Dr. Solomon Orero, Consulting Obstetrician/Gynecologist Nairobi, Kenya May 8, 2008

1. CPAC IN KENYA
WHERE WE ARE
By Dr Solomon Orero
(MD,MMED,IMH)

2. The Origin of PAC
 The history of legalization of abortion care
 From the 1950s
 This is not visible in the African Continent
and Latin America

3. Arguments for legalization
 Maternal mortality and morbidity
 The public Health Platform and resources
 The Sexual reproductive Health and Rights
Platform

4. The Landmark Decisions in Abortion
Care
 The USA 1973 Judicial ruling-How it has
since affected the rest of the world
 The 1984 Mexico policy and its impact-The
“Gag Rule”
 The 1994 Landmark ICPD
 The Mexico City Liberalization of abortion
Law-GIRE

5. PAC
 The term PAC first articulated in 1991
 The Historical origins of PAC
 The logic of inclusion of PAFP
 The logic for the inclusion of referrals and
linkages with other RH services

6. In 1993-The PAC consortium
 AVSC now Engender health
 IPPF
 IPAS
 Pathfinder International
 JHPIEGO

7. The Original PAC model 1994
 Emergency Treatment-Evacuation of the
uterus
 Post Abortion Family Planning counseling
and services
 Referrals and Linkages with other RH
services

8. ICPD 1994 and Land mark para 8.25
 “All governments and organizations to
strengthen their commitment to women’s
health" and “deal with the health impact of
unsafe abortion”

9. Expansion of the programmes and
access issues
 Decentralization of:
– The provider skill-
– The health facility
– Involvement of the informal providers and the
community

10. Consultants
Referral
hospitals
General Practitioners
First level referral hospitals
Sub-district
hospitals
Mid level providers
All hospitals
Health Centers
Dispensaries
Informal providers
( TBAs, Health workers, community based health workers)
Found in the communities

11. The reviewed PAC concept
 Community and service provider partnership
 Counseling
 Emergency treatment
 Family Planning and Contraceptive Services
 Referrals and Linkages to RH and other
services

12. Community and service provider
partnership
1. Community and service provider
partnerships for prevention (of unwanted
pregnancies and unsafe abortion),
mobilization of resources (to help women
receive appropriate and timely care for
complications from abortion), and ensuring
that health services reflects and meet
community expectations and needs

13. Community and service provider
partnership
Cont’d
2. Counseling to identify and respond to
women’s emotional and physical health
needs and other concerns.
3. Treatment of incomplete and unsafe
abortions and complications that are life
threatening.

14. Community and service provider
partnership
Cont’d
4. Contraceptive and family planning services
to help women prevent unwanted
pregnancy or practice birth spacing: and
5. Linkages with other reproductive health
services that are preferably provided on-
site or via referral to other accessible
facilities in the providers network.

15. Community and provider partnerships
 The partnership includes education:
1. To increase FP use, prevention of unwanted
pregnancies
2. Risks and consequences of unsafe abortions
3. Promotion of client oriented health rights based on
sexual and RH services
4. Signs and symptoms of obstetric emergencies

16. Community and provider partnerships
cont..
5. In what sexual and RH services are provided
6. Mobilization of community resources to ensure that
women with obstetric emergencies (including PAC)
receive timely and appropriate care
7. Planning and sustaining PAC and other RH
services (HIV/AIDS, FGM, gender violence etc)

17. Counseling
1. To find and affirm the women’s feelings
2. Ensure that women receive appropriate answers to
their questions or provided with adequate
information on their condition and treatment.
3. Help women clarify their thoughts about pregnancy,
PAC, return of ovulation and RH future
4. Address other concerns that women may have

18. Treatment
 Provision of emergency treatment by
evacuation of the uterine contents through:
1. Manual Vacuum Aspiration (MVA) or
2. Sharp Curettage (SC) or
3. Electric Vacuum Aspiration (EVA) or
4. Use of chemicals e.g Misoprostol.

19. Contraceptive and FP services
 Access to a wide range of contraceptive
methods to women who desire to delay or
avoid pregnancy so as to avoid unwanted
pregnancies.

20. What is going on in the recent past and
now?
 Community Based Abortion Care
 Creation of community partnerships
 High profile newspaper reported cases
regarding unsafe abortion ,Street dumped
fetuses

21. What is new in Kenya?
 The challenges of providing all the PAC
components:
– PAFP -counseling and services
– Continuous decentralization of MVA/PAC services
– Obs/Gyn,MOs,MLPs,Informal Providers
– Training,MVA kit new to MVA Plus
– The Environment is getting more hostile

22. 40th
Anniversary of FP
 On May 13th,2008
will be the 40th
anniversary of
FP as a recognized Human rights issue
 “On that day, there will be many couples who
will have an unmet need for FP”For many
reasons they will not access Family planning
methods
 One reason in Kenya :there has been no
major investment in FP the last almost 2
decades

23. On Investment in Health
 Investment at the community level in creating
awareness and seeking to improve health
seeking behaviour
 Investment in the institutional level in getting
the infrastructure up and running with the
right mix of skills

24. On Investment in Health
 Investment in health systems development
and use of RH abortion included as a fulcrum
for change
 Investment in policy and strategy
development for Health and therefore RH
and undertake advocacy for stronger
legislation and better services integration

25. CPAC
EQUITY FOR WOMEN
PRIMARY HEALTH CARE
Basic Maternity Care
PILLARS OF
SAFE
MOTHERHOODFamily
Planning
Essential
ObstetricCare
Safe
Delivery
ANC

26. MAP OF KENYA & KMET PROJECT AREAS

27. The Map of Kenya and some facts
Kenya: Country Background
•Population:
33 million
•GDP: Kshs.
920 b
(US $ 12.5 b)
•Per capital
income: US$ 380

28. A map of Kenya showing the PEV hot
spots what it will mean in PAC

29. KMET PROGRAMS
SAFE
MOTHERHOOD
INITIATIVE
KMET
PROGRAMS
POST ABORTION
CARE
HOME BASED
CARE FOR
PLWHA
NUTR’N AS A
COMPONENT
OF HBCSAGAM COMM
HOSPITAL
CLINICAL
SERVICES
MICRO-
FIANANCE
YOUTH
FRIENDLY
SERVICES
INT’L
STUDENTS/
VOLUNTEERS

30. The allocation of health budget-Kenya
 Reproductive health services cover a meager
0.6% of the health budget.
 Households are the greatest source of
expenditure on health they spend from their
pockets.
 The households expenditure on RH is
minimal

31. Transportation of a patient with impending uterine
rupture and choriamnionitis worse for abortion
patients.