The Rights of Youth and Adolescent to Sexual Reproductive Healthcare: The KMET Experience

Introduction: The National Health Sector Strategic Plan II 2005–2010 (NHSSP II) recognizes adolescent SRH as a priority within the Kenya Essential Package of Health (KEPH). KEPH further commits itself to establish youth friendly Sexual and Reproductive Health (SRH) services including; counselling, contraceptives and HIV/AIDS related services to young people. In line with KEPH provisions, KMET’s 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 between 10–24 years. The program is implemented through a public private partnership approach (PPP) 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. a. The health facility interventions: upgrading, renovating and setting of a youth friendly clinic, supplies and equipment, staff capacity building to provide quality integrated YFS services. b. 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 RH departments to galvanize their support towards sustainability Datal data includes number of maternal deaths per severe hemorrhage cases per month per facility, both 2 years prior (historical controls) and subsequent to UBT implementation. Results: Although data collection continues, to date we have amassed results on service utilization, access, affordability and availability of services; and support from providers and the community. To date fourteen (14) facilities have been upgraded and offering Youth friendly services (4 in Siaya, 5 in Migori & 5 in Kisumu) 66 Youth Friendly service providers trained, 44 YPS and 66 CHVs trained. The clinics have registered a tremendous increase of clients below 24years seeking for RH services. From 20,046 in year one to 14971 in mid-year 2 (until June) with a breakdown as follows: 5,049 IUCDs, 10,591 Implants, and 725 PAC clients. In terms of access and availability, grassroots advocacy and community conversation has created demand for services and has 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. Conclusion and Recommendation: Preliminary results indicate that youth friendly services are an effective way to improve access to SRH service for youth and adolescent but more qualitative research is recommended to validate the results. There is 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 corners is key to realizing the right to healthcare among youth and adolescents.