Exploring experiences in peer mentoring as a strategy for capacity building in sexual reproductive health and HIV service integration in Kenya.

BACKGROUND: The Integra Initiative designed, tested, and adapted protocols for peer mentorship in order to improve service providers' skills, knowledge, and capacity to provide quality integrated HIV and sexual and reproductive health (SRH) services. This paper describes providers' experiences in mentoring as a method of capacity building. Service providers who were skilled in the provision of FP or PNC services were selected to undergo a mentorship training program and to subsequently build the capacity of their peers in SRH-HIV integration. METHODS: A qualitative assessment was conducted to assess provider experiences and perceptions about peer mentoring. In-depth interviews were conducted with twelve mentors and twenty-three mentees who were trained in SRH and HIV integration. Interviews were recorded, transcribed, and imported to NVivo 9 for analysis. Thematic analysis methods were used to develop a coding framework from the research questions and other emerging themes. RESULTS: Mentorship was perceived as a feasible and acceptable method of training among mentors and mentees. Both mentors and mentees agreed that the success of peer mentoring largely depended on cordial relationship and consensus to work together to achieve a specific set of skills. Mentees reported improved knowledge, skills, self-confidence, and team work in delivering integrated SRH and HIV services as benefits associated with mentoring. They also associated mentoring with an increase in the range of services available and the number of clients seeking those services. Successful mentorship was conditional upon facility management support, sufficient supplies and commodities, a positive work environment, and mentors selection. CONCLUSION: Mentoring was perceived by both mentors and mentees as a sustainable method for capacity building, which increased providers' ability to offer a wide range of and improved access to integrated SRH and HIV services

Strengthening the delivery of comprehensive reproductive health services through the community midwifery model in Kenya

The overall objective of this project was to strengthen the delivery of family planning/reproductive health and HIV (FP/RH/HIV) services at the community level. The interventions included revision of existing guidelines and protocols for the community midwifery approach, training of providers, provision of equipment and supplies, and creating awareness on the use of community referral cards. In addition, cost analysis of community midwives’ services and willingness-to-pay assessments for various reproductive health services among current and potential users of community midwifery services were undertaken. The results showed that the community midwifery model improved clients’ access to a comprehensive package of RH/HIV including long-term family planning methods. The report provides specific recommendations for additional improvements to strengthen the delivery system

Linking HIV-positive family planning clients to treatment and care services in Kenya

A project from the Population Council’s USAID-funded FRONTIERS program found that integrating HIV counseling and testing into family planning (FP) services was feasible and acceptable to clients and providers, and led to significant improvement in the quality of care provided. However, a major limitation was that FP clients who tested HIV-positive were not actively linked to care and treatment services, including antiretroviral treatment, and screening and management of sexually transmitted infections. A new initiative aimed to design and test a referral framework for linking HIV-positive FP clients to treatment and care in selected health facilities; assess the acceptability of the proposed referral framework to providers; and assess its effectiveness in increasing the number of eligible HIV-positive FP clients receiving HIV care and treatment services. The findings of the project evaluation show that the referral mechanism put in place was effective and the study recommends that the Division of Reproductive Health, NASCOP, and other units within the Ministry of Health, such as the Health Management Information System, support the provincial and district health management teams to scale up the use of the referral form developed under this project to other FP clinics within Central and other provinces

The community midwifery model in Kenya: Expanding access to comprehensive reproductive health services at the community level

The ‘community midwifery approach’ is an innovation involving the engagement of skilled midwives residing in communities to take critical maternal health services to women’s homes, thus improving maternal, newborn and infant health. This paper is based on a study that aimed to assess the effect of expanding community midwives’ mandate to go beyond the provision of delivery services alone, to incorporate a more comprehensive package of reproductive health and HIV services. This operations research project involved pre- and post-intervention data collection without a comparison group to assess intervention effects. The project was implemented in the Bungoma and Lugari Districts of Western Province, Kenya. Findings from the project indicate that the expanded community midwifery model improved clients’ access to a comprehensive package of family planning, reproductive health and HIV services at the community level. However, the intervention was less successful in improving the provision of a continuum of care by community midwives