by Patricia Orawo, Caroline Nyandat, Monica Oguttu
Social Science Research Network Electronic Journal, 24 January 2018
Introduction The National Health Sector Strategic Plan II (2005–2010) recognizes adolescent sexual and reproductive health (SRH) as a priority within the Kenya Essential Package of Health (KEPH). The KEPH further commits itself to establish youth-friendly SRH services including; counselling, contraceptives and HIV/AIDS-related services to young people. In line with KEPH provisions, the Kisumu Medical and Education Trust’s (KMET) model seeks to ensure that youth-friendly SRH services are affordable, accessible, acceptable, equitable and appropriate to meet the SRH needs of young people aged 10-24 years. The program is implemented through a public–private partnership approach in three counties with the highest burden of teenage pregnancy, HIV prevalence and maternal mortality in Kenya, i.e. Migori, Siaya and Kisumu.
Methods The KMET youth-friendly model is at two levels of interventions: the health facility and community levels. The health facility interventions: upgrading, renovating and setting up of a youth-friendly clinic, supplies and equipment, staff capacity building to provide quality integrated youth-friendly services. The community level intervention: recruitment and training of community health volunteers (CHVs) and youth peer providers (YPPs) to create demand for the services; facilitating grassroots advocacy and community conversations/dialogues on youth and adolescent health. The model also cushions these young clients from cost implications because services at the youth-friendly services are completely free. The YPPs and the CHVs are given stipends based on performance. The public–private partnership approach has been adopted to ensure no missed opportunities in each intervention county. The County Health Management Teams are actively involved and all trainers are drawn from the County Reproductive Health Departments to galvanize their support towards collecting sustainability Datal data, which includes the number of maternal deaths per severe hemorrhage cases per month per facility, both two years prior (historical controls) and subsequent to UBT implementation.
Results Although data collection continues, we have amassed results on service utilization, access, affordability and availability of services; and support from providers and the community. To date, 14 facilities have been upgraded and are offering youth-friendly services (4 in Siaya, 5 in Migori & 5 in Kisumu); 66 youth-friendly service providers trained, 44 youth peer providers and 66 community health volunteers trained. The clinics have registered a tremendous increase in clients below 24 years of age seeking reproductive health services. From 20,046 in year one to 14,971 in in the first half of year two, with a breakdown as follows: 5,049 IUCDs, 10,591 implants, and 725 post-abortion care clients. In terms of access and availability, grassroots advocacy and community conversation have created demand for services and subsequently contributed to an increase in clientele. Factors such as SRH information, provider skills, equipment for service provision, and poor enforcement of policies were all addressed.
Conclusions and recommendations Preliminary results indicate that youth-friendly services are an effective way to improve access to SRH services for youth and adolescents but more qualitative research is recommended to validate the results. There is a need for more collaborative engagement with relevant county ministries to increase focus on integration of youth-friendly facilities issues in line with the policies in place, including resource allocation and development of facilitative policies, guidelines and tools. Improving facilities by integrating youth-friendly clinics is key to realizing the right to healthcare among youth and adolescents.
PHOTO, Jennifer Dreher/IWHC, March 2014