Date/Time: Friday, November 15, 2013 Session: Poster Session 5 Contraceptive Financing, Policy, Innovation in Service Delivery, Monitoring,

Evaluation and Research

Author(s): Mark Kabue, Jhpiego Kenneth Owino, Jhpiego Linda H Archer, Jhpiego Kenya Charles Waka, Jhpiego Charles Waka, Jhpiego Alan Johnston, Independent Nelson Keyonzo, Jhpiego

Title of Abstract: Data Use in Informing Project Strategies Example from the Initiation of the Tupange Project in Kenya Abstract Type: Topic: Program/Best Practices Abstract Innovations in family planning monitoring, evaluation and research

Significance/background
Having representative baseline data to inform the strategy and interventions at the outset of a five year project is rare. In the case of the Kenya Urban Reproductive Health Initiative (Tupange), a 5year project funded by the Bill and Melinda Gates Foundation, such data were available. The Measure Learning and Evaluation (MLE)/Tupange baseline surveys (household and health facility) were conducted during the first year and a half of the project (2010 to mid-2011) to provide an evidence-based baseline allowing the project decision-makers to review and refine the strategies before implementation commenced in July 2011. The aim of Tupange is to achieve a 20 percent point increase in the contraceptive prevalence rate (CPR) in three selected cities of Nairobi, Mombasa and Kisumu focusing on the urban poor by 2014. Some key assumptions were made at the beginning of the project in 2010 based on the information then available in designing the key strategies and interventions. Using the baseline survey data and other existing data sources, the project designers with its key stakeholders were able to design an evidence-based strategy of implementation.

Program intervention/activity tested

The MLE and Tupange carried out two surveys, two assessments and used routine project monitoring data to inform the formulation of appropriate interventions before implementation began. Five key areas where the Tupange project and stakeholder officers used the data for reviewing and refining its interventions are presented here: Use of integrated FP outreaches to increase access and uptake of FP; Use of pharmacies to increase access to FP services;

FP commodity security; Use of worksites for provision of FP services; and Use of private health facilities to increase access and uptake of FP.

Methodology
The MLE/ Tupange baseline household survey was done in 2010 and the MLE/Tupange health facility survey in 2011. Other baseline assessments included the Urban Reproductive Health Supply Chain survey and the Health facility readiness assessment both done in 2010. The evaluation approach was to analyze results of the surveys, assessment, and project monitoring data in light of the initial assumptions made at project start-up. Comparisons were made between the initial assumptions and the available evidence. Triangulation of data from the various sources was done do determine whether the initial assumption(s) should stand or alternative action would be taken.

Results/key findings
The decisions made by the project based on the data review resulted in both major changes and small refinements.For example, when considering outreaches, a refinement was made: results showed that although a majority of public health facilities operated outreach activities, FP services were offered only on request and almost exclusively only short-term FP methods were provided. The project strategy became to support FP services within existing outreach programs making FP, and long term methods, a focus in the promotion and provision of services. When reviewing the use of pharmacies, a major shift occurred: Pharmacies were to be used as entry points for short-term FP with clients later transitioning to long acting and permanent methods. However, a majority of the pharmacies in urban areas (especially near slum areas) were not properly registered and only 11%25% of women of reproductive age accessed FP from pharmacies.Given these results, the project dropped its intervention on improving pharmacies and focused instead on community promotion for its outreaches. A geographic shift occurred for worksites which were thought to be key potential FP access points in all cities. This intervention changed to be focused only in Nairobi where most industries are located.

Program implications/lessons
The use of evidence-based data to inform key strategies at the initiation of a project is rare. For Tupange, the availability and use of this data resulted in refining and shifting program strategies. Some of the program activities that resulted from these changes include:- Improving scheduling and integrating long acting and permanent methods of FP into existing outreach activities in collaboration with local health management teams and other stakeholders;- Strengthening distribution and introducing re-distribution of FP commodities while exploring the possibility of public health facilities seeking additional funds for these activities; and- Using Tupange to advocate

for a mechanism for the private facilities to purchase equipment at bulk negotiated prices and seeking additional funding to support franchised facilities to meet local demand for FP services.