Mid-term evaluation of AMREF's MCH/FP/Nutrition Project (USAID OPG Family Planning Management and Research Project Grant No. 615-0216)

Abstract

Between 1970 and 1984, Kenya's rate of population growth increased from 3.5% to 4% a year; while the rate of increase of Kenya's gross domestic product fell from 6.6% to an annual rate of 3.1%. A pilot project is evaluated that was started by the African Medical and Research Foundation (AMREF) in 1983 to reduce the high rate of growth in a replicable program through which family planning (FP), and maternal and child health (MCH) and nutrition services provided to rural communities stressed child survival and increased use of contraceptives. Training materials were reviewed, community health workers (CHWs), traditional birth attendants (TBAs), shopkeepers, and MCH/FP/Nutrition Unit staff in Nairobi were interviewed. AMREF began field tests of the strategy in Kibwezi Division of Machakos District in 1984. CHWs, TBAs, shopkeepers, and facility-based health workers took courses in MCH, FP, and nutrition education. 30 TBAs were trained about the modern methods of FP. 40 CHWs took courses in Fp and were given condoms and foaming tablets to distribute free of charge to the communities they serve. CHWs distributed contraceptives to about 2520 people between March 1983 and August 1985. 640 people received contraceptives from 32 trained shopkeepers. Materials developed for training and teaching and recent research works were acquired from abroad. The project's objective of reducing the rate of population growth in Kenya is not achievable, but replicable methods of reducing the growth rate of population can be developed. The training of community-based health workers in the distribution of contraceptives, child survival services (oral rehydration solution and balanced diet) will probably improve the health of mothers and children in 3 years. The TBAs provide information about FP methods, but did not distribute contraceptives. Both the shopkeepers and the CHWs are distributing contraceptives on a voluntary basis. The project has established a MCH/FP/Nutrition Unit with a highly qualified staff capable of advising the Kenya Ministry of Health on the training of health workers in MCH, FP, and nutrition. The link between the community-based health workers, Kibwezi Health Centre and government health facilities in Kibwezi Division was strengthened. As of June 1985 the project had spent about 38% of its 3-year budget. The addition of the FP work substantially increased the workload of unpaid CHWs.