ICRH Kenya

Diagonal Interventions to Fast Forward Enhanced Reproductive Health (DIFFER)


Overall objective:

To improve SRH for all women by expanding and strengthening SRH services, and providing and testing targeted interventions for female sex workers in the context of existing health systems

Specific objectives:

  • To assess the feasibility of integrating a combination of new SRH services into existing services for general population women;
  • To assess the feasibility of linking and/or integrating services for FSW into existing services for the general population;
  • To assess the feasibility of participatory processes involving FSW, local service delivery partners and the general population in design and delivery of improved SRH services for FSW;
  • To design packages of SRH care interventions which are feasible, appropriate, sustainable, effective, scalable and tailored to the conditions of each study site;
  • To implement and evaluate site-specific packages of improved SRH services delivered at facilities, at targeted services, and within the community;
  • To evaluate effectiveness of 3 years of strengthened services by conducting a cross-country assessment of the determinants of improved SRH services and outcomes pre and post-intervention, and to measure cost effectiveness of improved SRH care for FSW;
  • To engage policy makers from the outset in planning, implementing, evaluating and expanding the project;
  • To inform SRH policy and service delivery guidelines development that serve the needs of the general population and vulnerable groups such as FSW.


Case study at 4 different sites: Mombasa, Kenya; Tete, Mozambique; Durban, South Africa; and Mysore, India
Pre-post intervention comparison
Combination of quantitative and qualitative research methods


  • Policy analysis identifying current policies and policy gaps
  • Detailed situation analysis of the scope and quality of existing SRH services
  • Design a package of SRH interventions and services, based on acquired knowledge of cost, context and preference of local stakeholders
  • Build capacity in knowledge, skills and capabilities of health providers, community members, government and policy makers
  • Implement the optimum package of SRH interventions and services in the four study sites
  • Evaluate feasibility, acceptability, client satisfaction, care seeking behaviour, service utilization, quality of care and some SRH outcomes
  • Evaluate cost and determinants of sustainability
  • Promote participation and involvement of local and national health authorities and policymakers
  • Disseminate  key results locally, nationally and internationally


  • More women, both from the general population and FSW, make better use of the different SRH services that will be offered at the different health services;
  • The quality of SRH services is improved;
  • Both clients and providers are satisfied with the services;
  • The costs of the SRH services are reasonable, in relation to the effects, and sustainable.


Staff members involved during the project:

Mr. Yves Lafort

Ms. Katherine Muylaert

Ms. Aurore Guieu

Prof. dr. Olivier Degomme

Prof. dr. Marleen Temmerman