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Revitalizing family planning in Christian Health Associations through community health workers and religious leaders
1. Revitalizing family planning in
Christian Health Associations
through community health
workers and religious leaders
Lauren VanEnk, MPH
Institute for Reproductive Health
Georgetown University
3. CHAK’s dream:
• That family planning (FP) education and options
will become easily accessible through a
community-based distribution system
• That FP will cease to be restricted to hospitals
where it is offered as medical treatment but
instead will be transformed into an opportunity
for Family Centered Health Care
• That FP will become a right for every woman
and family
- Dr. Samuel Mwenda, Director of
CHAK and ACHA Platform
4. Mobilizing FBOs to expand access
to and choice in FP
Donor
World Bank
Christian
Partners
Christian
Institute for Connections
Health
Reproductive for
Association of
Health (IRH) International
Kenya (CHAK)
Health (CCIH)
Strengthen the capacity of Christian Health Associations to
Goal
improve access to FP information and services, emphasizing
opportunities for regional scale-up.
5. Project Objectives
1. Strengthen FP service delivery
– TOT for master trainers
– Facility-based Trainings
– Community-based Trainings
2. Sensitize Religious Leaders
– Develop IEC materials for FBO context
– Informational workshops for pastors
3. Strengthen reporting process
– Develop CHW reporting tools
– Ensure supportive supervision provided to CHWs
4. Develop capacity building strategy for regional
implementation
– Introduce project at regional conference in Ghana
– Disseminate model at an end of project workshop
6. Pilot introduction of community-
based FP through CHAK facilities
• 67 community health workers (CHWs)
trained to provide FP information and
methods
• CHWs distributed pills, condoms,
Standard Days Method® (SDM)/
CycleBeads®, Lactational Amenorrhea
Method (LAM), referrals to facility for all
other methods
• SDM was introduced for the first time as
a new method, bringing new users to FP
7. Capacity Building Strategy
components
Establish Create a Ongoing
Establish Supportive
Training Reporting Supervision
5
Supply Chain Environment
Mechanism of CHWs
Capacity Building Strategy
In order for project This capacity building strategy Project managers/ To create a CHWs attend
to be relies on a training curriculum supervisors must supportive supervision visits
successful, CHWs for CHWs based on the WHO ensure CHWs are able environment for FP monthly to submit
must have access to flipchart for FP provision. to complete FP reports. provision at the reporting
FP supplies. community level, a forms, receive
Activities
Supervisors are equipped to It is equally important one-day workshop resupplies of FP
provide this training as well as that facilities readily with pastors is commodities (if
ongoing supervision to CHWs. receive CHW reports conducted. possible), and
and record them in receive support and
their service statistics. Pastors create action refresher
plans detailing how instruction on
they will use this knowledge gaps.
information with
their congregations.
• CHW Curriculum • Reporting forms • Bible Study guide • Supervision
• Presentations, including • WHO flipchart for checklist
• Knowledge
Tools
HTSP FP provision
• WHO flipchart for FP • HTSP Improvement
provision presentation Tool
• Client cards
8. Establish Supply Chain
Must Haves:
• Pills, condoms, and
CycleBeads at the
community level
• Stakeholder
involvement
9. Training
Must Haves: Tools:
• Work with existing • CHW Curriculum
cadre of CHWs • Presentations, including
HTSP
• WHO flipchart for FP
provision
• Client cards
10. Establish Reporting
Mechanism
Must Haves: Tools:
• Tested reporting forms • Reporting forms
• Facility staff
understands their role
• MOH buy-in
11. Create a Supportive
Environment
Must Haves: Tools:
• Pastors willing to share • Bible study guide
health information with • WHO flipchart for FP
their congregations provision
• HTSP presentation
12. Ongoing Supervision of
CHWs
Must Haves: Tools:
• Stakeholder • Supervision checklist
involvement • Knowledge
• Incentive for CHWs Improvement Tool
• Capable supervisors
equipped to support
CHWs
13. Capacity Building Strategy
components
Establish Create a Ongoing
Establish Supportive
Training Reporting Supervision
5
Supply Chain Environment
Mechanism of CHWs
Capacity Building Strategy
In order for project This capacity building strategy Project managers/ To create a CHWs attend
to be relies on a training curriculum supervisors must supportive supervision visits
successful, CHWs for CHWs based on the WHO ensure CHWs are able environment for FP monthly to submit
must have access to flipchart for FP provision. to complete FP reports. provision at the reporting
FP supplies. community level, a forms, receive
Activities
Supervisors are equipped to It is equally important one-day workshop resupplies of FP
provide this training as well as that facilities readily with pastors is commodities (if
ongoing supervision to CHWs. receive CHW reports conducted. possible), and
and record them in receive support and
their service statistics. Pastors create action refresher
plans detailing how instruction on
they will use this knowledge gaps.
information with
their congregations.
• CHW Curriculum • Reporting forms • Bible Study guide • Supervision
• Presentations, including • WHO flipchart for checklist
• Knowledge
Tools
HTSP FP provision
• WHO flipchart for FP • HTSP Improvement
provision presentation Tool
• Client cards
14. Change in Pill Use and
SDM/CycleBeads Use Pre and Post
Community-based FP Provision
3500 350
3000 300
2500 250
2000 200
Jan-Feb
1500 150 2011
100 Jan-Feb
1000
2012
500 50
0 0
Pills dispersed CycleBeads
dispersed
Statistics from Chogoria Presbyterian Hospital
15. Changes in Injectable, IUD, and
Implant Use Pre and Post
Community-based FP Provision
1300 25 20
1250 20
15
1200
15
1150 10
10
1100 5
1050 5
0
1000 0
Implants
Injectables IUDs dispersed
dispersed
dispersed
Statistics from Chogoria Presbyterian Hospital
16. Lessons Learned
• No Product, No Program
• Lay the ground work:
advocacy and stakeholder
involvement is crucial
• Expanding the method mix
at the community level can
increase method use and
bring new users to FP
You can see here the 5 components of the strategy which are outlined in greater detail in a forthcoming report.
You can see here the 5 components of the strategy which are outlined in greater detail in a forthcoming report.
No Product, No Program. This couldn’t be more applicable for community-based family planning programs. Success hinges on the availability of family planning supplies, and CHWs rely on supervisors and project managers to ensure their availability. Stockouts are a common problem in most countries and even moreso within most CHAs. Special attention must be paid to addressing stockouts before the project begins, not after/during because then it is too late. If no formal CHW training program exists in-country, special attention must be given to communicating with ALL stakeholders about the project. Emphasis the credibility of CHWs to provide FP and distribute supplies. Ensure that facilities incorporate CHW reports into facility statistics submitted to the district and national level. This is especially important if CHWs in church-based networks visit government facilities rather than CHA facilities to pick up supplies and turn in reports.Introducing SDM in project sites brought renewed interest to family planning use. Project results showed that use of pills more than tripled as compared to the previous year, and uptake of CycleBeads--which was added to the method mix for the first time--was high. Use of implants and injectables also increased, indicating that the CHWs are referring clients to health facilities for methods they are not able to provide at the community level.