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Awọn ọna kika Akoko kika: 3 iseju

Iṣeto idile ati Awọn eto Ilera Ibisi:

Lessons from Kenya

Nkan yii ṣe akopọ iriri ti iṣakojọpọ eto idile ati ilera ibisi (FP/RH) in the USAID Kenya-funded AFYA TIMIZA program, implemented by Amref Health Africa ni 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.

The AFYA TIMIZA Project

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.

Awọn ILERA KUN initiative aims to sustainably improve health outcomes for vulnerable communities by increasing the availability of affordable, high-quality family planning; reproductive, maternal, omo tuntun, ọmọ, ati ilera ọdọ (FP/RMNCAH) awọn iṣẹ; nutrition; and water, hygiene, and sanitation (WASH) awọn iṣẹ.

A community health volunteer offers family planning information during a home visit. Photo: Edna Mosiara, AFYA TIMIZA.
Oluyọọda ilera agbegbe nfunni ni alaye igbero idile lakoko ibẹwo ile kan. aworan: Edna Mosiara, ILERA KUN.

How We Integrated FP/RH into Project Activities

ILERA KUN, 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.

AFYA TIMIZA's successful integration of FP/RH depends on making community connections and referrals.
AFYA TIMIZA's successful integration of FP/RH depends on making community connections and referrals.

Comprehensive Service Delivery Points

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.

A couple learns about their family planning options while also receiving HIV testing. Photo: Edna Mosiara, AFYA TIMIZA.
A couple learns about their family planning options while also receiving HIV testing. aworan: Edna Mosiara, ILERA KUN.

Uptake of Family Planning Commodities Among Women of Reproductive Age (Oct– Dec 2019)1

Challenges and Lessons Learned

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.

  • Innovative integration models: Our key takeaway from this project is that it is advisable to integrate FP/RH activities into project outreach services. Due to the nature of the populations we serve, AFYA TIMIZA integrated FP/RH services into innovative outreach models like Kimormor2 and camel outreach3. This is a best practice we plan to replicate in other projects.
  • Ease of integration: A fully integrated model is easier to implement in lower-level facilities with committed health workers, compared to county and sub-county hospitals. This is because at these lower levels, there is a lighter workload and fewer clients, unlike county referral hospitals where the workload is greater. In HIV service delivery points, this model helps improve patient outcomes, especially regarding EMTCT.
  • Client satisfaction: AFYA TIMIZA clients are happy and satisfied, which we determined from our exit interview analysis. This is due to the fact that the health facilities offer a one-stop shop, saving time and maximizing opportunities to offer FP/RH services. Clients also feel a sense of attention from the health workers; once they leave the facility, they report that they feel all their needs were met.
  • Reduced waiting time: The integration of FP/RH into program activities has contributed to reduced waiting time for clients, which is also tied to client satisfaction. Integration has reduced the need for clients to make an appointment for one service, then another for a separate service. Ensuring that services are offered comprehensively in one location reduces the overall time spent at the health facility.

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.

A couple receives information on healthy timing and spacing of pregnancy while their baby receives an immunization. Photo: Edna Mosiara, AFYA TIMIZA.
A couple receives information on healthy timing and spacing of pregnancy while their baby receives an immunization. aworan: Edna Mosiara, ILERA KUN.

Final Thoughts

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.

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Oluyọọda ilera agbegbe nfunni ni alaye igbero idile lakoko ibẹwo ile kan. aworan: Edna Mosiara, ILERA KUN.
Dr. Dickson M. Mwakangalu

Dr. Dickson Mtungu Mwakangalu, a Manchester Metropolitan University MPH, and Moi University MD graduate, is a seasoned public health professional with a proven record of accomplishment of managing and implementing programs in maternal, newborn and child health, ebi igbogun, ilera ibisi, adolescent health, nutrition, HIV/AIDS, and other infectious diseases. He is currently working as a Deputy Chief of Party for AFYA TIMIZA, a USAID-funded FP/RMNCAH, nutrition, and WASH project and has served in different other capacities including Public Health Specialist at the US Centers for Disease Control and Prevention, Division of Global HIV and TB in Kenya, and Director of Technical Services at Pathfinder International, Kenya among others. He has in-depth knowledge about disease prevention, clinical management, project implementation, monitoring and evaluation, specifically in resource poor settings. He is passionate about saving lives and building systems to ensure equitable access to health care. Out of work, he loves spending time with family, farming, swimming and travelling.

Diana Mukami

Diana is the Digital Learning Director and Head of Programmes at Amref Health Africa’s Institute of Capacity Development. She has experience in project planning, design, development, imuse, management, and evaluation. Since 2005, Diana has been involved in distance education programmes in the public and private health sectors. These have included the implementation of in-service and pre-service training programmes for health workers in countries such as Kenya, Uganda, Tanzania, Zambia, Malawi, Senegal, and Lesotho, in partnership with Ministries of Health, regulatory bodies, health worker training institutions, and funding organisations. Diana believes that technology, used the right way, contributes significantly towards the development of responsive human resources for health in Africa. Diana holds a degree in social sciences, a postgraduate degree in international relations, and a post-baccalaureate certificate in instructional design from Athabasca University. Outside of work, Diana is a voracious reader and has lived many lives through books. She also enjoys traveling to new places.

Sarah Kosgei

Sarah jẹ Alakoso Awọn Nẹtiwọọki ati Awọn ajọṣepọ ni Institute of Development Capacity. O ti pari 10 iriri awọn ọdun ti n pese idari si awọn eto orilẹ-ede pupọ ti o murasilẹ si gbigbo agbara ti eto ilera fun ilera alagbero ni Ila-oorun, Central and Southern Africa. O tun jẹ apakan ti Awọn Obirin ni Ilera Agbaye - Africa Hub secretariat ti o wa ni Amref Health Africa, Abala Agbegbe ti o pese aaye fun awọn ijiroro ati aaye ifowosowopo fun aṣaaju-iyipada abo laarin Afirika. Sarah tun jẹ ọmọ ẹgbẹ ti Ibobo Ilera Agbaye (UHC) Oro Eda Eniyan fun Ilera (HRH) iha-igbimọ ni Kenya. O ni awọn iwọn ni Ilera Awujọ ati Awọn Masters Alase ni Isakoso Iṣowo – Ilera Agbaye, Olori ati Management. Sarah jẹ agbẹjọro itara fun itọju ilera akọkọ ati dọgbadọgba abo ni iha isale asale Sahara.

Alex Omari

Alex jẹ Eto Imọ-ẹrọ Ìdílé/Oṣiṣẹ Ilera ti ibisi ni Ile-ẹkọ Amref Health ti Ile-ẹkọ Idagbasoke Agbara ti Afirika. O ṣiṣẹ bi Alakoso Alakoso Imọye Agbegbe (Ila-oorun Afirika) fun ise agbese Aseyori Imọ. Alex ti pari 8 iriri awọn ọdun ni ọdọ ati ọdọ ibalopo ati ilera ibisi (AYSRH) apẹrẹ eto, imuse, research and advocacy. He has previously served in various capacities at Marie Stopes International, International Center for Reproductive Health (ICRH), Center for Reproductive Rights and Kenya Medical Association. Alex currently sits as a Technical Working Group member for the AYSRH program at the Ministry of Health in Kenya. He is a website contributor / writer for the Youth for Change and the outgoing volunteer Kenya Country Coordinator for International Youth Alliance for Family Planning (IYAFP). O si Oun ni a Apon of Science (Ilera olugbe) and is currently pursuing his Master of Public Health (Ilera ibisi).

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