This document proposes health promotion strategies to increase family planning uptake in North Eastern Kenya. It begins with an analysis of the region's low contraceptive prevalence rate of 4% compared to the national average of 46%. It then recommends a multi-pronged approach including educational activities to provide family planning information, behavior change programs, medical outreach services, empowerment of women and youth, and policy advocacy. The proposed interventions aim to address social determinants of family planning at various levels of the community through strategies grounded in health behavior theories.
The influence of prevention of mother to-child hiv transmission campaigns on ...Alexander Decker
The document discusses mother-to-child transmission of HIV in Nigeria and prevention efforts. It notes that mother-to-child transmission accounts for over 90% of pediatric AIDS cases globally. To address this, Nigeria and other countries have implemented Prevention of Mother-to-Child Transmission (PMTCT) campaigns. However, the document aims to study whether these campaigns have effectively improved knowledge, attitudes and practices around PMTCT among Nigerian women. It finds that while campaigns have increased to some degree, overall knowledge, attitudes and practices regarding PMTCT among Nigerian women remains quite low. It recommends campaign messages be more clear, specific and convincing to better educate women and encourage improved PMTCT practices.
Every two hours in Kenya, a woman dies during pregnancy or childbirth, devastating her family. A new study in Kenya calculated the economic and social impact of maternal death on families. The study found that when a woman dies, her family faces medical and funeral costs greater than their total yearly household spending. Families also lose the woman's contributions to household work and income generation. The death pushes many families into poverty and debt from which it is difficult to recover.
International Journal of Humanities and Social Science Invention (IJHSSI)inventionjournals
International Journal of Humanities and Social Science Invention (IJHSSI) is an international journal intended for professionals and researchers in all fields of Humanities and Social Science. IJHSSI publishes research articles and reviews within the whole field Humanities and Social Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...iosrphr_editor
This document discusses Kenya's programmatic responses to increasing utilization of family planning services. It reviews Kenya's existing policies and strategies and how they have impacted total fertility rate, contraceptive prevalence rate, and unmet need. Despite initiatives, total fertility rate and unmet need remain high while contraceptive prevalence rate is low, suggesting responses have not fully addressed the issue. The document proposes recommendations to enhance family planning services, such as increased political commitment, tailored community initiatives, and improved education and awareness campaigns. Family planning is important as it benefits households, communities and society by reducing population growth pressures on social services and stimulating economic growth.
Rural Women Perceptions of Digital Media Influence on Awareness Creation abou...AJSSMTJournal
This study has investigated the perception of digital media influence in awareness creation on
maternal health amongst rural women in Minna, Nigeria. Survey questionnaire was administered to a sample
of 384 respondents randomly drawn from a population of 96,886. The response was 99.2%. Findings reveal
that 109(28.61%) of the respondents rural women in Minna metropolis were very much exposed to maternal
health information on digital media with (Mean=4.14), while WhatsApp group 111(29.13%) (Mean=4.09),
whereas 107(28.08%) with (Mean= 3.88) were exposed to Internet discussion forum. However, discussion
forum and social networks appear to be the major sources of maternal health information among rural women
in Minna metropolis. Lack of local content on maternal health issues and inadequate relevant maternal health
information were revealed as the challenges to maternal health. The study recommends that digital media
should be effectively and efficiently used for maternal health improvement in Nigeria health centres.
Balancing demand, quality and efficiency in nigerian health care delivery systemAlexander Decker
The document discusses several challenges facing Nigeria's health care system that reduce progress and universal access to health care. Some key issues include inadequate health facilities and infrastructure, poor human resources and management, low government spending on health, and high out-of-pocket costs for citizens. Nigeria's health indicators, such as maternal mortality and child mortality, are among the worst in the world. Many factors contribute to these problems, including a lack of integrated disease prevention and treatment systems, shortages of essential drugs and supplies, and inadequate supervision of health care providers. Overall, the health system in Nigeria faces significant issues that must be addressed to improve quality, access, and efficiency of care.
This document provides a stakeholder and landscape analysis of integrated community care management in Nigeria, conducted for the Bill & Melinda Gates Foundation. It summarizes key partners and child health activities in Nigeria. Over 30 interviews were conducted with principal partners and NGOs working in child health. The analysis finds that pneumonia and diarrhea remain the top killers of children in Nigeria. Despite economic growth, health outcomes have not improved significantly, with under-five mortality still high. The document outlines Nigeria's government health structure and key child health policies and initiatives.
mHealth for Family Planning_Lairmore_finalKate Lairmore
Mobile health (mHealth) tools show promise in increasing access to family planning services and education by leveraging the widespread availability of mobile phones. However, while mHealth applications are growing rapidly, evidence of their effectiveness remains limited. This paper examines the potential uses of mHealth strategies in family planning programs and presents examples to address unmet needs for information and services. The goal is to provide an overview of how adding mobile phone tools could help reduce high unmet need levels.
The influence of prevention of mother to-child hiv transmission campaigns on ...Alexander Decker
The document discusses mother-to-child transmission of HIV in Nigeria and prevention efforts. It notes that mother-to-child transmission accounts for over 90% of pediatric AIDS cases globally. To address this, Nigeria and other countries have implemented Prevention of Mother-to-Child Transmission (PMTCT) campaigns. However, the document aims to study whether these campaigns have effectively improved knowledge, attitudes and practices around PMTCT among Nigerian women. It finds that while campaigns have increased to some degree, overall knowledge, attitudes and practices regarding PMTCT among Nigerian women remains quite low. It recommends campaign messages be more clear, specific and convincing to better educate women and encourage improved PMTCT practices.
Every two hours in Kenya, a woman dies during pregnancy or childbirth, devastating her family. A new study in Kenya calculated the economic and social impact of maternal death on families. The study found that when a woman dies, her family faces medical and funeral costs greater than their total yearly household spending. Families also lose the woman's contributions to household work and income generation. The death pushes many families into poverty and debt from which it is difficult to recover.
International Journal of Humanities and Social Science Invention (IJHSSI)inventionjournals
International Journal of Humanities and Social Science Invention (IJHSSI) is an international journal intended for professionals and researchers in all fields of Humanities and Social Science. IJHSSI publishes research articles and reviews within the whole field Humanities and Social Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...iosrphr_editor
This document discusses Kenya's programmatic responses to increasing utilization of family planning services. It reviews Kenya's existing policies and strategies and how they have impacted total fertility rate, contraceptive prevalence rate, and unmet need. Despite initiatives, total fertility rate and unmet need remain high while contraceptive prevalence rate is low, suggesting responses have not fully addressed the issue. The document proposes recommendations to enhance family planning services, such as increased political commitment, tailored community initiatives, and improved education and awareness campaigns. Family planning is important as it benefits households, communities and society by reducing population growth pressures on social services and stimulating economic growth.
Rural Women Perceptions of Digital Media Influence on Awareness Creation abou...AJSSMTJournal
This study has investigated the perception of digital media influence in awareness creation on
maternal health amongst rural women in Minna, Nigeria. Survey questionnaire was administered to a sample
of 384 respondents randomly drawn from a population of 96,886. The response was 99.2%. Findings reveal
that 109(28.61%) of the respondents rural women in Minna metropolis were very much exposed to maternal
health information on digital media with (Mean=4.14), while WhatsApp group 111(29.13%) (Mean=4.09),
whereas 107(28.08%) with (Mean= 3.88) were exposed to Internet discussion forum. However, discussion
forum and social networks appear to be the major sources of maternal health information among rural women
in Minna metropolis. Lack of local content on maternal health issues and inadequate relevant maternal health
information were revealed as the challenges to maternal health. The study recommends that digital media
should be effectively and efficiently used for maternal health improvement in Nigeria health centres.
Balancing demand, quality and efficiency in nigerian health care delivery systemAlexander Decker
The document discusses several challenges facing Nigeria's health care system that reduce progress and universal access to health care. Some key issues include inadequate health facilities and infrastructure, poor human resources and management, low government spending on health, and high out-of-pocket costs for citizens. Nigeria's health indicators, such as maternal mortality and child mortality, are among the worst in the world. Many factors contribute to these problems, including a lack of integrated disease prevention and treatment systems, shortages of essential drugs and supplies, and inadequate supervision of health care providers. Overall, the health system in Nigeria faces significant issues that must be addressed to improve quality, access, and efficiency of care.
This document provides a stakeholder and landscape analysis of integrated community care management in Nigeria, conducted for the Bill & Melinda Gates Foundation. It summarizes key partners and child health activities in Nigeria. Over 30 interviews were conducted with principal partners and NGOs working in child health. The analysis finds that pneumonia and diarrhea remain the top killers of children in Nigeria. Despite economic growth, health outcomes have not improved significantly, with under-five mortality still high. The document outlines Nigeria's government health structure and key child health policies and initiatives.
mHealth for Family Planning_Lairmore_finalKate Lairmore
Mobile health (mHealth) tools show promise in increasing access to family planning services and education by leveraging the widespread availability of mobile phones. However, while mHealth applications are growing rapidly, evidence of their effectiveness remains limited. This paper examines the potential uses of mHealth strategies in family planning programs and presents examples to address unmet needs for information and services. The goal is to provide an overview of how adding mobile phone tools could help reduce high unmet need levels.
Philip Otieno: Documenting the linkages between population growth, reproducti...AfricaAdapt
This document discusses the relationship between population growth, reproductive health, gender, and climate change adaptation in Kenya. It finds that high population growth increases vulnerability to climate disasters by straining resources. Promoting family planning and gender equity can help address this. However, Kenya's policies and plans still lack clear strategies to mainstream these issues into climate adaptation efforts at national and international levels.
The document discusses UNFPA's work in Myanmar from 2013-2014. It focuses on supporting the country's first census in 30 years, improving maternal health through increasing access to skilled birth attendants and midwives, and advancing sexual and reproductive health and rights (especially for youth and key populations). Key activities included supporting the national census, advocating for policies to reduce maternal mortality in line with international standards, and building capacity of midwives and traditional birth attendants. However, more work remains to be done to ensure every birth is safe and every person can fulfill their potential.
Save the Children is focused on reducing newborn mortality globally. It has three main goals:
1. Getting newborn health on global and national agendas through research showing the major causes of newborn deaths and effective interventions.
2. Supporting country programs that have led to important declines in newborn mortality rates in places like Bangladesh, Bolivia, and Tanzania.
3. Continuing to scale up high-impact newborn interventions through health systems, strengthen implementation, and institutionalize newborn survival within countries and organizations.
Adolescents and utilization of family planning services in rural community of...Alexander Decker
This study examined family planning services utilization among adolescents in a rural Nigerian community. 400 adolescents ages 10-19 completed questionnaires. Over two-thirds reported family planning services being available, with main sources being health centers, chemists, and pharmacies. Reasons for service selection included low cost, privacy, and proximity. While most adolescents were sexually active and knowledgeable about contraception, condom use was low and many were unconcerned about pregnancy or STDs. The study concluded family planning services were available but underutilized, with worrisome attitudes towards unprotected sex among adolescents in the community.
The Kuinua Foundation seeks grant funding to expand their program preventing mother-to-child transmission of HIV in Kenya. They will implement the WHO's Option B+ recommendations to provide lifelong antiretroviral treatment to all HIV-positive pregnant and breastfeeding women. This aims to increase treatment coverage and lower transmission rates compared to previous approaches. The foundation recognizes social, economic, geographic, and individual barriers women face in accessing prevention and treatment services in Kenya. With additional resources, they plan to strengthen partnerships and further decentralize services to improve health outcomes for mothers and children.
This document discusses progress towards Millennium Development Goal 4 (MDG4) of reducing child mortality. While overall progress has been made, neonatal mortality rates have declined more slowly. Simple, low-cost interventions like kangaroo mother care, neonatal resuscitation, and breastfeeding can significantly reduce neonatal deaths. However, implementation faces barriers like lack of healthcare workers, cultural practices, financial barriers to care, and poor quality of services. Political will is needed to fully achieve MDG4 targets through strengthened health systems and addressing inequities between regions.
The document discusses sleep health as a public health concern in West Point, New York. An assessment found sleeplessness to be a major issue affecting the community. A presentation was developed to educate cadets on insufficient sleep, its effects, and importance of getting 7-9 hours per night. A pre-test and post-test were administered, and the presentation was successful with 20% of participants improving their knowledge about sleep health. While the presentation met its goal, scheduling cadets was challenging due to their academic and military commitments.
PBH101 Group Presentation on MGD-4 Reduce Child MortalityGaulib Haidar
This group presentation discusses child mortality as it relates to Millennium Development Goal 4. It introduces the group members and provides background on the MDGs, defining them as goals established by the UN to be achieved by 2015. It defines child mortality as deaths under age 5 and discusses the main causes. The presentation outlines strategies to prevent child mortality, such as immunization programs and improving access to healthcare. It notes that progress has been made in reducing child mortality but that more work remains to be done to meet MDG targets by 2015.
This document discusses the implementation of an innovative "Basket Fund" financing mechanism in Zamfara State, Nigeria to address funding challenges for primary health care (PHC) services including routine immunization.
Routine immunization coverage in Zamfara State had declined to only 11% due to inadequate funding for vaccine distribution, staff supervision, and other essential recurrent costs, despite efforts by international partners. A proposal was developed to create a pooled "PHC service delivery fund", also called the "Basket Fund", to centrally manage and transparently disburse funds for PHC activities across the state. Key stakeholders collaborated on the proposal. The Basket Fund mechanism has helped smooth service delivery by resolving issues around both acquiring and properly using
This document summarizes the key points from an analysis of accelerating progress on MDG 5 in Nigeria using the MDGs Acceleration Framework. It provides justifications for selecting MDG 5, including its importance to the government's agenda and addressing disparities across zones. Key data on Nigeria's maternal mortality ratio, causes of maternal death, and coverage of interventions is presented. The analysis identified five priority interventions within MDG 5: family planning, skilled birth attendants, emergency obstetric and newborn care, universal antenatal and postnatal care coverage, and an improved referral system. Bottlenecks within these areas were also identified.
This document provides an overview and analysis of progress towards universal access to reproductive health and family planning based on key indicators. Some key points:
- Globally, contraceptive use has increased to two-thirds of married women, but 12% still have unmet need. The most common methods are female sterilization and IUD.
- Over 80% of married women's family planning needs are satisfied globally, but less than half in Africa.
- 15.3 million adolescent girls give birth each year. Adolescent contraceptive use and access to family planning services lag behind other age groups.
- Disparities exist based on location, education, and wealth. Rural, less educated and poorer
Achievements and Implications of HIV Prevention of Mother-toChild Transmissio...QUESTJOURNAL
This intervention provided HIV prevention services to women of reproductive age in Plateau State, Nigeria. A total of 9,258 women were reached, exceeding the target of 7,460. Structural interventions included 85 community dialogues and 17 income generation activities. Behavioral interventions included distributing 87,028 condoms and providing HIV education to 5,079 peers. Biomedical interventions saw 5,606 women receive counseling, testing and results, with 44 (0.8%) testing positive for HIV. While the intervention helped reduce HIV burden, future programs need to improve coverage and extend services to more local government areas.
The document discusses child and infant mortality rates globally and in India. It provides definitions for under-five mortality rate, infant mortality rate, and neonatal mortality rate. The three main causes of under-five mortality are neonatal mortality (0-4 weeks), post-neonatal mortality (1-12 months), and factors like low birth weight, prematurity, and infectious diseases. While global under-five mortality has decreased 53% from 1990-2015, Africa still has the highest rate. India accounts for 20% of global under-five deaths despite its rate decreasing 61% from 1990-2015. Preventive measures discussed include prenatal nutrition, immunizations, breastfeeding, and improved access to primary healthcare.
Ghia foundation strategy document v4.dec.17.2015 (ab)Ghia Foundation
GHIA FOUNDATION WAS FOUNDED IN 2013 by a team of kind-heated Professionals.
VISION: A World where women in developing Countries live healthier , longer lives
MISSION – To reduce morbidity and mortality among women in developing Countries by strengthening Health Systems to deliver high quality, comprehensive health services.
Strengthening Nepal’s Female Community Health Volunteer Network through Publi...Bibhusan Basnet
This document summarizes a two-year public sector program in Nepal that provided oversight, training, compensation and incentives to strengthen the country's existing network of over 48,000 Female Community Health Volunteers (FCHVs). The program was implemented in 9 villages with 92 FCHVs serving over 20,000 people. Key outputs included expanded coverage, high meeting attendance, 183 patient encounters per village per month, and a total annual cost of $30,111 or $1.72 per patient encounter. FCHVs reported the program increased their skills, pride in their work and sense of community.
Achievements and Implications of Care and Support Programme among Orphans and...QUESTJOURNAL
Background: In Nigeria, children who need special protection on the account of being in vulnerable situations are observably increasing due to growing levels of poverty and the poor socio-economic situation of the country and it is necessary to ameliorate the problem by strengthening the capacity of families. This article therefore presents the achievements of care and support programme among orphans and vulnerable children (OVC) in Bayelsa State, Nigeria as well as the implications for future programming. Methods: The project was an intervention study carried out among OVC in Bayelsa State, Nigeria. Four civil society organizations were engaged by Bayelsa State Agency for the Control of AIDS (BYSACA) under HIV and AIDS Fund (HAF) II project to provide care and support services for OVC. The target population consisted of paternal orphan or maternal orphan, double orphan and vulnerable children whose parents are infected with HIV but alive in six local government areas. A total of 3000 was an estimated sample size for this intervention and data were collected using various data reporting tools and analyzed using Microsoft Excel. Results: The total number of OVC reached during the project period was 5410 given a target reached of 180.3%. Among these, 87.7% of the children were reached with at least one service, 74.9% were reached with psychosocial services, nutrition (37.4%), educational services (33.3%), healthcare services (9.5%) and protection services (4.4%). Thirty-five children withdrawn from the programme and two children reported died during this project. Conclusion: Efforts to care, support and protect vulnerable children should not only focus on their immediate survival needs such as food, education, water, shelter and clothing, but also on long-term developmental needs that reduce children's vulnerability such as life skills, child protection, vocational training, food security, and household economic strengthening.
The document discusses accountability for women's, children's and adolescents' health in the era of the Sustainable Development Goals (SDGs). It notes that while the Millennium Development Goals (MDGs) significantly reduced maternal and child mortality, rates remain unacceptably high. The SDGs launched in 2015 aim to ensure healthy lives for all at all ages. A new Global Strategy aligned with the SDGs provides a roadmap to end preventable deaths of women, children and adolescents by 2030. The Independent Accountability Panel will prepare annual reports on progress using data from UN agencies and others to ensure accountability. Better data and national leadership are crucial to true accountability.
A synthetic review of contraceptive supplies in punjabAlexander Decker
This document discusses contraceptive use in Punjab, Pakistan. It begins by providing background on the benefits of family planning and contraceptive use for maternal and child health. It then analyzes contraceptive commodity data from Punjab, finding that use is still low despite efforts to improve access. The document concludes by emphasizing the need for strategies to bridge gaps and meet the unmet need for effective and affordable contraceptive methods and supplies in Punjab in order to improve health outcomes.
The document summarizes Nepal's Safe Motherhood program. It describes the program's goals of reducing maternal and neonatal mortality and improving health. Major activities include promoting birth preparedness and emergency funds, expanding skilled birth attendants and emergency obstetric care, managing reproductive health issues, expanding service sites, and programs like Aama that provide incentives for institutional delivery. The program aims to make quality maternal care accessible to all women through these various community-based and facility-based strategies.
MEASURE Evaluation PIMA poster on maternal morbidity and mortality. Access a larger version at https://www.measureevaluation.org/pima/maternal-and-reproductive-health/maternal-mortality-poster.
AWDF Woman of Substance on Maternal Health in GhanaAmos Anyimadu
The document discusses the role of midwives and public health nurses in reducing maternal, newborn and child mortality in Ghana. It provides background on Ghana and defines key terms like maternal mortality rate. It describes the causes of maternal deaths as the three delays - delays in seeking care, reaching care, and receiving adequate care. The document outlines Ghana's policies and efforts to improve maternal health, including the Millennium Development Goals. It discusses the midwife's role in antenatal care, labor/delivery care, and postpartum care. Strategies have been implemented before and after 2000 to strengthen the midwife's role in reducing mortality.
Philip Otieno: Documenting the linkages between population growth, reproducti...AfricaAdapt
This document discusses the relationship between population growth, reproductive health, gender, and climate change adaptation in Kenya. It finds that high population growth increases vulnerability to climate disasters by straining resources. Promoting family planning and gender equity can help address this. However, Kenya's policies and plans still lack clear strategies to mainstream these issues into climate adaptation efforts at national and international levels.
The document discusses UNFPA's work in Myanmar from 2013-2014. It focuses on supporting the country's first census in 30 years, improving maternal health through increasing access to skilled birth attendants and midwives, and advancing sexual and reproductive health and rights (especially for youth and key populations). Key activities included supporting the national census, advocating for policies to reduce maternal mortality in line with international standards, and building capacity of midwives and traditional birth attendants. However, more work remains to be done to ensure every birth is safe and every person can fulfill their potential.
Save the Children is focused on reducing newborn mortality globally. It has three main goals:
1. Getting newborn health on global and national agendas through research showing the major causes of newborn deaths and effective interventions.
2. Supporting country programs that have led to important declines in newborn mortality rates in places like Bangladesh, Bolivia, and Tanzania.
3. Continuing to scale up high-impact newborn interventions through health systems, strengthen implementation, and institutionalize newborn survival within countries and organizations.
Adolescents and utilization of family planning services in rural community of...Alexander Decker
This study examined family planning services utilization among adolescents in a rural Nigerian community. 400 adolescents ages 10-19 completed questionnaires. Over two-thirds reported family planning services being available, with main sources being health centers, chemists, and pharmacies. Reasons for service selection included low cost, privacy, and proximity. While most adolescents were sexually active and knowledgeable about contraception, condom use was low and many were unconcerned about pregnancy or STDs. The study concluded family planning services were available but underutilized, with worrisome attitudes towards unprotected sex among adolescents in the community.
The Kuinua Foundation seeks grant funding to expand their program preventing mother-to-child transmission of HIV in Kenya. They will implement the WHO's Option B+ recommendations to provide lifelong antiretroviral treatment to all HIV-positive pregnant and breastfeeding women. This aims to increase treatment coverage and lower transmission rates compared to previous approaches. The foundation recognizes social, economic, geographic, and individual barriers women face in accessing prevention and treatment services in Kenya. With additional resources, they plan to strengthen partnerships and further decentralize services to improve health outcomes for mothers and children.
This document discusses progress towards Millennium Development Goal 4 (MDG4) of reducing child mortality. While overall progress has been made, neonatal mortality rates have declined more slowly. Simple, low-cost interventions like kangaroo mother care, neonatal resuscitation, and breastfeeding can significantly reduce neonatal deaths. However, implementation faces barriers like lack of healthcare workers, cultural practices, financial barriers to care, and poor quality of services. Political will is needed to fully achieve MDG4 targets through strengthened health systems and addressing inequities between regions.
The document discusses sleep health as a public health concern in West Point, New York. An assessment found sleeplessness to be a major issue affecting the community. A presentation was developed to educate cadets on insufficient sleep, its effects, and importance of getting 7-9 hours per night. A pre-test and post-test were administered, and the presentation was successful with 20% of participants improving their knowledge about sleep health. While the presentation met its goal, scheduling cadets was challenging due to their academic and military commitments.
PBH101 Group Presentation on MGD-4 Reduce Child MortalityGaulib Haidar
This group presentation discusses child mortality as it relates to Millennium Development Goal 4. It introduces the group members and provides background on the MDGs, defining them as goals established by the UN to be achieved by 2015. It defines child mortality as deaths under age 5 and discusses the main causes. The presentation outlines strategies to prevent child mortality, such as immunization programs and improving access to healthcare. It notes that progress has been made in reducing child mortality but that more work remains to be done to meet MDG targets by 2015.
This document discusses the implementation of an innovative "Basket Fund" financing mechanism in Zamfara State, Nigeria to address funding challenges for primary health care (PHC) services including routine immunization.
Routine immunization coverage in Zamfara State had declined to only 11% due to inadequate funding for vaccine distribution, staff supervision, and other essential recurrent costs, despite efforts by international partners. A proposal was developed to create a pooled "PHC service delivery fund", also called the "Basket Fund", to centrally manage and transparently disburse funds for PHC activities across the state. Key stakeholders collaborated on the proposal. The Basket Fund mechanism has helped smooth service delivery by resolving issues around both acquiring and properly using
This document summarizes the key points from an analysis of accelerating progress on MDG 5 in Nigeria using the MDGs Acceleration Framework. It provides justifications for selecting MDG 5, including its importance to the government's agenda and addressing disparities across zones. Key data on Nigeria's maternal mortality ratio, causes of maternal death, and coverage of interventions is presented. The analysis identified five priority interventions within MDG 5: family planning, skilled birth attendants, emergency obstetric and newborn care, universal antenatal and postnatal care coverage, and an improved referral system. Bottlenecks within these areas were also identified.
This document provides an overview and analysis of progress towards universal access to reproductive health and family planning based on key indicators. Some key points:
- Globally, contraceptive use has increased to two-thirds of married women, but 12% still have unmet need. The most common methods are female sterilization and IUD.
- Over 80% of married women's family planning needs are satisfied globally, but less than half in Africa.
- 15.3 million adolescent girls give birth each year. Adolescent contraceptive use and access to family planning services lag behind other age groups.
- Disparities exist based on location, education, and wealth. Rural, less educated and poorer
Achievements and Implications of HIV Prevention of Mother-toChild Transmissio...QUESTJOURNAL
This intervention provided HIV prevention services to women of reproductive age in Plateau State, Nigeria. A total of 9,258 women were reached, exceeding the target of 7,460. Structural interventions included 85 community dialogues and 17 income generation activities. Behavioral interventions included distributing 87,028 condoms and providing HIV education to 5,079 peers. Biomedical interventions saw 5,606 women receive counseling, testing and results, with 44 (0.8%) testing positive for HIV. While the intervention helped reduce HIV burden, future programs need to improve coverage and extend services to more local government areas.
The document discusses child and infant mortality rates globally and in India. It provides definitions for under-five mortality rate, infant mortality rate, and neonatal mortality rate. The three main causes of under-five mortality are neonatal mortality (0-4 weeks), post-neonatal mortality (1-12 months), and factors like low birth weight, prematurity, and infectious diseases. While global under-five mortality has decreased 53% from 1990-2015, Africa still has the highest rate. India accounts for 20% of global under-five deaths despite its rate decreasing 61% from 1990-2015. Preventive measures discussed include prenatal nutrition, immunizations, breastfeeding, and improved access to primary healthcare.
Ghia foundation strategy document v4.dec.17.2015 (ab)Ghia Foundation
GHIA FOUNDATION WAS FOUNDED IN 2013 by a team of kind-heated Professionals.
VISION: A World where women in developing Countries live healthier , longer lives
MISSION – To reduce morbidity and mortality among women in developing Countries by strengthening Health Systems to deliver high quality, comprehensive health services.
Strengthening Nepal’s Female Community Health Volunteer Network through Publi...Bibhusan Basnet
This document summarizes a two-year public sector program in Nepal that provided oversight, training, compensation and incentives to strengthen the country's existing network of over 48,000 Female Community Health Volunteers (FCHVs). The program was implemented in 9 villages with 92 FCHVs serving over 20,000 people. Key outputs included expanded coverage, high meeting attendance, 183 patient encounters per village per month, and a total annual cost of $30,111 or $1.72 per patient encounter. FCHVs reported the program increased their skills, pride in their work and sense of community.
Achievements and Implications of Care and Support Programme among Orphans and...QUESTJOURNAL
Background: In Nigeria, children who need special protection on the account of being in vulnerable situations are observably increasing due to growing levels of poverty and the poor socio-economic situation of the country and it is necessary to ameliorate the problem by strengthening the capacity of families. This article therefore presents the achievements of care and support programme among orphans and vulnerable children (OVC) in Bayelsa State, Nigeria as well as the implications for future programming. Methods: The project was an intervention study carried out among OVC in Bayelsa State, Nigeria. Four civil society organizations were engaged by Bayelsa State Agency for the Control of AIDS (BYSACA) under HIV and AIDS Fund (HAF) II project to provide care and support services for OVC. The target population consisted of paternal orphan or maternal orphan, double orphan and vulnerable children whose parents are infected with HIV but alive in six local government areas. A total of 3000 was an estimated sample size for this intervention and data were collected using various data reporting tools and analyzed using Microsoft Excel. Results: The total number of OVC reached during the project period was 5410 given a target reached of 180.3%. Among these, 87.7% of the children were reached with at least one service, 74.9% were reached with psychosocial services, nutrition (37.4%), educational services (33.3%), healthcare services (9.5%) and protection services (4.4%). Thirty-five children withdrawn from the programme and two children reported died during this project. Conclusion: Efforts to care, support and protect vulnerable children should not only focus on their immediate survival needs such as food, education, water, shelter and clothing, but also on long-term developmental needs that reduce children's vulnerability such as life skills, child protection, vocational training, food security, and household economic strengthening.
The document discusses accountability for women's, children's and adolescents' health in the era of the Sustainable Development Goals (SDGs). It notes that while the Millennium Development Goals (MDGs) significantly reduced maternal and child mortality, rates remain unacceptably high. The SDGs launched in 2015 aim to ensure healthy lives for all at all ages. A new Global Strategy aligned with the SDGs provides a roadmap to end preventable deaths of women, children and adolescents by 2030. The Independent Accountability Panel will prepare annual reports on progress using data from UN agencies and others to ensure accountability. Better data and national leadership are crucial to true accountability.
A synthetic review of contraceptive supplies in punjabAlexander Decker
This document discusses contraceptive use in Punjab, Pakistan. It begins by providing background on the benefits of family planning and contraceptive use for maternal and child health. It then analyzes contraceptive commodity data from Punjab, finding that use is still low despite efforts to improve access. The document concludes by emphasizing the need for strategies to bridge gaps and meet the unmet need for effective and affordable contraceptive methods and supplies in Punjab in order to improve health outcomes.
The document summarizes Nepal's Safe Motherhood program. It describes the program's goals of reducing maternal and neonatal mortality and improving health. Major activities include promoting birth preparedness and emergency funds, expanding skilled birth attendants and emergency obstetric care, managing reproductive health issues, expanding service sites, and programs like Aama that provide incentives for institutional delivery. The program aims to make quality maternal care accessible to all women through these various community-based and facility-based strategies.
MEASURE Evaluation PIMA poster on maternal morbidity and mortality. Access a larger version at https://www.measureevaluation.org/pima/maternal-and-reproductive-health/maternal-mortality-poster.
AWDF Woman of Substance on Maternal Health in GhanaAmos Anyimadu
The document discusses the role of midwives and public health nurses in reducing maternal, newborn and child mortality in Ghana. It provides background on Ghana and defines key terms like maternal mortality rate. It describes the causes of maternal deaths as the three delays - delays in seeking care, reaching care, and receiving adequate care. The document outlines Ghana's policies and efforts to improve maternal health, including the Millennium Development Goals. It discusses the midwife's role in antenatal care, labor/delivery care, and postpartum care. Strategies have been implemented before and after 2000 to strengthen the midwife's role in reducing mortality.
Over the past decade, Kenya has made tremendous efforts to enhance maternal and child health. Secure maternity policies such as free maternity care are one of the initiatives that have enhanced maternal and child health in all public health facilities. Despite these attempts, public health facilities for maternal and child health are still underused. This study employed a cross-sectional descriptive study design to identify determinants of free maternal health services by evaluating factors determining perceptions and health-seeking behavior of 384 pregnant mothers in Malava Sub-County, Kakamega County. The study used a mixed-method (quantitative and qualitative approaches). Questionnaires were administered to pregnant mothers selected for the study. The study employed a purposive sampling of research participants. Quantitative data were collected using the questionnaire administered by the research assistants whereas qualitative data were collected by the researcher through interview schedules. Quantitative data analysis was carried out using SPSS 23. However, qualitative data were analyzed through content analysis. Quantitative data representation was done in terms of frequency and percentages. Analysis of chi-square testing was used to assess the association between the variables of socio-economic and health facilities and the provision of free maternity facilities (p<0.05). The study established that the uptake of free maternal service by pregnant mothers was influenced by their level of primitivism and religious beliefs. In addition, this study found out that 53.8% and 77.7% of the pregnant mothers could not attend antenatal and post-natal care because government facilities were located far away from their residences and they also had less access to some information about free maternal health care. The results of this research would be disseminated to the hospital management team, Sub-Country health management team, County health management team, and other stakeholders, thereby demonstrating reasons for low uptake of free maternity services and helping to strategize for better service delivery. Based on the finding, the study recommends that to improve access to free maternal health care, the county government ought to place health services as close as possible to the community where people live. Secondly, there is a need to embrace the usage of the existing media network to sensitize pregnant mothers to the danger signs and the need to have decision-making powers over their safety. Lastly, hospital management ought to increase the awareness of free maternal health care and to include it among the community priorities during dialog days, action days, and other group discussions.
Contraceptive use in sub saharan africa -the sociocultural contextJake Odunga
This document provides an outline on contraceptive use in sub-Saharan Africa. It begins with an introduction on the importance of family planning for improving maternal and child health. It then discusses targets under MDG5 on improving maternal health and reproductive health. It notes that while contraceptive prevalence is increasing in parts of sub-Saharan Africa, rates remain low overall and unmet need for family planning remains high. Key factors influencing contraceptive use include levels of education, cultural and religious barriers, and access to family planning services. The document recommends multi-sectoral approaches including improving access to education and reproductive healthcare to increase contraceptive use in the region beyond 2015.
Childbirth practices in the akpabuyo rural health and demographic surveillanc...Alexander Decker
This document discusses a study on childbirth practices in rural communities in Akpabuyo, Nigeria. The study found that:
1) The majority (84.6%) of births occurred outside formal health facilities and were attended by traditional birth attendants. Only 15.4% of births occurred in hospitals or health centers.
2) Common objects used to cut the umbilical cord included knives (46.2%) and new razor blades (30.8%), with knives being most common. Methylated spirits (63.1%) and "western medicine" (23.8%) were most commonly used to treat the umbilical cord after birth.
3) While 39.5% of women sought
Kilifi County in Kenya has high rates of teenage pregnancy due to cultural and socioeconomic factors. This project aims to address this issue by strengthening health worker capacity and increasing access to reproductive healthcare and family planning services, especially in rural areas. It proposes introducing portable ultrasound devices and telehealth solutions to expand medical services. The expected outcomes are improved access to maternal healthcare, increased contraceptive use among youth, and a reduction in teenage pregnancy rates in Kilifi County.
This document summarizes a study that used multilevel logistic regression to identify individual and community level factors associated with exclusive breastfeeding among infants under six months in Ethiopia. The study used 2016 Ethiopian Demographic and Health Survey data including 1,185 infants. Results found that at the individual level, factors like infant age, sex, health issues, household wealth, and antenatal care were associated with exclusive breastfeeding. At the community level, region, postnatal care visits, and maternal employment were associated factors. Both individual and community factors explained around 47% of the variation in exclusive breastfeeding.
This document provides information on family planning in Nepal, including:
1. Definitions of family planning, its aims to improve health and contribute to national development.
2. A history of family planning initiatives in Nepal beginning in 1959 with NGO programs and the government adopting policies in the 1960s-1970s.
3. How family planning can help achieve the Millennium Development Goals by reducing poverty, improving education and gender equality, and decreasing disease and mortality. Meeting family planning needs can prevent maternal and child deaths.
On the Margins of Health Care Provision: Delivering at Home in Harare, Zimbabwepaperpublications3
Abstract: This paper analyses the phenomenon of home deliveries by pregnant women in an urban setting in Zimbabwe. It argues that, though home deliveries are commonly practiced in the rural areas, they have now found their way into and are even proliferating in the urban areas. Social cultural values, religious belief and economic status/resources determine women’s place of birth. Whilst government policies expounded through the Ministry of Health (MoH) programs and policies denounce home deliveries, the frail health care system characterized by mass exodus of qualified personnel, in availability of drugs and understaffing of healthcare centres do little to lure pregnant women to deliver in hospitals. Furthermore, the high levels of poverty among the populace entail that people cannot afford either public or private hospital services; and thus resort to home-based healthcare and subsequently home deliveries. The paper explores the factors fuelling home deliveries and the challenges associated with this practice in Harare, Zimbabwe.
The PRRINN-MNCH programme operated in four northern Nigerian states from 2006-2013 with the goal of improving maternal, newborn and child health services. It achieved significant impacts including:
1) Reducing maternal and child mortality and morbidity in the target states by strengthening health systems, service delivery, community engagement, and governance.
2) Providing evidence of value for money through improved health indicators and lives saved due to programme interventions.
3) Facing challenges in the unstable security environment, particularly in Yobe State, but continuing operations with government commitment to improving health services.
2008 Shsop Fin Obstetric Care Vouchers In Cambodia Por &Cwvdamme
1) Voucher and Health Equity Fund (HEF) schemes in Cambodia aimed to improve access to safe delivery for poor pregnant women by increasing facility deliveries at public health centers and hospitals.
2) The programs increased the number of deliveries at public facilities, with voucher and HEF beneficiaries accounting for about one-third of total facility deliveries.
3) However, the impact on improving access remained limited due to various financial and non-financial barriers. To be fully effective, vouchers and HEFs need to be complemented by supply-side interventions that also address issues like staff incentives and transportation barriers.
Health System Factors Affecting Uptake of Antenatal Care by Women of Reproduc...Premier Publishers
This study sought to determine how health system factors affect antenatal care services uptake. A descriptive cross-sectional study design was adopted. The population under study was selected household members of the community, facility in charges as well as community own resource persons in Kisumu county. The study used purposive sampling method in selecting the Key Informants. A total sample size of 300 respondents were interviewed. The study used an interview and questionnaires to collect data. Descriptive statistics and chi-square tests were used to analyse data with the help of Statistical Package for the Social Sciences. Chi-square analysis showed that distance to facility (p=0.043), waiting time (p=0.012), means of transport used (p=0.016), perceived quality of services (p=0.000) and perceived attitude of service provider (p=0.000) were significant as pertains to number of ANC visits. The study concluded that health system factors affect uptake of ANC. Specifically, lack long distance to hospital, long waiting time, poor quality of services, commodity stock outs and poor attitude of staff. The combination of these factors reduced uptake of ANC. The study recommended integration of traditional birth attendants, community health workers and health care workers services, regular ANC Outreaches and better equipping of rural health facilities.
Professor Lanre Olaniyan: Family Planning, COVID-19 Pandemic and Progress Tow...NigeriaFamilyPlannin
This was presented at the guest lecture on the second day of the 6th Nigeria Family Planning Conference which happened in Abuja from December 7 - 11, 2020.
Bridging the gap between concept and reality in the nigerian midwives service...Ute Inegbenebor
The document summarizes barriers to the effective implementation of the Nigerian Midwives Service Scheme, which aims to provide 24-hour coverage by skilled birth attendants at primary health centers. Some key barriers discussed include political barriers like bills supporting child marriage; religious barriers like unsafe deliveries in churches; community hostility towards midwives; and low educational and literacy levels, particularly in northern zones where the scheme has not met targets. Overcoming these barriers through innovative health communication, social marketing, and inter-sectoral collaboration could help bridge the gap between the scheme's goals and current realities.
Effectiveness of Community based Interventions in Reducing Maternal Mortality...ObinnaOrjingene1
Background & Aim: Maternal mortality ratio for sub-Saharan Africa in 2010 was estimated to be about 600 per 100,000 live births, which is approximately higher than what is obtainable in advanced countries. To this end, several community-based interventions have been put in place by governments and developmental partners in the region to address the situation. This review aimed to seek evidence from existing literature on the level of effectiveness of these interventions in improving maternal health outcomes in the region. The literature search process resulted in retrieval of six full text studies that were written in English, published between 2000 and 2019 and were focused on intervention based at the community level which resulted in the reduction of maternal deaths in some sub-Saharan African countries. The Critical Appraisal Skills Programme (CASP) tool was used to critically review retrieved literature.
Findings: Findings from the articles reviewed show that community-based interventions with a direct reduction in maternal mortality were implemented in Ethiopia and Nigeria and were effective since maternal mortality declined by 64% and 43.5% respectively. Other community based interventions did not directly address the reduction in maternal mortality but rather addressed leading causes of maternal mortality such as home and unskilled birth attendance, low Ante-Natal Care (ANC) & Post-Natal Care (PNC) services utilization, Eclampsia, delay in accessing care and Postpartum Hemorrhage (PPH). Such interventions were implemented in Nigeria, Zambia, Tanzania, and the Democratic Republic of Congo and were proved to be effective in reducing maternal mortality.
Conclusions and Recommendations: Based on the literatures reviewed, it was concluded that community based interventions were effective in reducing maternal mortality in Sub-Saharan Africa. The following recommendations were made based on gaps observed in the implementation of some interventions. Introduction of emergency transport scheme in countries where they do not exist as despite the existence of maternity waiting homes and dedicated maternity ambulances in Zambia, many expectant mothers still had difficulty reaching the health facilities in time to deliver, Engagement and training of more health workers so as to avoid human resources challenges that may be associated with increased demand for health facility deliveries.
Social and economic factors influence contraceptive use in Tanzania. Only 27% of married women in Tanzania used modern contraceptive methods in 2010, and the rate was even lower in Mwanza region at 12%. Both men and women have concerns and misconceptions about side effects of contraceptives. Research shows contraceptive use is associated with greater knowledge about contraceptives and higher education levels. A woman's social network and partner approval also impact her contraceptive use. Economic shocks can disrupt access to contraceptives or encourage greater use to avoid child expenses. National investments in family planning programs aim to expand access and increase contraceptive rates.
Maternal health care trends in afghanistanIslam Saeed
The document summarizes findings from a 2010 Afghanistan mortality survey on trends in maternal health care. It finds that coverage of antenatal care, deliveries assisted by skilled birth attendants, and postnatal care have increased by about 10% on average. However, this level of progress is not as high as expected given major investments in Afghanistan's basic health package and hospital system aimed at improving maternal and child health. The results indicate efforts to expand access to maternal services have had an impact but more improvement is still needed.
1) The document discusses utilization of maternal health services in seven Empowered Action Group (EAG) states in India based on data from the National Rural Health Mission.
2) It finds variation in utilization of services like tetanus injections, institutional delivery, and postnatal care across EAG states, with some states performing better than others.
3) The role of Accredited Social Health Activists (ASHAs) in promoting utilization of maternal health services is also examined based on their assigned responsibilities related to pregnancy and delivery.
Os cuidados de saúde prestados durante a gravidez salvaguardam o bem-estar da mãe e do feto e proporcionam um bom começo de vida aos bebês. Os custos financeiros de ter um bebê podem ser catastróficos, impedindo as mulheres grávidas de procurar serviços essenciais de saúde materna e colocando em risco a vida das mães e de seus filhos.
De acordo com a análise recentemente divulgada, estima-se que 5 milhões de famílias vivendo na África, Ásia, América Latina e Caribe incorrerão em grandes dificuldades financeiras a cada ano - ou gastos catastróficos em saúde - devido a ausência de cuidados pré-natal e parto. Os gastos com saúde são considerados grandes se excederem 40% dos gastos não essenciais, não alimentares, de um domicílio. Quase dois terços dessas famílias, ou cerca de 3 milhões de famílias, estão na Ásia.
O documento aborda ainda, a epidemia de cesáreas, o casamento infantil, a gravidez na adolescência...
Obrigado e parabéns ao Unicef!
Prof. Marcus Renato de Carvalho
Healthy mothers, healthy babies: Taking stock of maternal health - Unicef
End of Module 1 Project 12292014
1. THE UNIVERSITY OF LIVERPOOL
MASTER OF PUBLIC HEALTH PROGRAMME
PUBH 520: Practicing and Promoting Public Health in a Global Context
End of Module Project
TOPIC: HEALTH PROMOTION STRATEGIES TO INCREASE UPTAKE OF FAMILY
PLANNING IN NORTH EASTERN KENYA
A REPORT BY CAMLUS ODHUS, (as) PUBLIC HEALTH CONSULTANT
DECEMBER 2014
2. ii
Executive Summary (266 words)
Contraceptive prevalence rates (CPR) in North Eastern (NE) Kenya stood at 4% against the
national average of 46% in 2008/9; lower than Kenya’s CPR in 1978. North Eastern Kenya covers
21% of Kenya’s land mass, has 6% of the country’s populace; and has bleak health and
development indicators including a poverty rate of up to 97%. The maternal mortality rate is
estimated at 1,683 per 100,000 live births (Kenya average is 488/100,000) and infant mortality
rate of “121 per 1,000 live births” (Kenya’s “average is 52 per 1,000”). An increase in family
planning (FP) usage could help avert most of these needless deaths. However, family planning
promotion in North Eastern Kenya requires a non-traditional approach. Available data suggests
that numerous factors have contributed to this scenario including: low levels of education, high
poverty rates, inequitable gender and religious attitudes, myths and misconceptions regarding
FP, and historical neglect in the provision of services. This document proposes a mix of theory-
based activities to tackle determinants of family planning at various levels. Strengthening
individuals with accurate FP information, building stronger communities through sustained
community dialogue, ensuring macroeconomic and cultural change through social analysis and
action methodologies, and improving access to services by regular comprehensive outreaches
are proposed. Youth and women empowerment initiatives and lobbying for adequate budget
support for health and social services are further recommended. Possible limitations to
implementing this strategy include inadequate financial and human resource capacity in North
Eastern Kenya, and additional data on cultural and health systems dimensions to be obtained
from a Health Needs Assessment, are needed to fully understand FP in this setting.
4. 1
Section One: Family Planning in North Eastern Kenya (1094 words)
Kenya is listed amongst the few countries with a successful FP programme in sub-Saharan Africa (AU,
2014). Although it is “estimated that meeting the unmet need for family planning could reduce
maternal deaths by about 30%” (AU, 2014), “25% of currently married women in Kenya have an unmet
need”accordingto the Kenya Demographic and Health Survey (KDHS) (KNBS and ICF Macro, 2010). The
situation is worse for North Eastern (NE) Kenya.
NE region is an arid area of Kenya prone to insecurity, bordering the Somalia Republic to the east and
Ethiopia to the north. The estimated population (though disputed) of 2.5 million, is predominantly
Muslim, rural, nomadic, pastoralist Somali ethnic group (KNBS, 2010). The CPR for NE Kenya was 4% in
2008/9 against the national average of 46% (KNBS and ICF Macro, 2010). KDHS is a widely reliable
population-basedsurveycarriedout everyfive years. Other unpublished studies of unknown sampling
errorshave estimated CPRinNE at 6.1% in 2014 (Khayombe,2014).Health service utilization data have
also put the CPR at between 4% and 6% (less than the national average in 1978) but with gross
inaccuracy in health facility reports (DHIS, 2014).
According to WHO (2006) better spacing of births can save the lives of children. Conde-Agudelo and
Belizan (2000) evaluated results for over a million pregnancies and established the following: being
pregnantlessthansix months aftera birthleadsto 150% more chance of maternal death, 70% increased
probability of hemorrhage in the last three months of a pregnancy, and 30% more risk of uterine
inflammation after delivery during the following pregnancy. As shown in Table 1, NE Kenya with high
rates of maternal and child mortality can gain immensely from family planning promotion.
Table 1 Health Impact and Inequality Indicators
Source:Regional estimatesfrom KNBSandICFMacro (2010) reproduced inCountyHealthSectoral
StrategicPlan2013/14 – 2017/18
Key Health Impact Indicators NE Region estimates National average
Life Expectancy atbirth (years) 43
61 years (2012 World Bank
figures)
Annual Rate of Population Increase 1.36% 1%
Annual deaths (per 1,000 persons) – Crude mortality 9.3 8
Neonatal Mortality Rate (per 1,000 livebirths) 33 31
InfantMortality Rate (per 1,000 livebirths) 121 52
Under 5 Mortality Rate (per 1,000 livebirths) 158 74
Maternal Mortality Rate (per 100,000 livebirths) 1,683 488
5. 2
Even though UNICEF (n.d.) explains that NE Kenya “has twice the relative poverty headcount” of the
country’s richestareas,andliteracylevelsare lowestinthispartof Kenya,thisdoes not entirely explain
the small family planning uptake compared to the rest of Kenya. This area has borne the brunt of
historical, political marginalization (with inadequate investment in health and social services) since
independencedue toits inaccurately perceivedlow contribution to Kenya’s economy (Ruto, Ongwenyi
and Mugo, 2009).
As exhibited inFigure1,more marriedwomeninurbanareas (53%) use contraceptive comparedto rural
women(43%).NorthEasternKenya with just 4% of married women using any contraceptive method is
widely rural, partly explaining the disparity in contraceptive use. Further, a woman in “poor” NE is
unlikely to use a contraceptive because contraceptive use increases from the lowest wealth quintile
towards the fourth wealth quintile.
Figure 1: Contraceptive Use among Married Women of Reproductive Age, by
Background Characteristics
Image (graph) fromKNBSand ICF Macro (2010)
Table 2 shows thatnationally,exposuretoFPmessages throughtelevision, newspaperand magazines is
moderate, butvery little in NE. Expectedly, exposure to family planning messages “level of education
and wealth quintile,” again putting NE at a disadvantage.
6. 3
Table 2: Exposure to Family Planning Messages
Image (table) fromKNBSandICFMacro (2010)
“Womenin NE Kenyaandthose withnoeducation”expressthe leastacceptability tothe dissemination
of messages about condoms through print and electronic media (KNBS and ICF Macro, 2010). This is in
tandem with an assessment conducted by Save the Children in the region that found condoms to be
much contested as a form of contraception (RGA, 2014), influenced by religious beliefs.
7. 4
Table 3 Acceptability of Condom Messages
Image (table) fromKNBSand ICFMacro (2010)
The resultsinTable 4 indicate that21% of meninNE believethatcontraceptioniswomen’sbusiness
againstthe national average of 16%.
8. 5
Table 4: Men’s attitude towards contraception
Image (table) fromKNBSandICFMacro (2010)
Comparedtoother partsof Kenya,womeninNEKenyaprefermanychildren.Forexample, up to 96% of
marriedKenyan women do not want more than six children but 90% of NE women want more than six
children and every man in this region reportedly wants more children (KNBS and ICF Macro, 2010).
A qualitative study by RGA (2014) found that in North Eastern Kenya, most women, men, traditional
birthattendants,andsome Muslimreligiousleaders,harboredstrong attitudes regarding FP. The study
identified Muslimreligiousleaders’teachings as significant influences on men, youths and women but
also established that the religious leaders left a leeway for health workers to recommend acceptable
(shortand longacting) FPchoicesto couples.Male andfemale sterilizationbeingpermanentmethods,it
found, are unacceptable (RGA, 2014). This study may not be generalizable because of its non-random,
small sample -frame, but it provides useful insights into Somali cultural beliefs and Islamic teachings
regarding FP.
9. 6
Religious leaders also prefer the term “child spacing” to family planning, explaining that the term
“planning”hasconnotationsof birth control, something that is against Somali culture and Islamic faith
(RGA, 2014). As such, any successful FP programmes need to work with health workers and religious
leaders to demystify family planning using culturally appropriate and Islam-sensitive approaches to
reach the community.One identifiedentrypointisthe provision by Islam for mothers to breastfeed up
to twoyears forhealthybabies and mothers (aligns with the WHO (2006) recommendation on optimal
birthspacing. Highstigmaand the belief that‘Allah (God) provides” leaves no chance for promoting FP
on the basis of “small, economical families” (RGA, 2014).
Additional information about FP in NE Kenya will help design a robust health promotion campaign.
Comprehensivefamilyplanninghealthpackage includesthree components: commodities and supplies,
demand generation and an enabling environment. Within the context of the “Supply, Enabling
Environment and Demand (SEED) framework for Family planning” by EngenderHealth (2011), more
qualitative and quantitative data on available public resources, policies and guidelines on FP,
contraceptive security situation and presence of possible FP champions should be obtained from a
HealthNeedsAssessment (HNA).Moreover,anHNA will clarifynormative andexpressedneeds as far as
the contested concept of “unmet need for FP” is concerned.
Section Two: Recommended Health Promotion Activities (1082 words)
Different interventions at various levels of health determinants are proposed to reduce the unequal
healthimpactsof low familyplanning.Suchevidence-basedactivities targettoaddresssupply (provision
of FPthat isaccessible,available andinline withcommunityneeds),anddemand(how genderdynamics
influencedecisionsonFPincluding the number, timing and spacing of children), while also creating an
enabling environment (policies, laws and norms) for quality family planning (ICRW, 2014 and
EngenderHealth, 2011). The proposed activities by health promotion approaches are as follows:
Educational activities
- Provide tailoredinformation onthe benefits,methodsandmisconceptionsaboutFP inlocal Somali
language usingmultiple channels (ICRW,2014; Cleland,Harbison,andShah,2014)
- Use Mass media(withlive audiences) suchascommunity(vernacular) radiotodisseminate
informationonFP (ICRW,2014; Cleland,HarbisonandShah,2014)
- Supportinterpersonalcommunicationto promote FP usingpeereducators (ICRW,2014; BALANCED
Project,2012)
- Reach youth-at-school throughintegratedsexual andlife skillseducationusing existingschool-based
curriculum(ICRW,2014; WHO,2014; Cleland,Harbison,andShah,2014)
- Supportcommunityhealthworkerstovisithouseholdsandpromote familyplanningthrough
couple/spousal counseling,service provision andreferral (BALANCEDProject,2012)
- Provide refreshertrainingto healthworkerstoprovide quality,culturally-appropriate family
planningcounseling andservices (ICRW,2014; FP2020, 2014)
Behaviorchange approaches
- Enhance community-baseddistribution(CBD) of FPcommoditiesandsuppliesthroughselected
service deliverychannelstoreachthose with unequal access (BALANCEDProject,2012)
10. 7
- Promote social franchiseswith FP voucherstoencourage the lowestwealthquintilestoutilize
qualityservices (FP2020,2014)
- Developareligious-basedFPmassmobilization andcommunitydialoguecampaignwithselected
Muslimscholarsas “FP champions” incorporating“new adopters”toreduce FP-associatedstigma
(ESD Project,2008)
Medical approaches
- Strengtheningintegrationof FPservice provisionintoantenatal,postnatal,nutritionandHIV/AIDS
care (ACCESS-FP,2010)
- Initiate anintegrated, publicized, comprehensive free outreachservices tounderservedpopulations
- Promote voluntarychoice,privacyandconfidentialityinFPservice provision
- StrengthenlogisticsplanningandprocurementforFPcommoditiesanddrugsaspart of essential
services (FP2020,2014; Cleland,HarbisonandShah,2014)
Social change approaches
- Initiate social analysisandaction(SAA) asa local advocacyapproach to deconstructinginequitable
gendernorms (CARE,2013)
Empowermentapproaches
- Integrate sexual andreproductive healthintoyouthdevelopmentactivitiesatyouth economic
centers(ICRW,2014)
- Mobilize womentoform groupsforeconomicandhealthempowerment andintegrateFPpeerto
peerin-reachingroupactivities
- In the medium-term,provide performance-basedincentivesforFPservice deliveryandlobbyfor the
eliminationof userfeesbyserviceproviders forlong-termsustainability(FP2020,2014)
- Supportwomenandyouthsto demandqualitysexual andreproductive healthservicesthrough
annual citizenbudgethearingsatgrass-rootslevel
Healthypublicpolicy basedapproaches
- Advocate formore budgetaryallocationtoMinistryof Healthbythe Treasuryfor adequate health
humanresourcesandFP budget
- Lobbythe governmenttoensure free maternitypolicyincludes waiversof familyplanninguserfees
(MoH, n.d.)
- Lobbypolitical leaderstodelivermessageson “healthytimingandspacingof pregnancy”(HTSP) and
to pass lawstosafeguard the rightto reproductive health
- Lobbythe educationsectortopass/implementanAdultLiteracyPolicyforNorthEasternKenya and
to strengthenbasiceducation
Personal counselingaboutFPathouseholdsand healthfacilities isbasedonthe “Social LearningTheory”
by Bandura (1992) explained in Baum (2008), and Beattie Model (Naidoo and Wills, 2009). Community
dialogue facilitated by religious leaders and FP champions (new adopters) is meant to demonstrate
efficacyandshowbenefitsof child spacing and are grounded in the “Health Belief Model” (Becker and
Rosenstock, 1987) described by Baum (2008). It is also supported by the “Diffusion of Innovations
Theory” by Rogers (1962) discussed by Schiavo (2007). The use of Social Analysis and Action to tackle
inequitable gendernormsinthispatriarchal society is informed by Ajzen and Fishbein's (1980) “Theory
11. 8
of Reasoned Action” (Baum (2008) which postulates that individual attitudes and communal customs
influence health behaviours.
Educational activities are proposed from an understanding of “Ideation theory” and “Convergence
theory”(Schiavo,2007) whichemphasize strategicbehaviorchange communicationandthe importance
of sharing information, respectively. Empowerment and social change leaning activities are rooted in
“radical structuralist” perspective of Caplan and Holland Model (Naidoo and Wills, 2009). To foster
policy and social change that makes FP decisions the healthier choices (Naidoo and Wills, 2009, p.67),
recommendations toadvocate formore budgetary support to the Ministry of Health earmarked for FP,
to lobby for elimination of user fees, to ensure well-funded plans and strategies to promote FP are in
place at all levels, have been made.
“Positive health protection” aspects of the Tannahill model (Naidoo and Wills, 2009) have informed
proposedlegislative andpolicyinitiatives to safeguard reproductive health. The recommended health
promotion interventions are relevant because they aim to tackle major social determinants of family
planninginNEKenya.Whitehead(2007) and DahlgrenandWhitehead(1991) in Naidoo and Wills (2009,
p.19) provide the basis for the ensuing analysis.
Proposed activities will educate and strengthen NE Kenya community members with targeted and
tailored messages on FP, tackling common myths and misconceptions. It will also present this
information throughmultiple channels inthe local dialect, for effective targeting (Kreuter et al., 2003).
Involving Muslim religious leaders in community dialogue will help address social, and community
influencesthatpose barrierstoindividuals’accesstoFP.Improvementsinlivingandworking conditions
are expected to accrue from incentive and voucher schemes, besides promoting opportunities for
individuals to participate in community groups for income generation.
Strategiestostrengthenthe NEKenyacommunityinclude making FP services widely available through
health facilities and regular mobile health outreaches, backed with a mobilization/communication
strategy. Social analysis and action will see community influences on gender norms adequately
addressed and mainstreaming sexuality and life skills education in school will help youths acquire
credible healthinformation to build self-esteem and improve self-efficacy for better decision-making
regarding FP.
Workingwithpolitical,religiousand cultural leaders andbylobbyingforapplicable laws,regulationsand
policies to assure sexual and reproductive health is expected to result in macroeconomic and cultural
change for marginalized NE Kenya, but this will not be easy given deeply entrenched political and
cultural interests (RGA,2014). Empoweringyouthsandwomeneconomically will enable them to access
better health and social services and improve their capacity to take up economic opportunities.
12. 9
Conclusion (249 words)
This paper has discussed the issue of inequitable family planning in North Eastern Kenya whose
determinants include lowlevels of education; a predominantly rural population with low access to FP,
health and other social services; and high poverty rates compared to other parts of Kenya. Prevalent
socio-cultural misconceptions informed by religious beliefs; and traditional historical and political
disempowerment of NE Kenya are also contributors. The contraceptive rate of between 4% and 6.1%
against the national average of nearly 50% does not augur well for maternal and child health with
unacceptably high rates of mortalities in both sub-groups. The extent of unmet need is not apparent.
Subsequently, interventions to promote FP have been proposed based on the various approaches,
models and theories of health promotion. As part of this, specific activities to address the social
determinants of health and inequality in Family Planning services are suggested. All activities aim to
create an enabling environment, improving supply and addressing demand side factors that have
constrained FP in this remote, vast and marginalized part of Kenya. Some key activities include
supporting citizens to demand quality services, lobbying the government to enact policies and
regulations to address inequitable access to FP and public health education to increase community
knowledge on FP.
Lastly, possible fundingandskillslimitations are acknowledgedbutmore in-depthdataisneededto plan
FP promotion. In this setup, condoms, abortion, and emergency contraception remain controversial
formsof FP and a cautious, innovative, culturallyappropriate interventions as proposed, are necessary.
13. 10
References
ACCESS-FP (2010) Postpartum Family Planning for Community Health Workers: Trainer’s Manual.
Baltimore, MD: Jhpiego
African Union (2014) 2013 Status Report on Maternal Newborn and Child Health in Africa [Online]
Available from: http://www.carmma.org/resource/2013-status-report-maternal-newborn-and-child-
health-africa (Accessed December 10, 2014)
BALANCEDProject(2012) Population,HealthandEnvironment(PHE) Community-basedDistributionand
Peer Education System: A Guide for Training PHE Community-based Distributors. Narragansett, RI:
University of Rhode Island. [Online] Available from:
http://www.crc.uri.edu/download/CBD_Manual_508_FINAL.pdf (Accessed June 12, 2014)
Baum,F. (2008) The new publichealth.Melbourne:OxfordUniversityPress. The New Public Health, 3rd
Edition by Baum, F. Copyright 2008 by Oxford University Press (Australia). Reprinted by permission of
Oxford University Press (Australia) via the Copyright Clearance Center
CARE (2013) The Family Planning Results Initiative in Kenya (2009-2012): Initial Findings from End Line
Evaluation. [Online]. Available from:
http://familyplanning.care2share.wikispaces.net/file/view/Results_Initiative_Kenya_Report.pdf
(Accessed May 2, 2014)
Cleland, J., Harbison, S. and Shah, I. H. (2014) Unmet Need for Contraception: Issues and Challenges.
[Online] Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1728-4465.2014.00380.x/pdf
(Accessed December 20, 2014)
Conde-Agudelo, A. and Belizan, J. M. (2000) Maternal mortality and morbidity associated with
interpregnancy interval: cross sectional study. [Online] Available from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC27528/pdf/1255.pdf (Accessed December 15, 2014)
County Department for Health (2013) Wajir County Health Sectoral Strategic Plan 2013/14 – 2017/18
Wajir: (unpublished strategy)
Engenderhealth (2011) The SEED assessment guide for family planning programming. New York:
Engenderhealth [Online] Available from: http://www.engenderhealth.org/files/pubs/family-
planning/seed-model/seed-assessment-guide-for-family-planning-programming-english.pdf (Accessed
December 22, 2014)
Extending Service Delivery Project (2008) Lessons Learned in Programming and Implementing the
Religious Leaders RH/FP Program: A Case f or Dadaab Refugee Camp. [Online]. Available from:
http://www.esdproj.org/site/DocServer/RL_Activity_in_Dadaab_Report_FINAL_for_distibution.pdf?docI
D=2521 (Accessed August 21, 2013)
14. 11
Family Planning 2020 (2014) Partnership in Progress 2013-2014 [Online] Available from:
http://progress.familyplanning2020.org/ (Accessed November 4, 2014)
International Centre for Research on Women (2014) Adolescents and Family Planning: What the
Evidence Shows. [Online] Available from:
http://www.icrw.org/files/publications/140701%20ICRW%20Family%20Planning%20Rpt%20Web.pdf
(Accessed November 10, 2014)
Kenya National Bureau of Statistics (2010) The 2009 Kenya Housing and Population Census. Nairobi:
KNBS
KenyaNational Bureau of Statistics and ICF Macro (2010) Kenya Demographic and Health Survey 2008-
09. Calverton, Maryland: KNBS and ICF Macro.
Khayombe, P. O. (2014) End Term Evaluation of Accelerating reduction in Maternal and under-five
mortality among Marginalized communities in Wajir County North Eastern Kenya Project. Nairobi:
unpublished report
Kreuter, M. W., et al. (2003). ‘Achieving cultural appropriateness in health promotion programs:
Targeted and tailored approaches’, Health Education & Behavior, 30 (2), pp.133-146 [PDF online] DOI:
10.1177/1090198102251021 (Accessed October 23, 2014)
Ministry of Health (n.d.) Press Release: FREE MATERNITY SERVICES. Nairobi: Office of the Cabinet
Secretary for Health
Naidoo, J., & Wills, J. (2009) Foundations for health promotion. Edinburgh: Baillière Tindall/Elsevier.
ResearchGuide Africa(2014) Formative Assessment of Family Planning (FP) Knowledge, Attitudes and
Barriers in Wajir and Mandera Counties, Kenya. Nairobi: Unpublished report
Ruto, S. J., Ongwenyi, Z. N. and Mugo, J. K. (2009) Education for All Global Monitoring Report 2010:
Educational Marginalization in Northern Kenya [Online] Available from:
http://datatopics.worldbank.org/hnp/files/edstats/KENgmrpap09.pdf (Accessed December 21, 2014)
Schiavo,R.(2007) Health Communication:FromTheory to Practice. San Francisco, CA: Jossey-Bass/John
Wiley & Sons
United Nations Children’s Fund (n.d.) [Online webpage] Available from:
http://www.unicef.org/kenya/overview_4616.html (Accessed December 22, 2014)
Whitehead, M. (2007) ‘A typology of actions to tackle social inequalities in health’, Journal of
Epidemiology and Community Health, 61, pp.473-478 [Online]. Available from:
http://ezproxy.liv.ac.uk/login?url=http://openurl.ac.uk/?title=Journal+of+Epidemiology+and+Communit
y+Health&volume=61&issue=&spage=473&date=2007 (Accessed November 27, 2014).
15. 12
World Health Organization (2006) Health for the World’s Adolescents: A second chance in the second
decade. [Online] Available from: http://apps.who.int/adolescent/second-
decade/files/1612_MNCAH_HWA_Executive_Summary.pdf (Accessed December 20, 2014)