Date/Time: Thursday, November 14, 2013 Session:

Author(s):

2.3.13 Research in Family Planning

Paul Nyachae, Jhpiego, Tupange Project ,Janet Omyonga, Jhpiego ,Margaret Kilonzo, Jhpiego ,Jenipher Ang'aha, Jhpiego ,Michael Muthamia, Jhpiego ,Heryne Dok, Jhpiego ,Margaret Odhiambo, Jhpiego Whole-site family planning Orientation as a Sustainable and Efficient Way of Empowering all Cadres of Staff to Promote Uptake of FP. Program/Best Practices Abstract Effective family planning programs

Title of Abstract: Abstract Type: Topic:

Significance/background / Importance
Facility staffs play a key role in passing health messages and influencing behaviour change among clients. Support staffs (security staff, clerks, cleaners etc) are usually the first contact for clients accessing services in a facility. Awareness of family planning (FP) by all staff working in a health facility can therefore influence FP uptake: when the staffs themselves have myths and misconceptions about FP, this can impart negatively on client choice for FP. Formal classroom training (central training) has been effective but it is expensive and is prone to disrupting services, especially in poorly staffed facilities. Some cadres of staff, such as support staff, are rarely considered for these central FP trainings contributing to their lack of knowledge on FP and other health issues. Based on the Kenya Urban Reproductive Health Initiative (Tupange) project Facility Assessments conducted in 70 public facilities in Nairobi, Mombasa and Kisumu in 2011, 42% of service providers were not trained on FP. Of those trained, less than 21% had received FP update training in the preceding 12 months. Despite the lack of training and updates, these service providers continue to offer FP counseling and services to clients.

Program intervention/activity tested

As part of the Tupange project, the whole-site orientation approach was introduced to provide FP updates in short (1 hour) and frequent sessions to all cadres of staff. A whole-site FP orientation package containing information about all FP methods and other related topics was prepared in collaboration with the Division of Reproductive Health in the Ministry of Health using updated national FP guidelines and FP training curricula (Contraceptive Technology Update and Long Acting & Permanent Methods training). Twelve topics are organized in short 1-hour sessions that

are offered by trainers from within the facility. The material is designed to be understood by all cadres of staff and handouts are given after each session for further reference. The FP orientation sessions are conducted weekly or twice a week depending on individual facility workload. This approach is intended to be flexible to respond to the specific needs and type of health facility to facilitate ownership and motivate staff.

Methodology
A total of 81 facility trainers (mainly nurses and midwives) from 70 public facilities in Tupange project sites (Nairobi, Mombasa and Kisumu) were selected and updated on FP and training skills in a 3-day training. The whole-site FP orientation was implemented by these facility trainers over a period of 12 months starting in July 2011 in these 70 facilities. The average duration taken to complete the FP orientation sessions was 3 months. Larger facilities (district and provincial hospital) did the training in 2 or 3 groups. Quarterly program supportive supervision was conducted in all sites to evaluate progress and address challenges. Qualitative interviews with staff were done to assess impact in relation to FP knowledge and records were reviewed to determine FP uptake within the facilities.

Results/key findings
At the end of this period, 72% (2,185) of 3,035 staff working in 70 health facilities had been oriented on family planning. Of those trained 61% (1,327) were clinical staff and 39% (858) were supportive staff. Most staff, especially support staff, when interviewed indicated they had gained significant FP knowledge and most myths and misconceptions about FP corrected. Staffs in non-FP service areas were able to initiate FP counseling and refer clients for FP. Support staffs were able to initiate FP discussion with incoming clients and direct them appropriately. The number of new FP acceptors in these facilities increased by 80% from 2011 to 2012(from 61,631 to 111,196). Long acting FP provision increased three-fold from 1,000 new clients in 2011 to 4,500 new clients by December 2012. Average direct costs associated with orienting a staff were found to be USD 25 compared to USD 353 for central residential training.

Program implications/lessons
The use of whole site orientation to FP has many positive implications in the Tupange project: it facilitated improved FP knowledge among all cadres of staff working in health facilities (from self-reporting); there was improved FP uptake in sites completing whole site orientation, especially long acting FP methods;

its flexibility allowed staff to learn at a comfortable pace and minimized disruptions to service provision; it is cheaper compared to central residential FP training; it transfers knowledge of health issues to non-clinical staff who are otherwise not given an opportunity for clinical trainings and updates and yet can be key to influencing client behaviour and uptake of services.