Strengthening postnatal care services including postpartum family planning in Kenya.

To improve the health and survival of mothers and infants in the postnatal period the Ministry of Health (MOH) in Kenya increased both the recommended timing and content of postnatal services a women and her infant should receive to at least three assessments within the first six weeks after childbirth. The feasibility and acceptability of providing postnatal care at these times has not been evaluated however and most providers are not aware of this change in policy or how to implement it. The objectives of the study were develop and introduce a strengthened postnatal care package into one hospital and four health centers in one district to document the feasibility acceptability and quality of care of the strengthened postnatal care and to evaluate the effectiveness of the postnatal package on womens reproductive health behaviors. The study was implemented jointly by the Population Councils Frontiers in Reproductive Health (FRONTIERS) project and by Jhpiegos ACCESS-FP project both fundedby USAID. The study was conducted in Embu district Eastern Province between 2006 and 2008. The study used a pre-post intervention design for assessing quality of care received within the facilities and compared stratified samples of postpartum women recruited and interviewed following childbirth and again six months later before and after introduction of the intervention. For the quality of care assessment data were collected through interviews with health care providers structured observations of client -provider interactions during the postnatal consultations and a facility inventory for assessing availability of equipment drugs family planning commodities and supplies. Postpartum women were recruited and interviewed following childbirth on the postnatal ward in Embu Provincial General Hospital and interviewed again in their community after six months. A postnatal care -family planning (PNC-FP) orientation package for providers was developed by ACCESS-FP DRH and FRONTIERS. This incorporated relevantmaternal and newborn health care services in the postnatal period with a specific focus on postpartum family planning. Job aids were also produced. The three day orientation training included staff from the maternity and MCH- FP units from the four health facilities as well as provincial and district RH trainers/supervisors. In total 73 health care providers were oriented in the PNC -FP package as well as in the use of a new postnatal register recently released by the MOH. Regular supportive supervision visits were made during the intervention period to reinforce application of the package. (authors)