Kenya faces a reproductive health care crisis caused by two converging trends-increased demands for care due to a young population, and the HIV epidemic. And after decades of improvement, child mortality rates are worsening. Fundamental changes in how Kenyans receive health care are needed.
EngenderHealth’s work in Kenya dates to 1982 and has expanded through the years in response to evolving needs. Initially, our family planning programs focused on training doctors in safer, more client-centered surgical sterilization and counseling styles. Today, EngenderHealth’s breadth of work includes maternal health care, HIV prevention, child survival initiatives, and more.
Reducing HIV Infections Through Male Circumcision
Research has suggested that male circumcision reduces the risk of female to male HIV transmission by more than 50%, In response to this situation, EngenderHealth is working to improve the quality of and access to male circumcision services in Kenya through the Male Circumcision Consortium. Launched by EngenderHealth, Family Health International, and the University of Illinois at Chicago in November 2008, the Consortium works to expand voluntary medical circumcision services in Kenya as part of an overall strategy to reduce HIV infections in men.
In 2009, EngenderHealth, working with Weill Cornell Medical Center and the Kenyan Ministry of Health, completed a pilot study of the Shang Ring, a device for male circumcision that dramatically reduces the time it takes to perform the procedure. This efficient and simple tool stands to greatly increase the productivity of large-scale male circumcision efforts by:
- Reducing costs to the health system
- Improving safety
- Allowing for use by non-physicians
Through a grant to FHI from the Bill & Melinda Gates Foundation, EngenderHealth and Cornell are working with FHI to conduct additional studies to better understand how the Shang Ring might transform the provision of male circumcision services in Africa. The research consists of a safety study and a randomized controlled trial to compare the Shang Ring with conventional surgery.
Implementing Community-Based Postabortion Care
Abortion and abortion-related complications account for almost half of all gynecological admissions in Kenya, and are particularly problematic in the Rift Valley. The high number of people who want to practice family planning but lack access to contraception, stigma and lack of knowledge about bleeding during pregnancy, and lack of post-abortion care services are some of the factors that contribute to the acute situation in the Rift Valley.
The RESPOND Project at EngenderHealth supported the Ministry of Health in the Naivasha district of the Rift Valley province to implement a community strategy that enhances access to health care and establishes sustainable systems for service provision.
This model emphasizes community engagement to improve maternal health and also involved:
- Training health care professionals in comprehensive postabortion care
- Equipping health facilities
- Developing communication materials to educate communities about the availability of health services
Building on previous work conducted in Nakuru, Kenya (2005-2007) EngenderHealth and its partners sought to increase community knowledge about danger signs of abortion-related complications, locations of services, and family planning-related information, as well as encourage communities to take action for their health.
Long Acting and Permanent Methods of Contraception
The RESPOND Project supported the Kenyan Ministry of Health in implementing a national strategy to increase access to and use of long-acting and permanent methods of contraception (LA/PMs). This work included:
- Assessing and updating training materials
- Training trainers of health care providers
- Strengthening collaborative partnerships to increase use of LA/PMs
- Conducting national Facilitative Supervision training with an emphasis on FP and LA/PMs
- Advocating for contraceptive security for long-acting and permanent methods using Reality √: A Planning and Advocacy Tool for Family Planning Programming
Improving Comprehensive Health Care in Nyanza
Nyanza province has Kenya’s highest HIV and infant and child mortality rates-as well as the highest number of people who want to practice family planning but lack access to contraception. From 2006-2010, the APHIA II Nyanza Project, EngenderHealth and its partners:
- Expanded HIV, malaria, and tuberculosis services
- Increased access to family planning
- Improved reproductive health, maternal health, and child survival
Taking a holistic approach, EngenderHealth worked with the Kenyan government and local faith- and community-based groups to:
- Enhance the quality of health services
- Raise awareness of and promote healthier behaviors
- Reduce the stigma associated with HIV
- Improve home and community support for vulnerable children
In addition, encouraging and improving access to male circumcision was an important strategy for decreasing HIV in Nyanza. EngenderHealth worked to advance voluntary male circumcision in the region, and promote its integration with other health services, making it more accessible to local men.