Summary

AMUA is a social franchise implemented on behalf of Government of Kenya by Marie Stopes. It currently consists of over 270 privately owned and operated clinics that focus primarily on providing reproductive health & family planning programs, maternal & child health services, and ser

Program goals

AMUA was launched to provide family planning to under-served communities in three provinces in Kenya, where health indicators such as the contraceptive prevalence rate, Poverty Index and fertility rates are not ideal. AMUA aims to achieve significant increases in the use of contraception methods, aid family planning services and address HIV/AIDs testing and counseling needs. On this foundation, basic health indicators have improved over the last 5 years.

Key program components

The majority of franchises are comprised of small, stand-alone medical clients that are owned and operated by a licensed nurse, and staffed by a few other health workers. The services provided include provision of a variety of contraceptives, sterilization, HCT (the volume percentage of red blood cells in the blood), labor and delivery, Malaria, TB, nutrition and diarrhoea management services.

SMS reporting of stock-outs is planned. AMUA currently works with over 600 Community Health Workers (CHW), in which two individuals are assigned per franchise, and each CHW receives branded materials, pictorial aids and bicycles. The franchise is currently facing difficulties in increasing quality standards and recruiting medical doctors due to the currently low interest in family planning.

In September 2012, AMUA clinics launched a two month road show campaign to take the family planning message to the people and offer free breast and cervix cancer screening; the campaign targeted 100, 000 people. In 2013, AMUA operated in 40 counties across Kenya.

AMUA has been successful in improving private-public partnership with the Ministry of Health; the franchisees are now recognized by the government and are able to source family planning commodities from the Ministry stores.

AMUA Project Reporting System: In March 2009, AMUA implemented an SMS Data Collection system in all its franchise outlets aimed to increase the timeliness and accuracy of service reporting . All franchisees were able to send in monthly service reports for 12 services in a single text using a numeric code. Reports could also be submitted via an online form. SMS reminders were sent if service reports were not submitted. Franchisees were reimbursed with mobile airtime to cover the cost of sending in the monthly SMS. Data from all franchisees could be viewed on a web-based real time reporting system, and exported as PDF or CSV files. Regional coordinators were provided with laptops and internet connections in order to verify and approve service reports. Paper-based service reporting continued alongside the SMS data collection, with the eventual intention of halting paper-based reporting. This system was successful in establishing an electronic data system, and was acceptable to franchisees. At the time of system closing, data was being received from around 70% of franchisees. However, several difficulties were encountered - such as mobile network difficulties, staff mobility between sites, intensive training required, staff insecurity and turnover, cost - which lead to the closure of the system.

Quality assurance and performance monitoring methods include:

• Site visits (6/year)

• Internal clinic audits (2/year)

• External clinic audits (1/year)

• Mystery clients (1/year)

• Vignettes (2/year)

• Client exit interviews (2/year)

As of 2012, AMUA had 280 outlets (58 hospitals and 222 clinics) and had 663,000 total visits.