Family planning management and research project no. 615-0216

PVO) to develop a model program to provide family planning/maternal child health (FP/MCH) and nutrition services in Kenya"s Kibwezi Division. The evaluation was based on document review, field visits, and interviews with USAID/K, AMREF, and community personnel. Despite delays due to difficulties in recruiting staff and the diversion of staff to food distribution in response to famine in the project area, activities are being carried out efficiently. As planned, a well-staffed and functional MCH/FP Nutrition Unit has been fully established within AMREF"s organizational structure. The Unit has carried out a number of baseline surveys on FP acceptance; knowledge, attitudes, and practices; nutrition, breastfeeding, and weaning practices; and has provided some of the training for community health personnel. The project has trained traditional birth attendants (TBA"s) as FP advocates and community health workers (CHW"s) and shopkeepers as motivators and contraceptive distributors, and has integrated the activities of the three types of workers in providing MCH/FP and nutrition services. In particular, CHW"s have become active advocates of FP, even though the addition of FP work has substantially increased their workload; adding further work is likely to have an adverse effect, especially since the CHW"s are not being paid. The shopkeepers are currently distributing, not selling, contraceptives; some of them, however, know that contraceptives are being sold in Nairobi, and probably expect to sell them in the future. It will be impossible to determine the impact of the training and distribution during the life of the project. Completion of project activities cannot be expected within the planned time frame. If interventions are to be replicable, a 6-month extension will be needed. Action decisions are, inter alia, to: (1) extend nutrition education to communities by training mothers; (2) train CHW"s and TBA"s to provide non-prescription contraceptives and health education; (3) establish a system to monitor the extent to which TBA"s utilize their training; (4) provide IUD and tubal ligation services at the Kibwezi Health Center; and (5) provide repair services for clinic equipment and replace worn out equipment.