advocate for improved commodity security from MOH and county health departments CHAK participated in family planning policy and planning meetings at county and national levels.
CHAK supported health facility staff to attend quarterly county meetings to discuss family planning distribution to their facilities.
Access to family planning commodities was ensured through strong collaboration with the county and national health management.
Abbreviations: CCIH, Christian Connections for International Health; CHAK, Christian Health Association of Kenya; CHV, community health volunteer; FBO, faith-based organization; MOH, Ministry of Health.
Name Phases Facility Level County Affiliation Dophil Maternity and Nursing Home 1 and 2 3 Siaya Nomiya Church Kendu Adventist Mission Hospital 2 4 Siaya Seventh Day Adventist Kima Mission Hospital 2 2 Vihiga Church of God Namasoli Health Center 1 and 2 2 Kakamega Anglican Church of Kenya Ng'iya Health Center 2 3 Siaya Anglican Church of Kenya Sagam Community Hospital 2 4 Siaya CHAK Abbreviation: CHAK, Christian Health Association of Kenya.
- TABLE 4.
Perspectives From Religious Leaders and CHVs on the CHAK Family Planning Project, Kenya
Quotes Religious leaders The whole concept of family planning has always been viewed as a woman issue, that's the reason I decided to focus my messages towards men so that they can also get involved in family planning activities … [education] has changed the perception of many men about family planning. —Female religious leader
I am happy that my community regards me as a family planning pastor. I am not ashamed to talk about family planning to the congregation wherever I get a chance. Many couples that I have encouraged to use family planning methods are now using the methods because as a teacher of the word of God they believe in my words. … I have been able to refer more than 100 clients to the health facilities for family planning methods … I have become a daktari meaning a doctor of family planning. —Male religious leader
I referred one of my clients who had 7 children to the health center for an implant and her husband no longer quarrels her and insults her for “having many children like a rat.” I am happy when my clients are happy. —Male religious leader
CHVs Before I started distributing pills to clients at my house, some of my clients used to have difficulty accessing the pills from the health facility since they had no approval from their husbands. Currently my clients can tell their husbands that they are coming to borrow something like salt or a pair of scissors from me and they get a chance to collect pills from me. —Female CHV
I give my clients family planning pills during our monthly merry-go-round women's meeting [voluntary savings and loan association]. They don't have to travel to the health facility. —Female CHV
Abbreviations: CHAK, Christian Health Association of Kenya; CHV, community health volunteer.
- TABLE 5.
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.
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