Population Council Research that makes a difference

2011 International Conference on Family Planning
29 November–2 December 2011

Abstract

"Scaling-up a multi-sectoral adolescent reproductive health program in Kenya: Experiences and programming implications for very young adolescents"
Ian Askew, Humphres Evelia, Monica Wanjiru, Francis Obare, and Harriet Birungi

Background
Improving awareness of reproductive health issues among adolescents, especially very young adolescents (VYAs), has been, and continues to be, a highly contentious, sensitive issue in Kenya. To address these complexities, Population Council and PATH, with funding from USAID, supported three Kenyan ministries (education, social services, health) to develop a multi-sectoral, integrated approach that not only provided education to adolescents aged 10–19 years in schools, but also sensitized broad community and parental support for the in-school activities. Using a peer-education and support mechanism, the program created linkages with local health services and enabled them to offer “youth-friendly” information and services.

Methods
Through a three-year operations research program, the feasibility and effectiveness of this approach was rigorously evaluated through a prospective quasi-experimental design with disaggregated samples for adolescents aged 10–14 years and 15–19 years. After seven years of program scale up, an evaluation was conducted using qualitative/quantitative methodologies, to assess the extent of scale up and whether adolescent RH outcomes were sustained.

Results
The study demonstrated the feasibility of systematically implementing the multi-sectoral approach through existing public health structures, although sustainability without technical assistance was only achievable with the Ministry of Education. The 10–14 age group showed significant increases in knowledge and awareness of physiology, contraception and other reproductive health issues, especially when the in-school curriculum was supported by community sensitization activities. Importantly, the study demonstrated that educating VYAs about life skills did not encourage them to experiment sexually, a key concern among policymakers and communities before the initiative began.

Following the success of this pilot project, a strategically planned program of expansion was undertaken over seven years, which has led to the approach (termed the Kenya Adolescent Reproductive Health Program or KARHP) being introduced, adapted and rolled out in seven of Kenya’s eight provinces by the three ministries, with financial and technical support from the USAID-funded APHIA partners. How this approach was adapted and scaled up and the challenges and lessons learnt will be discussed.

Conclusions
Implementing multi-sectoral interventions through several ministries highlights the importance of developing and implementing an integrated set of activities from the pilot phase. The interventions not only sought to improve the VYAs’ understanding of reproductive health issues by building the education and health sectors’ capacity to provide such sensitive information to VYAs, but also generated community support for public sector engagement in what had previously been considered the sole responsibility of the family.

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