Top

BMC Health Services Research

Published in:

Open Access 01-12-2021 | Research article

Reducing unmet need for contraceptive services among youth in Homabay and Narok counties, Kenya: the role of community health volunteers – a qualitative study

Authors: Hermen Ormel, George Oele, Maryse Kok, Happiness Oruko, Beatrice Oluoch, Eefje Smet, Dorcus Indalo

Published in: BMC Health Services Research | Issue 1/2021

Abstract

Background

Access to contraceptive services is a cornerstone of human well-being. While Community Health Volunteers (CHVs) promote family planning in Kenya, the unmet need for contraceptives among youth remains high. CHVs seem to pay little specific attention to the contraceptive needs of the youth.

Methods

We conducted a qualitative study exploring the role of CHVs in increasing access and uptake of contraceptive services among youth aged 18–24 years in Narok and Homabay Counties, Kenya. We undertook 37 interviews and 15 focus group discussions involving CHVs, youth, community members, community leaders, youth leaders and health programme managers. Data were recorded, transcribed, translated, coded and thematically analysed, according to a framework that included community, CHV and health system-related factors.

Results

CHVs often operated in traditional contexts that challenge contraceptive use among unmarried female and male youth and young married couples. Yet many CHVs seemed to have overcome this potential ‘barrier’ as well as reigning misconceptions about contraceptives. While private and facility-based public contraceptive services were somehow available, CHVs were the preferred service provider for many youth due to ease of access and saving time and transport costs. This was influenced by varied perceptions among youth of CHVs’ knowledge, skills and attitudes regarding contraceptives and provider-client interaction, and specifically their commitment to maintain confidentiality.

Conclusions

CHVs have the potential to increase access to contraceptives for young people, reducing unmet need for contraceptives. Their knowledge, skills and attitudes need strengthening through training and supervision, while incentives to motivate them and broadening the range of contraceptives they are allowed to offer should be considered.

Available only for authorised users

United Nations. Transforming our world: the 2030 agenda for sustainable development. A/RES/70/1. 2015.

Peterson HB, Darmstadt GL, Bongaarts J. Meeting the unmet need for family planning: now is the time. Lancet. 2013;381(9879):1696–9. https://doi.org/10.1016/S0140-6736(13)60999-X.CrossRefPubMed

World Health Organization. Consolidated guideline on sexual and reproductive health and rights of women living with HIV. Geneva: World Health Organization; 2017.

National Bureau of Statistics Ministry of Health National AIDS Control Council Kenya Medical Research Institute National Council for Population and Development The DHS Program/ICF International. Kenya Demographic and Health Survey 2014. Nairobi: Kenya National Bureau of Statistics; 2015.

Njoroge KM, Olsson P, Pertet AM, Ahlberg BM. Voices unheard: youth and sexuality in the wake of HIV prevention in Kenya. Sexual Reprod Healthcare. 2010;1(4):143–8. https://doi.org/10.1016/j.srhc.2010.07.006.CrossRef

Godia PM, Olenja JM, Hofman JJ, Van Den Broek N. Young people’s perception of sexual and reproductive health services in Kenya. BMC Health Serv Res. 2014;14(1):1–13.CrossRef

Wegs C, Creanga AA, Galavotti C, Wamalwa E. Community dialogue to shift social norms and enable family planning: an evaluation of the family planning results initiative in Kenya. PLoS One. 2016;11(4):e0153907. https://doi.org/10.1371/journal.pone.0153907.CrossRefPubMedPubMedCentral

Wanyonyi HS. Youth sexual behaviour and sex education. Int J Educ Res. 2014;2(3):1–14.CrossRef

Government of Kenya. Family Planning 2020 Commitment. 2017.

10.

Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, Van Wyk BE, et al. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database Syst Rev. 2010(3):CD004015.

11.

Kok MC, Dieleman M, Taegtmeyer M, Broerse JE, Kane SS, Ormel H, et al. Which intervention design factors influence performance of community health workers in low-and middle-income countries? A systematic review. Health Policy Plan. 2015a;30(9):1207–27. https://doi.org/10.1093/heapol/czu126.CrossRefPubMed

12.

Ministry of Health. Strategy for Community Health 2014–2019. Transforming health: Accelerating the attainment of health goals. Nairobi: Minsitry of Health Kenya; 2013a.

13.

Ministry of Health. Reversing the trends. The Second National Health Sector Strategic Plan of Kenya. Taking the Kenya Essential Package for Health to the Community. A Strategy for the Delivery of Level One Services. Nairobi: Ministry of Health Kenya; 2006.

14.

Ministry of Health. Strategic Plan of Kenya Community Strategy. Implementation Guidelines for Managers of the Kenya Essential Package for Health at the Community Level. Nairobi: Ministry of Health Kenya; 2007.

15.

World Health Organization. WHO recommendations. Optimizing health worker roles to improve access to key maternal and newborn health interventions through task shifting. Geneva: WHO; 2012.

16.

IPPF UNFPA USAID WHO. High impact practices in family planning (HIP). Common Vision 2015.

17.

Ministry of Health. Community Health Volunteers (CHVs) Integrated Curriculum. Nairobi: Ministry of Health Kenya; 2013b.

18.

Ministry of Health. Task Sharing Policy Guidelines 2017-2030. Nairobi: Ministry of Health Kenya; 2017.

19.

Mack N. Qualitative research methods: a data collector’s field guide. Research Triangle Park: North Carolina; 2005.

20.

Ritchie JSL, O’Connor W. Carrying out qualitative analysis. In: Ritchie J, Lewis J, editors. Qualitative research practice: A guide for social science students and researchers. London: Sage; 2003. p. 219–61.

21.

Charmaz K. Constructing grounded theory. Los Angeles: Sage; 2014.

22.

Scott VK, Gottschalk LB, Wright KQ, Twose C, Bohren MA, Schmitt ME, et al. Community health workers’ provision of family planning Services in low-and Middle-Income Countries: a systematic review of effectiveness. Stud Fam Plan. 2015;46(3):241–61. https://doi.org/10.1111/j.1728-4465.2015.00028.x.CrossRef

23.

Sedlander E, Bingenheimer JB, Thiongo M, Gichangi P, Rimal RN, Edberg M, et al. “They destroy the reproductive system”: exploring the belief that modern contraceptive use causes infertility. Stud Fam Plan. 2018;49(4):345–65. https://doi.org/10.1111/sifp.12076.CrossRef

24.

Wambui T, Ek AC, Alehagen S. Perceptions of family planning among low-income men in Western Kenya. Int Nurs Rev. 2009;56(3):340–5. https://doi.org/10.1111/j.1466-7657.2009.00726.x.CrossRefPubMed

25.

Tavrow P, Karei EM, Obbuyi A, Omollo V. Community norms about youth condom use in Western Kenya: is transition occurring? Afr J Reprod Health. 2012;16(2):241–52.PubMed

26.

Global Health Workforce Alliance. Global experience of community health Workers for Delivery of health-related Millenium development goals: a systematic review, country case studies, and recommendations for integration into National Health Systems. Geneva: GHWA; 2010.

27.

Kane S, Kok M, Ormel H, Otiso L, Sidat M, Namakhoma I, et al. Limits and opportunities to community health worker empowerment: a multi-country comparative study. Soc Sci Med. 2016;164:27–34. https://doi.org/10.1016/j.socscimed.2016.07.019.CrossRefPubMed

28.

Kok M, Tolani M, Mtonga W, Salamba T, Mwabungulu T, Munthali A, et al. Enabling and hindering factors of health surveillance assistants’ roles in the provision of contraceptive services in Mangochi, Malawi. Reproductive Health. 2020;17:1–13.CrossRef

29.

Michaels-Igbokwe C, Terris-Prestholt F, Lagarde M, Chipeta E, Initiative I, Cairns J. Young people’s preferences for family planning service providers in rural Malawi: a discrete choice experiment. PLoS One. 2015;10(12):e0143287. https://doi.org/10.1371/journal.pone.0143287.CrossRefPubMedPubMedCentral

30.

Juma PA, Mutombo N, Mukiira C. Women’s attitudes towards receiving family planning services from community health workers in rural Western Kenya. Afr Health Sci. 2015;15(1):161–70. https://doi.org/10.4314/ahs.v15i1.22.CrossRefPubMedPubMedCentral

31.

Glenton C, Colvin CJ, Carlsen B, Swartz A, Lewin S, Noyes J, et al. Barriers and facilitators to the implementation of lay health worker programmes to improve access to maternal and child health: a qualitative evidence synthesis. Cochrane Database Syst Rev. 2013;10. https://doi.org/10.1002/14651858.CD010414.

32.

Swiss TPH. Adolescent and youth sexual and reproductive health survey: survey report 2014, Burundi. Basel: Swiss TPH; 2014.

33.

Martinez R, Vivancos R, Visschers B, Namatovu L, Nyangoma E, Walley J. Training needs, practices and barriers in the work of community reproductive health workers in Masindi district, Uganda. Tropical Doctor. 2008;38(2):93–5. https://doi.org/10.1258/td.2007.070116.CrossRefPubMed

34.

Kok MC, Kane SS, Tulloch O, Ormel H, Theobald S, Dieleman M, et al. How does context influence performance of community health workers in low-and middle-income countries? Evidence from the literature. Health Res Policy Syst. 2015b;13(1):13. https://doi.org/10.1186/s12961-015-0001-3.CrossRefPubMedPubMedCentral

35.

World Health Organization. WHO guideline on health policy and system support to optimize community health worker programmes. Geneva: World Health Organization; 2018.

36.

Dusabe J, Mchome Z, Nnko S, Changalucha J, Obasi A. “There are bugs in condoms”: Tanzanian close-to-community providers' ability to offer effective adolescent reproductive health services. J Fam Plan Reprod Health Care. 2015;41(1):e2-e.CrossRef

37.

Appleford G. Community health workers–motivation and incentives. Dev Pract. 2013;23(2):196–204. https://doi.org/10.1080/09614524.2013.772117.CrossRef

38.

Takasugi T, Lee A. Why do community health workers volunteer? A qualitative study in Kenya. Public Health. 2012;126(10):839–45. https://doi.org/10.1016/j.puhe.2012.06.005.CrossRefPubMed

39.

Greenspan JA, McMahon SA, Chebet JJ, Mpunga M, Urassa DP, Winch PJ. Sources of community health worker motivation: a qualitative study in Morogoro region, Tanzania. Hum Resour Health. 2013;11(1):52. https://doi.org/10.1186/1478-4491-11-52.CrossRefPubMedPubMedCentral

40.

McCollum R, Otiso L, Mireku M, Theobald S, de Koning K, Hussein S, et al. Exploring perceptions of community health policy in Kenya and identifying implications for policy change. Health Policy Plan. 2016;31(1):10–20. https://doi.org/10.1093/heapol/czv007.CrossRefPubMed

41.

Ormel H, Kok M, Kane S, Ahmed R, Chikaphupha K, Rashid SF, et al. Salaried and voluntary community health workers: exploring how incentives and expectation gaps influence motivation. Hum Resour Health. 2019;17(1):59. https://doi.org/10.1186/s12960-019-0387-z.CrossRefPubMedPubMedCentral

Title: Reducing unmet need for contraceptive services among youth in Homabay and Narok counties, Kenya: the role of community health volunteers – a qualitative study
Authors: Hermen Ormel
George Oele
Maryse Kok
Happiness Oruko
Beatrice Oluoch
Eefje Smet
Dorcus Indalo
Publication date: 01-12-2021
Publisher: BioMed Central
Published in: BMC Health Services Research / Issue 1/2021
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-021-06363-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Reducing unmet need for contraceptive services among youth in Homabay and Narok counties, Kenya: the role of community health volunteers – a qualitative study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Incremental burden of comorbid major depressive disorder in patients with type 2 diabetes or cardiovascular disease: a retrospective claims analysis

Association between Medicare’s Hospital Readmission Reduction Program and readmission rates across hospitals by medicare bed share

Experiences of psychiatrists and support staff providing telemental health services to Indigenous peoples of Northern Quebec

Provision of dental services for vulnerable groups: a scoping review on children with special health care needs

Meta-ethnography in healthcare research: a guide to using a meta-ethnographic approach for literature synthesis

Proactive integrated virtual healthcare resource use in primary care