CPAC IN KENYA WHERE WE ARE

By Dr Solomon Orero

(MD,MMED,IMH)

The Origin of PAC

The history of legalization of abortion care From the 1950s This is not visible in the African Continent

and Latin America

Arguments for legalization

Maternal mortality and morbidity The public Health Platform and resources The Sexual reproductive Health and Rights

Platform

The Landmark Decisions in Abortion Care

The USA 1973 Judicial ruling-How it has since affected the rest of the world

The 1984 Mexico policy and its impact-The “Gag Rule”

The 1994 Landmark ICPD The Mexico City Liberalization of abortion

Law-GIRE

PAC

The term PAC first articulated in 1991 The Historical origins of PAC The logic of inclusion of PAFP The logic for the inclusion of referrals and

linkages with other RH services

In 1993-The PAC consortium

AVSC now Engender health IPPF IPAS Pathfinder International JHPIEGO

The Original PAC model 1994

Emergency Treatment-Evacuation of the uterus

Post Abortion Family Planning counseling and services

Referrals and Linkages with other RH services

ICPD 1994 and Land mark para 8.25

“All governments and organizations to strengthen their commitment to women’s health" and “deal with the health impact of unsafe abortion”

Expansion of the programmes and access issues

Decentralization of:– The provider skill-– The health facility– Involvement of the informal providers and the

community

ConsultantsReferralhospitals

General PractitionersFirst level referral hospitals

Sub-district hospitals

Mid level providersAll hospitals

Health CentersDispensaries

Informal providers( TBAs, Health workers, community based health workers)

Found in the communities

The reviewed PAC concept

Community and service provider partnership Counseling Emergency treatment Family Planning and Contraceptive Services Referrals and Linkages to RH and other

services

Community and service provider partnership

1. Community and service provider partnerships for prevention (of unwanted pregnancies and unsafe abortion), mobilization of resources (to help women receive appropriate and timely care for complications from abortion), and ensuring that health services reflects and meet community expectations and needs

Community and service provider partnershipCont’d

2. Counseling to identify and respond to women’s emotional and physical health needs and other concerns.

3. Treatment of incomplete and unsafe abortions and complications that are life threatening.

Community and service provider partnershipCont’d

4. Contraceptive and family planning services to help women prevent unwanted pregnancy or practice birth spacing: and

5. Linkages with other reproductive health services that are preferably provided on- site or via referral to other accessible facilities in the providers network.

Community and provider partnerships

The partnership includes education:1. To increase FP use, prevention of unwanted

pregnancies

2. Risks and consequences of unsafe abortions

3. Promotion of client oriented health rights based on sexual and RH services

4. Signs and symptoms of obstetric emergencies

Community and provider partnerships cont..

5. In what sexual and RH services are provided

6. Mobilization of community resources to ensure that women with obstetric emergencies (including PAC) receive timely and appropriate care

7. Planning and sustaining PAC and other RH services (HIV/AIDS, FGM, gender violence etc)

Counseling

1. To find and affirm the women’s feelings

2. Ensure that women receive appropriate answers to their questions or provided with adequate information on their condition and treatment.

3. Help women clarify their thoughts about pregnancy, PAC, return of ovulation and RH future

4. Address other concerns that women may have

Treatment

Provision of emergency treatment by evacuation of the uterine contents through:

1. Manual Vacuum Aspiration (MVA) or

2. Sharp Curettage (SC) or

3. Electric Vacuum Aspiration (EVA) or

4. Use of chemicals e.g Misoprostol.

Contraceptive and FP services

Access to a wide range of contraceptive methods to women who desire to delay or avoid pregnancy so as to avoid unwanted pregnancies.

What is going on in the recent past and now?

Community Based Abortion Care Creation of community partnerships High profile newspaper reported cases

regarding unsafe abortion ,Street dumped fetuses

What is new in Kenya?

The challenges of providing all the PAC components:– PAFP -counseling and services– Continuous decentralization of MVA/PAC services– Obs/Gyn,MOs,MLPs,Informal Providers– Training,MVA kit new to MVA Plus– The Environment is getting more hostile

40th Anniversary of FP

On May 13th,2008 will be the 40th anniversary of FP as a recognized Human rights issue

“On that day, there will be many couples who will have an unmet need for FP”For many reasons they will not access Family planning methods

One reason in Kenya :there has been no major investment in FP the last almost 2 decades

On Investment in Health

Investment at the community level in creating awareness and seeking to improve health seeking behaviour

Investment in the institutional level in getting the infrastructure up and running with the right mix of skills

On Investment in Health

Investment in health systems development and use of RH abortion included as a fulcrum for change

Investment in policy and strategy development for Health and therefore RH and undertake advocacy for stronger legislation and better services integration

CPAC

EQUITY FOR WOMEN

PRIMARY HEALTH CARE

Basic Maternity Care

PILLARS OF SAFE

MOTHERHOODF

amil

yP

lan

nin

g

Ess

enti

alO

bst

etri

c C

are

Safe Delivery

ANC

MAP OF KENYA & KMET PROJECT AREAS

The Map of Kenya and some facts

Kenya: Country Background

•Population: 33 million

•GDP: Kshs. 920 b (US $ 12.5 b)

•Per capitalincome: US$ 380

A map of Kenya showing the PEV hot spots what it will mean in PAC

KMET PROGRAMS

SAFEMOTHERHOOD

INITIATIVE

KMET PROGRAMS

POST ABORTION CARE

HOME BASEDCARE FOR

PLWHA

NUTR’N AS A COMPONENT

OF HBCSAGAM COMMHOSPITAL

CLINICAL SERVICES

MICRO-FIANANCE

YOUTH FRIENDLY SERVICES

INT’L STUDENTS/

VOLUNTEERS

The allocation of health budget-Kenya

Reproductive health services cover a meager 0.6% of the health budget.

Households are the greatest source of expenditure on health they spend from their pockets.

The households expenditure on RH is minimal

Transportation of a patient with impending uterine rupture and choriamnionitis worse for abortion patients.