HEALTH SYSTEMS STRENGTHENING AND INNOVATION FOR PROVISION OF QUALITY AYFS FOR REALIZATION OF UHC UNDER PHC

Since the launch of SDGs, Kenya has been a front runner country in implementing UHC agenda as an approach to health services delivery. In October 2019 at the UN General Assembly, President Kenyatta reaffirmed Kenyan Commitment to UHC Agenda as a key pillar in the government’s strategy for poverty alleviation. In December 2018, Kenya begun UHC pilot project under “Afya Care” in Kisumu, Nyeri, Machakos and Isiolo Counties.
Kenya has thereafter developed national
UHC policy and rolled up UHC program nationally.

In 2019, OAY began UHC accountability program and collected data from Kisumu, Nyeri, Machakos and Isiolo, Kiambu, Kajiado, Kirinyaga and Kakamega, Busia, Migori and Siaya Counties.

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Project Goal

Determinants of health are positively influenced by all stakeholders and sustainable actions especially at Primary Healthcare (PHC) level, and within Universal Health Coverage (UHC) Principles so that adolescents and youth health is improved and safeguarded within a predictable ecosystem

Project Objectives

  • HSPs capacity strengthening to improve provision of quality and acceptable services to AY at PHC level
  • Advocate for principles of universal access to health services in line with SDG 3, Target 3.8. Our ask entail reduction of physical, financial, referral and acceptance barriers in health services provision
  • Improved MAYE in the health facilities management and governance in line with Kenya RMNCAH+N framework and THS Project Appraisal Document and Piloting roll out of responsive Innovative Demand Creation and Referral Systems for AYFS within a facilities’ ecosystem
Our main focus under HSS entails;
  • PHC within UHC: An approach that speaks to the health and needs and priorities of young people in Kenya, and truly embrace, in totality, principles of universal access to health services in line with SDG 3, Target 3.8
  • Specifically, this approach that is informed by the needs, issues and challenges of young people especially at PHC level; with a clear implementation framework focusing on dismantling physical , financial, referral and acceptance barriers in health services provision
  • Training and attitude change: The program seeks to offer training, mentorship and coaching to Health Service Providers (HSPs) , facilities management , policy and decision makers on how best to offer AYFS that are responsive to their needs. The main outcome is better incentivized AYFs service delivery to the marginalized and vulnerable by the entire Health workforce
  • Meaningful Adolescents and Youth Engagement (MAYE) : We believe that when young people are actively involved in the management of the health facilities especially at oversight level, there will be enhanced Leadership and Governance outcomes. They will be able to bring their issues to the table through their trusted representatives, engage in budgeting processes, influence resources allocation and offer feedback. We support HSS through MAYE by training youth leaders on principles of MAYE derived from global consensus statement on meaningful adolescent and youth engagement and GFF Youth Engagement Addendum that we helped develop. Evidence Generation on Responsive AYFS, Innovative Demand Creation and Referral: This program, being implemented currently, in partnership with County Government of Kisumu and NMS seek to strengthen HS especially at PHC through demand creation models hinged on access to quality and verified information, technology adoption and functional community health strategies

Key activities Conducted

In early 2019, Organization of African Youth - a youth led organization set out to collect youth voices, opinions and aspirations on UHC. This was a multi-phased process that employed a build-up and participatory action including the first ever Devolution Youth Caravan that directly reached about 650 adolescents and youth.

Further , OAY has been engaging young people and duty bearers in Kisumu County on issues of prioritization of Adolescent Youth Friendly Services (AYFS) as a primary health care package within Universal Health Care (UHC) since May 2019.

We also developed a Joint development of a communique with youth, governments and partners on prioritization of SRH within PHC, covering not only SRH specific issues but inclusive of other triggers towards negative SRH indicators.

On 12th December, 2019, OAY led ceremony in Kenya on World UHC day, an event that (1) led to Nyangoma Community delving deep on what UHC is (2) Led to CSOs in Kisumu County working around UHC to come together to ensure synergy of efforts with youth at the centre.

Through the interventions, different youth serving organizations in Kisumu have come up to create a UHC-SRHR alliance to advocate for inclusion of SRH services in the UHC package. The alliance also serves as a space for social accountability actions.

Expected Outcomes

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OAY’s HSS outcomes are derived from WHO’s HS framework. We believe that if there principles of service delivery, quality HRH, information and medicine access , financing and good governance are adhered to in any level , then there will be improved health , responsiveness , social and financial protection and efficiency.

OAY’s believes that the six HSS pillars should interact and be invested on simultaneous and sustainably for better results.

By young people being part of the County programs, they get to be in a more strategic position to get access to relevant information in strategic spaces that will enable them to contribute and influence discourses on UHC therein improving the quality of UHC services to the youth and adolescent communities.

Investing in UHC offers both opportunities for youth, the government, private sector, donors and other stakeholders.

ACHIEVEMENTS SO FAR

OAY generated Evidence on the key UHC/PHC Bottlenecks
OAY Pilot Project

The OAY pilot project established that there were registered cases of; Inadequate staffing, influx of service recipients to the facilities, rampant stock outs, inaccurate information on UHC and services and inadequate YFSs

Infrastructure, Services and Commodities

At the lower local levels, Dispensaries are the first call point followed by, hospitals and clinics moving upwards.

However, most people at the lower local levels skip the dispensaries because of poor infrastructure, services and commodities.

At the Sub County level, access points are there but at the Dispensary, the access points are not defined. They have to get referrals from tier one facilities

SRHR Services

Within most facilities, there are limited access points for services related to SRH especially for youth and adolescents. As such, the spirit of UHC is still not being felt by uninformed / unaware communities

Access Points

Some of the access points are too far from the population more so looking at the preventive aspect therein limiting communities’ access to them due to hampering factors such the high costs of transport for poor households

Service Centre

On multiple levels – dispensaries, clinics and hospitals, the first level service centre is more of curative than preventive as opposed to the best practice of preventive as opposed to curative

CALL TO ACTION

We seek partnerships to expand our current HSS engagements to support young people to influence and positively change narratives around AYFS. Our main focus is primary health care level where we seek to have responsive health systems with accountable governance, effective communication challenges and health literacy programs, predictable resourcing (human and financial) and availability of supplies and basic infrastructure.

A functional health system should enhance health standards, service provision and remove all barriers and inequalities through in an optimal resource utilization, universal access, dignified and safe care.

Call to Action