Task shifting: The Case of Implants in Kenya

1
Task shifting The Case of Implants in Kenya

• Janet Wasiche, Marsden Solomon, Maureen Kuyoh

ICFP, Kampala, Uganda November 15-18, 2009
2
Implant Provision The Kenya History

• Norplant (1989)
• Jadelle (2003)
• Implanon (2005)
• Sino Implant II (Zarin) (2008)

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• Why Implants?

• Increasingly popular among women
• Effectiveness comparable to surgical
  contraception
• High potential for task shifting to lower levels
  of care

If 20 of OC users switched to implants in
Africaover next 5 years would avert - 1.8
million unintended pregnancies - 576,000
abortions - 10,000 maternal deaths

(Source Hubacher et al, 2008)
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Rationale for Implant Task Shifting

• 50,000 Norplants about to expire in 2002
• Increasing demand for implants
• Only medical doctors allowed to insert and remove
  implants
• Acute shortage of medical doctors
• Ad hoc task shifting to respond to demand

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MOH Response

• Formation of a task force to strategize on way
  forward
• Repeal of policy that prevented other cadres
  (nurses and clinical officers) from providing
  implants
• Establishment of decentralized training centers
• Cascade training of nurses and clinical officers
  countrywide
• Commodity distribution to facilities
• Facilitative supervision and follow up strategy
• Intervention implemented in March June 2002

6
Immediate Outcomes

• 400 nurses clinical officers trained
• 40,000 Norplant inserted
• Looming expiry crisis averted

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Long-term Outcomes

• 1000 nurses clinical officers trained to date
• Facilities offering implants increased from 72 in
  1995 to 1200 in 2006 1300 in 2008
• 25,000 implants inserted in 2008
• MOH partners (USAID centrally funded
  bilateral projects) continue with training using
  cascade on-the-job training approaches

8
Challenges of Implant Provision

• Perennial implant stock outs
• Inadequate funding to procure commodities/supplie
  s
• Relatively high cost of Implants
• Long lead time to get stocks in country
• Distribution system not efficient
• Exact demand for implants not yet established
• Continuous training and update of providers on
  implants
• Inadequate provision of implants in the private
  sector

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Conclusions/Recommendation

• Task shifting increases access to FP uptake of
  services
• MOH commitment to task shift galvanization of
  stakeholder support enhances transfer of skills
• Cascade training, mentoring and supportive
  supervision critical elements
• Task shifting should go in tandem with commodity
  procurement to meet increased supply demand
• Expand availability of low cost Implants in
  public sector

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Asante sana