A review published in the Journal of Reproductive Health and Contraception, recommends,
‘To achieve Universal Health Coverage (UHC) there is a need to increase the accessibility of health services through task-shifting due to skilled staff shortages. With proper training and supervision, delivery of contraceptives can be offered in a safe and effective way by other cadres of healthcare providers who in normal circumstances are not qualified to offer these services.’
In Kilifi County, Kenya, Population Services (PS) Kenya in collaboration with the Ministry of Health — Reproductive Maternal Health Services Unit (RMHSU); the Community Health and Development Unit (CHDU); the Kenya Medical Training College (KMTC) and the County Government of Kilifi (through the Maverick project) is seeking to generate evidence and advocate for task-sharing of Family Planning (FP) service delivery from level 2 (Dispensary) to level 1 (community level) by Community Health Extension Workers (CHEWs) with proper structures for training and support supervision, as a contributor to UHC.
To enable documentation of this approach an operational research study is being conducted with the following objectives:
· Assess whether capacity building (training and provision of FP commodities) CHEWs to provide FP counselling and services at the community–level increases access to, and utilization of FP among women aged 18–49 years
· Assess whether capacity building (training and provision of FP commodities) CHEWs to provide FP counselling and services at the community–level increases access to, and utilization of LARC among women aged 18–49 years
· Assess whether capacity building (training and provision of FP commodities) CHEWs to provide FP counselling and services at the community–level increases informed demand for FP among women aged 18–49 years
· Assess whether capacity building (training and provision of FP commodities) CHEWs to provide FP counselling and services at the community–level increases informed demand for Long-Acting Reversible Contraception (LARC) among women aged 18–49 years.
· Assess the availability of family planning services at the community and facility levels.
· Assess the referral / linkage structures for family planning at the community and facility.
· Track changes in the social and policy environment for family planning.
· Assess the perceptions of policy makers and service providers on task sharing of FP service provision within the community.
The CHEW training in Kilifi was two-pronged. The first phase was comprised of 1-week classroom theory sessions, 1-week practice with humanistic models for skills acquisition and 1-week clinical experience and practice in high volume facilities where the County based trainers and the facility preceptors oversaw skills acquisition. The national trainers then joined the CHEWs in the last week in the link facilities for competency assessment, and thereafter the graduation ceremony for the first phase of training. The second phase of training comprised of 6 months CHEW modular at Kenya Medical Training College (KMTC) comprising of a classroom, online and onsite training.
‘Bringing health information and services directly to consumers is a quiet revolution that is disrupting healthcare systems worldwide. New technology and task shifting to community health workers bring care — previously provided only by medical professionals in brick and mortar facilities — directly to patients while making it safer and more affordable. Mobile phones and tablets allow community health workers to collect data and bring information and care directly to consumers in even the most remote areas.’ Ann Morris, Maverick Collective Member, pens in The Quiet Revolution That’s Bringing Healthcare Closer To You.
Under the guidance of MoH Reproductive Health Coordinators at the sub-counties in Kilifi, and the preceptors at the link facilities, the CHEWs have been offering FP services mainly at the facility level with a few having initiated the same services at the community level post-training as a way of increasing access as they move towards achieving proficiency.
Kilifi County is one of Kenya‘s 14 Counties considered hard to reach for FP nationally, and also one of the Counties with high unmet need for family planning among women of reproductive age (WRAs). The current modern CPR stands at 33% compared to the National CPR at 53%; thus Only 3 out of 10 women are using modern family planning methods. There is over reliance on short-acting methods with 60% using injectable methods compared with 5 in 10 women at the national level. Teenage pregnancy is one of the highest in the country; 22% of girls aged 15–19 years in Kilifi County have begun childbearing; higher than the national level (18%) (KDHS 2014). Teenage pregnancies often result from low use of contraceptives and/or unmet need for contraceptives. Unmet need for contraceptives among currently married adolescents in Kilifi (59%) is more than two times higher than the national level (23%).
Challenges? In Kilifi, unintended pregnancies often result in negative health, economic and social consequences for both the woman and her child, including increased maternal morbidity and mortality, poor breastfeeding and nutritional status, and infant mortality.
The first time we started thinking about family planning we had 6 children however my wife was afraid because she says her friend, who was on a method, had discouraged her. The health workers really helped her understand that there were different methods for every woman. This knowledge helped in contributing to the decision to get FP. Karisa Kaingu, 47
What do we want to do? To open a conversation with women and men about the benefits and the importance of family planning for healthy timing and spacing. We need to make FP a discussion that involves all stakeholders and in so doing achieve the following;-
Increased access for quality family planning products and services by women ages 18–49
Increased informed demand for family planning products and services by women ages 18–49
Increased availability of a range of contraceptive methods at the community and facility level
Improve the social and policy environment for FP services in Kenya
Generate evidence on task sharing for FP service delivery from level 2 to level 1 by the Community health extension workers (CHEWs)