kenya

Slide1: 

CPIs in the provision of FP in VCT services Dr. Marsden Solomon, DRH-MOH, Kenya Jennifer Liku, FHI, Kenya

FP-VCT Integration Partners: 

FP-VCT Integration Partners MOH NASCOP Main VCT committee FP-VCT sub-committee DRH & NASCOP (Co-chairs) AMKENI Project (EngenderHealth & partners) JHPIEGO FHI Population Council Funded by USAID

Objectives of Integration Program: 

Objectives of Integration Program Broad objective To provide integrated RH and HIV/AIDS services Specific objectives To meet the RH needs of clients in an HIV/AIDS environment To provide opportunities for RH clients to know their HIV status and access care To increase FP uptake at VCT service points and vice versa

Kenya Context: 

Kenya Context Contraceptive prevalence rate of 39% HIV population prevalence of 7% Shift in focus/decline in FP funding FP integrated into Maternal Child Health clinics

Enabling factors for Integration: 

Enabling factors for Integration Supportive policy environment and MOH structure HIV/AIDS and FP exist as components of the country’s RH strategy Existence of service provision guidelines VCT and PMTCT guidelines include provision of FP services Existence of the relevant technical committees

Integration process in Kenya: 

Integration process in Kenya National level advocacy and sensitization Provincial sensitization workshops Training 38 TOT 101 VCT providers 62 sites in 8 provinces

Key milestones: 

Key milestones FP-VCT sub-committee Development of FP-VCT integration strategy Development of FP-VCT training tools Site assessments TOT & Service provider training

Key milestones (cont’d.): 

Key milestones (cont’d.) Facilitative supervision conducted FP provision initiated at some VCT centers Development of client brochure Evaluation of the pilot intervention

Challenges: 

Challenges Administrative support (provincial thru facility level) Shortage of staff Mal-deployment Access to commodities Inadequate funding for scaling up

FP-VCT integration evaluation: 

FP-VCT integration evaluation 14 facilities participated 60 providers interviewed/observed 20 of 60 VCT providers in these facilities participated in the FP-VCT training < 2 providers per facility 363 observations of client-provider interactions

Observations of fertility and family planning use discussions by FP-VCT training: 

Observations of fertility and family planning use discussions by FP-VCT training

Observations of family planning counseling by FP-VCT training : 

Observations of family planning counseling by FP-VCT training

Observations about male condoms by FP-VCT training: 

Observations about male condoms by FP-VCT training

Observations of VCT mean session length by provider training: 

Observations of VCT mean session length by provider training

Conclusions: 

Conclusions Pregnancy risk screening and informed choice counseling low Fertility related discussions occurring in a minority of CPIs Need to establish the effect of integration on contraceptive uptake

Implications for improvement of CPIs in FP-VCT integration: 

Implications for improvement of CPIs in FP-VCT integration Identify/implement training strategies to increase pregnancy risk screening and informed choice counseling Train additional VCT providers in each site Conduct more sensitization activities at provincial, district and facility levels Identify and implement sustainable supportive supervision approaches Assess intervention effect on contraceptive uptake