January 8, 2016

Urban Health Project Makes Significant Family Planning Gains

Written by By Catherine Ndungu and Ann LoLordo

Nairobi, Kenya—Family planning use among Kenyan women and couples increased significantly through a Jhpiego-led urban reproductive health program aimed at expanding access to quality health services and contraceptives for hard-to-reach populations between 2011 and 2015.

The project, which reached out to women and couples in three cities and two fast-growing towns, offered family planning education, counseling and services in an effort to reduce unmet need for contraceptives. Known as Tupange, a Kiswahili word for “let’s plan,” the project was funded by the Bill & Melinda Gates Foundation. The project aimed to expand access to and reduce inequities in delivering quality health services for the urban poor.

Through innovative, strategic and community-based interventions, Tupange increased the rate of contraceptive use in the targeted cities—Nairobi, Mombasa and Kisumu—by about 13.9 percent and in the two selected towns—Machakos and Kakamega—by 11 percent and 7 percent, respectively. From 2011 to 2015, Jhpiego led the five-member Tupange project consortium, which included Marie Stopes Kenya, Pharm Access Africa Ltd., the National Council for Population and Development, and the Johns Hopkins Center for Communication Programs. Jhpiego also collaborated closely with the Ministry of Public Health and Sanitation, other ministries and county governments to increase use of family planning and reduce maternal and newborn deaths.

The largest gains in contraceptive use were made among the poorest women and couples in Nairobi, Machakos and Kakamega, an important step in achieving equity in family planning services. Among the urban poor segment of women, there was a 20 percentage point increase on average in the number of women who adopted a family planning method during the project. Middle-income participants in Mombasa and Kisumu also showed impressive gains in contraceptive use, according to final project data.

Thanks to the project, between 2011 and 2015, 425,974 women accepted a new contraceptive method to help space their pregnancies. Dedicated and enthusiastic teams of community health workers led Tupange’s outreach efforts.

Tupange-supported mobile health clinics, commodity tracking tools and community mobilization efforts among religious leaders and men helped local county health departments achieve their objectives to expand access to short- and long-term family planning methods.

“As religious leaders, we need to come together and advocate for family planning,” Sheikh Mahamoud, of the Council of Imams and Preachers of Kenya, said.

More than 750,000 people received family planning counseling during the project, and 137,000 were referred to services through community-based efforts. They included couples like Peter Kimani, 50, and his wife, Charity Nyokabi, 45, who live in a one-room house in Mombasa.

Nyokabi, who is paralyzed as a result of a traumatic stillbirth several years ago, first learned about Tupange’s free family planning services through a loudspeaker announcement made by a group of community health workers who visited her neighborhood. “I yearned to know more but I had no way of following up,” said Nyokabi, who was bedridden at the time.

The couple, who have two daughters, ages 14 and 20, lived in constant fear of conceiving another child and wanted protection. “My wife is unwell and I am retired,” Kimani explained. “Another child would set us back a long way.”

Then they met Evelyn Anyango, a community health worker with Tupange. In conversations with Nyokabi, Anyango described the different family planning methods available to her. After counseling, Nyokabi settled on an intrauterine contraceptive device (IUCD). Nyokabi was carried to an outreach center where she was screened for cervical cancer and fitted with an IUCD.

Since that day, Kimani said, he and his wife have lived in peace. “We have no fear because we are protected,” he said.

Anyango, who has worked with Tupange for four years, says people living with disabilities suffer from stigma and discrimination when trying to access family planning services. She says that before Tupange, most health care workers did not think that people living with disabilities had a right to family planning services, so many people stayed away out of fear of humiliation. However, through Tupange, community health volunteers received training on counseling all types of people about family planning and healthy birth spacing and on the importance of linking clients to services.

But there’s more work to be done; not every facility provides contraceptive implants and IUCDs.

Dr. Khadija Shikely, County Director of Health in Mombasa, emphasized the need for partnerships like Tupange in achieving reproductive health successes across all communities. “I can tell you, as a government alone, we won’t achieve it. We really need partnerships. We can’t do it alone.”