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It is nearly 10am in Olasiti Village in Narok County and most people are already busy with their daily chores. Today is, however, not an ordinary day. By 10:30am, the men begin trickling into the AIC Olasiti Church compound. By 11am, the crowd is sizeable, and goat meat is boiling away merrily in a large pot set on an open fire.

As the men arrive, they sit on plastic chairs under a huge tree in the Church compound. Soon all the plastic chairs are filled and the late comers either lean on something, perch on rocks, logs or whatever is available to be used as a seat.
The Clinical Officer In Charge at AIC Olasiti Dispensary, Julius Pion, locally known as Daktari Pion, calls the meeting to order and the men quickly heed his calls to pay attention.

Daktari Pion has organized a male dialogue day where the men in Olasiti Village will discuss reproductive health and other health challenges facing their community. Daktari Pion holds the male dialogue forums at least one day every month in different villages within the health facility catchment area. With 16 villages in his facility catchment area, he has a lot of ground to cover.

The male dialogue forums are part of CHAK efforts to strengthen community-based interventions towards increasing demand for essential reproductive, maternal, newborn, child and adolescent health services such as Antenatal Care (ANC) and Skilled Birth Attendance (SBA). This includes rallying men to support the continuum of maternal and child health services.

The AIC Olasiti male dialogue forum is one of over 50 such meetings supported by the CHAK RMNCAH Programme in the four counties of Narok, Turkana, West Pokot and Marsabit over the past two years of implementation, reaching over 2000 men. The counties were selected for support due to poor maternal and newborn health outcomes, inadequate access to maternal health and newborn services and information, cultural practices such as Female Gentile Mutilation (FGM) and early marriages leading to increased dangers during pregnancy and childbirth, thus contributing to Kenya’s high maternal mortality rate.

Data shows that the performance of Narok County is lower than the national average for most reproductive health indicators.
Comparison of Narok County and national reproductive health indicators (KDHS 2022)

Indicator Narok real 006

In organising the male dialogue forums, Daktari Pion works closely with the Sub County Community Health Assistant (CHA), Community Health Promoters (CHPs), area chiefs, faith leaders and other health care workers. The CHPs begin mobilizing the men to attend the meeting three days prior to the arranged date. Religious leaders support in dissemination of messages to the men in the local community to attend the dialogue days. The chief provides security and encourages the men to attend the meeting, including informing the village elders of the intended forum.

The health topics discussed during the men dialogue forums that on average last two to three hours are quite diverse and include early ANC attendance, attendance of eight ANC contact visits, preparation for Skilled Birth Attendance (SBA), child immunization, nutrition for pregnant women, breast feeding, postnatal care, post partum family planning, personal hygiene, relationships, child spacing and family planning, female genital mutilation and its risks, early pregnancies and sexually transmitted infections. The men are also given information on and screened for diabetes, hypertension and HIV.

As evidence of progressive change, Daktari Pion says AIC Olasiti Health Centre currently sees 50 plus ANC cases and does 15-22 deliveries monthly, compared to one delivery when the health facility began offering maternity services in 2018.
Today, Daktari Pion will be giving information on modern family planning methods to the men to address myths and misconceptions and encourage uptake of the contraceptive methods. Support from the men, who are the heads of their families, can go a long way in improving uptake of the methods.

The Clinical Officer also hopes to encourage the men to actively participate in their partners’ pregnancy journeys by giving financial assistance for health care and nutrition, taking a keen interest in the health of the mother and baby and ensuring adequate rest for their pregnant and lactating wives.

The men listen keenly as Daktari Pion goes skillfully through each topic, nodding in agreement with some of his statements but completely disagreeing with others. Many of them disagree that they should accompany their wives to the health facility for ANC visits, but they are united in agreeing that girls should be allowed to complete schooling before being married. Daktari says that although the men are reluctant to accompany their wives to ANC and PNC visits, most of them give financial support and even follow up on their wives’ visit to the health facility through phone calls to him.

Addressing myths and misconceptions about family planning 
Moving swiftly to the discussion on modern contraceptives, Daktari explains each method in detail. The CHAK team, led by RMNCAH Programmes Coordinator Jane Kishoyian, are present in today’s meeting and have carried with them samples of each contraceptive method. The samples are circulated among the men who get to see them up close and touch them.

While 99.5 per cent of the men have seen a condom, other modern contraceptive methods such as the IUCD, implant and female condom attract a lot of attention from the men, many taking time to examine the samples closely and exclaim at their appearance.

Many of the men admit to having used the male condom but believe modern contraceptives have serious side effects on the health of their wives and negative implications on their fertility. Some of the men say modern contraceptives cause pain to the male during sexual intercourse. However, the CHAK team and Daktari Pion are on hand to give the correct information about modern contraceptives to the men.

The older men have a hard time accepting the use of modern family planning methods, while the younger ones are more interested in establishing whether the myths and misconceptions are true. Acceptance of modern family planning methods is still very low in the Olasiti community although this is changing slowly as more people get information from reliable sources, including health care workers in the CHAK RMNCAH programme which began in 2022. Short term methods (depo) are preferred by the women who are currently using modern family planning methods.

The CHAK RMNCAH programme has trained health workers from the 60 implementing health facilities on Focus Antenatal care, Adolescent and Youth friendly training, NCDs (Diabetes and hypertension) in pregnancy, essential newborn care, post-natal care and management of pregnancy related complications and baby friendly health initiatives (BFHI). Additionally, Community Health Promoters from 15 counties have been trained on community package of care.

The programme supports the male dialogue meetings by ensuring the men have something to eat on the day of the meetings. The programme also provides the health care workers and Community Health Promoters with transport and lunch on the day of the event. The CHPs mobilise the men to attend the event and provide blood pressure and diabetes screening services for the men who attend the event. The CHPs are equipped with a kit containing a digital blood pressure machine, a glucometer machine and 50 strips as well as a thermometer. The CHPs are well trained to screen for these conditions. Men suspected to have any of these conditions are reviewed at a later date and if the readings remain abnormal are referred to the nearest health facility.

At the end of the discussion, the men sit together, each with a piece of boiled meat in his hand, using a traditional Maasai knife to cut meat held at one end by the teeth.

The age-old Maasai practice of men sharing goat meat continues but some things are slowly changing. Despite challenges the of poor transport infrastructure, especially felt during the rainy season and long distances to health facilities, a large majority of the men are ensuring their wives and babies receive antenatal and post-natal care and births take place in a designated health facility. They also ensure that their women get nutritious food and children are immunized. Additionally, the men are slowly being convinced of the need to adopt modern family planning methods.

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