Center for Health Market Innovations (CHMI)

Programs

AMUA

last updated Mar 27, 2013

Overview

Implementing organization: 
Marie Stopes International (MSI), Kenya
Implementation Partner(s): 
Government of Kenya
Legal Status: 
Public-private partnership
Year Launched: 
2004
Stage: 
Existing/expansion stage
Income Level of Target Population: 
Bottom 20%, 20-60% (lower to lower-middle)

Funding

Primary Source of Funding: 
Out-of-pocket payments
Additional Source(s) of Funding: 
Donor
Funders: 
German Development Bank (KfW), UNFPA, Venture Strategies

Technology

Technology Used: 
Computer › Apps/Software, Phones › SMS/MMS (Text Message)
Technology Purpose: 
Improving Data Management › Data Collection, Improving Data Management › Data Organization/Analysis

Scale

Personnel Employed: 
100<
Number of Clients Served: 
157,103 (2009)
Number of Facilities Operated/Networked: 
>270
Other Measures of Scale: 
In 2012, the network contributed over 152,000 CYPs to the MSI grid, a 90% performance against the set target. This translated to aversion of 43,395 births, 230 maternal deaths, 17,834 abortions and a saving of USD 7,853,580. In 2010, served over 400,000 clients with family planning and HIV/AIDs testing and counseling needs. Basic health indicators have also improved, with CPR increasing from 39% in 2005 to 46% in 2008/9.
Upscaling: 
Plans to extend to Eastern Province, Kenya
Summary: 

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

Program goals/rationale: 

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, and emergency obstetric care. SMS reporting of stock-outs is planned.

AMUA currently works with 350 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.

Despite this, 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 (165 across five provinces) 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.

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