Evaluation of the Replication of the Community Postabortion Care (COMMPAC) Model in Kenya
The Council engaged in a replication of the COMMPAC model in Kenya's Rift Valley Province to increase access to postabortion care services by enhancing knowledge of sources of care and reducing fear of stigma, dissatisfaction with provider attitudes and performance, cost of services, and other barriers to care.
In the developing world, a woman dies every eighth minute because of complications arising from unsafe abortion and miscarriage. In Kenya, such maternal health complications were the fourth leading cause of morbidity among women in 2006. Rift Valley Province, where this study takes place, has consistently had the highest number of cases of abortion-related outpatient morbidity in the country since at least 2003.
In 2005–07, the first phase of the Community Post-Abortion Care (COMMPAC) project was implemented in Nakuru, Rift Valley Province, Kenya, by EngenderHealth under the USAID-funded ACQUIRE project. COMMPAC aimed to increase access to postabortion care (PAC) services by enhancing knowledge of sources of care and reducing fear of stigma, dissatisfaction with provider attitudes and performance, the cost of services, transportation difficulties, misperceptions among communities regarding PAC, and the perceived severity of complications. During this intervention community mobilization had a significant effect on the local environment and on health service delivery.
Following the successful implementation of COMMPAC, the Population Council replicated the COMMPAC model in a new site in Rift Valley Province and undertook a rigorous evaluation to systematically determine and document the most effective strategies to engage communities in PAC and to measure the effects of these strategies.
The evaluation has multiple purposes. It will provide documentation of the knowledge gained by the community on complications related to unsafe abortion and miscarriage and unplanned pregnancy, the acceptability of PAC services to clients and communities; the ability for the model to be scaled up within the resources and frameworks available from Kenya's Ministry of Health; and the potential for the COMMPAC model to improve health care utilization and thus contribute to improved health outcomes.
The Population Council is managing the research process, data management, and dissemination of the findings. It is responsible for developing the research protocol and tools, obtaining ethical clearance, managing the subcontracted agency that will do fieldwork and collect and analyze data, and disseminating the findings. A subagreement will be awarded to the Council by EngenderHealth for the collection of data; the Council is responsible for identifying and choosing an appropriate data collection agency.
The first phase of the project took place from August 2009 to June 2010. A second phase has now begun, to be finished in June 2011.
The COMMPAC replication involves the following specific interventions implemented by the service-delivery team from EngenderHealth's RESPOND project (the follow-up to the ACQUIRE project):
- Upon identification by community groups of the need to train service providers in PAC and contraceptive updates, RESPOND will train service providers (primarily clinical officers, registered nurses, and registered midwives) within Level II Ministry of Health dispensaries and health centers in Naivasha in the management of complications related to miscarriage and unsafe abortion so that they are able to respond comprehensively to potential demand for PAC services by community members. Providers in the 12 participating health centers and dispensaries will be trained.
- RESPOND will train staff from the Nakuru branch of the Society for Women and AIDS in Kenya (SWAK) on the idea of the Community Action Cycle and the modalities of training communities in its use. This will include capacity-building of SWAK to provide ongoing mentoring and support to community health extension workers (CHEWs) and community health workers (CHWs) in Naivasha as they support their own respective communities while applying the Community Action Cycle.
- SWAK will train Level I Ministry of Health CHEWs and CHWs to facilitate the Community Action Cycle for postabortion care.
- SWAK will support trained CHEWs and CHWs to conduct community mobilization sessions in their communities.
- SWAK will provide ongoing mentoring and support to trained CHEWs and CHWs via monthly monitoring visits and quarterly meetings.
Communities take action in Kenya: Strengthening postabortion care (PDF)
Undie,Chi-Chi; Obare,Francis; RamaRao,Saumya; Van Lith,Lynn
RESPOND Project Brief (no. 13)
Publication date: 2013
Replication of the Community Mobilization for Postabortion Care (COMMPAC) model in Naivasha District, Rift Valley Province, Kenya: An evaluation report
Undie,Chi-Chi; Obare,Francis; RamaRao,Saumya
The RESPOND Project Study Series: Contributions to Global Knowledge, Report (no. 9)
Publication date: 2012
Community mobilization for postabortion care in Kenya: Baseline evaluation report (PDF)
The RESPOND Project Study Series: Contributions to Global Knowledge, Report (no. 2)
Publication date: 2010
Location: Kenya (Rift Valley Province, Naivasha District)
Safe abortion and postabortion care
Duration: 8/2009 - 6/2010
Kenya Ministry of Health
Society for Women and AIDS in Kenya