Nairobi, Kenya – Community health workers across Kenya will be able to distribute injectable contraceptives to women in need of family planning services under new national guidelines approved through the intervention and assistance of Jhpiego and partners.
The amended family planning guidelines signed by Kenya’s Directors of Medical Services and Public Health and Sanitation took effect in late 2012; they allow community health workers to distribute and inject contraceptives at the community level. The guidelines formalize a family planning service that had been under way in parts of Kenya for some time. But, according to Rose Maina, Jhpiego’s lead staffer on the Bill & Melinda Gates Foundation-funded Advance Family Planning (AFP) project, the new national guidelines will ensure that all women can now benefit from these services.
“This strategy of getting family planning to communities through community health workers has actually been working in parts of Kenya for decades,” she explains earnestly. “And now FINALLY we have the policy signed to make it happen everywhere in Kenya! This is truly a great day for our women.”
The AFP project provided targeted financial and technical support to enable a group of family planning advocates, in collaboration with the Ministry of Health (MOH), to create and implement a strategy for bringing about the policy change for injectable contraceptives to be made available through community-based distribution (CBD). Many people contributed significantly to this effort including the MOH officers under the leadership of Dr. Bashir Isaak, Head of the Division of Reproductive Health, and the Directors of Medical Services and Public Health and Sanitation.
Maina, a registered nurse, has been advocating for community-based distribution of pills and injectable contraceptives since her days in the MOH. In 2006, while working as the Community Health Contact for the Kenyan Division of Reproductive Health in the health ministry, she joined a group of influential stakeholders invited to Uganda by Family Health International to see lay community health workers giving injections and prescribing pills. The Kenyan delegation was convinced it was the way to go, but policymakers wanted hard data on Kenyans’ ability to provide the services to standard.
After joining Jhpiego in 2009, Maina keenly followed the progress of an operations research pilot study implemented by Jhpiego and FHI through the U.S. Agency for International Development-funded APHIA II Eastern Project. The pilot was successful, but developing a national policy took more time.
When Jhpiego received funding in 2011 from the Bill & Melinda Gates Foundation to concentrate intensively on making CBD a reality in Kenya, Maina was eager to take on the challenge and work behind the scenes to make it happen. “I know all the people in this,” she says, “and everybody knows that Rose loves community. I had to do it.”
Maina explains how the AFP project managed to accelerate adoption of the policy. “We used the Spitfire technique, which is a model where key stakeholders who are supportive of the change get together and make a very targeted plan of action,” she explains.
Dr. Bashir Isaak, Head of the Division of Reproductive Health, hosted a strategy workshop that featured an outside Spitfire expert who was able to answer questions and clarify assumptions. Participants included 21 key stakeholders from donors, institutions, the MOH and nongovernmental organizations. The strategy identified not only key individuals who needed to take action, but also those individuals to whom they would listen, and the messages upon which they would most likely act.
Maina organized the various meetings and efforts to keep everyone focused on the goal.
“I coordinated the meetings…to give people the opportunity to continue solving problems. Every time they needed something else, we found a way to get it to them. For example, when they needed more data about the counties, our Monitoring and Evaluation team made a map.”
International momentum also played a role in motivating the change, as more and more countries joined Rwanda and Uganda in allowing community health workers to distribute contraceptive injectables. “There was a conference in Cairo, then one in Dakar…,” said Maina. “Then there was an International Association of Nurses meeting in Malaysia, where they endorsed task shifting. The World Health Organization also issued guidelines on task shifting, and contraceptives are in there.”
“Kenya likes to lead,” she added. “We see ourselves as very capable.”
With the national policy now signed and in effect, Maina says there’s more work ahead. “We’re not talking about ‘if’ we do CBD anymore. Now we have to start talking about how and when! Now is when it gets interesting!”