Factors affecting provision of female family planning commodities in public health facilities in Kajiado county, Kenya

  • Journal of Pharmaceutical Policy and Practice, Volume 15, No. 1, Year 2022

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Study Justification:
– The study aimed to address the limited information on factors affecting the utilization of female family planning commodities in Kajiado county, Kenya.
– Family planning is crucial for preventing maternal and infant mortality associated with unintended pregnancies and negative economic outcomes.
– In sub-Saharan Africa, the unmet need for modern family planning is approximately 66%.
Study Highlights:
– Shorter-term family planning methods were more readily available (60-75%) compared to long-term methods (20-60%).
– Approximately 60% of service providers did not comprehensively utilize the recommended World Health Organization Medicine Eligibility Criteria (WHO MEC) during service provision.
– The major barriers identified were stock outs, myths and misconceptions, male interference, and cultural factors.
– Stock levels at the national program and provider knowledge on WHO MEC were found to affect the provision of family planning commodities in public health facilities in Kajiado county.
Recommendations for Lay Reader and Policy Maker:
1. Improve stock management: Address stock outs of family planning commodities by ensuring adequate supply at the national program level.
2. Enhance provider knowledge: Provide training and support to healthcare workers on the recommended WHO MEC for family planning service provision.
3. Address myths and misconceptions: Conduct community education programs to dispel myths and misconceptions surrounding contraceptives.
4. Promote male involvement: Encourage male partners to be actively involved in family planning decisions and services.
5. Increase community engagement: Raise awareness about the potential benefits of family planning through community engagement activities.
Key Role Players:
1. Ministry of Health: Responsible for coordinating and implementing policies related to family planning services.
2. County Health Department: Oversees the provision of healthcare services, including family planning, at the county level.
3. Public Health Facilities: Responsible for delivering family planning services and ensuring the availability of commodities.
4. Non-Governmental Organizations (NGOs): Collaborate with government agencies to support family planning programs and community engagement activities.
5. Community Leaders and Educators: Engage with the community to address myths, misconceptions, and promote the benefits of family planning.
Cost Items for Planning Recommendations:
1. Training and Capacity Building: Budget for training programs to enhance provider knowledge on WHO MEC and family planning service provision.
2. Commodity Procurement: Allocate funds for the procurement and supply of family planning commodities to prevent stock outs.
3. Community Engagement Activities: Plan and budget for community education programs, including workshops, awareness campaigns, and materials.
4. Male Involvement Initiatives: Allocate resources for targeted interventions to encourage male partners’ participation in family planning.
5. Monitoring and Evaluation: Set aside funds for monitoring and evaluating the implementation and impact of the recommendations.
Please note that the provided cost items are general categories and not actual cost estimates. The specific budget requirements would depend on the scale and scope of the interventions.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study design is described as a health facility-based descriptive cross-sectional research design, which provides valuable information about the factors affecting provision of female family planning commodities in public health facilities in Kajiado county, Kenya. The study collected data from a sample size of 86 health care workers responsible for family planning commodities and 85 family planning service providers. Data were analyzed using Microsoft Excel 2019 and SPSS version 20. The study identified key factors affecting provision of family planning, such as stock outs, myths and misconceptions, male interference, and inadequate community engagement. However, the abstract does not provide information about the representativeness of the sample or the response rate, which could affect the generalizability of the findings. To improve the strength of the evidence, future studies could consider using a larger and more representative sample, provide information about the response rate, and use statistical tests to assess the significance of the findings.

Background: Family planning involves the use of traditional or modern methods to prevent maternal and infant mortality associated with unintended pregnancies and negative economic outcomes. In sub-Saharan Africa, the unmet need for modern family planning is approximately 66%. However, information on factors affecting utilization of female family planning commodities is limited. Therefore, this research was conducted to bridge this gap. Methods: Health facility-based descriptive cross-sectional research design was conducted and involved the public health facilities offering family planning, targeting respondents who handle the commodities and service providers themselves. A semi-structured questionnaire was used to collect data about availability of the commodities, knowledge of service providers and barriers affecting provision of the service. Data were coded and analyzed via Microsoft Excel 2019 and SPSS version 20. Results: The study showed that shorter term methods were more readily available, 60–75% than the long-term methods, 20–60%. Approximately 60% of the service providers did not comprehensively utilize the recommended World Health Organization Medicine Eligibility Criteria (WHO MEC) during service provision. Stock outs, myths and misconceptions, male interference and culture were the major barriers identified. Conclusion: Provision of family planning commodities in public health facilities in Kajiado county is affected by stock levels at the national program, and provider knowledge on WHO MEC. The key factors affecting provision of family planning were stock outs, myths and misconceptions on the contraceptives, inadequate male involvement and inadequate community engagement on potential benefits of the service. These challenges need to be part of the solutions to bridging the gap identified.

Data were collected from October to December 2021 within selected public health facilities in Kajiado county, located in the southern part of Kenya. It covers an area of approximately 21,900 km2. Administratively, it is subdivided into 5 sub counties with an approximate population of 1,117,840 people as per the 2019 census and a total of 110 public facilities offering family planning services. The study adopted a descriptive cross-sectional design using semi-structured questionnaires to capture the required data. The study population comprised 86 health care workers responsible for family planning commodities in the pharmacy and 85 family planning service providers. The sample size was 86 facilities which were obtained using Yamane’s formula that provides a 95% confidence interval. These facilities were stratified as per the Kenya essential package of health (KEPH). They included dispensaries, health centers, sub county hospitals and referral hospitals. For the female family planning commodities, six products were assessed in each health facility; combined oral contraceptive pills (COCs), progestin only pills (POPs), deoxy medroxyprogesterone acetate (DMPA) injection, etonogestrel implants, levonorgestrel implants and intra-uterine contraceptive devices (IUCDs). All the hospitals were sampled, due to the few numbers in that KEPH level. For the health centers and dispensaries, systematic sampling was done guided by proportions in each tier. Semi-structured questionnaire was used to collect the data. It had several variables categorized as biodata, types of health commodities and duration of stock outs. To assess knowledge, the WHO MEC was used to assess the key steps of family planning provision which also incorporated any challenges that they may be facing as well. The questionnaire was pre-tested and validated to check for reliability before conducting the actual data collection. Research assistants were trained on how to how to ask questions and fill the questionnaire. This was followed by pre-testing of the tool where respondents from nine facilities drawn from the pharmacy, and family planning clinics were involved. Adjustments were done on the questionnaire to make it more comprehensive. The principal investigator printed the revised questionnaire and sent it to the consenting respondents who filled it as appropriate. A physical site visit was then conducted by the researcher and assistants, to access the bin cards for purposes of assessing the stock status and getting the challenges faced during service provision by the respondents. The filled questionnaires were collected concurrently for further processing. Quantitative data were entered, cleaned, and coded using Microsoft excel 2019 prior to the analysis. Descriptive statistics were used to analyze data and data were presented using frequency and percentage using the SPSS version 20.

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Based on the information provided, here are some potential innovations that could improve access to maternal health:

1. Mobile Health (mHealth) Solutions: Develop mobile applications or text messaging services to provide information and reminders about family planning methods, appointments, and availability of commodities. This can help overcome barriers such as myths and misconceptions and improve communication between service providers and clients.

2. Supply Chain Management Systems: Implement digital systems to track and manage the supply of family planning commodities. This can help address stockouts and ensure that health facilities have an adequate and consistent supply of contraceptives.

3. Male Involvement Programs: Design and implement programs that actively engage men in family planning discussions and decision-making. This can help address barriers related to male interference and cultural norms that may discourage women from accessing family planning services.

4. Community Education and Awareness Campaigns: Conduct targeted campaigns to raise awareness about the benefits of family planning and dispel myths and misconceptions. This can be done through community meetings, radio programs, and other channels to reach a wide audience.

5. Training and Capacity Building for Service Providers: Provide comprehensive training on the World Health Organization Medicine Eligibility Criteria (WHO MEC) and ensure that service providers have up-to-date knowledge on family planning methods. This can improve the quality of service provision and increase the range of contraceptive options available to clients.

These innovations have the potential to address the specific challenges identified in the study, such as stockouts, myths and misconceptions, male interference, and inadequate community engagement. However, it is important to assess the feasibility and effectiveness of these innovations in the local context before implementation.
AI Innovations Description
Based on the research findings, here is a recommendation that can be developed into an innovation to improve access to maternal health:

1. Strengthen supply chain management: Addressing stock outs of female family planning commodities is crucial for improving access to maternal health. Innovations can be developed to enhance supply chain management, such as implementing real-time inventory tracking systems, establishing effective communication channels between health facilities and the national program, and utilizing predictive analytics to anticipate demand and prevent stock outs.

2. Improve provider knowledge and adherence to guidelines: The study highlighted that many service providers did not comprehensively utilize the recommended World Health Organization Medicine Eligibility Criteria (WHO MEC) during service provision. Innovations can be developed to enhance provider knowledge and adherence to guidelines, such as developing mobile applications or online platforms that provide easy access to updated guidelines and training materials, implementing regular refresher trainings, and utilizing decision support tools integrated into electronic health records systems.

3. Address myths, misconceptions, and cultural barriers: Myths, misconceptions, and cultural factors were identified as barriers to the provision of family planning services. Innovations can be developed to address these barriers, such as implementing community-based education and awareness campaigns to dispel myths and misconceptions, engaging community leaders and influencers to promote the benefits of family planning, and integrating culturally sensitive approaches into service delivery.

4. Promote male involvement and community engagement: Inadequate male involvement and inadequate community engagement were identified as challenges to the provision of family planning services. Innovations can be developed to promote male involvement and community engagement, such as implementing targeted outreach programs specifically designed to engage men, involving male community health workers in family planning education and counseling, and utilizing community-based platforms (e.g., community meetings, radio programs) to raise awareness and promote dialogue on family planning.

By implementing these recommendations and developing innovative solutions, access to maternal health can be improved in Kajiado county, Kenya, and potentially replicated in other settings facing similar challenges.
AI Innovations Methodology
To improve access to maternal health, here are some potential recommendations:

1. Strengthening Supply Chain Management: Addressing stock outs of family planning commodities is crucial. Implementing robust supply chain management systems can ensure an uninterrupted supply of contraceptives to public health facilities. This can involve improving forecasting methods, optimizing inventory management, and establishing effective distribution networks.

2. Provider Training and Knowledge Enhancement: Enhancing the knowledge and skills of healthcare providers in family planning services is essential. Training programs can focus on comprehensive utilization of the World Health Organization Medicine Eligibility Criteria (WHO MEC) during service provision. This will ensure that providers are equipped to offer a wide range of contraceptive options and make appropriate recommendations based on individual needs.

3. Community Engagement and Education: Increasing community awareness and engagement on the benefits of family planning can help overcome myths, misconceptions, and cultural barriers. Conducting educational campaigns, involving community leaders, and utilizing local media channels can promote positive attitudes towards family planning and encourage its utilization.

4. Male Involvement: Involving men in family planning discussions and decision-making can have a significant impact. Engaging men through targeted interventions, such as male-friendly clinics or educational programs, can help address barriers related to male interference and promote shared responsibility for family planning.

Methodology to simulate the impact of these recommendations on improving access to maternal health:

1. Define Key Indicators: Identify key indicators that reflect access to maternal health, such as contraceptive prevalence rate, availability of family planning commodities, provider knowledge on WHO MEC, and community awareness. These indicators will serve as the basis for measuring the impact of the recommendations.

2. Collect Baseline Data: Gather baseline data on the identified indicators before implementing the recommendations. This can involve surveys, interviews, and data analysis from relevant sources, such as public health facilities, community surveys, and existing health records.

3. Implement Recommendations: Implement the recommended interventions, such as strengthening supply chain management, provider training, community engagement, and male involvement. Ensure proper monitoring and evaluation mechanisms are in place to track the progress of each intervention.

4. Data Collection and Analysis: Collect data on the indicators after implementing the recommendations. This can be done through surveys, interviews, and monitoring systems. Analyze the data using statistical methods to assess the impact of the interventions on the identified indicators.

5. Compare Results: Compare the post-intervention data with the baseline data to determine the impact of the recommendations. Calculate the changes in the indicators and assess the significance of these changes using appropriate statistical tests.

6. Interpret and Communicate Findings: Interpret the findings of the impact assessment and communicate them to relevant stakeholders, such as policymakers, healthcare providers, and community members. Highlight the improvements in access to maternal health resulting from the implemented recommendations and identify areas for further improvement.

By following this methodology, it will be possible to simulate the impact of the recommendations on improving access to maternal health and provide evidence-based insights for decision-making and future interventions.


Identifiers:
DOI: 10.1186/s40545-022-00488-y
Research Areas:
Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health
Study Countries:
Kenya
Study Design:
Cross Sectional Study, Grounded Theory
Study Approach:
Quantitative
Participants Gender:
Male & Female
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