Fostering Change in Medical Settings: A Holistic Programming Approach to “Revitalizing” IUD Use in Kenya

Abstract

This paper discusses strategies to accelerate the rate, extent, and sustainability of change in medical care settings, using as a case example a 2-year technical assistance project mounted by EngenderHealth to “revitalize” use of the IUD in Kisii District of Kenya’s Nyanza Province. This project followed a holistic programming model, which holds that a coordinated package of programmatic activities among the supply, demand, and policy/advocacy program areas can be not only efficacious, but mutually reinforcing. Attention was also paid to four important crosscutting elements in reproductive health programming: the fundamentals of care (safety, quality, and choice); use of local data for decision making; gender equity; and stakeholder participation. IUD use rose with each program intervention, e.g., training, community and male engagement, and district-wide multimedia demand creation campaigns. At project close in 2007, 142 IUDs were being inserted monthly at the 13 project sites, up from a baseline average of 28 insertions monthly, an increase of 507 %. Despite district restructuring and transfer of skilled staff, increased annual levels of IUD provision (over 300 %) were sustained for 30 months after project close. Other positive changes generated district-wide included: improvements in the supervision system; implementation of a CBD program, with increased linkages between the community and project sites; increased male engagement in FP; 33 % more new clients for all FP methods at project sites; and greater use of other RH services.