Strengthening Postnatal Care Services Including Postpartum Family Planning in Kenya

Key intervention activities focused on interpersonal communication as a strategy for helping reduce maternal and neonatal morbidity and mortality. This process included:

1. A series of meetings held with the MOH at central, provincial, and district levels to sensitise stakeholders to the project, and ensure their commitment and participation in the package design.
2. A draft package of training materials on PNC (including postpartum FP) was developed and then reviewed and revised by 8 provincial and district staff from the MOH and staff from ACCESS-FP and FRONTIERS. The package of materials included guidance on the technical content of each visit as well as a contraceptive technology update oriented towards the FP needs of postpartum women. The package was then pre-tested among 25 providers over a 3-day period, and assessed in terms of content, flow, duration, and relevance. It was modified accordingly.
3. Training service providers in the strengthened services. The content of each visit they were trained to carry out would be specific to the timing of the visit, such that it would be "focused" PNC that included such activities as: sexually transmitted infection (STI) screening; maternal health checks; counselling on self-care (breast care, clean perineum, maternal nutrition); vitamin A supplementation; newborn checks and counselling on basic newborn care (exclusive breastfeeding, clean cord care, warmth, infant feeding, hygiene, infant growth monitoring, and immunisation); danger signs for mother and newborn in the postnatal period; FP information and services or referral; HIV testing; nutritional and other supportive advice for HIV-positive women; antiretroviral therapy (ART) for HIV-positive women and babies; and follow-up consultations, if required. To learn how to carry out these activities, the trainees worked in groups, discussing various case studies and practising and demonstrating adequate skills in counselling for postpartum FP contraceptive methods in the classroom setting; this was enhanced by role playing and supported by printed job aids. All participants developed individual action plans detailing how they were going to implement the strengthened package in their health facilities. This included orienting their colleagues who were unable to attend the training.
4. Conducting supportive supervision visits (in January and May 2007). Trainers from the MOH and staff from ACCESS-FP and FRONTIERS observed practices, supported providers, collect service data to monitor implementation, and resolve gaps identified during the visit.

Child Health, Maternal Health, Family Planning.

Here are some figures, cited by organisers, which illustrate the motivation for the project described above:

• Over 60% of maternal deaths occur in the first 48 hours after childbirth (World Health Organization (WHO), 2005).
• For many women in eastern and southern Africa the postnatal period is a time of increased susceptibility to HIV and STIs (McIntyre, 2005; Dept of Health, South Africa, 2003).
• It has been estimated that if 90% of babies and mothers received routine PNC, 10% to 27% of newborn deaths could be averted (Warren, Daly, Touré, and Mongi, 2006).
• Couples should wait at least 2 years after the birth of their last infant before they try to conceive again to reduce risks of adverse maternal, perinatal, and infant outcomes (WHO, 2005). But in Kenya, 23% of births are at intervals of less than 24 months (Demographic and Health Survey (DHS), 2003). Many of these births are unintended: An analysis of the 2003 Kenya DHS found that 68% of postpartum women had an unmet need for FP during the first year (Borda 2006), with only 23% using a method.
• In Kenya, skilled health personnel assist 42% of births. Eighty-one percent of women delivering at home do not receive a postnatal check-up, and only 12% of those women who do receive PNC are seen within 6 days of the birth.
• In Kenya, the maternal mortality ratio is 414 per 100,000 live births, and the neonatal mortality rate is 33 per 1,000 live births; 77 infants out of 1,000 live births die before their first birthday.