Report by CHASE Africa to PopOffsets
Grant for 6 one day clinics from September to November 2015
Dandelion Africa has a well-established procedure for operating one day clinics. Key to success is effective mobilisation before the clinic happens. Many people in rural areas have a negative attitude to family planning and it is essential that Community mobilisers spend enough time in the community trying to dispel the many misconceptions and highlighting all the benefits family planning can bring. The clinic is further publicised with posters displayed around the community and with announcements on the local radio station.
Six one day Clinics were held in the following communities:
Athinai 26th Sept, Lomolo A 16thOct , Oterit 23rd Oct, Lomolo B 5th Nov, MajaniMingi 12th Nov and Alfega on the 26th Nov.
Steve Bown a board member of Population Matters visited Dandelion twice in 2015 seeing a clinic in operation in February in Lomolo B and one in Gaakwen in September. His report on Dandelions activities was very informative and encouraging.
The staff on a one day clinic comprises two doctors, up to three nurses, two mobilisers, and two of Dandelion Africa’s staff to organise the day. Each of the nurses or doctor work from a small pop-up tent to provide privacy for the patient. A range of different services are offered including basic healthcare, family planning counselling, family planning treatment, anti-natal care, HIV/AIDS counselling and testing, cervical screening, immunisation, deworming and a small pharmacy. If any of the patients present with a case that is too serious to be dealt with they referred to the nearest hospital.
The table below gives the results of the family planning element of the six clinics;
|Type of family planning||Quantity||Couple Year Protection|
|5 year implant, first time||185||703|
|5 year implant, repeat||60||228|
|3 year implant,first time||566||1415|
|3 year implant, repeat||114||285|
|Depo-provera, first time||355||88|
|CYP without condoms||2763|
|Total Couple Year Protection||2869|
In our original application we stated that we hoped to achieve a CYP of 2910 without including condoms. If condoms are included this figure was nearly reached but we feel the CYP figure of 2763 still represents very good value for money.
Other clinical results
The most common symptoms which presented were chest infections, indigestion, diarrhoea and backache. Women have to carry heavy loads of water and firewood and backache is a common ailment.
Worms in children are a big problem and to encourage lots of children to attend the clinic hires 2 professional artists/peer educators for the day. They keep the children laughing and running around while their parents attend the clinic. But they also talk to them about other issues such as hygiene, discipline and abstinence.
|Patients receiving primary health care||2911|
|Number of people testing positive for HIV||17|
The actual spend was slightly higher than was anticipated and this was covered by an under spend from another Dandelion project supported by CHASE.
|Details for 6 one day clinics||Budget for 6 day clinics. £||Actual for 6 day clinics. £|
|Medical supplies (FP commodities provided free by MoH)||699||589
|Outreach, mobilisation and training||279||667|
|Salaries and other allowances for 5/6 free clinic days||1,157||1366|
|Materials and publications||471||379|
|Logistics, implementation, transport, communications, monitoring||2,471||2376|
|UK contribution to management @ 8%||406||406|
Monitoring and Evaluation
Data collection is an important and routine part of every clinic. The data helps Dandelion to understand the needs of the community and plan accordingly. It also helps Dandelion to understand what to focus on in the area e.g. behaviour change and communication based on the number of people who test positive for HIV, or addressing stigma and discrimination depending on the number of people who agree to be tested for HIV.
The data collected is passed on to the Ministry of Health to be included in the compilation of national records.
Across Kenya, especially in urban areas, the acceptance of family planning is rising but there are still many barriers to uptake in rural areas. Women are often reluctant to discuss what their husbands think about family planning but in the privacy of the tents the nurses will often get the their patients to talk about the issues they face at home.
Challenges and lessons learned
Dandelion operates in remote rural areas where conflict between communities is quite common leading to security problems. They try and mitigate this by involving the local authorities and getting support from community leaders. Access to these rural areas can also be difficult as the roads are not metalled. In wet weather, what was a relatively easy trip in dry weather, can become very time consuming and sometimes not possible.
In rural areas family planning still has many obstacles to overcome. Many people still see Children as a sign of wealth hence the reason many women have around 8 children. Dandelion places great emphasis on engaging with men to discuss the issues surrounding sexual reproductive health. It is still a widely held belief that modern methods of family planning can make you infertile. They try to convince men that by having fewer Children women have more time for productive work. This will mean the whole family will be better off and the children have a much better chance of finishing school. It is estimated that a girl who finishes secondary school will have around half the number of children compared to a girl who does not attend secondary school.
The one day clinics carried out by Dandelion with the generous support of PopOffsets are changing the lives of many families, giving them a chance to escape poverty.