A new, relatively "quick and clean" operations research approach called a "situation analysis" was developed for examining the strengths and weaknesses of the family planning program of Kenya. Field research teams visited a stratified random sample of 99 of the Ministry of Health's approximately 775 service delivery points. Observation techniques and interviewing were used to collect information on program components and on the quality of care provided to new family planning clients during the observation day. As late as 1986, the Kenya program was rated "weak" and "poor" in the international literature. The Kenya Situation Analysis Study found a functioning, integrated maternal and child health/family planning program serving large numbers of clients, with an emphasis on oral contraceptives and Depo-Provera (and an underemphasis on permanent methods). Although a number of program problems were revealed by the study, overall, in terms of performance, a rating of "moderate" is suggested as more appropriate for Kenya's national family planning program today. In terms of the quality of care, a "moderate to moderate-high" rating is suggested.
PIP: In 1989, researchers conducted a situation analysis of 100 service delivery points (SDPs) in Kenya. They wanted to evaluate the usefulness of collecting and analyzing data on factors that influence the impact of family planning (FP). FP workers took a gynecological history and blood pressure on 96% of new clients and did a pelvic exam on 73%. 80 SDPs had Depo-Provera and foam tablets on hand and 85 had condoms. Even though the Ministry of Health had 8 varieties of oral contraceptives (OCs), not all SDPs had all types. 97 SDPs had the OC Microgynon, yet 24 had 10 cycles. 53 SDPs had at least 1 FP poster on the wall. 38 had charts or other educational aids. None provided educational material for the clients to take home with them. 32 SDPs had health talks and only 16 addressed FP. 1 on 1 client counseling made up somewhat for this lack of information (31% of clients interviewed reported the clinic as their 1st source of FP information). Yet the SDP workers often did not tell clients about contraindications, complications, and how to manage complications. Supervision was minimal. 87 SDPs kept records on FP clients. 81 SDPs had referred some women for FP services. Only 54% of the nurses and midwives attended the core 7 week training course in FP designed to certify them to deliver FP services. A mean of 9443 clients attended these SDPs each month. 71% used OCs, 19% Depo-Provera, 5% condoms, and 5% IUDs and foam. 94% of clients learned of 2+ methods at the SDPs, especially OCs and Depo-Provera. FP workers provided little information about sterilization. The researchers observed the quality of care indicators on an 1 client/clinic basis which probably biased the results in a positive direction. Nevertheless, FP workers did know how to provide acceptable good care. These results showed that the quality of FP in Kenya should be upgraded from weak and poor to moderate to moderately high.