1. Translating Research to Practice: Community Based Distribution (CBD) of DepoProvera (DMPA) in Kenya Alice Olawo 1, Jane Gitonga 2, Elizabeth Washika 3 1.Family Health International, Kenya 2.USAID/APHIA II Eastern 3.Division of Reproductive Health, MOPH&S International Conference on Family Planning: Research and Best Practises Wednesday, November 18, 2009

2. Background on FP in Kenya CPR increasing after a period of stagnation (39% for over 10 years but is now 46%) High unmet need (25%) among currently married women in Kenya Depo is most preferred method (45% of modern method users) Renewed MOH focus towards provision of services beginning with the community level

3. Community-based distribution of DMPA It is the provision of DMPA by competent and appropriately trained community-based health workers Research shows it is safe, feasible and acceptable, and is recommended by global technical experts. CBD of DMPA in Kenya is a research utilization introduction project and is part of a larger effort to address issues of family planning access and health worker shortages in Africa It aims to support the Kenya Ministry of Public Health and Sanitation (MOPHS) in its efforts to increase access to contraceptive services

4. CBD of DMPA introduction has taken time and is challenging MOH Steering Committee Strategy Development ID of potential implementing partner Advocacy meetings (Provincial and District) Site ID for pilot study Consensus Building 2006 2007 2008 Implementation plan, MOU with Jhpiego Multi-sectoral advisory committee Educational tour to Uganda 2009 Materials development CBD Training Service provision

5. Consensus building process Began by meeting with head of the Department of Reproductive Health (DRH), followed by DRH program managers MOH steering committee led by DRH was formed, to guide related activities Development of a strategy to introduce injectables Development of an advocacy kit Consultations with Professional medical associations (National Nurses Association of Kenya, KOGS etc.) Meetings with MOH provincial level and district level officials

6. Addressing stakeholder concerns South to south knowledge sharing: Educational tour to Uganda to see CBD of DMPA in action addressed professional medical associations’ concerns about safety and infection prevention Broader group of stakeholders’ meeting was held to consult key players Stakeholder meeting advised formation of multi-sectoral advisory committee guide the program in Kenya

7. Implementation Development of training materials (January to August 2009) Identification of CBD agents in consultation with the community 7 days classroom training of 31 CBD agents, followed by 6 days clinical practicum (August 2009) Provision of services at the community (August 2009) Monitoring and evaluation visits (Monthly visits since August 2009) Since August 2009, over 300 women have received DMPA injections.

8. Lessons Learned It takes time to introduce a new concept that involves change in practice There is need to contextualize evidence to facilitate buy-in MOH leadership and authority is critical in obtaining support for the project at all level It is essential that partners work together hence synchronized work plans for effectiveness Kenya is successfully piloting an evidence-based strategy for addressing issues of contraceptive access. Additional research questions will be generated, along with lessons learned, which can be applied to future in-country scale up.

9. Acknowledgements Ministry of Public Health and Sanitation, Division of Reproductive Health Jhpiego USAID APHIA II Eastern