Sexual reproductive health service provision to young people in Kenya : what is the best model?

Background: Young people are a demographic force and their sexual and reproductive health (SRH) has become an area of focus for many national governments in both developed and developing countries. Addressing the SRH problems of young people is essential for the social and economic development of any nation and presents an opportunity for building human capital, respecting human rights and alleviating the intergeneration cycle of poverty across societies. Aim: This study aimed at firstly exploring experiences and perceptions of young people aged 10-24, community members, health service providers (HSP), programme managers and policy makers on the SRH problems of young people and available SRH services. Secondly, the study sought to explore the different models of SRH service provision and, through a stakeholder consultative process, develop an SRH service delivery model for young people in Kenya. The development of the model was also informed by findings from literature review on ASRH interventions and components of models of health service delivery. Methodology: This was a qualitative study which took a social constructionism approach. The study took place in four areas, Nairobi city and three district hospitals (Laikipia, Meru central, and Kirinyaga). Data was collected from a total of 8 health facilities, 5 integrated facilities and three youth centres, using focus group discussions (FGDs) and in-depth interviews (IDIs). 18 FGDs and 39 IDIs were conducted with young people; 10 FGDs with community members; 19 IDIs with health service providers; and 11 IDIs with facility managers and programme managers. Interviews were tape recorded and transcribed. With the assistance of NVIVO8 data was coded and analysed using the thematic framework approach. Results: Young people’s perceptions of available SRH services show variations between boys and girls with regards to the model of service delivery. Young girls seeking ANC and FP services at integrated facilities characterised the available services as good. On the contrary, boys indicated that SRH services at integrated facilities have been designed for women and children, and so they felt uncomfortable seeking services from these facilities. Apart from receiving SRH services at youth centres, young people place emphasis on the non-health benefits they personally receive from youth centres such as preventing idleness, confidence building, information gap-bridging, improving interpersonal communication skills, vocational training and facilitating career progression. Majority of community members are not aware of the SRH services available at the health facilities even in areas where youth centres are present. Community members approve of young people receiving services which they feel are educative and preventive in nature and disapprove of services which they feel encourage young people to engage in sexual activity such as promotion of contraceptives. HSP report not being competent in adolescent counselling, facing a dilemma and not being comfortable with providing SRH services to young people. HSP also report being torn between their personal feelings, cultural norms and values and respecting young people’s right to accessing SRH services. Broadly two models of SRH services are examined in this study; the integrated model and youth centres. Youth centres can either be facility-based or community-based. The findings presented in this study do not point to one single model as the best SRH service provision model as each have their own strengths and weaknesses. However, both models face implementation challenges which include: a weak monitoring and supervisory system, weak linkages with other government line ministries and departments and heavy reliance on donor funding. Specific to facility-based youth centres implementation challenges include: lack of ownership and support by district managers, being seen as parallel health structures and conflicts of interest in youth centre utilization between district managers and young people. Although the youth centre is reported as the preferred model by some young people and healthcare providers, its sustainability is not guaranteed. Moreover, the range of services it’s able to provide is limited due to deficiencies in staffing, supplies and equipments. Conclusion: Addressing the SRH problems of young people in Kenya remain a big challenge for the health sector. Although some progress has been made with regards to creating a friendly policy environment for SRH service provision, the major drawback lies in implementation of these policies. This study recommends a multi-component SRH service delivery model with six core services, a strong support structure onto which to anchor service delivery and linkages to existing government systems and processes to enhance sustainability. This is the first study to be conducted in Kenya using qualitative methodology and result in the development of a SRH service delivery model for young people after triangulation of views and experiences of young people themselves, community members, health care providers, programme managers and policy makers.EThOS - Electronic Theses Online ServiceGBUnited Kingdo