Evelyn Makena @evemake_g

Four months ago, Fancy Mwanza’s typical work day entailed visiting households in her community in Kiambiu slums, which neighnours Kariobangi area in Nairobi, supporting expectant women, sensitising public on family planning services and monitoring progress of newborns.

But when Covid-19 pandemic broke out in Kenya in March, her work  was disrupted. As a Community Health Volunteer (CHV), Mwanza is at the frontline ensuring that primary health services are accessible to communities even in the most hard to reach places.

Access to family planning services was one of the sectors affected by the pandemic as people shied away from health facilities for fear of infection by the virus.

For Mwanza, who has been a CHV under the Nairobi County Government, the pandemic necessitated change of tact to ensure continuity of these crucial health services.

Despite movement restrictions and social distancing, Mwanza is still reaching households either physically or through the phone to ensure mothers are able to access family planning commodities and services.

“Though we have minimised home visits, we have been referring those in need of family planning services to health centres,” she says. 

Other times the government and development partners have arranged to bring services closer to the people through medical camps at the chief’s office, thus reducing the need to visit health facilities.

That also saves the community the hustle of visiting the nearest public health facility in Bahati about 2.5 Km from Kiambiu.

Neglected services

Amid the disruptions caused by Covid-19, it has been crucial for the government and other stakeholders to protect the gains made in increasing family planning uptake in the country.

Disruption in access of modern contraceptives has spillover effects that can be experienced in the long term, according to Dr Geofrey Okumu Strategy Lead, Options Kenya. 

“Reduction of family planning commodities uptake means there could be a spike of unintended pregnancies and that comes with complications of spacing children and with poor maternal health outcomes.

In the long-run lack of this service has both economic and health effects on communities ,” he says.

 Okumu, a public health specialist advocate for family planning, notes that the country has made significant gains in increasing coverage of family planning services.

Data from the Kenya Demographic and Health Survey 2014 shows that contraceptive prevalence rate was 58 per cent among married women and 65 per cent among sexually active unmarried women.

Contraception has numerous non-health benefits including women empowerment, sustainable population and economic growth for countries according to World Health Organisation.

Okumu notes that due to increased sensitisation on family planning benefits, more women are adopting long term methods of contraception such as implants and IntraUterine Device (IUD) that have lower rates of disruption. That has a spillover effect that can be experienced in the long term.

With the attention of health facilities and workers shifting to response of Covid-19, there were fears that family planning services would be neglected, losing on the gains made so far.

In many counties across the country community, health volunteers have stepped in to ensure continuity of services.

Ruth Rono, Community Health Services Coordinator, Elgeyo Marakwet has been leading a group of over 1,300 health volunteers  under the county government at the frontline of helping communities prevent disease.

Beside sensitising the community on hand washing, social distancing and other Covid-19 preventative measures, the volunteers are also ensuring that family planning commodities reach the people.

With a team of 50 trained community based distributors, they have been carrying out home to home sensitisation on family planning and referring those in need of the services to health facilities.

“The community distributors reach men and women of reproductive health to mobilise the community to access family planning services.

We do not encourage them to directly issue commodities, but they create awareness and refer clients to heath facilities,” she says.

Ruth says that the public has been cautious about visiting health facilities as many relate them with the Covid-19 virus.

Thus home visits have ensured that all people in need on contraception services can access easily and conveniently.

Collaborative efforts from development partners, private sector and the county government, Ruth says, have been crucial in ensuring continuity of health services. 

Covid-19 pandemic has come at a time when the country has been gaining momentum in efforts to prioritise the often-ignored family planning services. Okumu says family planning services had not received enough attention for few years after devolution. 

With devolution of health, there was confusion about which unit would take care of family planning services, therefore, it had ceased being a strategic function meaning that there was no funding allocation from the national treasury. Instead, counties had to take it up. 

Matching fund

“That brought about challenge of quality assurance, because counties were sourcing commodities in different places. Different counties had varied priorities and family planning did not rank highly,” says Okumu. 

Until 2018 when the family planning function was taken under the national government. Even then, counties are required to make financial allocations to support family planning services such as awareness creation.

Health financing has been key in ensuring continuity of services with both national government and county units increasing their commitment.

In line with commitments made during F20 London Summit on family planning in 2012, the government allocated Sh785 million for financial year 2019/2020 towards family planning and approved a budget of Sh863 million for 2020/2021.

It also made a commitment to increase this financial allocation. 

Counties are also stepping up in financing family planning services. For instance Kilifi county increased their family planning services allocation from Sh6.4 million in 2018/2019 to Sh25.2 million in 2019/2020 and Narok county also increased their allocation from Sh146 million in 2018/2019 to Sh235.7 in 2019/2020.

With donor funding decreasing due to the change of status to middle-income economy, the government has had to increase financial commitments towards family planning.

Through an MOU reached between the Kenya and donors including Bill and Melinda Gates Foundation, USAID and DFID, the government is increasing the funding gradually through a matching fund. 

“The idea is to match donor funding to what the government allocates based on a certain ratio.

The ratios will keep reducing for donors until a point where government achieves 100 per cent financing,” adds Okumu.

Apart from relying on community health volunteers, Okumu notes that Covid 19 disruption is an opportunity for health facilities to adopt telemedicine to bring services closer to the people. 

“This could be an opportunity to adopt telemedicine given that people still have fear to access health facilities.

It’s an opportunity for the county and national government to strengthen telemedicine to ensure that they can communicate with patients via phone and other technologies,” he says.