MINIMUM PACKAGE FOR

REPRODUCTIVE HEALTH (RH)

& HIV SERVICES
 Definition

The minimum package is a set of

recommendations for integrated services that
are feasible for the integration of RH-HIV
services by level of care
 Objectives of the Minimum Package
• To operationalize (translate into action) the national
RH-HIV integration strategy
• To standardize the provision of RH-HIV integration
services
• To improve access to and uptake of key HIV and RH
services
• To give a baseline entry point to the provision of HIV
and RH services
• A guide on basic service provision requirements for
RH & HIV services
 Rationale for the Minimum Package

• Follow up to the National RH-HIV integration

strategy launched in 2010
• Several types of RH-HIV integration services were
suggested
• Operationalization of strategy requires lot of
resources
• A minimum set of RH-HIV integration services
required to “kick start” operationalization of the
strategy
The “Road Map”
Tertiary/Referr
al Hospital

Knowledge, Skills, practice, Equipment

Provincial/Secon
dary Hospital

District/Primary
Hospitals

increases with the level

Health Centres

Dispensaries

Community Level
 Types of RH-HIV Integration Services by
Level of Care
• Community level:
• HIV counselling and testing
• FP information& counselling
• STI information
• Information on Reproductive Tract cancers(cervix, prostate,
breast)
• Information on post rape care service
• Information on TB & MNH
 Facility Level
• MCH/FP Unit: FANC, PNC, FP
• OPD: FP, HTC, Cx cancer screening, prostrate and breast
cancer screening, PRC
• CCC Unit: FP, STI & Cacx screening, prostate and breast cancer
screening
• YFS: FP, HTC, STI, Ca Cx screening & PRC

Inpatient:
• Maternity & Post Natal Wards: HTC, FP (Post Natal Wards)
• Male & Female ward: HTC, PAC (Female Ward )
 What is Factored Under Each Type of
Integrated Services
• Minimum level of the integrated service
• Basic requirements for each of the type of integrated
service:
 Infrastructure
 Human resource
 Skills set & training materials
 Equipment
 Commodities & supplies
 M&E
 Cross Cutting Issues

• Administration Support

• Support Supervision

• Referral Mechanism
THANK YOU!
 THE REVISED BALANCED
COUNSELING STRATEGY PLUS
(BCS+) TOOLKIT
 Definition
• The Balanced Counseling Strategy Plus (BCS +) is a practical,
interactive, and client-friendly counseling approach that uses job
aids to facilitate family planning consultations
• Using BCS simplifies decision-making and responds to the client’s
needs and reproductive intentions
• The job aids used are: an algorithm, counseling cards and
contraceptive method brochures
• BCS Plus was adapted from the original BCS in order to make the
strategy appropriate for settings such as Southern, Central and
East Africa that have high HIV & STI prevalence
 Background and Rationale - 1
• Initially used in other countries e.g. Latin America in the 1990’s
• Findings from studies in Latin America between 1999 and 2001
showed that:
• Providers failed to discuss client’s wishes
 They failed to ask the client basic questions about the client’s
reproductive intentions - such as whether she wants more children, or
whether her partner cooperate in contraceptive use
• Providers often gave excessive information
 Providers gave excessive details on most of the methods available in the
clinics - whether or not the methods are suitable for the client’s needs.
This overloaded clients with more information than they could remember
or use
 Background and Rationale - 2
• Information provided on chosen method was sparse:
 Important information to clients such as when not to give, side
effects, etc for chosen method were often neglected
• As a result, clients interviewed after consultations knew little
about the method they had chosen
• Pre tested in Kenya and South Africa between 2005 and 2007
• Found to Improve the quality of the integrated family
planning (FP) and HIV services
 Objectives

• To improve the quality of consultations for clients

seeking FP and other RH services
• To equip the provider with critical counselling skills
• To facilitate the provision of evidence based
information/instructions with regards to standard
MNH and RH/HIV management protocols
• To serve as a reference materials for both health
providers and clients
 Composition of BCS+ Tool Kit

The toolkit includes the following:

1) BCS Trainer’s Guide for use in training health care providers
2) BCS User’s Guide on how to implement the Balanced
Counseling Strategy
3) BCS job aids that comprise:
 The BCS algorithm
 Counseling cards
 Method brochures
4) Balanced Counseling Strategy CD-ROM
 Structure of Counseling Process

• BCS + 2007 Algorithm or checklist had three stages:

 Pre-Choice: to help clients select an FP method;
 Method Choice: information regarding the clients method
choice is offered and;
 Post-Choice the client is given information about the
chosen method including HCT and STI screening and
management
 What is New in the BCS Plus 2011?-1

• The second edition BCS + toolkit address additional

areas and updated the FP counseling cards
• Rationale - to respond to the revised MEC 2010 and
the MOH expanded package of care for integrated FP
and HIV services namely:
 Postnatal care, HIV C&T, HIV services, STI syndromic
management, screening for cervical cancer
 What is New in the BCS Plus 2011?-2

The Algorithm or checklist has four stages:

1. Pre-Choice; to help clients select an FP method,
2. Method Choice;-information regarding the clients
method choice is offered;
3. Post-Choice the client is given information about the
chosen method
4. Systematic screening for any other client’s RH/HIV need
– PNC, HIV CT, STI, HIV care, Cervical cancer screening
 Target Audience
• FP and HIV programs, trainers
• PMHT and DHMTs
• FP and HIV service providers
• Training institutions – pre-service and in-service
• FP clients and their partners (brochures)
THANK YOU!
National Guidelines for
Quality Obstetrics and
Perinatal Care
 Introduction

• The development of this reference manual is in

response to the need for emerging, updated evidence
based interventions that have proved successful when
applied throughout the continuum of care of the
woman’s pre conception, pregnancy, childbirth and
the postpartum periods
 Introduction .. Cont’d.
• Both the obstetrical and medical conditions and the
complications that would affect a woman during this
period have extensively been described along with
the management of the same
• This manual also describes the evidence based
management of neonatal conditions and will be
useful to students as well as health care workers at
all levels of service delivery
 Objectives
• To standardise Maternal and Newborn Health (MNH)
clinical practice in the country hence facilitating MNH
program implementation as well as monitoring and
evaluation
• To provide evidence based information/instructions
with regards to standard MNH management
protocols
• To serve as a reference manual for health
practitioners both pre and in-service on accepted
MNH practice in Kenya
 Target Audience

• These guidelines are recommended for:

 Reproductive Health (RH) training institutions
 All levels of RH service delivery
 All cadres of RH service providers including health
administrative staff and other support personnel
 Content

• Two main sections:

 Section 1: Maternal Health
 Section 2: Newborn Health
 Maternal Health - Content - 1
• Overview of MNH services in Kenya
• Functional Anatomy and Physiology
• Pre-conception Care
• Maternal Nutrition
• Focused Antenatal Care
• Complications/conditions during the Antenatal
Period
• Interpersonal Communication and Counselling
 Maternal Health Content - 2

• Management of Labour and delivery

• Complications of Labour and Delivery
• Targeted Postnatal care
• Complications and Danger signs in the Puerperium
• Community Maternal and Newborn Health
• Maternal and Perinatal Death Surveillance and
Response
 Maternal Health Content - 3
• Infection Prevention in MNH
• Research in MNH
• Monitoring, Evaluation and Supervision
• Kenya MNH Essential Drug list
• Millennium Development goals and targets
• Several job aides e.g. Magnesium Sulphate
Monitoring sheet
• Minimum Package of MNH services by different
levels
 Newborn Health Content

• Care of the Normal Neonate

• Breastfeeding
• Neonatal Resuscitation
• Management of High Risk Neonate
• Neonatal emergencies and their management
 New and Emerging Issues
• These include but not limited to:
 Overview of health system in Kenya
 Maternal Nutrition along the continuum of pregnancy
 Overview of different Uterotonics and their use
 New and emerging issues in management of malaria in
pregnancy, PMTCT
 Targetted postpartum care
 Post partum Family Planning
 Comprehensive guidance on essential newborn Care
 New and emerging issues in newborn Care
 How to use the Guidelines
• It is important to screen the entire document topic by
topic and ask yourself whether this is what you have
been practicing. In so doing you will standardise your
practice with the guide
• You might find some of the management techniques
new. This will give you an opportunity to update yourself
or to seek appropriate support
• You can judge when the guide is most useful to you
depending on the facilities available at your station and
your competency to manage the conditions you may
encounter
 Conclusions
• It is recommended that this document is reviewed
every 3 years so as to keep up with the rapidly
growing evidence base and best practice in MNH

• This document should not stand alone. It does not

have ALL the information available. Neither does it
cover ALL possible management approaches. It
should therefore be used alongside other reference
materials and job aids
THANK YOU!
 Emergency Obstetric and
Newborn Care Standardised
Training Curriculum
 Introduction
• It was realized the existence of several and different
curriculum, approaches and variations of techniques used to
teach service providers by different organizations, schools and
agencies
• This results in confusion of the health workers, affecting
Maternal and Newborn Health (MNH) service implementation
•
• It was proposed to standardize the Emergency Obstetrics and
Newborn Care (EmONC) training package, to include critical
competencies that address the major causes of maternal and
newborn morbidity and mortality
 Goal

• To standardize EmONC training for Critical frontline

Health workers (nurses, Clinical officers and medical
officers) in Kenya to acquire the necessary
competencies for delivery of Emergency Obstetric
and Newborn care that addresses the major causes
of maternal and neonatal morbidity and mortality
 Objectives

• Objective: Standardize training of basic

competencies necessary for addressing the major
causes of maternal and neonatal morbidity and
mortality
• Expected Outcome: Competencies of critical front
line health workers to manage major causes of
maternal and newborn mortality enhanced
 Target Audience

• All stakeholders conducting EmONC training

 Pre service and in-service training
 Private, government training institutions
 Format

• Modular format
 user friendly

 Allows for shorter training periods

 Targets specific interventions

• Five day training an ideal course for resource

constrained settings with limited health workforce,
which are struggling to achieve the MDGs 4 & 5
 Content
• The manual has 5 modules namely:
 Antenatal care
 Emergencies in Labour & Delivery
 Neonatal care
 Postnatal care and
 Post-abortal care
• A cross-cutting section on Communication, Triage
and Referral
• Includes charts, multimedia resources, equipment
lists, essential reading
 Structure of Modules
• Each module aims to facilitate
 planning
 organization
 implementation of the training
• Each section comprises:
• the learning objectives and skills to be acquired
 job aids

 practical skills

 equipment list

 monitoring and evaluation

 New and Emerging Issues
• Competecy based training curriculum
• Short duration of training- 5 days
• Skills acquisition focus as opposed to lectures
• It embraces humanistic and clinical practice training
approaches
• Skills necessary to address the major causes of
maternal and newborn morbidity and mortality in
Kenya
• Includes the best in available job aids and
mnemonics
 Conclusions
• The curriculum has been developed through a
participatory interactive process involving multiple
Maternal and newborn health stakeholders led by
the MOH Division of Reproductive Health and
Division of Child and Adolescent Health
• It has been adopted by the Maternal and Newborn
Health Technical Working Group as the minimum
package for EmONC training by all stakeholders.
THANK YOU!
 Community Midwifery Services
in
Kenya Implementation Guidelines
 Introduction and Justification
• Maternal mortality ratio in Kenya has remained unacceptably high
(488/100,000 live births KDHS 08/09).
• More effort is needed to attain especially MDG 5 which targets reducing
MMR to 147/100,000 live birth by 2015.
• Women still experience poor accessibility to skilled attendance during
pregnancy (especially x 4visits), child birth (only 43.8% had access- KDHS
08/09) and during post natal period.
• Majority of women still deliver at home (56.2%), despite the emphasis for
facility based deliveries
• Hence the need for the guidelines to standardize the implementation of
community midwifery services as a strategy for improving skilled
attendance in the provision of M&NH care at the community level.
 Objectives
• To provide guidance on the availability and access to skilled
care at the community level during pregnancy, labour, child
birth and postnatal period including the provision of family
planning services
• To standardize the implementation of community midwifery
services as a strategy for improving skilled attendance in the
provision of M&NH at the community level
• To contribute to the reduction of maternal mortality ratio and
perinatal and neonatal mortality rates
 Target Audience
• Policy makers (including Councils and Boards)
• Programme managers (for MNH &FP, Child Health-
Community/IMCI, Nutrition, Community Health
Services)
• Training institutions for health professionals
• RH/Community Health services coordinators
• County/Sub-County health management teams
• Community Units/Community Health committees
 Structure/Key Areas of Focus - 2
1) Introduction:
Background, the Policy Context, KEPH Tiers of Care and
Service Cohorts, Organization of Health Services,
Implementation Experience with the CM Model
2) Community Midwifery Model:
Definition, Selection Criteria, Roles and responsibilities of the
CM, Practice Setting, Scope of Practice and Training
3) Process of Implementing CM Services:
Preparation, rapid assessment, reaching consensus,
identification and selection of CMs, interventions, follow-up
and supervision, M&E and sustainability
 Structure/Key Areas of Focus - 3
4) Institutional Framework for the CM Model:
 Strategic/National level/policy & stewardship activities
 Management level (planning, training, M&E, supervision)
 Implementation level – Day-day mgt of Level1 activities
5) Quality Assurance (QA)
 Based on the performance & quality impr (PQI) framework
 QA will focus on FANC, lab/delivery, PPC, NBC, FP, Referral
 Supportive Environment (equip, supplies, IP, IEC materials)
6) Sustainability of Community Midwifery Model
 (Critical Sustainability Factors, Financing, entrepreneurship &
Replenishing Supplies)
THANK YOU!
NATIONAL FAMILY PLANNING COSTED
IMPLEMENTATION PLAN 2012 TO 2016
 Presentation Outline

1. Why Invest in FP in Kenya

2. Goal of the CIP on FP
3. Overview of the CIP
4. Target Audience
 Why Invest in Family Planning?

FP the “social vaccine”

• FP is to maternal health what immunization is to
child health:

"We wouldn't consider a child health program without

immunization. How can we think about women's health
without family planning?"

(Dr. Khama Rogo)

 Goal of CIP

By 2015, Increase Contraceptive Prevalence

Rate to 56%

All Methods
All Women of RH Age
 What is CIP on FP?
 Costed strategic actions that sets direction on what
needs to be implemented in order to maintain the
current contraceptive use of 46% as well as
accelerate it to 56% by 2015done hence achieving
the national targets

 Call for a Renewed Commitment, Partnership and

Coordination among all partners to reposition FP
 Purpose of the CIP on FP
1. Strengthen FP as a priority area in the National
Development Agenda
2. Understand the budgetary needs to implement a FP
program to reach projected targets
3. Mobilize and sustain quality resources
4. Prioritize FP program strategic actions for
implementation
5. Provide benchmarks and indicators to monitor and
support the FP program
 Thematic Areas of the CIP
• The CIP defines five key thematic groups; Human
Resources, Commodity Security, Youth, Demand
Creation and Integration and Cross-Cutting Issues
• Each of priority action has been costed with
interventions and activities for each of thematic area
• A total of approximately KShs. 26.6 billion is
calculated as the money that is required to enable
the FP program to attain the goal of reaching the CPR
of 56 % by 2015/2016
 Cost Estimates by Thematic area

Thematic Area Action Total

I. Human Resources 13,520,043,000
II. Commodity Security 5,576,845,000
III. Youth 5,773,737,000
IV. Demand Creation 1,520,401,000
V. Integration & Cross-cutting
240,050,000
Issues
Total (In KShs) 26,631,076,000
Greater percentage of Capacity building funding for the CIP would be from HIV/AIDs
through integration and leveraging on funds from County Stakeholders, Public
Private Partnerships (PPP) and NOT GoK funds only!
 Cost Estimates by Year
Year USD$
10,786,012,000 [KSHS]
FY 2012-2013 126,894,259
5,777,514,000[KSHS]
FY 2013-2014 67,970,753
4,952,008,000
FY 2014-2015 KSHS 58,258,918
5,115,542,000
FY 2015-2016 KSHS 60,182,847
The total amount needed to attain the goal of 56% CPR by 2015 is 26,631,076,000Kshs,
or about 26.6 Billion KShs.
 Target Audiences & Roles To Enhance
Utilization of CIP
• MOH – Coordinate, monitors and mobilize actions including
resources from Ministry of Finance and a wide range of
partners and stakeholders at all levels
• Implementing Partner - technical assistance, Provision of
resources (including leveraging from HIV programs) and
expertise in support of National FP program
• Private Sector – Implementation of the CIP in collaboration
with relevant stakeholders (MOH to strengthen public private
sector partnerships in implementation of CIP priority actions)
Thank You!