The provision of emergency contraceptives in private sector pharmacies in urban Kenya: Experiences of mystery clients

This paper presents the results of an assessment of the provision of emergency contraceptives (EC) in private pharmacies in Nairobi, Kenya. Trained female mystery clients (MCs) made a total of 103 visits to 20 randomly selected pharmacies and presented accounts of their experiences. The results show that: 1) some providers insist on doctors’ prescriptions before they can dispense EC; 2) there are variations among providers on the recommended dosage and possible side-effects of EC pills; 3) MCs presenting as inexperienced clients were significantly more likely to be given additional information on EC than the experienced ones; 4) there was no significant difference in the provision of additional reproductive health (RH) information/services by the scenario presented. This suggests the need for: 1) provider training and/or updates on EC to enhance their capacity to offer additional RH information/services; 2) sensitizing EC clients on the importance of obtaining additional RH information/services from providers

Delivering contraceptive vaginal rings—Task shifting and task sharing in the delivery of family planning services: Experiences from Kenya

This report describes the task-shifting and task-sharing policies and experiences relevant to the provision of family planning (FP) services in Kenya and the potential place for contraceptive vaginal rings. The feasibility, effectiveness, and acceptability of mid- and lower-level providers in the provision of FP services is documented. The report highlights how the provision of integrated RH/FP/HIV services could be delivered by various levels in the national health care system through task-sharing. Opportunities for facilitating delivery of the Population Council’s Progesterone Contraceptive Vaginal Ring (PCVR) within the national health care system in Kenya are also described. Kenya has in place policies that allow lower- and mid-level health workers to deliver contraceptive methods, and task-shifting approaches are likely to lead to a more rational distribution of responsibilities among different cadres of health workers with regard to provision of RH services, including eventually contraceptive vaginal rings. By including rings among tasks being shifted, a wider distribution could be achieved within a relatively short time-period. Any success with the PCVR would provide clues to the likely high acceptability that may accompany the Council’s Nestorone®/Ethinyl Estradiol Contraceptive Vaginal Ring (NES®/EECVR) when it becomes available

Delivering contraceptive vaginal rings: Review of postpartum service packages in Kenya

The postnatal period is a critical phase in the lives of mothers and newborn babies. Most maternal and infant deaths occur during this time, yet this is the most neglected period for the coverage and provision of quality care. The building blocks of the WHO health systems model were applied in describing the status and health system structures that support the provision of postpartum and postnatal care (PNC) services in Kenya. Many opportunities exist for facilitating the delivery of the Population Council’s Progesterone Contraceptive Vaginal Rings (PCVR) within PNC services in Kenya, such as integration with other primary health care components. Given that about 60 percent of neonatal deaths occur within the first week following childbirth, this means that a substantial proportion of newborns and their mothers do not receive quality PNC. Additionally, inadequate financial resources are allocated to reproductive health activities. This report concludes that available PNC packages provide useful entry points not only for integrating the PCVR but also for making it accessible and available in nearly all maternal and newborn points of contact with postnatal clients

Family planning counselling and use among clients seeking abortion services in private health facilities in Kenya

This paper examines family planning service provision and use among clients seeking abortion services in private health facilities in Kenya. Data are from observations of client-provider interactions and exit interviews conducted in May-June 2013 with 125 clients from 30 private clinics in Kisumu, Nairobi, and Mombasa counties. Analysis entails simple frequencies, cross-tabulations with Chi-square tests, and estimation of multivariate logistic regression models. The results show that: (1) although 78% of the clients had used family planning before, it was mostly short-acting methods such as condoms (44%), injectables (35%), oral (40%) and emergency (26%) pills; (2) providers did not counsel clients on family planning in 20% of the consultations while clients were offered a method in 47% of the consultations; and (3) among clients who had ever used family planning and accepted a method during the visit, 60% chose a different method with the shift being from short-acting to long-term methods

Contraceptive Failure among Women in Homa Bay County of Kenya: A Matter of User and Provider Deficiencies

Although the Kenya family planning program appears successful at the national level—with contraceptive prevalence rate (CPR) in 2014 surpassing the 2015 target of 56%—sub-national variations suggest the need to understand the patterns at the local levels to inform programs to either sustain or improve further the levels that the country has attained. This chapter examines the reasons for contraceptive failure among 166 women aged 15–39 years in three sub-counties of Homa Bay County in Kenya. The findings show that failure of methods such as injectables, pills and condoms was mostly because of challenges with client adherence and inconsistent use. Failure of long-acting and permanent methods such as implants and female sterilization was partly due to limited provider capacity to offer the methods and partly due to inability to afford the costs of resupplies of implants. These patterns were further exacerbated by limited access to adequate information on the part of users, which could enable them make informed contraceptive choices. The experiences of women regarding contraceptive failures—including highly effective long-acting and permanent methods—suggest the need for targeted interventions to address challenges that might hamper the success of the family planning program in such localized settings

Mainstreaming emergency contraception in Kenya: Final project report

For more than a decade, advocates have sought to improve access to emergency contraception (EC) around the world. These efforts have been highly successful in Europe and North America, have generated much debate in Latin America, and are beginning to take hold in Asia. In Africa, however, the success of EC programs remains limited. Even in countries where the regulatory environment is favorable, resource constraints within the public sector limit the ability to provide consistent and quality EC services at low cost. In a growing number of African countries, the private sector has emerged to fill these gaps, increasing access primarily among young, affluent urbanites. Low knowledge levels among the general population ultimately undermine the impact of such provision strategies. The initiative described in this report includes activities aimed at improving overall awareness of EC across Kenya and strengthening the quality of EC services in the public and private sectors. It was intended to serve as a model for other countries interested in improving access to EC, and to generate in-depth knowledge on EC program strategies and utilization characteristics in sub-Saharan Africa. This final project report details the outcomes of this initiative

Infographic—Getting to market: Roadmap for user access

The Population Council is an established leader in the development of reproductive health technologies. An estimated 170 million individuals worldwide use a highly effective contraceptive that was developed based on science generated by the Council. This infographic provides the Council’s four-stage product introduction framework that spans the continuum from product development to reaching the end-user. Stage 1 is Innovation, Stage 2 is Investment, Stage 3 is Launch, and Stage 4 is Scale Up. The Council works with stakeholders every step of the way from innovation to scale up into health systems. Advocates identify health areas of critical need; users inform our product design; donors, social entrepreneurs, manufacturers, and other market actors invest in our ideas; policymakers and implementers in the public and private sectors assist in launching the health technology; and health-care providers and consumers provide feedback on how well technologies are addressing needs while product designers and manufacturers continuously improve the technology

Mainstreaming emergency contraception in developing countries: A toolkit for policymakers and service providers

In late 2006, the Kenyan Ministry of Health (MOH), the Population Council, and Population Services International (PSI) launched an initiative to mainstream emergency contraception (EC) in Kenya. The initiative included a core set of activities aimed at improving overall awareness of EC across the country and strengthening the quality of EC services in both the public and private sectors. It was intended to serve as a model for other countries interested in improving access to EC, and to generate in-depth knowledge on EC program strategies and utilization characteristics in sub-Saharan Africa. The MOH drew lessons and experiences from the initiative to substantially revise the EC component of the 2010 National Family Planning Guidelines for Health Providers. This toolkit on mainstreaming emergency contraception in developing countries has been developed in response to one of the objectives of the 2006 initiative that sought to generate lessons that could serve as a model for other countries interested in improving access to EC, and to generate in-depth knowledge on EC program strategies and utilization characteristics in sub-Saharan Africa

Mainstreaming EC in Africa: The EC facilitative re-granting program—Final narrative report

Since 2006, ECafrique has been working to build the capacity of African nongovernmental organizations to design, implement, and evaluate successful emergency contraception (EC) mainstreaming projects. Through a process of “facilitative regranting,” ECafrique annually awarded nine grants ranging from $25,000 to$30,000 to organizations from across Anglophone and Francophone Africa. The program’s objectives were to increase access to EC across Africa by supporting projects intended to introduce, scale up, or mainstream the method, and build the capacity of African NGOs to design, implement, and evaluate successful EC mainstreaming projects. Each grantee participated in an international proposal development workshop and received individualized technical support throughout the life of their project. The nine projects supported under this program took place in Burkina Faso, Cameroon, Cote d’Ivoire, Ghana, Kenya, Nigeria, Senegal, and Uganda (two). This final narrative report details the accomplishments of each grantee, and highlights lessons learned regarding this approach to grant making

Pharmacy workers in Kenya need training and support on medical abortion information and referrals to prevent unsafe service provision

Despite the centrality of pharmacists in the provision of abortion services in Kenya, little is known about their medical abortion (MA) knowledge, attitudes, or practices. This policy brief reports on a study that set out to bridge this gap in the evidence. The report concludes that comprehensive training for pharmacy workers could improve the quality of MA provision and referrals, and help pharmacy workers identify opportunities to simultaneously provide clients with information on contraception and STI prevention. Such efforts would be in line with current Kenyan government policies to reduce the public health burden caused by the prevalence of unsafe abortion and HIV, and within the boundaries of the current legal framework