Kisumu, Kenya — When Silper Agandi, a cleaner at the Tupange-supported Migosi Health Centre, received an invitation to a training session on family planning, she was sure there had been a mistake.
“Those things are always for the nurses and doctors only—why would they ever want a sweeper to go to that class?” she asked herself.
On the day of the training, Agandi summoned the courage to enter the class and found that the entire staff—including the night watchman—had been invited. The 32-year-old mother of seven took a seat on one of the long wooden benches and, today, couldn’t be more glad that she did.
“We learned so much about family planning in those classes,” Agandi says. “With seven children, I knew I just couldn’t manage anymore. I was so tired. But I was fearing that [contraception] was going to hurt my body.”
After attending just two of the series of classes, Agandi decided to adopt a family planning method—Depo-Provera, an injectable contraceptive. She has never looked back.
“Family planning is good. Tupange made me feel like I belong to myself again,” she says, of the urban reproductive health initiative led by Jhpiego and supported by the Bill & Melinda Gates Foundation.
For the past year, through the Tupange project, Jhpiego’s Kenya team and partners have been working with the country’s government and private health providers to offer a full range of family planning services to some of Kenya’s most vulnerable women and families: those living in urban slums. This is part of Jhpiego’s ongoing work within the country—a decades-long collaboration with health leaders—to build the capacity of health care workers, strengthen and sustain health systems, and innovate to save lives.
No more than 39 percent of Kenya’s urban poor are using contraceptives, largely because they are unaware of family planning options, hold false beliefs about many of the methods or don’t have access to services. The goal of Tupange—which means “to plan” in Swahili—is to increase contraceptive use in such settings by 20 percent, helping to reduce maternal deaths. A key feature of the plan is offering family planning options to women when they come to a clinic to be tested for HIV or bring a child to be immunized—an integrated, “single visit” approach that is not customary in Kenya.
A cornerstone of the project’s approach will be to determine whether family planning use is highest when a choice of modern contraceptives, including long-acting and permanent methods, is consistently available to the urban poor; and when the social environment supports—and lowers barriers to—contraceptive use.
The project is operating in 68 public and private health facilities in three major urban areas of Kenya, expanding access to high-quality services and creating demand for these services through extensive community outreach and communication. As part of its innovative approach, Tupange includes not only health providers, but also other facility staff and community health workers, in its education and training on family planning methods.
The training sessions for staff at Migosi Health Centre are held before clients arrive. Nancy Aloo, the nursing officer in charge at Migosi, facilitated the sessions, with the support of Tupange’s nurse-trainer, Jennipher Anga’ha. The whole-site trainings are designed to address myths and misperceptions about family planning, complementing technical mentorship of the nurses who will provide the family planning services.
“What we found out is that every person who works at the hospital is asked questions about health in their community,” says Aloo, wearing a Tupange-branded apron. “Even if you are a sweeper at the clinic, your community expects you to know things. It means that all of us need to be good role models.”
Agandi agrees: “Now that I have taken those classes, I tell everybody about family planning. I encourage them to come and talk to our nurses and to choose a method.”
Agandi also explains to women she talks with what to expect as they begin a family planning regimen. “The problem is that if you just start a method and you don’t know what to expect, you can get scared—why am I not getting my menses? What is going on? If you know, then you don’t panic,” she says. “So far I have brought 10 ladies from my community to this clinic, and they have all gotten a family planning method!”
Since the Tupange project began working with Migosi Health Centre, Nurse Aloo has seen dramatic results: “My nurses are [providing family planning] counseling properly now. Since all of us know how to do family planning, we offer the services all the time—not just when a patient asks for it. Now that staff have learned how to do implants and [IUD, intrauterine contraceptive device] insertions, they are embracing those methods much more and use of these services has grown exponentially.
“We used to do maybe two [of these procedures] per month, and now we can do 75 to 100. We are very proud.”