Day: February 22, 2021

In Siaya County, teenage pregnancy (15-19 years)  has increased from 17% (KDHS 2014) to current 35% (KHIS2, 2018) against 18% nationally (KDHS, 2014).  About 1 in 5 girls (15-19 years) have begun childbearing – about same nationally. Specifically, 3.6% are pregnant with  first child, 13.6% have ever given birth, against 3.4% and 14.7% nationally (KDHS, 2014).

Teenage pregnancy (ages 12-19) remains serious health and social problem because it’s association with high maternal mortality and child morbidity. The risks include HIV/STI’s infections, early and forced marriages and

SGBV. At 27%, Siaya has high  fertility rates but low contraceptive use. The CPR 33%

among women aged 15-49 compared nationally 46%, (KDHS, 2009). An estimated 14%

of all pregnancies end in abortion and 1 in 5 maternal deaths are due to unsafe abortion. Hence need to address issues of unintended pregnancies, fertility reduction and access to CRH (Sedgh et al.  2007; WHO, 2007).

Objectives:

To determine the status of (AYSRHR) information and services in Bondo, Ugunja and Ugenya Sub Counties in Siaya.

The information generated would help health planners to design appropriate ASRHR programs  that would comprehensively address the needs of adolescents and young people in Siaya County.

Methodology/Interventions

The study used two methodologies; quantitative and qualitative.  The quantitative methodology involved the review of secondary data from the county health information system and other national sources including the 2014 (KDHS). 

The qualitative methodology involved focus group discussions, in-depth interviews, and KII. The UDI employed FGD, KII guides and documented case studies in healthfacilities purposively chosen where AYSRHR services are offered.  Non-probability andpurposive sampling were used to draw informants including sub county RH coordinators, HCWs and YPP. 

Five FGD comprising 11 participants each were conducted with adolescents and active YPP. Seven KIIs were conducted with purposively selected HCW.

Results

The study findings reveal that young people 49% get SRH information and services from health facilities while 21% from school. The type of information and services provided include; STIs and HIV/AIDS, contraceptives, SGBV, infertility, abortion, reproductive cancer, maternal and child health.

Majority of respondent were between age 10-19 years (10-14 -33%, 15-19-32%). It further showed that among (10-19 years), only 31%females and 18% males had knowledge on pregnancy prevention, a woman’s fertile period, able to reject misconceptions and familiar with atleast one modern method of contraception.

For (10-14 years) only 10%females and 6% males had same level of knowledge. Among the respondents, (40%) had discussed TP related matters with family members. Female were likely (34.9%) to discuss with their parents than male (5.1%). 

The AY  reported to be faced with challenges in accessing SRH/FP information and services. The study reveal that most 89% health facilities dont have Youth Friendly Services thus negative service provider attitude, lack of confidentiality among HCWs causes fear and embarrassment among AY to access services.

Other challenges include; fear of side effects, services cost, peer pressure to procure abortion, negative community perception, lack of parental guidance and ignorance, poverty and lack of disability friendly services.

Conclusions 

The study showed gaps in service delivery and information for AYSRHR. It provides information on areas health planners, designers, development partners need to invest in providing appropriate AYSRHR programs, CSE to AY in and out of school to empower them to make informed decisions about sexuality and sexual health.

Recommendations 

There is need for policymakers to prioritize, plan and mobilize resources to improve and increase universal access and uptake of high quality, affordable, youth friendly, stigma free, Sexual and reproductive health services and information by young people in and out of schools and parental guidance and counselling.

Challenges facing CSO’s in promoting access to universal health coverage in Siaya County: the experience of Ugunja Development Initiative

Introduction/Background.

In 2018, the county government of Siaya in partnership with Amref Health Africa Siaya Project launched a project to work with civil society organizations including U.D.I, to promote

enrolment of households in a planned universal health coverage program. At the inception of this partnership only about 27% of Siaya residents were on any form of insurance scheme. Our face

to face interviews with communities revealed that enrolment into health schemes was hampered by among others, poverty leading to inability to pay for premium, high dropout, poorly funded primary health care and inconsistent incomes among the majority who were largely employed in the informal sector.

Objectives.

1.   reduce direct costs and out of pocket expenditures;

2.   increase advocacy on registration and recruitment in insurance schemes; and to

3.   improve access and coverage in public health facilities.

In addition to the 3 objectives, the County Government of Siaya planned to use the lessons learnt from this recruitment to help health planners to design an appropriate UHC program that would comprehensively address the needs of the vulnerable households.

Problem statement.

High income inequalities in Siaya County has created barriers to UHC, even when there is existing political stability. Siaya like other low and middle-income economies is actively pursuing policies to achieve UHC. There is the experience and evidence from different settings that could help to build the knowledge base in Siaya on the effective strategies used to introduce UHC in order to expand health service access, provide financial protection, improve health outcomes and enhance user satisfaction.

How, there seems to be limited committed leadership, low economic growth and a poor health system transformation that could improve governance, financing and healthcare services that are all critical for achieving UHC.

Methodology/ approach

In the recruitment of community members into universal health coverage, U.D.I used various mechanisms including exploiting opportunities presented by the CBO’s integrated health outreaches, targeting hard-to-reach areas, using chiefs barazas, holding road shows and making

door-to-door visits in collaboration with community health volunteers (CHV). U.D.I also carried out informal interviews to seek opinions of household heads on the UHC program.

Results/findings

From the analysis, Siaya presented with inadequate commitment towards promoting UHC including; minimal solidarity in health care financing; cases of dysfunctionality of health care system; minimal opportunities for continuous medical training; quality concerns in terms of drug stock-outs and other medical supplies, dilapidated health infrastructure and inadequate health workers due to incentives for locating in hard-to-reach places, general motivation, incentives, working conditions, access to higher institution of learning for purposes of CME for purposes of advancing in skills and career growth, dysfunctionality of human resource management at the devolved level with cases of low morale, disjointed promotions, salary differentials amongst workers in the same job group .

Implication.

Most counties have mature health systems with UHC but still need to adjust the national policies to county specific to meet changing circumstances.

Conclusions

From the analysis, most effective and sustainable action in the realization of county based UHC as guaranteed in the Constitution is through strengthening dialogue among CSOs, academia, and private sector, to maximize engagement towards implementation through Intersectoral and multi stakeholder approach.

Recommendation

  Raise sufficient revenue to finance health systems and enact legislation to govern the program.

  Establish health insurance subsidy program for the vulnerable, elderly and PWSD.

  Strengthen accountability through developing and monitoring clear, explicit and measurable targets.

  Develop differentiated strategies and address equity and remove barriers to access for the vulnerable.

KEY WORDS.

• NHC- National Health Coverage CSO- Civil Society Organization. CHV- Community Health Volunteers.
• PWSD- People Living with Severe Disability
• CBO- Community Based Organization.