Fostering Change in Medical Settings: A Holistic Programming Approach to “Revitalizing” IUD Use in Kenya
This paper discusses strategies to accelerate the rate, extent, and sustainability of change in medical care settings, using as a case example a 2-year technical assistance project mounted by EngenderHealth to “revitalize” use of the IUD in Kisii District of Kenya’s Nyanza Province. This project followed a holistic programming model, which holds that a coordinated package of programmatic activities among the supply, demand, and policy/advocacy program areas can be not only efficacious, but mutually reinforcing. Attention was also paid to four important crosscutting elements in reproductive health programming: the fundamentals of care (safety, quality, and choice); use of local data for decision making; gender equity; and stakeholder participation. IUD use rose with each program intervention, e.g., training, community and male engagement, and district-wide multimedia demand creation campaigns. At project close in 2007, 142 IUDs were being inserted monthly at the 13 project sites, up from a baseline average of 28 insertions monthly, an increase of 507 %. Despite district restructuring and transfer of skilled staff, increased annual levels of IUD provision (over 300 %) were sustained for 30 months after project close. Other positive changes generated district-wide included: improvements in the supervision system; implementation of a CBD program, with increased linkages between the community and project sites; increased male engagement in FP; 33 % more new clients for all FP methods at project sites; and greater use of other RH services.
KeywordsFamily Planning Contraceptive Method Pelvic Inflammatory Disease Medical Setting Family Planning Service
Many staff from both the Kisii District Ministry of Health, the ACQUIRE Project, the RESPOND Project, and EngenderHealth worked on the IUD revitalization effort in Kisii. Too numerous to acknowledge individually, they contributed the knowledge and expertise of a number of professional disciplines including medicine, midwifery, nursing, communication, marketing, and project management and evaluation. Appreciation is also given to the many community leaders and volunteers who worked to increase access, quality, and use of FP among women and men in Kisii. The continuing encouragement and commitment of Patricia MacDonald and Carolyn Curtis of USAID was indispensible in allowing this project to proceed and succeed.
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