Community Health Workers Creating Family Planning Social Networks through Satisfied Clients

Author: Mercy Kamau Co-Authors: Malonza I , Keyonzo N, Nyachae P, Kilonzo M, Kabue M, Ouko V;

Outline
Tupange project Intervention objective & Assumption Background Rationale Methodology Data source Results Conclusion

Tupange Project
Intervention was implemented under the Kenya Urban Reproductive Health Initiative ProjectTupange-(Bill & Melinda Gates Foundation Funded)

Tupanges Goal To achieve a 20 percentage point increase in contraceptive prevalence rates in selected urban centers (Nairobi, Mombasa, Kisumu).

Tupange Project Sites

Urban Site (Municipality) Nairobi Mombasa Kisumu Population 3,133,518 938,131 409,928 Expansion Sites Machakos Kakamega 150,041 91,768

Source: 2009 Kenya population and Housing Census

Intervention Objective and Assumption

Objective To utilize satisfied clients to correct myths and misconception on FP. To recruit FP clients through a satisfied clients social network Assumption Women are comfortable discussing their FP needs with their friends and neighbors who are FP users. Use of FP satisfied clients can mobilize new FP clients.

Background
Studies have shown social networks are important in influencing RH behaviors. A clients perspective is not simply a matter of individual preference but is mediated through the social and cultural environment (AbouZahr et al. 1996). Clients believe that they can only get the truth about side effects from friends or relatives (Adongo et al 1996). Satisfied clients are more likely to re-visit clinical services and pass on positive messages by word of mouth to others (Rutenberg and Watkins, 1997)
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Rationale
Across Tupange projects sites, myths and misconceptions about FP were prevalent, thus influencing FP usage (KURHI HH survey 2010) The same baseline survey showed that 44 % of women heard about FP through friends and neighbors. In communities where we work , there exist social groups that influence decision making processes.

What are FP Social networks ?

In this context, FP Social networks are informal Interactions created by satisfied clients who use their personal experience to inform and discuss FP with their friends and neighbors. Satisfied client advocates the method to his/her friends and neighbors , then Snowballing effects takes place forming a very large network of FP satisfied users.
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Methodology
Intervention carried out at Kangemi Central CU with population of over 63,000 people and approximately 12,600 households who are served by only 10 CHWs. The population-to-CHW ratio was overwhelming for the CHWs and the site was a good place for implementing the satisfied clients social network.

The 10 CHWs were trained on FP to equip them with accurate FP knowledge and communication skills to enable them carry out community mobilisation.
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Methodology cont.
Potential clients were referred to the Health facility for the service.
CHWS conducted follow up visits to the clients. The satisfied clients were encouraged to discuss with at least ten of their friends and neighbours in the social network and refer them for FP services .

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Data Source
Project monitoring information was obtained during supervision visits. CHW referral slips (effective referrals) were received and counted monthly. Information on number of satisfied clients referred was obtained during CHW Monthly meetings.

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Results-Family Planning Social Network.

NEW USERS

CHW

SATISFIED CLIENT

INFORMATION AND REFERRAL

DISPELS MYTHS AND ENCOURAGES OTHERS TO USE METHOD

Comparison of FP Uptake
( April 2011-March 2012 & April 2012-March 2013 )
1600 1400
1375

1201

1200
984 869

1000

800

600

400
199 117

310 197 145 85 82

200

158

COC

POP

Injections April 2011 - March 2012

IUCD April 2012 - March 2013

Implants

Condoms

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Conclusions
Using satisfied clients is an effective way of improving access to FP as it uses already existing friendship networks. Using the approach is a no-cost way of creating demand for FP services and of counselling potential FP. The approach is sustainable as the effect can continue without further intervention by the project. The approach will be scaled up to other CUs to accelerate FP uptake.
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Thankyou

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