Garba Tulla Healthy Timing and Spacing of Pregnancies / Family Planning (HTSP/FP) Project, focuses on advancing and supporting community programs that seek to improve the overall health of communities and achieve other health-related impacts, especially in relationship to family planning.
In Kenya, the total fertility rate is 3.9% whereas the adolescent pregnancy rate is 18% and the modern Contraceptive Prevalence rate is 58% according to the KDHS 2014.
Garba Tulla is a sub-county within Isiolo county with a population of 80,000 people. The project commenced in 2014 and covered four locations, Sericho, Erasaboru and Malkadalka which only have dispensaries offering health services. Staffing levels are low with each facility having one registered nurse at any given time. The project aimed to ensure that HTSP/ FP services were integrated into all other maternal child health interventions offered at the dispensaries.
In Isiolo County which covers Garba Tulla sub-county in North Eastern Kenya, the population of approximately 80,000 people is 98 percent Muslim, and the people are pastoralists whose wealth is measured by the size of their camel and goat herds. Their traditional society is guided by Islamic teachings that support birth spacing and breastfeeding, but also early marriage that can lead to high rates of adolescent pregnancies. Men are the gatekeepers for their communities with large families and large herds viewed as increasing chances for survival. Husbands make all the decisions about timing and spacing of pregnancies.
The current APC project in Garba Tulla may be a global first in the approaches used to build men’s engagement in HTSP/FP, with a strong focus on faith leaders in the communities. One third of all reported contraceptive users in the project area are men, and more than one third of these men reported themselves as using the Standard Days Method (SDM), supplemented with condom use to plan and space their wives’ pregnancies.
The MOH system in Garba Tulla was initially under-resourced and poorly trained in HTSP and FP counselling and services. The APC Project enabled World Vision to strengthen the health care system, reduce commodity stock outs, train health care providers at four facilities and 80 Community Health Volunteers, (two-thirds of whom are men) in improved FP counselling and services. These successful strategies have now been expanded to two sites for a five month extension (March – July 2017) within Garba Tulla sub-county in addition to the current four sites; Duse and Mbarmabate. The project will continue to strengthen health systems at the community level by capacity building the Ministry of Health and community health volunteers to provide quality HTSP/FP services.
Additionally, the project will lay groundwork for research in community-based emergency contraception for pastoralists communities as well as pilot working with female faith leaders to sensitize the community on HTSP. The current modern contraceptive prevalence rate for Isiolo county is 27% which is way below the country rate.
Funding Agencies; Advancing Partners & Communities (APC) and U.S. Agency for International Development (USAID)
Implementing Agencies; JSI Research & Training Institute, Inc., in collaboration with FHI 360
National Lead Organization; World Vision Kenya
Focal Reach; Garba Tulla (Sericho, Erasaboru, Malkadalka, Duse, Mbarmabate locations)
Duration: 5 Years (2012-2016)
The project goal is to increase access to and use of voluntary FP services through integration of HTSP/FP into other maternal child health interventions in the county. Key objectives include:
- Improved capacity of health facility personnel and community health workers in educating and delivering HTSP/FP services.
- Increased knowledge and interest in HTSP/FP in key target groups.
- Improved understanding, monitoring, and accountability of HTSP/FP
The project commenced in 2014 by building the capacity of MOH staff, 71 male and 36 female community health workers (CHWs), and Community Health Extension workers (CHEWs) to counsel women and men on the benefits of HTSP and contraceptive options. In Garbatulla, the female CHWs reached women through ante-natal care and immunization programs. Male CHWs met with community gatekeepers, imams and chiefs, teachers, and husbands to discuss the benefits of HTSP/FP. They tutored men on contraceptive choices and joint decision-making. An emerging enabling environment began to shift social norms. In March 2014, a modified KPC baseline survey found that among women with a child U2, 32% had five or more children and 80% reported wanting another child within 24 months after delivery. Only 8% were using contraception although 77% knew where to get services.
World Vision then trained male leaders to hold community conversations, supplied counseling materials, and established male-friendly corners at Health Posts. CHWs made household visits and provided additional counseling at Health facilities. The end line, planned for Feb. 2017, used the KPC survey to determine knowledge of HTSP and contraceptive methods, contraceptive use, and sources for services. The data will be compared to the modified baseline done in March, 2014 and findings will guide programming for the five month extension( March 2017 – July 2017) granted so as to lay ground work for research in ECP The project will lay groundwork on research, and implementation, of Community-Based Emergency Contraception CB-EC).
See video on the impact of HTSP/FP in Garba Tulla.
For more information kindly contact
Lilian_Chebon [at] wvi [dot] org