They Are Engaged and Know It All: A Case of Increased Uptake of Long Acting Reversible Contraceptives in South West Kenya

Community health volunteers (CHVs) play an integral role in primary healthcare. Several countries rely on CHV programs as a major element in improving access to care and attaining universal health coverage. The concept of CHVs system has gained its popularity in developing countries to overcome the increasing demand for health care services and the shortage of formal health care providers (Magnussen, 2004). The Government of Kenya is committed to supporting community health initiatives and accelerating the achievement of the current NHSSP II goals, MDGs and providing support to Vision 2030 through community health training and involvement (DCHV, 2013).Several studies have reported the benefits of CHVs in improving health indicators (Maher, 2016). Despite CHVs engagement in the community many barriers prevent widespread utilization of LARC in Kenya with utilization of IUCD at 0.3% and implants of 10% (KDHS 2014). IKMET engaged CHVs as information and service delivery points for women and men through an intervention implemented around 22 health facilities in three counties. At inception, the volunteers were identified and recommended to KMET by the Community Health Assistants (CHAs). KMET then oriented the recommended group on the objectives, requirements and expectations and selected from the pool the final group. KMET used the demand and supply model by training CHVs on family planning especially Long Acting Reversible Contraceptives methods and equipped them with skills to educate and refer women for services. The CHVs were provided with job aids to guide them when conducting health education sessions in the community and with that referral coupons were indeed provided to capture clients that were referred by the CHVs to the facility. KMET ensured that the CHVs were mentored and supervised during their community engagement and delivery of family planning messages through the community health extension workers who were trained as mentors to ensure delivery of consistent and correct information on family planning methods and services. A management and support system was put in place through the office of ministry of health through the community focal persons who ensured that the CHVs were attached to respective facilities for proper community – facility linkages for provision of services in the 22 health facilities. A formal referral system established to track women who were referred to the facility by community health volunteers for uptake of services. Quarterly review meetings were held with the CHVs to share their experiences in educating and referring women for family planning services with various strategies developed based on geographical needs of the communities. KMET has observed increased participation of CHVs in contraceptive discussions at the community level. The CHVs have been empowered and mentored to build the confidence of women to access long acting reversible contraceptive methods. Service delivery data from 2015 and 2017 shows a 52% growth in uptake of LARC methods by women of reproductive age. In addition, 74% of women who sought for contraceptive services at the facilities were referred by the CHVs in the years and this was possible through provided training, equipping and support supervision throughout the project period.