Kenya has made significant progress in improving access to family planning (FP) services; however, challenges persist, particularly in underserved and remote counties. The Delivering Sustainable and Equitable Increases in Family Planning (DESIP) program aimed to enhance FP availability through targeted interventions at both community and facility levels. Key barriers addressed included limited access to services, inadequate healthcare provider capacity, frequent stockouts of FP commodities, and gaps in social marketing efforts. Through a combination of outreach programs, structured training, commodity security measures, and integration of FP services, DESIP successfully expanded FP availability and uptake across its implementation areas.
Many women, particularly in rural settings, face barriers such as long distances to health facilities, cultural perceptions, and limited access to FP services. To address geographic and socio-cultural barriers, DESIP conducted over 10,000 outreach and in-reach activities across 19 counties reaching over 100,000 women, prioritizing marginalized populations, including adolescents, poor women, and persons with disabilities (PWDs). These efforts, jointly planned with S/CHMTs, ensured equitable access to family planning (FP) services. Targeted interventions, such as bilateral tubal ligation (BTL) camps in Migori, reinforced FP service continuity even during the COVID-19 pandemic. Additionally, DESIP facilitated the integration of FP services into non-FP events as part of sustainability efforts.
For women in remote areas who struggle to access health facilities, community-based distributors (CBDs) have played an essential role in last-mile distribution of FP commodities. To strengthen community-based distribution (CBD), DESIP enhanced CBD initiatives in West Pokot, Elgeyo Marakwet, Narok, and Marsabit. A total of 207 community health volunteers (CHVs) were identified and trained to become community-based distributors (CBDs), though 41 from Elgeyo Marakwet could not be certified. These CBDs were linked to health facilities for documentation support and commodity refills. They provided FP counseling, delivered short-term FP methods, referred clients to health facilities, and conducted household visits to expand their reach. They provided FP counseling, delivered short-term FP methods, referred clients to health facilities, and conducted household visits to expand their reach.
Through sustained advocacy, DESIP successfully championed the integration of CBDs into FP/RH technical working group (TWG) discussions and influenced county governments to allocate resources for the CBD program in annual work plans (AWPs). Technical assistance was also provided to strengthen the implementation of the CBD program, ensuring long-term sustainability and increased FP uptake, particularly among young women in hard-to-reach areas.
DESIP mapped and segmented health facilities in 19 counties, initially identifying 725 facilities for program enrollment. Over time, additional facilities were incorporated, culminating in a total of 1,195 health facilities to enhance FP service provision. This expansion ensured a wider network for delivering quality FP services and improved access for underserved populations
To quantify the gaps and contextualize the interventions, DESIP adopted and digitized the WHO Service Availability and Readiness Assessment (SARA) tool to assess 514 health facilities. The findings informed targeted interventions, including:
- Facility in-charge meetings for orient healthcare workers.
- Structured training and mentorship programs to enhance provider skills.
- Equipment distribution and follow-up to ensure functionality.
DESIP also facilitated the distribution of FP equipment based on SARA findings.
A key challenge in FP service delivery has been the limited capacity of healthcare workers to provide a full range of FP services, especially long-acting reversible contraceptives (LARC).To address, DESIP developed and implemented a national family planning structured on the job -training and mentorship guide to mentor and support healthcare providers in the DESIP supported counties. Specific initiatives included:
- Sensitization Trainings: Adolescent Sexual and Reproductive Health (ASRH), and FP continuity during COVID-19.
- Classroom Trainings: Long-Acting Reversible Contraceptives (LARC), Postpartum FP (PPFP), and youth-friendly services.
- Structured On-the-Job Training: Continuous post-training follow-ups and structured mentorship.
- Online Learning: Development of an online LARC and C4C module for theoretical training.
To ensure standardization, 387 trainers were documented, and 300 mentees were certified. Structured healthcare worker transfers were also advocated to maintain service quality. These efforts resulted in over 1,500 healthcare workers being trained, significantly enhancing FP service delivery.
Frequent stockouts of FP commodities have also posed a major barrier to access, often disrupting service provision. DESIP strengthened commodity security by training on FP commodity dashboards for real-time tracking. These training included; Forecasting and Supply Planning Training for 137 C/SCMHT members in all 19 counties, FP Commodity Management Training for 30 SCPs and HCWs in Narok, and Integrated LMIS Training for 117 S/CHMT members.
DESIP also supported the development of F&Q plans/FASPs in all DESIP counties, facilitated FP commodity redistribution through integrated supervision visits, promoted the use of FP Dashboards for stock monitoring, and conducted stock verification exercises.
In collaboration with UNFPA DESIP supported last mile distribution of commodities by working closely with county governments and health facility staff, the program has reduced stockouts by 30%, ensuring continuous availability of FP commodities across supported counties.
The commercial market for FP commodities in Kenya remains low putting pressure on government supplies. To reduce overreliance on Government /Donor supplies, DESIP leveraged the vision of social marketing to increase access to quality family planning products and services through private sector channels. The products aligned with Ps Kenya's Priority Health Areas include Trust Condoms, Femi plan, Femiject, Femi pill, IUCDs, and implant, for family planning methods. Some of the key activities included last mile distribution campaign to enhance the availability and visibility of the products range, awareness creation, distribution of contraceptive and detailing to the pharmacy providers and ensuring adequate stocking levels were maintained at the retail levels.
Women face barriers to obtaining comprehensive reproductive health services due to fragmented healthcare delivery often resulting in missed opportunities for FP counseling and service provision, particularly during maternal and child health (MCH) visits. To optimize FP access, DESIP integrated FP services into maternal and child health programs.
Key initiatives included:
A critical moment for initiating FP is immediately after childbirth, yet many women miss this opportunity due to lack of awareness or inadequate services. DESIP programme trained Midwives and nurses to provide FP counseling and services to postpartum mothers which resulted in over 60% of postpartum women initiating FP within six weeks of delivery
FP services were integrated into annual cultural festivals, such as the Loyangalani Festival, Orpul among the Maasai Community and into different National public celebrations.
