the garba tulla htsp project: increasing contraceptive uptake in northern kenya

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Devina Shah, MPH Jan 28th 2016

www.worldvision.org/our-impact/health

The Garba Tulla HTSP Project: Increasing Contraceptive Uptake in Northern Kenya

International Conference on Family Planning Nusa Dua, Indonesia

Presenter

Presentation Notes

Good morning! Namaste! Habari zenu! Selamat Pagi! It is a pleasure to be here today and learn my fellow panelists of the good work that their respective organizations are doing in Integrating Family Planning into various development programs. I will be moving to next door Kenya to share the story of our Integration work there.


Overview

• Background/Context • Program Interventions • Early results/Lessons

Learned

Presenter

Presentation Notes

I hope to give you a snapshot of an integration project in Northern Kenya and some early results. I’ll start with some background, then get into what we did and are doing, and some early results that we’ve gathered and lessons that we’ve learned.


Background/Context: Where in the world is Garba Tulla, Kenya?

Presenter

Presentation Notes

The geography buffs might know this, but for the rest of us plebeians, here's a map. Beneficiary Population: Garba Tulla is located within Isiolo County which is in the Northern Kenya. Our project covers four locations within Garba Tulla sub-county. The district is characterized by unreliable rainfall and frequent drought. The community is made up of primarily of Muslim background, live with high rates of illiteracy, malnutrition, communicable disease, food insecurity, poor terrain, and ill-distributed health facilities. WV has been working in Garba Tulla via the ADP structure since 2008, through private sources of funding. Health System in Kenya: To give you a very quick snap-shot of the health system in Kenya. Kenya is divided into 47 administrative counties. Each county has a county-level health facility where referrals are sent to. At the sub-county level, we also have health facilities. And at the very local level – the location level – we have basic primary care facilities.


Background/Context: Some numbers

Indicator National Isiolo

Total Fertility Rate 3.9 4.9

Contraceptive Prevalence

58%

26.3% (GT: 10.7%)

Unmet Need for Contraception

18%

29.9%

Source: Kenya DHS, 2014

Presenter

Presentation Notes

Notes from Kenya DHS, 2014 Trends show that fertility rates have been dropping from 8.1 in 1977 to 4.6 in the last 2008 DHS. This year’s DHS showed a lower national TFR of 3.9 While this is good news, we still have a lot of work to do. Fertility levels are highly varied by urban-rural residence, education, and wealth quintile. CPR = currently married women who are currently using a method of contraception Garba Tulla’s CPR is 10.7% (as per baseline) Unmet need for Family Planning: The proportion of women who want to stop childbearing or who want to space their next birth, but are not using a contraceptive method Unmet need is highest in rural, uneducated, poor women


Background/Context: What does Garba Tulla look like?

Presenter

Presentation Notes

So what does Garba Tulla look like?



Programmatic Activities Focused on all Persons of Reproductive Age

Type Age Range Number of Beneficiaries

WRA 15-49 11,641

Married WRA 15-49 10,791

Men 15-49 21,990

Total Number of Beneficiaries 43,118

Presenter

Presentation Notes

I wanted to provide some population numbers so you appreciate the size and scope of the project. Our programmatic activities are focused on all persons of reproductive age, both men and women


Background/Context: Starting Strong Project

Starting Strong (2012-2017) is a five-year, $2 million Maternal and Child Health and Nutrition (MCHN) initiative privately funded by WV Canada.

• Improved uptake of MCHN services by mothers and their children

• Improved nutrition and WASH practices at community level

• Improved environment for MCHN services.

Presenter

Presentation Notes

As I mentioned before – the HTSP project under discussion is an integration project. I won’t go too much detail about the “mother project” as I like to call it – but I wanted to provide a quick snap-shot of what the larger project was, so you get the context for the integration work that we’re doing.


Presenter

Presentation Notes

This is our overall Project Framework. We have three Strategic Objectives. I’ll go through each – so you get a full picture of our interventions and activities on the ground. It must be noted that this project is an integration project – the “mother” project as I like to call is – is a 5-year MNCH project privately funded by WV-Canada called Starting Strong. That project aims to …


Points of integration to increase utilization for HTSP/FP

• Antenatal care: 73% of women get tetanus toxoid coverage during the fourth antenatal care visit

• Immunization: High immunization coverage (72.6 percent) for fully immunized children under 2

Presenter

Presentation Notes

Before I get into the Strategic Objectives and Intermediate Results, we have two points of integration. At both these intervention points, men are actively engaged and counseled to support their partner for antenatal care, preparation for skilled delivery, immunization, and HTSP/FP. ANC: is an entry point to reach a higher proportion of women with HTSP/FP counseling and to prepare them for early use of HTSP/FP services postpartum. This early contact also enables the project to counsel, prepare, and follow-up with women for delivery by a skilled provider at a health facility. Immunization: indicates frequent contact between the mother and the health worker and a continuous opportunity for at least nine contacts with mothers of children under 2 to counsel, provide contraceptives, and follow-up on HTSP/FP, while also increasing immunization counseling, mobilization, and follow-up.


SO 1: Capacity Building of CHEWs and CHVs

Presenter

Presentation Notes

Emphasis on recruiting and training Male CHVs The CHEWs and CHVs were trained to counsel on the health benefits of timing and spacing pregnancies to ensure healthiest outcomes for mothers and their infants


Presenter

Presentation Notes

- Male CHVs posing for a picture



Presenter

Presentation Notes

Picture: Supervision visit where CHEWs are trained on data collection and supportive supervision of CHVs


SO 2: Community Mobilization: Male engagement

Presenter

Presentation Notes

Male engagement – Male CHVs reaching out to men Male-friendly spaces in health facilities


SO 2: Community Mobilization: Faith Leaders

Presenter

Presentation Notes

Community Leaders engaged early and often


SO 2: Community Mobilization: WRA

Presenter

Presentation Notes

Obviously focus on WRA


Results

0

100

200

300

400

500

600

Capacity Building, Male-FPcounseling/services for CHWs

Capacity Building, Male-FPcounseling/services for other providers

working in health facilities

Cacacity Building, Female-FPcounseling/services for CHWs

Capacity Building, Female-FPcounseling/services for other providers

working in health facilities

Number of community health workers (CHWs) and/or other health providers trained or supported, disaggregated by gender

Presenter

Presentation Notes

This simply shows the numbers of health workers trained – given the cultural factors of this geography, our strategy was to train more male CHWs than female. These male CHWs have been an important factor in increasing buying within their communities.


Results

0

200

400

600

800

1000

1200

1400

Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15

Number of community members reached with family planning messages by type of provider

By CHEW (Other service providers in health facilities) By CHVs (Community health workers (CHWs)


Results

0

500

1000

1500

2000

2500

3000

3500

4000

4500

10-14 15-19 20-24 25+March 2014 - Dec 2015

Number of clients of reproductive age receiving FP counseling, disaggregated by gender, age

Male Female


Successes

0

100

200

300

400

500

600

700


# of clients receiving FP information integrated into MNCH services at the same location and time, disaggregated by sex

Male Female


Successes

0

50

100

150

200

250

300

350

400

450

500


# of clients receiving FP services integrated into MNCH services at the same location and time, disaggregated by sex

Male Female


Successes

2870

0

1867

184

3

0

45

1098

1

605

0

514

724

0 500 1000 1500 2000 2500 3000

Male condom, Male

Male Sterilization, Male

SDM, Male

Emergency Contraception, Female

Female condom, Female

Female Sterilization

Implants, Female

Injectables, Female

IUD, Female

Female Lactational Amenorrhea

Male condom, Female

Oral Contraceptive Pills, Female

Standard Days Method (SDM), Female

# of current users, disaggregated by sex and method

# of current users by gender and method


Successes

18 89

376

179

451

757

0

200

400

600

800

1000

1200

Sep-14 Dec-14 Mar-16 Jun-16 Sep-16 Dec,2015

Male condom, Male Male Sterilization, Male SDM, Male

Emergency Contraception, Female Female condom, Female Female Sterilization

Implants, Female Injectables, Female IUD, Female

Female Lactational Amenorrhea Oral Contraceptive Pills, Female Standard Days Method (SDM), Female

# of current users over time, disaggregated by sex and method


Challenges

• Hard to reach area: very tough terrain, scattered habitation, very low levels of literacy

• Socio-cultural factors: early child marriage, multiple marriages, religious factors,


Lessons Learned • The pivotal importance of men in FP programs

In traditional societies, where men are the gate-keepers who control all access to resources, the initial focus of family planning programs must be on men – chiefs, elders, imams and fathers

• Increasing Contraceptive Use in conservative rural societies takes time

In cultures with no tradition of contraceptive use, the initial step succeeds when it focuses on culturally compatible methods like LAM and SDM. Introducing LARC and LAPM later in the program is much more effective, once communities are comfortable with and have reduced myths/misconceptions about hormonal methods.

• Socio-cultural factors like early child marriage must be taken into consideration

Need to work on issues underlying child marriage through social norm-change interventions as well as economic interventions


Acknowledgements Project Staff: • Cynthia Nyakwama – WV Kenya • Shano Guyo – WV Kenya • Adrienne Allison – WVUS

We thank: • USAID • Advancing Partners & Communities • Ministry of Health - GOK

Presenter

Presentation Notes

In closing, we'd like to thank USAID and the APC project for their support. And of course, the hard work of my colleagues in the field. I would not be standing here - if it were not for them. Thank you.


Thank you!

Asante!

Shukriya!

Terima Kasih!

Dhonyawad!

the garba tulla htsp project: increasing contraceptive uptake in northern kenya

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