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Community Health Workers Creating Family Planning Social Networks through Satisfied

Clients

Author: Mercy KamauCo-Authors: Malonza I , Keyonzo N, Nyachae P, Kilonzo M, Kabue M, Ouko V;

Outline

Tupange project Intervention objective & Assumption Background Rationale Methodology Data source Results Conclusion

Tupange Project

Intervention was implemented under the Kenya Urban Reproductive Health Initiative Project-Tupange-(Bill & Melinda Gates Foundation Funded)

Tupange’s Goal To achieve a 20 percentage point increase in

contraceptive prevalence rates in selected urban centers (Nairobi, Mombasa, Kisumu).

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Urban Site (Municipality)

Population

Nairobi 3,133,518

Mombasa 938,131

Kisumu 409,928

Expansion Sites

Machakos 150,041

Kakamega 91,768

Source: 2009 Kenya population and Housing Census

Tupange Project Sites

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Intervention Objective and Assumption

Objective To utilize satisfied clients to correct myths and

misconception on FP. To recruit FP clients through a ‘satisfied clients social

network’Assumption Women are comfortable discussing their FP needs

with their friends and neighbors who are FP users. Use of FP satisfied clients can mobilize new FP clients.

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Background

Studies have shown social networks are important in influencing RH behaviors. A client’s perspective is not simply a matter of individual preference but is mediated through the social and cultural environment (AbouZahr et al. 1996).

Clients believe that they can only get the truth about side effects from friends or relatives (Adongo et al 1996).

Satisfied clients are more likely to re-visit clinical services and pass on positive messages by word of mouth to others (Rutenberg and Watkins, 1997)

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Rationale

Across Tupange projects sites, myths and misconceptions about FP were prevalent, thus influencing FP usage (KURHI – HH survey 2010)

The same baseline survey showed that 44 % of women heard about FP through friends and neighbors.

In communities where we work , there exist social groups that influence decision making processes.

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What are FP Social networks ?

In this context, FP Social networks are informal Interactions created by satisfied clients who use their personal experience to inform and discuss FP with their friends and neighbors.

Satisfied client advocates the method to his/her friends and neighbors , then Snowballing effects takes place forming a very large network of FP satisfied users.

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Methodology

Intervention carried out at Kangemi Central CU with population of over 63,000 people and approximately 12,600 households who are served by only 10 CHWs.

The population-to-CHW ratio was overwhelming for the CHWs and the site was a good place for implementing the satisfied clients social network.

The 10 CHWs were trained on FP to equip them with accurate FP knowledge and communication skills to enable them carry out community mobilisation.

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Methodology cont.

Potential clients were referred to the Health facility for the service.

CHWS conducted follow up visits to the clients.

The satisfied clients were encouraged to discuss with at least ten of their friends and neighbours in the social network and refer them for FP services .

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Data Source

Project monitoring information was obtained during supervision visits.

CHW referral slips (effective referrals) were received and counted monthly.

Information on number of satisfied clients referred was obtained during CHW Monthly meetings.

Results-Family Planning Social Network.

INFORMATION AND REFERRAL

CHWSATISFIED CLIENT

DISPELS MYTHS AND ENCOURAGES OTHERS TO USE METHOD

NEW USERS

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Comparison of FP Uptake ( April 2011-March 2012 & April 2012-March 2013 )

COC POP Injections IUCD Implants Condoms 0

200

400

600

800

1000

1200

1400

1600

199158

1375

85 82

869

117145

984

310

1201

197

April 2011 - March 2012 April 2012 - March 2013

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Conclusions

Using satisfied clients is an effective way of improving access to FP as it uses already existing friendship networks.

Using the approach is a no-cost way of creating demand for FP services and of counselling potential FP.

The approach is sustainable as the effect can continue without further intervention by the project.

The approach will be scaled up to other CUs to accelerate FP uptake.

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Thankyou

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