When Silper Agandi, part of the cleaning staff at the Tupange-supported Migosi Health Center in Kisumu, Kenya, was invited to a family planning training session, she was sure there had been a mistake. “Those things are always for nurses and doctors only. Why would they ever want a sweeper to go to that class?” However, in Kisumu, community members turn to even non-medical staff, such as Silper, for family planning advice.
This whole-site training initiative, developed collaboratively by Tupange (the Kenya Urban Reproductive Health Initiative) and the Ministry of Health, promotes the provision of basic family planning knowledge to providers and other clinic staff through a series of classes conducted within the health facility. Nancy Aloo, the nursing officer-in-charge of the Migosi Health Center where Silper works, explains, “Even if you are a sweeper at the clinic, your community expects you to know things about health. It means that all of us need to be good role models.” With the new family planning knowledge in hand, Silper is doing just that.
“Now that I have taken those classes, I tell everybody about family planning….So far I have brought 10 ladies from my community to this clinic, and they have all gotten a family planning method!” – Silper Agandi, Cleaning Staff, Migosi Health Center, Kisumu City
Tupange is also conducting onsite mentoring to improve health care providers’ family planning knowledge and skills in Ministry of Health facilities in the five Tupange project cities (Nairobi, Mombasa, Kisumu, Machakos and Kakamega).
Though all staff undergo pre- and in-service training to update their family planning knowledge, many still do not possess the skills to provide family planning counseling and services. These health providers were paired with skilled providers who serve as mentors in order to ensure that facility staff becomes competent and proficient in the provision of family planning – especially in providing long-acting and permanent methods (LAPMs). Mentors work collaboratively with health facilities and mentees to schedule family planning mentorship activities based on facility needs. With mentees, they review family planning knowledge, practice clinical skills on humanistic models, conduct clinical demonstrations, practice clinical skills on humanistic models and supervise family planning provision to actual clients. This one-on-one instruction includes how to counsel clients on family planning and how to determine a client’s medical eligibility criteria.
The mentoring curriculum is standardized through a reproductive health learning guide and classroom-based training. Thus far, 110 of the 424 providers who entered the program have successfully completed it, resulting in 110 more providers who are now able to offer full family planning counseling and services.
The need for these programs became evident when Tupange examined its baseline household data (2010) and found low use of LAPMs such as implants, intrauterine contraceptive devices (IUCDs) and male and female sterilization, compared to use of short-term spacing methods. LAPMs are an important part of the method mix because they are the most effective and cost-effective contraceptive methods, and their wider availability and use would reduce fertility rates more than wider use of most other methods.
Tupange discovered that limited family planning service provision, as well as no service provision at all, was contributing to the problem and saw an immediate need to increase provider and staff competence to provide family planning services. The Tupange service delivery point baseline survey found that about 40 percent of the facilities surveyed that had LAPMs available could not actually provide them due to inadequate resources and provider skills.
At baseline relatively few providers received in-service training on long-acting and permanent methods (LAPMs). Tupange is addressing this gap by updating providers’ clinical skills on LAPMs.
Before the Tupange program, around 30% of doctors, clinical officers and nurses could counsel clients about implants and IUCDs but could not provide the methods, and about half could counsel about sterilization but could not performs the procedures.
Short-acting methods–injectables, pills, and condoms–are popular in Tupange cities. But a higher percentage of women are now using long-acting and permanent methods, particularly implants.
All facilities in Kisumu that Tupange supports now offer implants and IUCDs, and the percentage of facilities offering IUCDs and sterilization has increased.
Furthermore, the survey showed that about 30 percent of the facility staff could counsel clients about implants and IUCDs but could not provide the methods and about half could counsel about sterilization but could not perform the procedures. Fewer than 30 percent of providers received in-service training on family planning.
“I was very excited to insert the first IUCD on a client. I was trained but I had never inserted one.” – Health Care Provider, Kisumu City
Since implementing the whole-site training and onsite mentoring complementary initiatives, all Tupange-supported facilities are now able to offer implants and IUCDs. Referrals to other clinics for LAPMs have decreased, while referrals within clinics have increased. From 2011 to 2012, Tupange monitoring data indicate that the number of new LAPM acceptors in Tupange-supported health facilities increased threefold from an average of 1,000 clients per month in January 2011 to 4,500 clients per month in September 2012 (mostly due to increases in use of implants and IUCDs).
Just as importantly, these initiatives have had a positive impact on provider and staff confidence. Providers who have completed the mentoring program are happy to have a colleague help strengthen their information and skills at their own pace and time. Other staff members are happy to learn about family planning and have applied it to their own lives. After attending two classes, Silper, a mother of seven, learned enough to calm her fears and adopt a LAPM herself. “Family planning is good,” she says. “Tupange made me feel like I belong to myself again.”