Population Council Research that makes a difference

2011 International Conference on Family Planning
29 November–2 December 2011

Abstract

"Connecting the dots: Health systems strengthening to improve family planning uptake in Kenya"
Sheila Macharia, Marsden Solomon, Wilson Liambila, Chi-Chi Undie, Francis Obare, and Ruth Jahonga

Background
Family planning (FP) is a key strategy for meeting all the Millenium Development Goals (MDGs). It provides an opportunity to ensure a balance between population size and available resources and directly contributes to improved maternal and newborn health by enabling women to space or limit births. Kenya registered a rise in the CPR from 39% in 2003 to 46% in 2009. A key question of interest is the factors that contributed towards this achievement, especially after experiencing a stall in CPR between 1998 and 2003. It is possible that these factors were systemic and might have involved, at least in part, health systems strengthening. This paper therefore describes the health systems strengthening activities that were undertaken in the country and trends in FP uptake over the period.

Methods
The Ministry of Health (MOH) initiated a multi-pronged approach to improve FP uptake country-wide in 2006 with support from the USAID-funded AIDS, Population and Health Integrated Assistance (APHIA) program. This paper reviews documents, reports, and data on FP uptake from the APHIA programs in Kenya between 2007 and 2010 as well as from the most recent Kenya Demographic and Health Survey. FP uptake is measured by couple years of protection (CYP), that is, the protection provided by contraceptive methods during a one-year period based upon the volume of all contraceptives sold or freely distributed to clients during that period.

Results
The health systems strengthening activities included advocacy for FP, dissemination of guidelines, capacity-building, including trainings on FP and integration of FP and HIV/AIDS services, distribution of job aids, and support supervision to health care staff. Other activities entailed ensuring contraceptive commodity security, procurement of essential equipment, and innovative approaches for creating demand such as mobile outreaches, integrated FP camps, community-based distribution, and the use of health wagons to provide long-acting or permanent methods in hard-to-reach areas. These activities led to substantial increases in FP uptake. The APHIA program achieved a CYP of 143,484 from 2006 to 2007; a CYP of 879,770 from 2007 to 2008; and a CYP of 1,171,999 from 2008 to 2009. Intermittent stock-outs and reduced activities of the project between 2009 and 2010 reduced the CYP to 870,777.

Conclusion
The comprehensive health systems strengthening approach contributed to increased FP uptake as demonstrated by the rise in CYP and may therefore explain, in part, the rise in CPR that was observed in the country between 2003 and 2009.

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