Replication of the Community Mobilization for Postabortion Care (COMMPAC) Model in Naivasha District, Rift Valley Province, Kenya: An Evaluation Report

This 24-page evaluation report shares findings of an assessment of the Community Mobilization for Postabortion Care (COMMPAC) intervention in Kenya, designed to increase awareness and use of post-abortion care (PAC) services, and improve family planning, reproductive health, and maternal health outcomes. The RESPOND Project replicated this existing intervention previously tested under the ACQUIRE Project.

RESPOND worked with districts and communities to: strengthen service delivery points to provide PAC services; conduct community mobilisation to improve community involvement in and knowledge on the prevention and treatment of post-abortion complications; build community capacity to address needs related to PAC; and encourage involvement in community action of those most marginalised and most affected by post-abortion complications. The interventions were carried out in three communities in Naivasha District, Rift Valley Province, over an 18-month period, from July 2010 to December 2011. The evaluation used a quasi-experimental design, with intervention and comparison groups covering six study sites within Naivasha District. Measurements were taken at baseline (from May to June 2010) and at endline (from January to February 2012).
Key findings are outlined as follows:

• Overall, awareness about danger signs in early pregnancy was higher among women in the intervention areas than among their peers at the comparison sites.
• Women who experienced pregnancy complications in the intervention areas had increased tendency to seek PAC services at dispensaries.
• In the general population of women, knowledge about where PAC services may be obtained did not increase significantly.
• Exposure to community discussions about PAC did not increase significantly.
• Partner support for obtaining PAC services did not increase.
• Providers' confidence about offering PAC services increased.
• Perceptions of the quality of care available for postabortion complications improved among intervention-site respondents.
• The proportion of women seeking PAC services who reported having received family planning (FP) information and methods at intervention sites increased.
• The FP components of the COMMPAC intervention not related to service provision did not produce the desired effects.
• Perceptions of the quality of care available for postabortion complications improved among intervention-site respondents.
• The evaluation showed evidence that community members were empowered to take action for their own health.

In summary, the COMMPAC intervention was successful in the following respects: increasing knowledge of a critical danger sign in early pregnancy; enabling providers to effectively offer PAC services at the dispensary level; raising awareness of PAC; encouraging women to seek and obtain PAC services at the dispensary level; inspiring communities to take action for their own health; and generating interest among key stakeholders in sustaining the intervention.

The COMMPAC intervention was less successful in increasing: FP knowledge and current use; approval and partner approval of FP use; knowledge of dispensaries and health centers as service delivery points for PAC among the general population of women; partner support for obtaining PAC services; and participation in community discussions about PAC.

Given interest among key stakeholders in sustaining the intervention, the evaluation notes that there are certain clear areas for which replicating and sustaining the COMMPAC model holds merit (i.e awareness creation around PAC, provider training to offer PAC services at lower level health facilities, creation of community ownership around a health issue). Aspects of the model that require strengthening have also been identified, especially those related to strengthening community health workers.

Based on the findings, the evaluation report gives the following recommendations:

• Given the importance of FP for any PAC programme, there is a need to ensure that FP is strengthened as an element of PAC at all levels of the COMMPAC intervention.
• To increase partner support for obtaining PAC services, including partner approval of FP, current efforts under the COMMPAC model must be enhanced to more effectively reach men.
• Community sensitisation around danger signs in early pregnancy needs to be framed in ways that resonate and that women find easy to remember. The fact that the danger sign of "bleeding more heavily than a normal period" was significantly more likely to be remembered by women in the intervention area points to the idea that women could simply relate to (and therefore remember) this sign better than others.
• Community participation and mobilisation should be part of programmes that seek to expand access to PAC services. The majority of the outcomes for which an effect is observed in this study are related to the intensive community action cycles that form part of the COMMPAC intervention. Engaging men as well as women in such processes is recommended. The intervention was able to demonstrate discernible differences in some behavioural outcomes, suggesting that the approach has the potential to show improvements in a number of additional outcomes once the intervention is in place for a longer period of time.
• The provision of PAC services at the dispensary level is a novel undertaking that was tested under the COMMPAC model and found to be feasible. As the accessibility of dispensaries can be greater than that of higher level health care facilities, introducing PAC services to dispensaries that are reasonably ready to provide such services is recommended as a means of expanding women’s access to PAC services.
• Linked to the recommendation to use dispensaries to broaden women’s access to PAC services is the need to train providers within dispensaries to offer PAC services and to ensure that they have the equipment they need to provide PAC services. The evaluation demonstrates that if providers are trained to offer PAC services and if communities are made aware of their existence, women will seek out these services.
• The number of community health workers employed to carry out the intervention under the current design of the COMMPAC model should be increased, to ensure greater exposure to PAC-focused community discussions.