Translating Research to Practice: Community Based Distribution (CBD) of

DepoProvera (DMPA) in Kenya

Alice Olawo1, Jane Gitonga2, Elizabeth Washika3

1. Family Health International, Kenya2. USAID/APHIA II Eastern3. Division of Reproductive Health, MOPH&S

International Conference on Family Planning: Research and Best PractisesWednesday, November 18, 2009

APHIA II EASTERN

Background on FP in Kenya

CPR increasing after a period of stagnation (39% for over 10 years but is now 46%)

High unmet need (25%) among currently married women in Kenya

Depo is most preferred method (45% of modern method users)

Renewed MOH focus towards provision of services beginning with the community level

Community-based distribution of DMPA

It is the provision of DMPA by competent and appropriately trained community-based health workers Research shows it is safe, feasible and acceptable, and is recommended by global technical experts. CBD of DMPA in Kenya is a research utilization introduction project and is part of a larger effort to address issues of family planning access and health worker shortages in Africa It aims to support the Kenya Ministry of Public Health and Sanitation (MOPHS) in its efforts to increase access to contraceptive services

CBD of DMPA introduction has taken time and is challenging

MOH Steering Committee

Strategy Development

ID of potential implementing partner

Advocacy meetings (Provincial and District)

Site ID for pilot study

Consensus Building

2006 2007 2008

Implementation plan, MOU with Jhpiego

Multi-sectoral advisory committee

Educational tour to Uganda

2009

Materials developmentCBD Training

Service provision

Consensus building process

Began by meeting with head of the Department of Reproductive Health (DRH), followed by DRH program managers

MOH steering committee led by DRH was formed, to guide related activities

Development of a strategy to introduce injectablesDevelopment of an advocacy kitConsultations with Professional medical associations

(National Nurses Association of Kenya, KOGS etc.)Meetings with MOH provincial level and district level officials

Addressing stakeholder concerns

South to south knowledge sharing: Educational tour to Uganda to see CBD of DMPA in action addressed professional medical associations’ concerns about safety and infection prevention Broader group of stakeholders’ meeting was held to consult key players

Stakeholder meeting advised formation of multi-sectoral advisory committee guide the program in Kenya

Implementation

Development of training materials (January to August 2009)

Identification of CBD agents in consultation with the community

7 days classroom training of 31 CBD agents, followed by 6 days clinical practicum (August 2009)

Provision of services at the community (August 2009)

Monitoring and evaluation visits (Monthly visits since August 2009)

Since August 2009, over 300 women have received DMPA injections.

Lessons Learned

It takes time to introduce a new concept that involves change in practice

There is need to contextualize evidence to facilitate buy-inMOH leadership and authority is critical in obtaining support for

the project at all level It is essential that partners work together hence synchronized

work plans for effectiveness

Kenya is successfully piloting an evidence-based strategy for addressing issues of contraceptive access. Additional research questions will be generated, along with lessons learned, which

can be applied to future in-country scale up.

Acknowledgements

Ministry of Public Health and Sanitation, Division of Reproductive Health

JhpiegoUSAID APHIA II Eastern