This piece summarizes the experience of integrating family planning and reproductive health (FP/RH) in the USAID Kenya-funded AFYA TIMIZA program, implemented by Amref Health Africa in Kenya. It provides insights to technical advisors and program managers that there is no one-size-fits-all approach in FP/RH service provision, access, and utilization: context is a critical factor in design and implementation. It demonstrates the need to continuously adapt to community dynamics to ensure that these essential services reach communities that would have otherwise been ostracized. This is done through innovative models that take advantage of the nomadic lifestyles of these communities.
Accessing affordable quality health care continues to be difficult for marginalized communities. This is even worse for the nomadic pastoral populations in the hard-to-reach areas of arid and semi-arid lands. The harsh climatic conditions make it difficult to attract and retain health workers, and communities struggle to reach the health facilities due to the vastness of the land. This is made worse by high illiteracy levels, harmful social cultural practices, and gender norms that do not support independent decision-making for women.
The AFYA TIMIZA initiative aims to sustainably improve health outcomes for vulnerable communities by increasing the availability of affordable, high-quality family planning; reproductive, maternal, newborn, child, and adolescent health (FP/RMNCAH) services; nutrition; and water, hygiene, and sanitation (WASH) services.
AFYA TIMIZA, through funding from USAID Kenya, has integrated FP/RH at the facility level by taking advantage of key service delivery points to minimize missed opportunities and reach women of reproductive age. These include comprehensive HIV testing and care, antiretroviral therapy, wards for female inpatients, maternity care, antenatal care, postnatal care, post-abortion care, and maternal and child health welfare clinics. During outreach services, information and services on FP/RH are provided as part of the integrated package of care. Furthermore, health workers both at the facility and community levels are trained and sensitized on FP counseling, information, method provision, and referral.
Depending on the client’s voluntary choice, provider training, and available infrastructure, the program/facility/outreach site provides either a fully integrated model (in which clients access FP services within the HIV clinic by the same or different provider), or partially integrated (in which clients are counseled and then referred to the family planning clinic for provision of methods).
We successfully integrated FP/RH at 154 health facilities. At these service delivery points, providers have counseling cards, job aids, client registers, and appointment documentation (including services/methods provided). FP counseling and method provision are also included as part of community-based distribution (CBD) programs linked with outreach efforts and other CBD work.
FP/RH integration helps minimize missed opportunities, because women are likely to seek other services at the same time they have unmet FP/RH needs.
One challenge we have experienced was a high workload in the initial phase of the project, especially for clients seeking short-acting methods. The other challenge has been around the infrastructure and equipment for privacy and confidentiality. This is a problem in service delivery points that were not designed for FP/RH service delivery, such as HIV testing and care clinics.
Effective integration of FP/RH interventions needs to take advantage of existing successful initiatives that can help to address unmet FP needs in a targeted context. Amref Health Africa has developed and tested innovative models like Kimormor—an integrated one-stop shop for service delivery—and camel outreach to take services closer to the people. These models and tools have been successful in FP/RH integration because of leveraging existing projects and providing FP/RH services as a value-add to our existing health services portfolio. We hope other organizations and programs can learn from our experience when it comes to integrating FP/RH into their programs, especially in relation to working with complex and vulnerable nomadic communities.
1. AFYA TIMIZA Year 4 Quarter 1 progress report. ↩
2. Kimormor serves the Turkana community and is an integrated, one-stop service provision targeting both humans and animals. Animals are an important part of the Turkana community. ↩
3. This is where camels act like mobile clinics and carry drugs to places no other means can reach. ↩