Family planning programs in Kenya have made enormous progress over the past decade, but this success is now being threatened by cuts in U.S. funding to Kenya and by further cuts projected through the year 2000.

Cuts in anticipated funding of up to 25 percent this year--and projected cuts of up to as much as 70 percent within the next four years--are expected to drastically curtail the expansion of training and services in Kenya planned by AVSC and other USAID- supported organizations.

For example, AVSC cancelled its plan to help establish 40 new sites that provide access to quality family planning and reproductive health services through the government and missionary hospital network and through private organizations and small health centers in areas where there are no other nearby medical facilities.

"It will be a struggle just to maintain the 100 existing sites," said Joseph Dwyer, director of AVSC's regional office for east and southern Africa.

The cutbacks are expected to have far-reaching effects throughout Kenya. Though contraceptive prevalence has risen dramatically (from 17 percent in 1984 to 33 percent in 1993), past high fertility rates have left Kenya with more than 48 percent of its population under the age of 15. As these young people enter their reproductive years, the number of clients served will actually have to increase--with less funding--merely to maintain the current 33 percent contraceptive prevalence rate.

AVSC-Supported Programs

Over the past decade, AVSC-supported programs in Kenya have been extremely successful, helping more than 100 service-delivery sites offer a range of effective contraceptive services and helping local institutions install highly effective quality management systems.

During this time, more than 600 surgical teams and more than 1,000 counselors have received training through AVSC-supported programs.

After a decade of work to help gain acceptability for family planning services in Kenya, AVSC has shifted its focus in the 1990s to expanding services, improving quality of care, and building sustainable support systems. A milestone in the history of family planning in Kenya was reached with the government's development of a five-year National Implementation Plan for family planning programs in 1995. The goal, with AVSC's assistance, is to build capacity and sustainability, with quality of services as the cornerstone of the plan.

Consequences of Cuts

However, time may be running out for many AVSC-supported service sites in Kenya. The cutbacks may put an end to expansion plans and leave AVSC struggling to preserve the ground it has worked so hard to gain.

If AVSC must curtail its support to Kenya by 35 percent or more, past investments will be eroded, training of additional surgical teams and counselors may be suspended, improvements and extensions of management and supervisory capacity will be stalled, and plans for new service-delivery sites have already been cancelled.

The cutback in family planning and reproductive health services will reverberate throughout the institutions where AVSC supports services. AVSC-supported counseling programs, clinic management techniques, and infection prevention programs reach out beyond the family planning clinics to involve hospital medical and nonmedical staff in all departments.

Time Needed

Kenya's family planning and reproductive health programs are still in a fragile stage of development, and important building blocks are still being put into place.

More time is needed to expand and improve services and to build sustainable support systems that local providers and national family planning and reproductive health care programs can take ownership of.

Funding for AVSC's work in Kenya is provided by the U.S. Agency for International Development.

Beth Farryn Levine is the assistant director of development for AVSC International.