PMA Agile is a component of the Performance Monitoring for Action project and aimed at the subnational level (state, county or city). It builds on the PMA monitoring

and evaluation platform and conducts continuous tracking of family planning service delivery and consumption through quarterly public and private health facility surveys and semi-annual client exit interviews. A phone follow-up survey is conducted with consenting female clients four months after their interviews.

PMA Agile monitors the urban areas of three counties in Kenya, Kericho, Migori and Uasin Gishu, and is conducted by the International Centre for Reproductive Health-Kenya (ICRHK), in collaboration with The Bill and Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health. This brief covers three rounds of baseline client exit surveys (Q2, Q4, Q6), and subsequent rounds of the client follow-up survey conducted in Q3 and Q5. The full results are accessible at site dashboards at pmadata.org/technical-areas/pma-agile. The project receives support from the Bill and Melinda Gates Foundation.

ABOUT PMA AGILE

Key highlights from Q2-Q6 CEI surveys in Uasin Gishu

• In Uasin Gishu, 1,810 clients (1289 females and 521 males) were interviewed at the selected public and private facilities in Q6.

• The highest level of education for female and male clients interviewed at public facilities

• tended to be primary and secondary. Private facilities saw a different distribution in highest level of education, between male and female clients, with secondary and university being the most prominent.

• Most clients interviewed at public and private facilities who contracept were mainly using injectables.

• About 75% of women interviewed at public and private facilities in Q2, Q4, and Q6 report choosing their contraceptive method themselves.

• Over the three survey rounds, the proportion of male and female clients that reported a provider ever explained how to use their method of contraception at any visit saw an increase.

• Female clients age 18-24 were more likely to be told about side effects at their FP visit when compared to the other age groups.

• More males interviewed at public facilities report discussing FP with their partner when compared to males interviewed at private facilities across all three survey rounds.

• At the follow-up interviews in Q3 and Q5, 50% of women were still using the method reported four months earlier. About 8% had switched methods in Q3 and Q5.

Kenya

Uasin Gishu

PMA Agile/Uasin Gishu, KenyaCLIENT BRIEF

UASIN GISHU CLIENT METHOD USE COMPOSITION

Most clients interviewed at public and private facilities who contracept were mainly using injectables or implants. Across the three survey rounds, method mix by facility type remained fairly constant, although pill and implant use increased slightly in public facilities.

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

In Uasin Gishu, 1810 clients (1289 females and 521 males) were interviewed at the selected public and private facilities in Q6. The gender composition of the Q2 and Q4 sample was similarly balanced, with more women being interviewed at public facilities.

Q2 Mar.-Aug. 2018

223

806

675

154

219

804

581

146

272

691

598

249

n Female-Public n Female-Private n Male-Public n Male-Private

Public Public Private PrivateFemale Male Female Male

Public Public Private PrivateFemale Male Female Male

The highest level of education for female and male clients interviewed at public facilities tended to be primary and secondary. Private facilities saw a different distribution in highest level of education, between male and female clients, with secondary and university being the most prominent.

Q2 Q2 Q4 Q4 Q6 Q6Public Private Public Private Public Private

n Sterilization n IUDn Implant n Injectable n Pill n Male condom n Emergency contraceptionn Other

Uasin Gishu—Client—2

Q4 Q2 Q6

Q4 Feb.-Jun. 2019

Q6 Oct. 2019-Jan. 2020

n None n Primary n Secondary n Vocational n University or higher

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%Public Public Private PrivateFemale Male Female Male

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

SAMPLE SIZE OF CLIENTS INTERVIEWED IN UASIN GISHU, BY PUBLIC/PRIVATE FACILITY AND GENDER

EDUCATIONAL COMPOSITION OF CLIENT SAMPLEPercent distribution of education levels of clients interviewed

19.1

0.9

40.1

39.2

0.6

26.7

2.6

44.2

26.0

0.5

47.7

0.3

35.3

16.5

0.2

50.2

1.6

28.9

19.1

0.2

24.9

0.7

40.4

33.7

0.3

23.5

0.4

41.6

34.5

41.9

0.1

45.6

12.10.31

50.6

1.1

36.4

12

30.5

0.3

44.4

24.8

30.8

2.3

49.4

17.5

47.6

0.6

41.9

0.9

54.4

0.2

36.8

8.6

1.3

13.3

24.8

49.8

3.2

7.1

0.65.5

1.9 3.50.84.4 0.3 4.4 0.7

7.9

2.7

19.3

23.0

34.8

12.3

0.510.2

6.4

31.7

46.4

0.5 2.3

18.9

26.6

38.4

8.8

0.3 1.18.8

34.3

41.5

8.7

0.5 2.9

17.5

23.1

34.0

14.4

0.20.5

0.1

60.1

77.8 77.1

85.4

About 75% of women interviewed at public and private facilities in Q2, Q4, and Q6 report choosing their contraceptive method themselves, with the exception of women interviewed at private facilities in Q6, which all women report choosing their method themselves.

Uasin Gishu—Client—3

PERCENT DISTRIBUTION OF FEMALE FP CLIENTS REPORTING WHO CHOSE CONTRACEPTIVE METHOD

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

Over the three survey rounds, the proportion of male and female clients that reported a provider ever explained how to use their method of contraception at any visit saw an increase.

PERCENT OF YOUTH CLIENTS (AGE 18-24) REPORTING A PROVIDER EVER EXPLAINED HOW TO USE THE METHOD AT ANY VISIT

Female Male

Uasin Gishu public and private

Female clients age 18-24 were more likely to be told about side effects at their FP visit when compared to the other age groups. Across all age groups and survey rounds, about 75% of women interviewed report being told when to return for a follow at their FP visit.

PERCENT OF FEMALE CLIENTS SEEN AT TODAY’S VISIT WHO WERE TOLD ABOUT SIDE EFFECTS AND WHEN TO RETURN FOR FOLLOW-UP VISIT, BY AGE AND QUARTER

Age Q2 Q4 Q6 Q2 Q4 Q6

18-24 52.6% 29.5% 97.8% 72.7% 86.1% 100.0%

25-34 46.9% 22.1% 60.2% 74.8% 100.0% 88.8%

35+ 52.7% 97.0% 14.7% 100.0% 72.1% 100.0%

Q2 Q2 Q4 Q4 Q6 Q6Public Private Public Private Public Private

Female clients interviewed at both public and private facilities report high levels of satisfaction with clarity of FP information, polite treatment, range of services, as indicated by their willingness to return or refer the facility.

Would return to this facility

Services here better/much better than other facilities

Treated politely/very politely

FP information was clear/ very clear

INDICATORS OF FP SERVICE QUALITY AMONG FEMALE CLIENTS

99.999.9

94.386.5

99.699.0

94.292.3

Would return to this facility

Services here better/much better than other facilities

Treated politely/very politely

FP information was clear/ very clear

Would return to this facility

Services here better/much better than other facilities

Treated politely/very politely

FP information was clear/ very clear

0% 20% 40% 60% 80% 100%

n Private n Public

99.399.5

96.092.0

100.0100.0

10099.0

Side Effects Follow-up

91.0

100.099.9

95.090.0

100.096.0

99.0

Q4

Q2

Q6

57.9

77.6

n Q2 n Q4 n Q6

0% 20% 40% 60% 80% 100%

0% 20% 40% 60% 80% 100%

n Respondent n Respondent/Partner n Respondent/Provider n Partner/Spouse/ Provider n Partner/Spouse n Provider

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

2.1

1.5

76.7

8.0

11.7

5.30.80.8

93.1

8.5

2.73.6

2.7

0.7

90.9

8.5 7.9

1.42.8

14.1

82.5 73.8 100

BILL & MELINDA GATES INSTITUTE for POPULATION and REPRODUCTIVE HEALTH

PMA AGILE SAMPLEPMA Agile uses probability sampling methods to select public and private SDPs from master lists of registered health facilities, stratified by type of facility. For each geography, up to 220 SDPs are sampled. The target sample is 100 public and 100 private health facilities, allowing for 10% non-participation. The SDP data are weighted to be statistically representative of the geography. The same panel of SDPs is visited quarterly for a subsequent interview and the weights re-adjusted as needed.

Every other quarter, a client exit survey is conducted by systematically selecting 10 clients per facility. Eligible clients are males aged 18-59 years or females aged 18-49 years. The target sample is approximately 1500-2000 clients. The client data for a given SDP are weighted by the client’s selection probability which is a function of the SDP’s average daily volume of clients and the client sampling interval. The client data are then weighted by the SDP selection probability. Female clients are asked to consent to a phone follow-up approximately four months later when they are asked about continued contraceptive use, switching and satisfaction with services received.

Suggested citation: International Centre for Reproductive Health-Kenya and The Bill & Melinda Gates Institute for Population and Reproductive Health at The Johns Hopkins Bloomberg School of Public Health. Performance Monitoring for Action Agile (PMA Agile) Quarterly Survey 2018-2020. Mombasa, Kenya and Baltimore, Maryland, USA. www.pmadata.org/technical-areas/pma-agile.

MALE FAMILY PLANNING Percent of male clients interviewed about their FP behaviors

No male clients interviewed at public facilities report paying a fee for contraception. More males interviewed at public facilities report discussing FP with their partner when compared to males interviewed at private facilities across all three survey rounds.

Uasin Gishu—Client—4

Q2

n Private n Public

Q6

100.0

Non-contraceptors intending future use

Report seeing FP messages on TV

Report hearing FP message on radio

Discussed FP with partner

Paid fee for contraception 0.0

Change in Baseline Q4- Follow-up Q5Change in Baseline Q2- Follow-up Q3

CHANGE IN CONTRACEPTIVE USE STATUS

At the follow-up interviews in Q3and Q5, 50% of women were still using the method reported four months earlier About 8% had switched methods in Q3 and Q5. In Q3, 15% became new adopters, while 12% became new adopters in Q5. In addition, 13% discontinued a method in Q3, while 11% discontinued a method in Q5. Lastly, 14% remained non-users at the follow-up interview in Q3 and 20% in Q5.

77.770.8

76.477.7

Q4

44.1

Non-contraceptors intending future use

Report seeing FP messages on TV

Report hearing FP message on radio

Discussed FP with partner

Paid fee for contraception

Non-contraceptors intending future use

Report seeing FP messages on TV

Report hearing FP message on radio

Discussed FP with partner

Paid fee for contraception

0 10 20 30 40 50 60 70 80 90 100

67.062.9

78.871.5

39.6

0 10 20 30 40 50 60 70 80 90 100

44.954.9

82.068.4

89.683.1

39.544.6

91.90.0

33.632.6

42.4

46.463.5

46.2

100.00.0

0 10 20 30 40 50 60 70 80 90 100