Title

Assessing equitable access to quality Sexual Reproductive Health and Rights

(SRHR) information and services among adolescents and youth (AY) in the six
Coastal Counties of Kenya: A mixed method study.

Funding source/details
The project is funded through the WHO Adolescent and Youth Sexual and Reproductive Health
and Rights (AYSRHR) Technical Assistance (TA) Mechanism. This is a component of the Bill
and Melinda Gates Foundation-supported FP Accelerator Project.
The Mechanism uses a systematic approach to deliver TA countries need for designing,
implementing, monitoring, reviewing, and documenting their AYSRHR programmes, in ways
that are timely; effective; efficient; and, where appropriate, in ways that contribute to
strengthening national capacity. While the focus of the Mechanism is AYSRHR, special
emphasis is placed on improving adolescent and young people’s uptake of contraception.

Collaborating institutions

Pwani University
P.O Box 80108, Kilifi
Dr Flaura Kidere (Principal Investigator (PI)
Email [email protected]

Jumuiya ya Kaunti za Pwani

P.O. BOX 519-80108- Kilifi, Kenya
Dr Anisa Omar-County Executive Committee Member-Department of Gender, Culture,
Social Services and Sports, County Government of Kilifi (Co-Principal Investigator (PI)
Email: [email protected]

Elizabeth Glaser Paediatric AIDS Foundation (TA CONSULTANTS)

Fidelity Insurance Centre, Mezzanine Floor
Waridi Lane, off Mahiga Mairu Avenue, Waiyaki Way, 9Westlands
P.O. Box 13612 – 00800, Nairobi, Kenya

1. Elizabeth A. Okoth (Co-Principal Investigator (PI)

Email: [email protected]
Tel: +254 723111787/ 735111787
2. Job Odoyance Akuno (Co-Principal Investigator (PI)
Technical Lead, Adolescents and Youth
Email: [email protected]
Tel: +254 723 212 435 | Mobile: +254 723 850 599

Aga Khan University – East Africa (TA CONSULTANTS)

3rd Parklands Avenue, PO Box 30270, 00100 Nairobi, Kenya
1. Prof Marleen Temmerman (Co-Principal Investigator (PI)
Email: [email protected],
Tel: +254 203662000; +254 (0) 780 554188; +254 (0) 701 961978

1
Contents

LIST OF ACRONYMS AND ABBREVIATIONS .................................................................................. 3

1. Background ....................................................................................................................................... 4
2. Rationale ........................................................................................................................................... 4
3. Study aim .......................................................................................................................................... 5
4. Methodology ......................................................................................................................................... 6
5. Data Management and Analysis ......................................................................................................... 11
6. Dissemination plan and activities ....................................................................................................... 11
7. Time plan ............................................................................................................................................ 12
8. Ethical Considerations ........................................................................................................................ 12
9. Risks, Benefits, and Adverse Events .................................................................................................. 13
10. Budget ......................................................................................................................................... 14
References ............................................................................................................................................... 18
Appendix A: Facility Site Assessment Checklist ................................................................................... 20
Appendix B: Kenya HMIS SRHR Indicators extraction tool .................................................................. 1
Appendix C: Information sheet and consent form for the Key Informant Interviews (KIIs) .................. 3
Appendix E: Information sheet and consent form for the FGDs: adolescents, parents/guardians,
healthcare stakeholders and sub-county leaders. .................................................................................... 11
Appendix F: Assent form for minors (10-17 years) ............................................................................... 13
Appendix G: FGD guide for healthcare providers and community health volunteers ........................... 20
Appendix H: FGD guide for adolescents and youths............................................................................. 22

2
LIST OF ACRONYMS AND ABBREVIATIONS

AKU- Aga Khan University

ARV- Anti-Retroviral
CHVs- Community Health Volunteers
Co-I – Co-Investigator
COEWC- Centre of Excellence in Women and
Child Health
EGPAF- Elizabeth Glaser Pediatric AIDS
Foundation
FGDs – Focus Group Discussions
GDPR – General Data Protection Regulation
HMIS-Health Management Information System
HIV-Human Immunodeficiency Virus
JKP- Jumuiya Ya Kaunti Za Pwani
KII-Key Informant Interviews
LMICs – Low and Middle-Income Countries
PI – Primary Investigator
PAC- Post Abortion Care
PMTCT- Prevention of Mother to Child Transmission of HIV
PNC- Post Natal Care

3
1. Background

More than a quarter of the world’s population is between the ages of 10 and 24 years, with 86%
living in Low and Middle-Income Countries (LMICs). The World Health Organization (WHO)
defines “adolescents” as individuals between ages 10-19 years old and “youth” as those between
the ages 15-24 years old; together they are referred to as young people. (WHO 2017).
Globally, young people, ages 10-24 years, continue to face challenges in accessing reproductive
health services (Kamau, 2006). These challenges span from limited access to reproductive health
information and services, violence, and exploitation, to extreme hardship when faced with an
unwanted pregnancy (NCPD, 2021).

Adolescent pregnancy is a major concern in Kenya, and part of the coastal counties (Tana River,
Kilifi and Kwale) that make up the Jumuiya za Kaunti ya Pwani (JKP) are among the counties
with relatively high adolescent pregnancy rates. According to the routine health service delivery
data (Kenya DHIS2) 2020, Kwale county has the high rate of adolescent pregnancy (30%) as
compared to the national average of 25%. The coastal block equally has higher rates of unmet
need for contraception for all women of reproductive age (43.9%) compared to 58% nationally.

The Kenya National Commission on Human Rights (KNCHR) report of 2012 indicates that
adolescents in Kenya lack easy access to quality and friendly health care, prevention, and treatment
of Sexually Transmitted Infections(STIs), safe abortion services, antenatal care, and skilled
attendance during delivery, which result in higher rates of maternal and perinatal mortality
(KNCHR, 2012). In Kenya, sexual and reproductive health (SRH) services are offered in health
facilities. These services include counseling, family planning, information on prevention and
treatment of sexually transmitted infections, maternal and child health (MCH) services targeting
pregnant and breastfeeding adolescent and youth, HIV and AIDS services, mental health services,
SRH / sexuality education, cervical cancer screening and vaccination, and basic life skills. The
Ministry of Education also provides age-appropriate Comprehensive Sexuality Education (CSE)

Despite the enactment of evidence-based policies that target access of SRH services by young
people in Kenya, such as the National Adolescent Reproductive health policy 2015 and the
Reproductive Health Policy of 2007, adolescents and youth in Kenya continue to face a high
prevalence of adolescent pregnancy and low access to and use of adolescent sexual reproductive
health services.

2. Rationale

4
Adolescents comprise about 24 percent of Kenya’s population. This large adolescent population
has implications on the country’s health and development agenda as it is likely to put increasing
demands on provision of services. Adolescents require priority attention from all sectors of
government and development partners for the country to be able to realize its Medium-Term
Development Plan (MTDP 2018-2022), Vision 2030, MDGs and Post-2015 Development Agenda.
(Kenya NAS&RHP 2015).

The WHO’s global strategy for women, children, and adolescents’ health (2016-2030) equally
acknowledges the unique health challenges facing young people and their pivotal role as drives of
change (WHO 017). Given the scarcity of scientific data on the effectiveness of services that target
young people in Sub-Saharan Africa in comparison to the number of adolescent SRH challenges
in the region (Denno et.al), this study seeks to generate information on the readiness, availability,
and accessibility of ASRH services in the six coastal counties in Kenya. The information generated
will be used to improve equitable access to quality SRH information and services for adolescents
and youth in the six coastal counties, with a focus on increasing uptake of contraception through
support for strategy development, harmonization and strengthened implementation, and
monitoring and evaluation system.

3. Study aim
To assess equitable access to quality Sexual Reproductive Health and Rights (SRHR)
information and services among adolescents and youth (AY) in the six Coastal Counties of
Kenya

Specific Objectives

• To explore the perspectives and experiences of the young people, health workers,
community health workers, county and sub-county Ministry of health officials and
decision makers on ASRH services.
• To investigate the barriers and facilitators in the six counties that affect access to quality
SRH information and services for the different groups of adolescents and young people
through health service institution assessments.
• To develop an acceptable and affordable regional strategy which includes multi-sectoral
evidence-based interventions/options to increase adolescents and young people’s access
to SRH information and services, and which considers the existing national AYSRH
policy and national school health policy.
• To develop County specific implementation plans, taking into consideration the
uniqueness, and monitoring and evaluation framework for the strategy, that engage
adolescents and young people and a range of relevant sectors (e.g., Departments of
Culture, Gender, Youth, Sports and Social Services, and universities).
• To map stakeholders and resources available in the JKP Counties

5
4. Methodology

4.1 Study site

The study will be carried out in Mombasa, Kwale, Kilifi, Lamu, Tana River and Taita Taveta
Counties, Kenya where the Centre of Excellence in Women and Child Health (CoEWCH) has a
well-established partnership with the Departments of Health, as well as Youth and Sports. These
Counties are six of the 47 semi-autonomous governments in Kenya.

Mombasa is an urban county. The local communities include the Mijikenda, Swahili and Kenyan
Arabs. The Mijikenda is the largest community in Mombasa County making almost 35% of the
total population in the county. The immigrant Kamba community is second largest ethnic
community in the county making almost 30% of the total population of the county. Population
size?

Kwale County has an estimated population of 649,931. Kwale is mainly an inland county, but it
has coastline south of Mombasa. The main ethnic communities in the county include the Digo and
Duruma clans of the larger Mijikenda tribe and also a significant presence of the Kamba tribe. The
Digos are the majority in Msambweni, Lunga Lunga and Matuga while the Durumas are the
dominant in Kinango. Most Kambas are found in Kinango and Lunga Lunga with a significant
population in Msambweni.Other significant immigrant communities include the Luo, Luhya, and
Somali communities.

Kilifi County is largely a rural area on the Kenyan Coast, 60 km north of Mombasa County with
a population of 1,453,787 in 2019. Fifty-two per cent of the population are female and 47% are 15
years of age and below. The County has been organised into four administrative units comprising
7 sub counties, 35 wards, 58 locations, and 181 sub locations. The residents of Kilifi County are
mainly Mijikenda, a Bantu group of nine tribes with Giriama (45%), Chonyi (33%), and Kauma
(11%) dominating. The main economic activities are subsistence farming and fishing and the
average income per person is roughly 700 Kenyan Shillings (US$8) per month. Approximately
55% of the population in Kilifi County is regarded as of low socioeconomic status, with 62% of
the population said to have low literacy levels. The health system service delivery in the county is
mainly made up 140 public facilities and 148 private facilities including faith-based organisations.

Lamu County is located in the Northern Coast of Kenya and borders Tana River County in the
southwest, Garissa County to the north, Republic of Somalia to the northeast and the Indian
Ocean to the South. It lies 1° 40’ and 2° 30’ south and longitude 40° 15’ and 40° 38’ east. The
county has a land surface of 6,273.1 km that include the mainland and over 65 islands that form
the Lamu Archipelago. The county has 2 constituencies namely Lamu West and Lamu East. These

6
two also consist of the two districts referred to as the sub-counties in Lamu County. Lamu West
has Amu Mkomani, Shela, Hindi, Mkunumbi, Hongwe, Bahari and Witu Divisions while Lamu
East has Faza, Basuba and Kiunga divisions. There are 10 wards, 23 locations, and 38 sub-
locations in the county. The main economic activities in the county include crop production,
livestock production, fisheries, tourism and mining, most notably quarrying. Among the challenges
facing Lamu is population growth owing to migration into Lamu from other parts of the country,
fuelled partly by the anticipated opportunities accruing from the Lamu Port South Sudan-Ethiopia
Transport (LAPSSET) Corridor. Other challenges include landlessness and poor land
management, insufficient social services such as healthcare and education, inadequate supply of
piped and fresh water, under-developed infrastructure, and food insecurity. Population size?

Tana River is named after the river Tana. It has an area of 38,437 square kilometres (14,841 sq mi)
and a population of 315,943. The major ethnic groups are the Somalis, Pokomo (many of whom
are farmers), the Orma people, and the Wardey The county is generally dry and prone to drought.
Conflicts have occurred between farmers and other people over access to water. Flooding is also
a regular problem, caused by heavy rainfall in upstream areas of the Tana River. Tana River
County presents an interesting case of the nexus between conflict and food security. A recent
survey prepared by ALMRP, Tana River District and presented to the Tana River District Steering
Group (2004) found that the county is 79% food insecure and with an incidence of poverty at 62%
(Interim Poverty Strategy Paper (I-PSP), 2000–2003, Kenya). Tana River County comprises
several areas of forest, woodland and grassland which are minor centres of endemism. Despite the
apparent adequate natural resources, the region remains marginalised from the rest of the country.
Population size?

Taita–Taveta a county lies approximately 140 km northwest of Mombasa and 380 km southeast
of Nairobi. The County headquarters are located in Mwatate, which is central to the county.The
population of the county was 340,671 persons according to the 2019 national census, with
population densities ranging from 14 persons per km2 to more than 117 persons per km2. This is
due to the varied rainfall and terrain with the lower zones receiving an average 440 mm of rain per
annum and the highland areas receiving up to 1,900 mm of rain. The county ranges in altitude from
500 m above sea level to 2,228 m at Vuria Peak, which is the county's highest point. Population
size?

4.2 Study design and data collection

This is a mixed method research study. Both qualitative and quantitative data will be collected to
address the study’s objectives.

Qualitative data will be collected using three (3) methods, namely:

7
Literature / desk review: Detailed review of grey literature on Coastal Counties Adolescent &
Youth ASRHR related policy /strategy documents, publications, evaluation / program technical
reports etc.

Key informant interviews (KIIs) targeting: JKP Reps (CEO, Chair health sector working group/
other), Reproductive health coordinators, HCWs, Youth Champions, Reps of other line ministries
i.e. from Youth & Gender and Ministry of Education and key ASRHR implementing partners.

Where do we hope to get data on stakeholders? Resource mobilization? Literature/desk review or

KIIs?

Focus group discussions (FGD): with young people (AYP) aged 10-14, 15-19, 20-24;
professional/related stakeholders (incl. duty-bearers); front-line service providers/HCWs.

The tools for the FGDs and KII’s are based on content from peer reviewed journals, other
published and anecdotal evidence from the Coastal counties. Observance of Covid-19 measures
will be in place for these procedures as required, social distancing for focus groups. The domains
of interest in the tools will explore the reasons for and its variation per county, the roles of
stakeholders, challenges faced, support and resources needed, consequences of barriers to
AYSRHR and recommendations.

Quantitative data will be collected through the health facility AYSRHR assessment (4 facilities in
each county will be assessed), the county health services assessment with the Malawi health
service institution Survey tool -used by the Malawi Ministry of Health as part of WHO TA
Mechanism. The tool has been validated, edited, and will be adopted to the local JKP context.
Secondary data extraction from the routine Kenya Health Management Information System
(KHMIS) data will be collected from health facilities and health facility assessment checklist. The
KHMIS dataset of young people health services utilization will include the following variables at
county level: Antenatal visits, family planning visits institutional deliveries; postnatal care (PNC)
visits, post abortion care (PAC) services, new and continuing HIV-Anti-Retroviral (ARV) clients;
and prevention of mother to child transmission (PMTCT) of HIV services.

The study participants will include:

• Adolescents, male and female (aged 10-14)

• Adolescents, male and female in-school (aged 15-19)
• Youths’ male and female (aged 15-24)
• Health Care Providers

8
 • Community Health Volunteers (CHVs)
• JKP Reps (CEO, Chair health sector working group/ other
• Reproductive Health Coordinators
• Youth Champions
• Reps of other line ministries i.e., from Youth and Gender and MoE
• Key AYSRHR implementing partners representatives

Eligibility Criteria

Inclusion criteria

• Adolescent males and females aged 10 – 19 years

• Youths aged 20-24
• Residents of the six (6) counties for more than one year
• Willingness to take part in the study by giving informed consent or assent
• Health Care Workers and CHVs working within the six counties
• Government Ministry officials of Health, Ministry of Education, Ministry of Youth
and Gender

Exclusion criteria

• Children below 10 years

• Non-resident of the six (6) counties for more than one year.

4.3 Study sampling and recruitment

The study population is outlined in table 1 below and will comprise:

a) 6 focus group discussions per county (2 for each age-group and one each for the professional,
related stakeholders and frontline Health Workers)
b) A total of 252 participants for FGDs and 30 participants will be selected purposefully to
participate in the study.
c) Between 4 to 6 KIIs per county

Table 1: Participants for FGDs and KIIs

9
Category of Method of Method of Number of participants
participants participant data
recruitment collection

Per Per Total (6)

Group County Counties
1. Adolescents (aged CHVs 2 FGDs (male 7 14 84
10-14 years) and female

2. Adolescents out of Community 2 FGDs (male 7 14 84

school (aged 15-19) Health and female)
Volunteers
3. Youths aged 20-24 From CHVs 1 FGDs (male 7 7 42
and female)
4. Professional and Sub-county 1FGD & KIIs 7 7 42
Related Stakeholders Health
and frontline health leadership
service providers

5. JKP Reps (CEO, JKP KIIs 1 1 6

Chair Health Care
working group)

6. Health Care Workers HCWs KIIs 1 1 6

7. Reproductive Health Su-county KIIs 1 1 6

Coordinators Health
Leadership
8. Youth Champions CHVs KIIs 1 1 6

9. Reps of other line Youth & KIIs 1 1 6

ministries Gender

Total Participants
( FGD 252 , KIIs 30)

10
5. Data Management and Analysis

Qualitative study data will be digitally recorded, then transcribed and translated. The data will be
collected by a team of trained qualitative interviewers. Data entry and quality of data will be
ensured by the research supervisors. Recurring themes and patterns in the data transcripts will be
identified. Codes will be generated iteratively with input from questions in the interview guides
and emergent themes. Coding and analysis will be facilitated by qualitative analysis computer
software such as NVivo. To verify accuracy and completeness of the data, transcripts will be
compared against audio recordings and hand recordings. To ensure reliability of the coding, two
researchers will independently review the coding framework and identified themes and patterns.
The researchers will then meet to compare their interpretation of the data and reach agreement on
final data analysis. Quotations from the study participants will be used to characterize issues and
themes that emerged from the assessment. Descriptive statistics will be used to analyse the
readiness, availability, accessibility, and affordability of the county health services and the health
facilities to offer ASRH services. The multi-year trend in health services utilization among the
young people will be analyse using the HMIS secondary data on the outcome variables of interest
for a five-year period i.e., from January 2017 through May 2022.

6. Dissemination plan and activities

The results of this study will be disseminated to the six counties and sub-county stakeholders
through meetings with the research team and a written report including policy briefs. The findings
will also be shared with stakeholders. Through peer-reviewed publications and fora such as
conferences, the findings will be made available to a wider audience and will cover the main
themes elicited and their implications for policy and practice. Target audiences include county and
national policymakers, healthcare professionals and professional associations and the public in
general.

11
7. Time plan

Actions 2021/22

Nov Dec Jan Feb Mar April May

Literature review & tools

development

Ethical approval

Stakeholder FGDs and Interviews

Transcription

Data analysis and write-up

Dissemination and report writing

8. Ethical Considerations

Ethical and scientific approval will be sought from the Pwani University Ethics Review Committee
and National Commission for Science, Technology and Innovation (NACOSTI). Administrative
permission to conduct the study will be obtained from the six County Governments, Department
of Health, Gender, and Department of Education, and other relevant authorities.

In this study, the following human subject’s considerations will be observed.

Do no harm

This study involves procedures that will not physically harm the participants. Study participants
will be provided with all the information about the study and will be allowed to voluntarily make
an informed choice regarding their participation including information about Covid-19 and
measures to address this risk. Initial permission to conduct the study in the County and healthcare
facilities will be obtained from County department of Health research Coordinating unit. At facility
level, permission will be sought from the in-charges.

Participation in the evaluation

12
Participation will be voluntary, and participants will be free to exit the interviews at any point in
time without any consequences.

Informed consent

The participants who will have been selected to take part in the research will have the work
explained to them and a written informed consent will be obtained in English or Kiswahili from
all participants prior to data collection. Person’s incapable or unwilling to consent will be
excluded. The informed consent documents will describe the purpose of the study, the procedures
to be followed, and the risks and benefits of participation. A copy of the consent will be given to
each participant in the official language chosen. The process of seeking informed consent will
involve presenting a detailed verbal description of the study as it is described on the printed,
approved consent form. The interviewer will emphasize that participation is voluntary, and that
participants can refuse to answer any question or discontinue participation at any time without
penalty. Participants will be informed of the procedures for ensuring confidentiality, including use
of unique non-personally identifying identification numbers instead of names on research materials
and maintenance of data in locked computer databases and locked filing cabinets in locked rooms.
Minors will be requested to give their consent and consent will be obtained from their
parent/guardian simultaneously.

Confidentiality of information

All information provided by participants will be treated with utmost confidentiality. Individual
names and any other identifying information will not be revealed in reports and will not be shared
with persons not directly involved in this study. All interview scripts will be assigned unique codes
in place of participants’ names. All interview documents, audio recordings and transcripts will be
securely stored in password-protected computers that will only be accessed by the investigators.
Any other hard copy materials that contain information from interviews e.g. field notebooks and
printed transcripts will be stored in locked cabinets in the research coordinating unit office, located
in Kilifi County Department of Health headquarters and will only be accessed by the study
investigators. Audio recordings will be kept until they have been transcribed and data analysis and
write up is complete and thereafter destroyed as per the MOH recommendations for duration of
storage for data.

9. Risks, Benefits, and Adverse Events

Nature and Degree of Risk

The risks of the proposed study to participants are limited. The community and the health facility
personnel may feel stress because of the study. The information collected through verbal

13
interviews, and record reviews could reflect well or poorly on the performance of the facility.
Some of the interviewees may feel stress associated with the time commitment involved in
participating in the study, which may divert them from regular job duties.

Minimization of Risk

To mitigate the risk to community members and health facility personnel the study organizers will
take the following measures: (i) not recording individual names on audio tapes and interview
transcripts; (ii) using serial codes for facilities within a password-protected file stored separately
from the collected data; (iii) holding individual interviews in a private space; (iv) storing all hard-
copy data collection forms in locked cabinets in the research offices, all six coastal counties; (v)
storing all digital files (including audio files) on password-protected computers, with access
permissions granted only to the evaluation team; (vi) destroying digital files from devices used to
temporarily store or transfer data files, once the transfer is complete; and (vii) assuring that any
publicly released report or presentation of the study findings sufficiently protects confidentiality
of individual facilities and informants.

Benefits of the study

Participants will benefit from contributing to further understanding young people’s equitable
access to sexual reproductive health information in the six counties and what can be done. They
may well also benefit from talking to others in the FGDs and with the interviewer (IDIs) about
best practice in mitigating such pregnancies. The scientific community will benefit from knowing
why large variations in adolescent pregnancy rates exist and insights into implementation science
aspects at a local level – from a LMIC setting.

10. Budget

Quantity/ Frequency
Activity Item Rate Total
# of units e.g. days

1. Proposal writing and

approval
Airtime for the project
2 2000 3 12000
Airtime team
Airtime for MoH
6 2000 6 72000
mobilisation during FGD
6 3000 2 36000
Mobilisation 36 FGDs in 6 counties
Subtotal
120,000
KES

14
 USD 1100.9

2. Training and meeting

Photocopy and printing 1 1 8000 8000
materials
Pens 1 1 1600 1600
Cartridge 1 9000 1 9000
20,000
Recorders and battery 2 1 40000
.00
MRO admin cost, staff -
3. Admin Costs (MRO/Nbi Eunice W; Grace W; Irene 11417
1 1 114175.4
eligible) K. Assumes for a 2- 5.4
month period
Subtotal 172,775.
KES 4
USD 1585.1
4. FGD data collection FGD participants (36 with
1 500 360 180000
costs 10 pax; allowance)
FGD Transcription (mixed
2,500.
5. Qualitative analysis language transcript cost @ 1 36 90000
00
2500 KES).
FGD translation (15 pages
15 500 30 0
@ 500KES each)
Cleaning and coding
1 2,500 36 90000
recordings @ 2500KES
Report writing ($262;
1 28558 7 199906
qualitative expertise/day)
6. Tools translation e.g.,
Translation 12 500 1 6000
survey tool
Subtotal
565,906
KES

USD 5191.8
In Person FGD & Site
Visits: visits by 2 AKU
staff to each of the 4
counties including
7. CoEWCH team travel transfers, 3 nights
logistics accommodation/4 days.
Note: assumes that 4
counties will need
overnight stay others are
day visits

15
 Lunch & Dinner while
conducting FGDs in
8 3000 4 96000
(Kwale, Taita Taveta,
Lunch, Dinner and water Tana River, Lamu)
during FGDs Lunch while conducting
FGDs for 2 Counties
8 2000 2 32000
(Kilifi, Mombasa) over 4
days
Accommodation while in
Accommodation during FGDs the 4 Counties (Kwale,
6 10000 4 240000
for further Counties Taita Taveta, Tana River,
Lamu)
If using AKU vehicle add
lunches and
accommodation
Flight from Mombasa to
2 11000 1 22000
Travel to Lamu by air for 2 Lamu
Airport transfers 2 2500 2 10000
Subtotal
400,000
KES
USD 3669.7
6 counties x 3 pax = 18
KII Data collection costs pax (2line ministry
officials + 1IP staff +
26 1 12.5 325
Airtime for virtual KIIs 2JKP official + 6
mobilizers per county

6 counties x KII & health

Printing: KII guides & Site facility AYSRH services
6 1 5 30
assessment tools assessment

8 days accom. i.e. 2 transit

days @Msa pre-post field
visit +
Accommodation & MIE to
2days/Counties/staff
conduct in-person KIIs &
(@$75x8)=600 + travel 4 1 750 3,000
health facility AYSRH
days MIE @$30+6full
services assessment
days MIE
(@$20x6)=$120=750

Air travel to conduct in-person Flight & airport transfer

KIIs & health facility AYSRH for @$215x5pax 5 1 215 1,075
services assessment
Subtotal
4,430
USD
Costs for organizing the
methodology meeting
Other cost 2 10 2 40
(transportation,
accommodation, per diem,

16
 event space, and printing)
for virtual and later
physical meeting day
before inception

Research permit
1 1 200 200
(NACOSTI
Subtotal 240.0
8. Staff Cost Phase 1 2397.0

Phase 2 4064.0

Phase 3 7347.0
Subtotal 13808.0

Vehicle costs (JKP part-

1 200 2 400.0
covering this cost)

Grand total 25995.5

Contingency 908.5

TOTAL (Maximum) 31,334

17
References
1. National Adolescent Sexual and Reproductive Health Policy [Internet] 2015
https://www.popcouncil.org/uploads/pdfs/2015STEPUP_KenyaNationalAdolSRHPolicy.pd
f

2. National Guidelines for provision of Adolescent and Youth Friendly Services in Kenya. 2nd
Edition 2016 [internet] https://tclurbanhealth.org/wp-content/uploads/2018/03/AYFS-
Guidelines-2016.pdf

3. AFIDEP, Teen Pregnancy in Kenya, Verifying the data and facts 26 June 2020: by
Elizabeth Kahurani [internet] https://www.afidep.org/newsrelease-teen-pregnancy-in-Keny-
verifying-the-data-and-the-facts/

4. The DHS Program - Kenya: Standard DHS, 2014 [Internet]. [cited 2020 Apr 30]. Available
from: https://www.dhsprogram.com/what-we-do/survey/survey-display-451.cfm

5. [Internet] https:www.cskenya.org/2017/11/24/adolescent-health-symposium-youth-
communique

6. AFIDEP Policy Document. Adolescents (age 10-19) Presenting with Pregnancy at Health
Facilities. @6 June 2020 [Internet]

7. Ssewanyana D, Mwangala PN, Marsh V, Jao I, van Baar A, Newton CR, et al. Young
people’s and stakeholders’ perspectives of adolescent sexual risk behavior in Kilifi County,
Kenya: A qualitative study. J Health Psychol. 2018 Feb;23(2):188–205.

8. Teenage Pregnancy in Kenya. Gloom and doom in Education and Health, by Glory Ngatha,
26 February 2021 Muturi [Internet] available https:ncpd.go.ke/2021/02/26/teenage-
pregnancy-in-kenya

9. Evaluating the Effectiveness of a Combined Approach to Improved Utilization of

Adolescent Sexual Reproductive Health Services in Kenya y L.Mutea, Susan Ontiri, Peter
Gichangi published 29 October 2019

10. Kilifi County HIV & AIDS Strategic Plan [Internet]. National AIDS Control Council. 2017
[cited 2020 Apr 30]. Available on: https://nacc.or.ke/mdocs-posts/kilifi-county-hiv-aids-
strategic-plan/

11. The National Adolescent Sexual Reproductive Health Policy Implementation Framework
2017-2021 available on https://www.prb.org/wp-content/uploads/2010/06/NATIONAL-
ADOLESCENT-SEXUAL-REPRODUCTIVE-HEALTH-IMPLELMENTATION-
FRAMEWORK-21.pdf

12. Pantoja T, Opiyo N, Lewin S, Paulsen E, Ciapponi A, Wiysonge CS, et al. Implementation
strategies for health systems in low-income countries: an overview of systematic reviews.
Cochrane Database Syst Rev. 2017 12;9:CD011086.

18
13. 2019 Kenya Population and Housing Census Volume I: Population by County and Sub-
County [Internet]. Kenya National Bureau of Statistics. [cited 2020 May 5]. Available
from: https://www.knbs.or.ke/?wpdmpro=2019-kenya-population-and-housing-census-
volume-i-population-by-county-and-sub-county

14. World Health Organization Adolescent Health and development:

http://searo.who.Int/entity/child-adolescent/topics/adolescent_health/en(2017) Accessed
November 2021

15. Denno DM, Hoopes AJ, Chandra-Mouli V. Effectives Strategies to provide adolescent
sexual and reproductive health services and to increase demand and community support. J.
Adolesce Health. 2015 Article: Google Scholar

16. Kenya National Bureau of Statistics, Ministry of Health/Kenya. Kenya Medical Research
Institute, National Council for Population and Development/Kenya. Kenya Demographic
and Health Survey 2014. Rockville: Kenya National Bureau of Statistics and ICF; 2015

17. Kenya National Bureau of Statistics, httpss://www.citypopulation.de - Coast

19
Appendix A: Facility Site Assessment Checklist

Study title: Assessing equitable access to Quality Sexual Reproductive Health Rights (SRHR) and services among adolescents and youth (AY) in the six Coastal C

Health Facility Sites Assessment Checklist for Adolescents and Youth Friendly

Objective: To assess health facilities for adolescents and youth friendly SRHR (AYSRHR) service provision. This is towards supporting JKP to Improve equit
contraception through support for strategy development, harmonization an

WHO describes Youth Friendly Health Services (YFHS) as; “Services that are accessible, acceptable & appropriate for adolescents. They are in the right place
effective, safe and affordable. They meet the individual needs of young people who return when they need to & recommend these services to friends.”

The Kenya Guidelines for provision of Adolescent and Youth Friendly Services state that: The service providers should be non-judgemental in their dealings w
and enable adolescents and youth to obtain the health services they need. These services should be appealing to adolescents and youth and respectful of them
obtain the health services they need. Community members should support the provision of

Date:_________________________ Start Time:___________________________________

Facility Details
Facility County
Facility Name:
Facility Level (tick 1): Level 2
Level 3

20
Manning agency: GoK
Other (Specify)

Facility In-charge: Title/ Cadre____________________________________

AYP Catchment population

Under 15years
10-14years (if data is available)
15-19years (if data is available)
15-24years

Service Charge
Are AYSRHR Services provided freely? (Y/N)
What costs are incurred (if any) and for which
services? List the AYSRH services provided at a cost
Service 1:
Service 2:
Service 3:

Kindly tick against AYSRHR services provided at the facility (includes provision of services / promotion / education or counseling provided at the Facility):

Modern Contraceptives (FP) i.e. long-acting reversible contraception including implant or intra uterine device (IUD); hormonal contraception including pill, e
contraception, and depo provera injection; vaginal ring; male and female condoms; permanent contraception such as vasectomy and tubal ligation

Sexually transmitted infections(STIs) screening

· STI & treatment/ management
· HIV and AIDS services
21
· Nutrition services
· SGBV: Sexual Abuse prevention & response
· Maternal and neonatal health care for pregnant & breastfeeding adolescent girls & young women
· Adolescent growth and development monitoring
· Voluntary medical male Circumcision (VMMC)
. Cervical cancer Screening
· HPV vaccine
· Mental Health and Psychosocial support
· Drug and Substance use /abuse screening and response
· Comprehensive Sexuality Education
· Youth recreational materials
· ASRH Rights education
. Community outreaches (specify specific services offered during outreaches)
Others (specify)

ASRHR Service Providers & Training

Cadre & No. No. Trained on Adolescent & Youth Friendly Health Services Provision
Medical Officer
Clinical Officer
Nursing Officer
Laboratory Technologist
Health Records Officer
Nutrition
Pharmacists
Youth Champions / Peer educators / Peer
Mentors
HTC Counselors / HTS Providers
22
Social Workers
Community Health Volunteers
Others Specify

What are the facility / operating hours? ___________________________________________________

Does the facility have flexy time for adolescents and youth (e.g. early morning, late evening, weekends?

Does facility have support from donor(s) or partner(s)? If yes Name partner(s) / donor(s) and specify support
Donor
Support provided
Partner
Support provided

Standard Means of Verification

Standard 1: Health Services are provided to Young People according to existing policies, strategies and guidelines at all service delivery points

Does the facility have key ASRHR

policies/strategies, guidelines for provision of
quality adolescents & youth friendly health Observe availability of key National or County ASRH documents e.g. SRH policy, YFHS Strategy National St
services? youth friendly services, GBV guideline, KASF for HIV, etc (other)

Are all service providers and young people

oriented on existing policy documents that
support provision of AYFHS Check for orientation reports & question service providers & AY about being oriented.

Does the facility have adolescent specific

ASRHR SOPs Check availability of SOPs for various ASRHR services with specified age, gender, population specific etc

23
Standard 2: Young People are able to receive health services including preventive, promotive, curative and rehabilitative services according to their needs, c
quality of health services provided to young people regardless of one`s sex, race, education, culture, religion, economic, marital and physical status)

Is scheduled days/ time, location and scope of

youth friendly health services provided by the
Observe, interview or question how this is communicated to the young people, other clients and the community
facility clearly visible and communicated to
the target population & the community?

Is there availability of adequate infrastructure Physical inspection / Check for adequate organised space with privacy within the facility for provision of YFH
to provide AYFHS an AY express health room/ a Youth corner / a tent for ASHR services etc

Does the facility provide appropriate /

minimum package of Adolescents / youth
friendly SRHR services?
i.e. Provision of a package of AYSRHR Check supervision reports if any, and also interview & observe if the facility provides: (1) Health education /
information, counselling, Counseling activities & has IEC materials on SRH. The materials should be available to read & or takeaway
diagnostic, treatment and care services that the facility provides SRH services as per age/ gender and need, and targeted to AY populations; and (3) If the
fulfil the needs of all adolescents and youth. appropriate Referral and follow up
Services are either all provided in the facility,
or through referral linkages, networks and
outreach

Are all young people able to obtain health

information (including SRH and HIV) relevant
to their needs, circumstances and stage of Observe if service delivery points have adequate information, education and communication materials that are
development understand and appropriate for young people. If IEC materials are displayed

24
Is there a staff responsible for ASRH in your
site Check responsibilities
Does facility / the AYSRH service delivery
point have flexible timing / days for school/
college/ working adolescents Check for weekend, late evening, early morning or holidays schedules. Check for fast tracking for adolescents

Standard 3: Engagement of Adolescents and Youth in Program Design, Implementation & Monitoring
Does the facility offer opportunities for
meaningful engagement with and seek young
people’s opinion during design,
implementation & monitoring of ASRH
services ? Check for reports or any documentation to support. Ask any youth chamion / peer educator at the facility
Does the facility reach out to female and male
adolescents equally for gender sensitive
considerations? Check for reports or any documentation to support. Any quotes etc
Is there feedback mechanism to establish
adolescents satisfaction with the services
provided? Check for client exit forms / interviews, suggestion box, feedback systems
Does the facility seek feedback from
parents/caregivers of adolescents? Check for reports or any documentation to support. Any quotes etc
Are adolescents & youth involved as peer /
near-peer service providers? (18 to 24 year
olds) Observe; check records of service providers

Standard 4 : Service providers in the Service delivery points have the required knowledge, skills and positive attitudes to effectively provide YFHS
Are all service providers who are directly
involved in the provision of services to AY, Check the proportion of health workers trained in YFHS. Check training report if available, Ask about the curric
trained in the provision of YFHS including used
their health rights?
Are all support staff in the Adolescents / youth
service delivery points (SDPs) & other key
people oriented in AYFHs? Check for orientation report & monitoring report

25
Is there is a structured mentorship/supportive
supervision approach for ASRHR service Check for mentorship/supervision tools e.g. observation tool, mentorship SOP, supervision book documentatio
providers mentorship
Standard 5: Health information related to Young People is collected, analysed and utilised in decision making at all levels. Confidentiality of Clients Recor
Is the facility profile and report for young
people disaggregated by appropriate age-
bands i.e. 10-14/ 15-19/ 20-24yrs, and by sex Check facility records / or on the wall

Documented reports on good / best practices. Dissemination reports / materials

Is there documentation of good / best practices
and lessons learned on AYFHS

Monitoring and evaluation Systems are in

place to support provision of AYFHS Check if all SRH services are documented, data analysed and reported through DHIS, plus records are on site
Is data that is collected utilized to improve
service delivery? Check for talking walls, graphs, charts, targets etc.
Is there a lockable place(s) for clients
records/records are kept confidentially Observe, ask about rights to access information

Does the facility have EMR system in place Observe and ask
Does the facility have EMR back up system for
records Observe and ask

Any other observations & comments:

Time
Ended:___________________________
Key Staff consulted:
Cadre:________________________________
Cadre:________________________________
Cadre:________________________________

26
Appendix B: Kenya HMIS SRHR Indicators extraction tool

Study title: Assessing equitable access to Quality Sexual Reproductive Health Rights (SRHR) and services among
adolescents and youth (AY) in the six Coastal Counties of Kenya

S# Ind # Indicator
MOH 711 – Section A: ANC/PMCT
x A14 No. of adolescents (10-14 years) presenting with pregnancy at 1st ANC visit
x A15 No. of adolescents (15-19 years) presenting with pregnancy at 1st ANC visit
No. of youth (20-24 years) presenting with pregnancy at 1st ANC visit (data available
till Sept 2021)
MOH 711 – Section B: Maternity and Delivery
x B18 No. of adolescents (10-19YRS) Maternal Deaths
No. of maternal deaths 15-19 years
No. of maternal deaths 20-24 years – data incomplete
Deliveries by adolescents (10-19 yrs) – no findings
MOH 711 – Section D: Family planning
x D13 Total adolescent clients (10-14 yrs) receiving FP services
x D14 Total adolescent clients (15-19 yrs) receiving FP services
D15 Total youth clients (20-24 yrs) receiving FP services
MOH 711 – Section E: PAC
x E1 Adolescent (10-19yrs) accessing PAC services – data available till Sept 2021
youth (20-24) yrs receiving PAC services – data only available from July 2020-Sept
2021
MOH – HIV/AIDS reporting monthly summary
MOH 731 - HIV Counselling and Testing program (data available till July 2020)
15-24 yrs receiving HIV + results (female)
15 yrs receiving HIV + results (female)
15-24 yrs receiving HIV + results (male)
15 yrs receiving HIV + results (male)
MOH 515 – CHEW monthly summary
(Include name of the community with this data)
1
S# Ind # Indicator
24 Number of under-age pregnancies (under 18 years) – data available till July 2020
Number of women (15-49yrs) provided with Family Planning commodities – data
25
available till July 2020

2
Appendix C: Information sheet and consent form for the Key Informant Interviews (KIIs)

Study Title Assessing equitable access to quality sexual and reproductive health
(SRH) information and services among adolescents and youth (AY),
in the six Coastal Counties of Kenya
Principal
Investigators
Collaborators

Written Informed Consent Form for policy makers, implementers, and youth

This Informed Consent Form has two parts:

• Information Sheet (to share information about the study with you)
• Certificate of Consent (for signatures if you choose to participate)

You will be offered a copy of the full Informed Consent Form to keep if you wish.

Part I: Information Sheet

Introduction
The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) and the Aga Khan University working in
collaboration with Jumuiya ya Kaunti za Pwani (JKP) and the Ministry of Health are doing a study on the
access to quality sexual and reproductive health (SRH) information and services among adolescents and youth
within coastal Kenya, with a focus on increasing contraception uptake through strategy development for
improved services. We are asking you to take part in this study since you are involved in policy development
and/or implementation about adolescent and youth sexual reproductive health and rights (AYSRHR). We
would like to give you more details about this study that will help you decide whether you want to take part. If
you choose not to take part, it is okay.

Why are we doing this study?

We are doing this study so that we can understand how the quality of adolescent and youth sexual and
reproductive health information and services can be improved. We want to know more about current policies,
programing and practice on AYSRHR, barriers and facilitators to implementation and what can be done to
improve the services.

Who can participate?

We will be talking to several policy makers and policy implementers who are engaged in the development and
implementation of policies specific to adolescent and youth sexual and reproductive health and rights as well as
youth champions. We will also have focus group discussions with youth and adolescents, healthcare workers
and other stakeholders involved in adolescent and youth sexual and reproductive health matters.

Voluntary participation

3
We would like you to know that your participation in this study is voluntary. You do not have to answer any
question that you do not want to. You can also leave the discussion at any time. If you decide not to take part or
leave early, this will not affect your job or any health care you receive.

What is involved in this study?

If you agree to join the study, we will interview you at a time of your convenience. We will first ask a few
questions about your background. Then we shall discuss about the current policies in place and interventions
regarding adolescent and youth sexual and reproductive health, your experience and your role in this, as well as
suggestions for how to improve. The discussion will take about one hour. There are no right or wrong answers.
Please feel free to say what you think. We will take notes and audio record the discussion. This will help us make
sure that we correctly collect all the information you give us.

How long will the study last?

The study will last about one year, but your participation will just be for this one time.

What are the risks?

Before you agree to take part in this study, you should know there may be minor risks to you if you take part.
There is a small chance that someone could overhear our interview or accidently learn information from study
documents. The study staff take your privacy very seriously and will do everything that we can to protect the
information you tell me.

What are the benefits?

You will not get any direct benefit from taking part in this study. However, the information you provide will be
used to help improve access to reproductive health information and services among adolescents and youth within
coastal Kenya.

How will we protect your information and maintain confidentiality?

We will talk in a private place to protect your privacy. We will not use your name on the recording. You will also
be given a study number that will be written on the form we use to record your answers. Your name will not be
written in any report about this study. We will record your name and contact information on a separate form.
Information contained on study forms and in audio recordings will be kept locked up in cabinets or locked on a
computer for this study with a password that only the study team can access. The interview recording will be
destroyed at the end of the study.

What will happen with the results?

Results will be used to develop a coastal regional strategy and county specific implementation plans. This will
provide guidelines to inform how adolescent and youth sexual and reproductive health services and rights can be
better tailored to suit their needs.

Compensation
Your taking part is voluntary. We thank you for giving us your time. We are not providing compensation for
taking part in the study. For participants who may be interviewed virtually, we shall provide data bundles for
participating in the study.

4
Who can I contact?
If you have any questions, you can ask me now. If you have questions later, you may contact the person in
charge of this study, Dr. Flaura Kidere, or another member of our team. If you have questions about your rights
as a study subject, you may contact:

Pwani University Ethics Research Committee

P.O Box 195-80108
Tel: +254 725 916145
+254 776 368946
Kilifi, Kenya

Do you have any questions at this time?

Yes No
Question-
_________________________________________________________________________________________
_________________________________________________________________________________________
____________________________________________________________________
Part II: Certificate of Consent
Do you agree to participate and have this discussion recorded? Yes No

Participant: I have read the above information, or it has been read to me. I have had the opportunity to ask
questions about it and any questions I have asked have been answered to my satisfaction. I consent voluntarily to
participate in this study.
Print name of
Subject

5
 Signature of Subject

DD/MM/YYYY

Statement by the person taking consent:

I confirm that the participant was given an opportunity to ask questions about the study, and all the questions
asked have been answered correctly and to the best of my ability. I confirm that the individual has not been
coerced into giving consent, and the consent for them to take part in the study has been given freely and
voluntarily. S/he has agreed the discussion may be audio-recorded.
Print name of person
taking the consent
Signature of person
taking the consent

DD/MM/YYYY

6
Appendix D: KII

Assessing equitable access to quality sexual and reproductive health and rights (SRHR) information and
services among adolescents and youth (AY), in the six Coastal Counties of Kenya.

Interview Date: __ __/ __ __/ 2 0 __ __

Interviewer ID □□

Interview Location: County____________________________________________

INTRODUCTION

I am going to start with introductory questions about your Job and role in AYSRHR matters. I will then continue
with other questions where you can talk freely about what you know, your opinion, perspective and experiences
on matters pertaining to access of SRH services and uptake of contraception among adolescents and youth in the
coastal region. I will take notes and audio record so that the information is available to review to ensure that it is
collected accurately. I will not use your name during the interview so it will not be connected to this interview in
any way. You do not have to answer any questions that you do not want to. We value your information and
would like to hear more from you

Instruction: The following questions are a guide. The interviewer should phrase the questions in a way that
works best for the participant

Demographic Questions

Sector/Department

JKP Official □
County/Sub-County MoH □
Other GoK line ministry □
Health Care Worker □
Youth Champion □
ASRHR Implementing partner □

Gender Male □
Female □

Age band: 18-24yrs □ 25 – 35yrs □ Above 35yrs □

7
Turn on the audio recorder now and indicate the start time for the interview:

Interview start time: __ __ hr __ __ min (to be indicated before start of questioning)

1. What role do you play in matters AYSRHR (adolescents and youth sexual reproductive health
and rights)?

2. What are the main AYSRHR priorities in the Coast Region?

What about in the County specifically? (ask this if participant is at county level & not regional /
JKP)

3. What policy interventions have been put in place for the implementation of AYSRHR services
in the county/ies or coast region? (question 3 is for GoK officials only)

4. What interventions have been put in place for the implementation of AYSRHR services at
program / service delivery level?
(question 4 is for HCW/ Youth Champion/ Program partners)

4b) . How about interventions to improve uptake of contraception among adolescents and youth
(AY) in the coastal region? (probe for policy level, program level, service delivery level, structural
interventions etc)

5. Do the interventions you’ve mentioned above ensure that all adolescents and youth obtain the
health services they need without discrimination?

(Including AY of all ages, gender, religious affiliations, those living with HIV, those living with
disability, in-school, sexually active, exploited adolescents, key populations, hard to reach
adolescents and youth, resource constrained and those with any other characteristics that may
put them at a disadvantage will receive the full range of health services they require)

6. Do the interventions you’ve mentioned above ensure quality of AYSRHR services or not?

i.e. Are the interventions safe, effective, timely, client centered, ensure meaningful AY engagement?
Are guidelines and standard operating procedures available for the facilities / community services?

8
7. What are some of the barriers to access to SRH services and uptake of contraception among
adolescents and youth in the region (Coast region/ or specific county)?

Are all AY able to receive health services free of charge or are able to afford any charges
that might be in place?
Are health services available to all AY during convenient hours e.g. after school /work
hours, weekend and holidays where applicable?
Is the physical infrastructure user-friendly?
Are AY aware of the health services being provided, where they are provided and how to
obtain them?
Is the location of the facility easy for young people to reach and do they feel free to go
there?

8. Has the community been involved in AYSRHR programs design, implementation and
monitoring? If so, how? And how is awareness created?

9. Have Adolescents and Youth been involved in AYSRHR programs design, implementation and
monitoring? If so, how have they been involved?

10. Do you think the current interventions you stated above are effective in addressing equitable
access and quality of AYSRHR services?

11. How do the interventions affect uptake of contraception among adolescents and youth?

What changes / improvements, if any would you like to suggest?

12. In your opinion, are there specific interventions that stand out in the coastal region / in the county
in enabling equitable access and quality AYSRHR services?

13. Are there specific interventions that stand out in enhancing uptake of contraception among
adolescents and youth? Can you give examples?

14. Who are the main partners in AYSRHR services in the region/ county?

15. How do the various stakeholders work together for advancement of AYSRHR in the county
(ies) i.e. GoK departments /ministries of Health, Education, Children’s Department, Youth &
Gender, Administration, and Legislatures, CSOs, private sector etc

16. What gaps exist in multi sectoral collaborations?

(if not mentioned, probe for multi-sectoral working group/ forums)

9
Is there anything else you would wish to share as concerns matters AYSRHR

Record the IDI end time: __ __ hr __ __ min

Thank you for taking part in this assessment. The information you shared will be very helpful. Is
there anything you would like to ask me? (pause here). Please remember that all of the information
you shared will be kept private. Thank you again for talking with me and for your time and
information.

Field Notes:

10
.

Appendix E: Information sheet and consent form for the FGDs: adolescents, parents/guardians,
healthcare stakeholders and sub-county leaders.

Study title: Assessing equitable access to Quality Sexual Reproductive Health Rights (SRHR) and services among
adolescents and youth (AY) in the six Coastal Counties of Kenya

Hello, my name is _______________ (introduce self) and I am working with the Aga Khan University. The Aga
Khan University together with the JKP (six coastal county governments) is doing a study to understand the
reasons for, and ways to mitigate, young people’s access to SRH services and information in the counties’ 10-24
years old.

We are inviting you to take part in this research study. Before you decide, it is important that you know why we
are doing the study and what is involved. Please read the following information carefully.

Why is the research being done?

The purpose of this research is to find out the reasons for, and ways to mitigate, equitable access to SRH
information in the six coastal counties for young adults aged 10-24 years old.

Who can participate in the research?

You can participate in this research if you are in one of the categories below (select as appropriate):

For young people: you were selected to participate in this study because you are an adolescent in [name] County
aged 10-24 years old.

For Parents/carers: you were selected to participate in this study because you are a parent/carer of an adolescent
in [Name] County.

For Healthcare stakeholders and - leaders: you were selected to participate in this study because you are a
healthcare worker, community health volunteer or a sub-county leader in [name] County

What will you be asked to do?

If you agree to participate, you will be invited to attend a focus group discussion (FGD) with about 7 to 10 people.
An interview guide will be used to guide the discussions and the FGD will be conducted by an experienced
facilitator who is fluent in Kiswahili and English. These discussions will take up to two hours. The data will be

11
audio taped to assist later in fully writing up the information. No one will be identified by name in the recording.
The adolescent groups will separate the boys and girls.

What choice do you have?

Participation in this research is entirely your choice. Only those people who give their informed consent will be
included in the project. Whether or not you decide to participate, your decision will not disadvantage you and
will not affect the services that you receive.

Will I be paid for participating?

Yes. You will receive 500 Kenyan Shillings to thank you for your time, a lunch allowance and we will also
reimburse you for the money you spent on travel to get here.

What are the risks and benefits of participating?

We hope that participants will find it beneficial to take part. If you do become distressed due to participation in
this focus group, you are free to opt out of the study at any time without giving any reasons whatsoever. If during
the focus group you are uncomfortable with any of the questions, you may decline to respond and move on to the
next question or terminate the discussion without giving any reason. We however hope that you will participate
until the end of the focus group.

How will your privacy be protected?

Any information collected by researchers which might identify you will be stored securely and only accessed by
the researchers unless you consent otherwise, except as required by law. Data will be retained for at least 5 years.
Results of this study will not be released or reported in any way that might allow for individual participants to be
known by people not involved in the study. All research materials will be assigned a confidential number for
coding purposes. Results will not be released or reported in any way that might allow for identification of
individual participants. All information will be summarized and will be used only for community reference and
not for individuals. Your name will not be associated with the findings.

How will the information collected be used?

The study outcomes may be used to develop a better understanding of to mitigate adolescent pregnancy and so
improve the health and wellbeing of adolescents. Study outcomes may also be published in journal articles or

12
presented at conferences. Individual participants will not be identified in any reports arising from the project. A
summary of the research results will be available to you upon request.

What do you need to do to participate?

Complete the consent form below and return it to the Project Research Assistant

Who is organising and funding the research?

The study is run by Dr. Flaura Kidere (Principal Investigator tel: XX) Pwani University, Kenya. The research
is being funded jointly by the World Health Organisation in partnership with Jumuiya ya Kaunti za Pwani.

Further information

This study has been reviewed and given approved opinion by the Pwani University Ethics Review Committee
Pwani University Ethics Review Committee, P. O. Box 195-80108, Kilifi Kenya. Tel: +254 41 752102/3/4,
+254 725 916145, +254 776 368946

If you would like further information, please contact one of the research team: Dr. Flaura Kidere (Principal
Investigator Tel: XX) Pwani University, Kenya

Consent Statement

I have read the preceding information, or it has been read to me. I have had the opportunity to ask questions about
it and they have been answered to my satisfaction. I consent voluntarily to be a participant in this study and
understand that I have the right to withdraw from the study/interview/discussion at any time.

 I agree to take part in the focus group discussion (please tick)

 I do not agree to take part in the focus group discussion (please tick)

Respondent’s Signature: ______________________________ Date: _____________________

Thumbprint of the respondent named above if they cannot write: _____________________

I, the undersigned, have fully explained the relevant details of this focus group to the respondent to consent.

Researcher’s name: ___________________________________________________________

Researcher’s signature: _____________________________ Date: _____________________

Appendix F: Assent form for minors (10-17 years)

13
Study title: Assessing equitable access to Quality Sexual Reproductive Health Rights (SRHR) and services
among adolescents and youth (AY) in the six Coastal Counties of Kenya

This informed assent form is for adolescents from 10 to 17years old from [name] County, Kenya who we are
inviting to participate in the study on understanding what the risk factors are of barriers and facilitators to access
sexual reproductive health services and information for adolescents and youth in [name] County and what needs
to be done to reduce it.

This Informed Assent Form has two parts:

• Information Sheet (gives you information about the study)

• Certificate of Assent (this is where you sign if you agree to participate)

You will be given a copy of the full Informed Assent Form

Part I: Information Sheet

Introduction

My name is ____and my job is to research barriers and facilitators that affect access to sexual reproductive
health and services for young people in the six coastal counties it. We want to know what may be leading to the
barriers and facilitators to access so that young people can have information and know what to do with it so that
future young people can have more choice and control regarding the information can try to stop or limit any bad
effects. We think this research could help tell us that.

I am going to give you information and invite you to be part of a research study. You can choose whether or not
you want to participate. We have discussed this research with your parent(s)/guardian and they know that we
are also asking you for your agreement. If you are going to participate in the research, your parent(s)/guardian
will also have to agree. But if you do not wish to take part in the research, you do not have to, even if your
parents/guardian have agreed.

You may discuss anything in this form with your parents or friends or anyone else you feel comfortable talking
to. You can decide whether to participate or not after you have talked it over. You do not have to decide
immediately.

There may be some words you don't understand or things that you want me to explain more about because you
are interested or concerned. Please ask me to stop at anytime and I will take time to explain).

Why are you doing this research?

[Name]County has barriers and/or facilitators that affect access to SRH information for young people in the
country and we want to know why. We want to find out the effects what e the risks and causes of barriers and
facilitators to access SRH services and information for young people in [name of county. We hope we will get
useful knowledge about what is behind this and also what the County can do to improve the same. To do this we
14
need to find out the experiences and views of many people in the community in general, Health providers and
also adolescents and youths.

Choice of participants: Why are you asking me?

We would like to know what you think about effects of barriers and facilitators to SRH information for young
adults. We are asking people who are in the 10-24 age group, both male and female.

Participation is voluntary: Do I have to do this?

You don't have to be in this research if you don't want to be. It’s up to you. If you decide not to be in the research,
it’s okay and nothing changes. Everything stays the same as before. Even if you say "yes" now, you can change
your mind later and it’s still okay.

➢ Examples of question to elucidate understanding: If you decide not to take part in this research study,
do you know what your options are? Do you know that you do not have to take part in this research study,
if you do not wish to? Do you have any questions?

I have checked with the child and they understand that participation is voluntary __(initial)

Procedures: What is going to happen to me?

If you decide that you want to do this, the next thing that will happen is you will be invited to take part in a group
discussion that will last about one and a half hours OR an interview that will last about one hour.

The group will have about 7-10 people and will be led by an experienced facilitator who is fluent in Kiswahili
and English. The interviewer will ask you about adolescent pregnancy, what is leading to it and what can be
done about it. You can contribute to the discussion at any point and if you prefer not to say anything, that is OK
too.

The interview will be done by an experienced interviewer who is fluent in Kiswahili and English. The interviewer
will ask you about adolescent pregnancy, what is leading to it and what can be done about it. You can contribute
to the discussion at any point and if you prefer not to say anything, that is OK too.

You can ask me to stop and explain again at any time and I will explain more about the process.

➢ Examples of question to elucidate understanding: Can you tell me if you remember what the next step
is? Do you have any other questions? Do you want me to go through the procedures again?

I have checked with the child and they understand the procedures ________(initial))

Risks: Is this bad or dangerous for me?

We do not think that there are any risks to you. But if you have concerns or questions you should let me know.

15
Discomforts: Will it hurt?

There is another thing that I want you to know. When you start talking about barriers and facilitators that affect
SRH information, the discussion may make you feel some discomfort or unhappiness so if you feel bad or strange,
tell us.

➢ Examples of question to elucidate understanding: Do you understand what can happen during the group
discussion? Etc. Do you have any other questions?

I have checked with the child and they understand the risks and discomforts ____(initial)

Benefits: Is there anything good that happens to me?

Nothing really good might happen to you. There are no individual benefits to taking part. But from what we get
from the research we hope to be able to reduce the adolescent pregnancy rate.

I have checked with the child and they understand the benefits_____ (initial)

Reimbursements: Do I get anything for being in the research?

We will give your parents enough money to pay for the trip here and whatever other expense is reasonable.

➢ Examples of question to elucidate understanding: Can you tell me if you have understood correctly the
benefits that you will have if you take part in the study? Do you know if the study will pay for your travel
costs and time lost, and do you know how much you will be re-imbursed? Do you have any other
questions?

Confidentiality: Is everybody going to know about this?

We will not tell other people that you are in this research and we won't share information about you with anyone
who does not work in the research study.

Information about you that will be collected from the research will be put away and no-one but the researchers
will be able to see it. Any information about you will have a number on it instead of your name. Only the
researchers will know what your number is and we will lock that information up with a lock and key.

➢ Example of question to elucidate understanding: Did you understand the procedures that we will be
using to make sure that any information that we as researchers collect about you will remain confidential?
Do you have any questions about them?

Sharing the Findings: Will you tell me the results?

16
When we are finished with the research in about 8-9 months time, I will tell you and your parents about what we
learnt. I will also give you a paper with the results written down. Afterwards, we will be telling more people,
scientists and others, about the research and what we found. We will do this by writing and sharing reports and
by going to meetings with people who are interested in the work we do.

Right to Refuse or Withdraw: Can I choose not to be in the research? Can I change my mind?

You do not have to be in this research. No one will be mad or disappointed with you if you say no. It’s your
choice. You can think about it and tell us later if you want. You can say "yes” now and change your mind later
and it will still be okay.)

Who to Contact: Who can I talk to or ask questions to?

You can ask me questions now or later. I have written a number and address where you can reach us. If you want
to talk to someone else that you know like your teacher or doctor or auntie, that's okay too. You can also talk to
the researcher in charge who is: If you would like further information please contact one of the research team:
Dr Flaura Kidere (Principal Investigator tel: XX) Pwani University, Kenya

If you choose to be part of this research I will also give you a copy of this paper to keep for yourself. You
can ask your parents to look after it if you want.

➢ Example of question to elucidate understanding: Do you know that you do not have to take part in this
study if you do not wish to? You can say No if you wish to? Do you know that you can ask me questions
later, if you wish to? Do you know that I have given the contact details of the person who can give you
more information about the study? Etc.

You can ask me any more questions about any part of the research study, if you wish to. Do you have any
questions?

PART 2: Certificate of Assent

I understand the research is about access to equitable SRH information. I understand that I will be invited to a
group discussion where I can let people know my views about adolescent pregnancy.

I have read this information (or had the information read to me) I have had my questions answered and
know that I can ask questions later if I have them.

I agree to take part in the research.

OR

I do not wish to take part in the research and I have not signed the assent below.___________(initialled by
child/minor)

Only if child assents:

17
Print name of child ___________________

Signature of child: ____________________

Date:________________ day/month/year

If illiterate:

A literate witness must sign (if possible, this person should be selected by the participant, not be a parent, and
should have no connection to the research team). Participants who are illiterate should include their thumb print
as well.

I have witnessed the accurate reading of the assent form to the child, and the individual has had the
opportunity to ask questions. I confirm that the individual has given consent freely.

Print name of witness (not a parent)_________________ AND Thumb print of participant

Signature of witness ______________________

Date ________________________

Day/month/year

I have accurately read or witnessed the accurate reading of the assent form to the potential participant,
and the individual has had the opportunity to ask questions. I confirm that the individual has given assent
freely.

Print name of researcher_________________

Signature of researcher___________________

Date__________________ Day/month/year

Statement by the researcher/person taking consent

I have accurately read out the information sheet to the potential participant, and to the best of my ability
made sure that the child understands that the following will be done:

1.
18
2.

3.

I confirm that the child was given an opportunity to ask questions about the study, and all the questions
asked by him/her have been answered correctly and to the best of my ability. I confirm that the individual
has not been coerced into giving consent, and the consent has been given freely and voluntarily.

A copy of this assent form has been provided to the participant.

Print Name of Researcher/person taking the assent________________________

Signature of Researcher /person taking the assent __________________________

Date ___________________________ Day/month/year

Copy provided to the participant ________(initialed by researcher/assistant)

Parent/Guardian has signed an informed consent ___Yes ___No _____(initialed by researcher/assistant)

19
Appendix G: FGD guide for healthcare providers and community health volunteers

Study title: Assessing equitable access to Quality Sexual Reproductive Health Rights (SRHR) and services
among adolescents and youth (AY) in the six Coastal Counties of Kenya

We are meeting to discuss your views about young adults’ barriers and facilitators to AYSRH information in
[name of county] in particular what you may think are the risk factors and ways of mitigating the same.

What we discuss here will remain confidential.

Thank you.

Session details

Interviewer/s:

Time (start/finish):___hrs ___mins

Date: ___ /____/____dd/mm/yr

FGD code: ____________

FGD participant profile

Collect the below from all participants (via a sign-in sheet):

• Age, gender, marital status, education level, work/occupation, number of children

Questions

Please tell me about the occurrence of barriers and facilitators to access SRH information in this area?

What do you consider are the contributors and causes of barriers and facilitators for accessing SRH
information in this area? Prompts: culture, parenting, teachers, peer pressure, relatives, access to SH services,
education/awareness, poverty

What are some of the barriers to access SRH services and uptake of contraception among adolescent and
youths in this area (name of county)

Are all AY able to receive health services free of charge or are able to afford any charges that might be in place?

Are health services available to all AY during convenient hours e.g. after school/work hours, weekend and
holidays where applicable?

Is the physical infrastructure user-friendly? (is the location accessible, easy to reach, free to go?)
20
Have you been involved in AYSRH program design, implementation and monitoring? (if so, how have you
been involved?)

Do you think this area has more or fewer barriers and facilitator to access SRH information than other
parts of [name] County? And why?

What is being done here in your area to mitigate barriers and facilitator to access SRH information?
Prompts: county services (e.g. health, education, employment), care SOPs/referral pathways, CSE, training,
information/sensitization e.g. services available, rights

What can be done to mitigate barriers and facilitator to access SRH information? Prompts: county services
(e.g. health, education, employment), care SOPs/referral pathways, training, information/sensitization e.g.
services available, rights

What challenges or gaps exist in your area that relates to mitigating barriers and facilitator to access SRH
information? Prompts: from your perspective (as a CHW, HCW)

How can they be addressed? Prompts: Support and resources they may need

Is there anything else you would like to share as concerns or recommendations which is needed in your
area to reduce barriers to access SRH information?

Prompt: county, national government, other stakeholders etc.

Is there anything else you wish to say about the discussion topic we have had today?

Record the FGD end time: __ __ hr __ __ min

Thank you for taking part in this assessment. The information you shared will be very helpful. Is there anything
you would like to ask me? (pause here). Please remember that all of the information you shared will be kept
private. Thank you again for talking with me and for your time and information.

21
Appendix H: FGD guide for adolescents and youths

Study title: Assessing equitable access to Quality Sexual Reproductive Health Rights (SRHR) and services
among adolescents and youth (AY) in the six Coastal Counties of Kenya

We are meeting to discuss your views about barriers and facilitator to access SRH information in [name] in
particular what you may think are the risk factors and ways of mitigating the same.

What we discuss here will remain confidential.

Thank you.

Session details

Interviewer/s:

Time (start/finish): ___hr __mins

Date:__/___/____dd/mn/yr

ID code: __________

FGD participant profile

Collect the below from all participants (via a sign-in sheet):

• Age, gender, education level, work/occupation (if relevant), in or out of school, number of siblings in
household

Questions

Please tell me about the occurrence of barriers and facilitators to access SRH information in this area?

What do you consider are the contributors and causes of barriers and facilitators for accessing SRH
information in this area? Prompts: culture, parenting, teachers, peer pressure, relatives, access to SH services,
education/awareness, poverty

What are some of the barriers to access SRH services and uptake of contraception among adolescent and
youths in this area (name of county)

Are all AY able to receive health services free of charge or are able to afford any charges that might be in place?

Are health services available to all AY during convenient hours e.g. after school/work hours, weekend and
holidays where applicable?

22
Is the physical infrastructure user-friendly? (is the location accessible, easy to reach, free to go?)

Have you been involved in AYSRH program design, implementation and monitoring? (if so, how have you
been involved?)

Do you think this area has more or fewer barriers and facilitator to access SRH information than other
parts of [name] County? And why?

What is being done here in your area to mitigate barriers and facilitator to access SRH information?
Prompts: county services (e.g. health, education, employment), care SOPs/referral pathways, CSE, training,
information/sensitization e.g. services available, rights

What can be done to mitigate barriers and facilitator to access SRH information? Prompts: county services
(e.g. health, education, employment), care SOPs/referral pathways, training, information/sensitization e.g.
services available, rights

What challenges or gaps exist in your area that relates to mitigating barriers and facilitator to access SRH
information? Prompts: from your perspective (as a CHW, HCW)

How can they be addressed? Prompts: Support and resources they may need

Is there anything else you would like to share as concerns or recommendations which is needed in your
area to reduce barriers to access SRH information?

Prompt: county, national government, other stakeholders etc.

Is there anything else you wish to say about the discussion topic we have had today?

Record the FGD end time: __ __ hr __ __ min

Thank you for taking part in this assessment. The information you shared will be very helpful. Is there anything
you would like to ask me? (pause here). Please remember that all of the information you shared will be kept
private. Thank you again for talking with me and for your time and information.

23
Appendix I: County Health Services Assessment tool

WHO TA Mechanism Data Collection Tool:

Mapping JKP AYSRHR Programming

1. Welcome & Objectives

24
Introduction & Instructions

Introduction
In support of the Kenya YFHS Strategy (2015-2020), and to enhance the nation's ability to meet ambitious national and global
adolescent and youth sexual and reproductive health and rights (AYSRHR) goals, a map of current AYSRHR programming is needed.
The following survey will collect data from health-serving institutions working to improve contraceptive uptake and prevention of HIV
among young people.

The survey results will map for the Reproductive Health Directorate (RHD) and Jumuiya ya Kaunti za Pwani detail about Kenya's Six
Coastal Counties AYSRHR programming such as objectives, funders, target population, location (e.g. service areas), key programmatic
components (e.g. interventions and activities), and timeframe. This map will offer the six county governments a full picture of what is
being done where, and can inform future decision-making about program inefficiencies, gaps, or duplication that impact AYSRHR
outcomes.

Instructions
The survey is organized by section. Please answer the questions and provide additional detail where asked. A glossary of terms is
included in the attached Word document that came with the survey link.

Section 1: Introduction & Instructions

Section 2: Requests background detail about your County as a government-run health service institution, local NGO, local CBO, INGO,
research institution, etc.

Section 3: Requests background detail about one (1) of your institution's AYSRHR projects/programmes. (Some institutions will have
more than one AYSRHR project/programme [i.e. with unique objectives, outcomes and funding] and each will be detailed individually in
this same survey.) Everyone will fill in Sections 3, 4 and 5.

Section 4: Requests technical detail about the first AYSRHR project/programme listed in Section 3.

Section 5: Requests results detail about the first AYSRHR project/programme listed in Section 3.

Only those institutions that have a second (2nd) AYSRHR project/programme will move on to answer project/programme background
questions (Section 6), technical detail questions (Section 7) and results detail questions (Section 8). Respondents have the capability to
come back to the survey if pulled away. Please do not start another link.

We appreciate your support in this activity.

25
WHO TA Mechanism Data Collection Tool:
Mapping Kenya AYSRHR Programming

2. County Health Department/Background

Tell us more about your health serving institution.

* 1. What is the name of your County?

* 2. How would you categorize your County Health Department?

Government institution Local CBO Local FBO Local NGO INGO Youth Club

Health Clinic Agency or Foundation Research institution

Other (please specify)

* 3. Is your county health department exclusively focused on serving young people?

Yes

No

Other (please specify)

26
WHO TA Mechanism Data Collection Tool:
Mapping JKP AYSRHR Programming

3. AYSRHR Project/Programme #1

Please describe one (1) project/programme your county health department has managed in the last 5
years either as the sole implementer or in collaboration with other partners. (Each project will be
added on a separate page.)

Adolescent and Youth Sexual and Reproductive Health and Rights (AYSRHR) activities to be mapped
in this activity include demand generation, service delivery and interventions that build an enabling
environment for young people to be able to access and continuously use high quality contraceptive
services and HIV testing.

* 4. Please provide the name of (1) AYSRHR project/programme you have implemented solely or in collaboration
with other partners in the last (5) years?

* 5. What is your target population for this specific project/programme?

VYAs (Very Young Adolescents): ALL Young People: Ages 10-24 yrs Unmarried Adolescents
Ages 10-14 yrs
AGYWs: Adolescent Girls and Married Youth
Mid-to-Late Adolescents: Ages 15- Young Women
19 yrs First Time Parents
ABYMs: Adolescent Boys and Young
Youth: Ages 15-24 yrs Men

* 6. Does/did this project/programme focus exclusively on young people as a target population or as part
of a community-health activity?
This particular project/programme is focused exclusively on young people

Young people are including as part of a community-wide health initiative

* 7. How is/was this specific project/programme funded?

Donor Other Government Ministries

Ministry of Health Philanthropy/Membership donations

Other (please specify)

* 8. Is/Was this project/programme time-bound or ongoing?

Time-bound

Ongoing

Other (please specify)

27
* 9. What stage of implementation are you in?
Start Up

Midway

End of Project/Programme

Concluded within the last 5 years

Other (please specify)

* 10. What is the annual project/programme budgetary ceiling?

$5,000 - $10,000 $100,000 - $500,000 +$5,000,000

$10,000 - $50,000 $500,000 - $1,000,000

$50,000 - $100,000 $1,000,000 - $5,000,000

Other (please specify)

* 11. In which sub county is/was this project/programme serving young

people?
Kilifi Kilifi Ganze Malindi Magarini Kaloleni Rabai
North South

Likoni
Changamwe Jomvu Kisaiuni Nyali Mvita

Matuga Msambweni Kinango Lunga Mwatate Taveta Voi

nga mba non Road Lunga

Wundanyi Bura Galole Garsen Lamu Lamu

East West

28
* 12. Select the expected AYSRHR outcomes of this specific project/programme.
Adol Girls & Young Adol Boys & Young
10-14 yr olds 15-19 yr olds 20-24 yr olds
Women (AGYW) Men (ABYM)
Increase contraceptive
uptake among young
people
Increase HIV testing and
counseling among young

people

Reduced HIV prevalence

among young people
Increased AGYW rights
and empowerment
Increased male (ABYM)
engagement
Improved rates of
contraceptive

continuation

Improved enabling
environment and/or social
norms for AYSRHR

Other (please specify)

29
WHO TOA Mechanism Data Collection Tool:
Mapping JKP AYSRHR Programming

4. AYSRHR Project/Programme #1: Technical Background

Please describe the technical components of the first AYSRHR project/programme described above.

Note: In an effort to target results, the mapping analysis will only ask questions related to AYSRHR
interventions that drive demand, deliver services or build an enabling environment including
improved gender norms, to achieve one or all of the following outcomes: increased contraceptive use,
reduced adolescent pregnancies and/or increased HIV testing among young people.

Other critical AYSRHR initiatives and outcomes that can support but do not directly influence the
above outcomes, such as health systems strengthening, improved supply chain, improved gender
norms, youth employment, or services that aim to influence other infectious diseases or other
reproductive health (e.g. HPV), or HIV outcomes (e.g. improved adherence), are not the current focus.
If these components are part of a full package of services offered by your project/programme, they
can be written in as additive components.

* 13. Please enter the name of AYSRHR project/programme #1

* 14. Please select all past, present or future activities aimed at increasing young people's demand for
contraception.
community mobilization aspirational programming in-school activities - (e.g. youth
interventions clubs, life skills, CSE- if linked to
peer mobilization services)
digital health approaches - (e.g.
mass media mobile applications) out-of-school activities (e.g. youth

edutainment activities clubs, sports groups, IGAs, etc.)

rights & empowerment activities
not applicable
couples communication & decision-
making

Other (please specify)

30
* 15. Please select all delivery settings that your project/programme uses to deliver contraception services.
mobile clinic outreach social franchise services not applicable

public sector clinic services community-based outreach (e.g. via

community health workers)
private sector services
drug shop/pharmacy (direct or via
partnerships)

Other (please specify)

* 16. Please select all past, present, and future activities aimed at increasing young people's demand to
access HIV testing.
community mobilization aspirational programming in-school activities (e.g. youth clubs,
s
interventions life skills, CSE- if linked to services)
peer mobilization
digital health approaches - (e.g. out-of-school activities (e.g. youth
mass media mobile applications) clubs, sports groups, IGAs)

edutainment activities rights & empowerment activities not applicable

couples communication & decision-

making

Other (please specify)

* 17. Please select all delivery settings that your project/programme uses to deliver HIV testing services.
mobile clinic outreach social franchise services not applicable

public sector clinic services community-based outreach (e.g. via

community health workers)
private sector services
drug shop/pharmacy (direct or via
partnerships)

Other (please specify)

31
* 18. Please list all services available to young people through your project/programme.
STI screening IUD/implant removal pregnancy testing

STI testing implant insertion services aimed specifically at

contraceptive continuation
STI treatment injectables
integrated health services (e.g.
HIV testing oral contraceptives FP/HIV integration)
contraceptive counseling DMPA-SC referral for HIV treatment

condoms emergency contraception referral for HIV prevention

IUD insertion post abortion services non-health integrated services (e.g.

income generation activities)

not applicable

Other (please specify)

* 19. Please check all activities your project/programme implements that build an enabling environment for
AYSRHR.
community engagement (e.g. increase community/youth social and/or gender norm change
parents, traditional/religious/political understanding of AYSRHR rights (e.g. adult/youth partnerships,
leaders) challenging harmful
supporting youth cultural/religious/gender norms)
address cost barriers groups/organizations to influence
local/political decision-making research and evaluation
policy/advocacy to change
policy (e.g. age/marital consent, full media/journalism not applicable
method choice) or
increased/targeted budget
allocations

Other (please specify)

* 20. Select all AYSRHR high impact practices that are applied in this project/programme.
age disaggregated data collection & targeted age-appropriate SBC current & consistent training and
use approaches values clarification
(in design, implementation, (i.e. applying adolescent
improvement & evaluation) development) meaningful youth engagement/youth
leadership
integrated/multi-component services FULL contraceptive method mix
available & accessible (including Positive Youth Development (PYD)
offering more than one YFHS service removals) approaches
delivery channel
free or subsidized services and
commodities

Other (please specify)

32
* 21. Please select ways that young people are meaningful partners in your organization's
AYSRHR programming.
young designers employed in human-centered design peer mobilizers

young researchers collect, analyze, report on data youth surveys inform program adaptations

young people as mystery clients N/A (young people are not decision-making partners)

Other (please specify)

33
WHO TA Mechanism Data Collection Tool:
Mapping JKP AYSRHR Programming

5. AYSRHR Project/Programme #1: Results

Please tell us a bit about the project/programme results you have seen thus far.

* 22. What is the average number of young people your program reaches monthly?
less than 50 500-1,000 more than 5,000

50-100 1,000-2,000

100-500 2,000-5,000

Other (please specify)

* 23. Of the monthly average of young people reached, what percentage are AGYW vs. ABYM?

AGYW being reached:

ABYM being reached:

* 24. What is the average number of young people who receive contraceptive services monthly?
less than 50 500-1,000 more than 5,000

50-100 1,000-2,000 not applicable

100-500 2,000-5,000

Other (please specify)

* 25. What is the average number of young people who receive HIV testing monthly?
less than 50 500-1,000 more than 5,000

50-100 1,000-2,000 not applicable

100-500 2,000-5,000

Other (please specify)

* 26. Is your project/programme on track to achieve your overall targets?

Very likely Unlikely

Likely Very unlikely

Neither likely nor unlikely

34
 * 27. What are the major challenges associated with your project/programme's inability to meet expected
outcomes?
funding gaps or reallocations geographic area challenges (e.g. inaccessible health sites)

programming interruptions due to COVID-19 workforce challenges (e.g. too few providers, training
deficiencies, healthcare worker bias)
young people not closing referral loops
inefficient contraceptive/HIV testing supply
young people are not returning for services

Other (please specify)

* 28. What are the major facilitators associated with your project/programme's ability to meet expected
outcomes
continuous or increased funding digital data tracking, analysis and programming location makes it
use easier to meet young people where
meaningful youth engagement they are
seconded government health staff,
positive social norms and supportive facilities, equipment flexible donor/government
environment agreements/expectations
longitudinal programme (ongoing
adaptive implementation - or strong rather than on a 3-5 yr cycle)
and nimble M&E
strong government, donor, partner
coordination

Other (please specify)

* 29. Were you required to reduce or eliminate programming components due to COVID-19?
Reduced due to
Reduced due to funding Reduced due to We increased
realignment of funding or
constraints government/donor request programming
new outcomes

demand generation

service delivery

building an enabling
environment
meaningful youth
engagement
implementing multiple
high impact practices

Other (please specify)

35
* 30. Do you have another AYSRHR project/programme?
Yes

No

36
WHO TA Mechanism Data Collection Tool:
Mapping JKP AYSRHR Programming

6. AYSRHR Project/Programme #2

Please describe a second (2nd) project/programme your health-serving institution has managed in the
last 5 years. (Each project will be added on a separate page.)

Adolescent and Youth Sexual and Reproductive Health and Rights (AYSRHR) activities to be mapped
in this activity include demand generation, service delivery and interventions that build an enabling
environment for young people to be able to access and continuously use high quality contraceptive
services and HIV testing.

* 31. Please provide the name of a second (2nd) AYSRHR project/programme you have implemented in the
last (5) years?

* 32. What is your target population for this specific project/programme?

VYAs (Very Young Adolescents): ALL Young People: Ages 10-24 yrs Unmarried Adolescents
Ages 10-14 yrs
AGYWs: Adolescent Girls and Married Youth
Mid-to-Late Adolescents: Ages 15- Young Women
19 yrs First Time Parents
ABYMs: Adolescent Boys and Young
Youth: Ages 15-24 yrs Men

Other (please specify)

* 33. Does this project/programme focus exclusively on young people as a target population or as part of a
community-health activity?
This particular project/programme is focused exclusively on young people

Young people are including as part of a community-wide health initiative

* 34. How is/was this specific project/programme funded?

Donor Other government Ministries

Ministry of Health Philanthropy/Membership donations

Other (please specify)

37
* 35. Is/Was this project/programme time-bound or ongoing?
Time-bound

Ongoing

Other (please specify)

* 36. What stage of implementation are you in?

Start Up

Midway

End of Project/Programme

Concluded within the last 5 years

* 37. What is the annual project/programme budgetary ceiling?

$5,000 - $10,000 $100,000 - $500,000 +$5,000,000

$10,000 - $50,000 $500,000 - $1,000,000

$50,000 - $100,000 $1,000,000 - $5,000,000

Other (please specify)

* 38. In which sub county is this project/programme serving young people?

Kilifi North
Kilifi Ganze Malindi Magarini Rabai Kaloleni Matuga

Msa
mwe
ni

Kinango Lunga Changa Jomvu Kisauni Nyali Mvita Mwatate

lunga

Voi

Wunda Bura Galole Garsen Lamu Lamu

Nyi East West

38
* 39. Select the expected AYSRHR outcomes of this specific project/programme.
Adol Girls & Young Adol Boys & Young
10-14 yr olds 15-19 yr olds 20-24 yr olds
Women (AGYW) Men (ABYM)
Increase contraceptive
uptake among young
people
Increase HIV testing and
counseling among young

people

Reduced HIV prevalence

among young people
Increased AGYW rights
and empowerment
Increased male (ABYM)
engagement
Improved rates of
contraceptive

continuation

Improved enabling
environment and/or social
norms for AYSRHR

Other (please specify)

39
WHO TA Mechanism Data Collection Tool:
Mapping JKP AYSRHR Programming

7. AYSRHR Project/Programme #2: Technical Background

Please describe the technical components of the second AYSRHR project/programme described
above.

Note: In an effort to target results, the mapping analysis will only ask questions related to AYSRHR
interventions that drive demand, deliver services or build an enabling environment including
improved gender norms, to achieve one or all of the following outcomes: increased contraceptive use,
reduced adolescent pregnancies and/or increased HIV testing among young people.

Other critical AYSRHR initiatives and outcomes that can support but do not directly influence the
above outcomes, such as health systems strengthening, improved supply chain, improved gender
norms, youth employment, or services that aim to influence other infectious diseases or other
reproductive health (e.g. HPV), or HIV outcomes (e.g. improved adherence), are not the current focus.
If these components are part of a full package of services offered by your project/programme, they
can be written in as additive components.

* 40. Please enter the name of AYSRHR project/programme #2

* 41. Please select all past, present or future activities aimed at increasing young people's demand for
contraception.
community mobilization aspirational programming in-school activities (e.g. youth clubs,
interventions life skills, CSE- if linked to services)
peer mobilization
digital health approaches - (e.g. out-of-school activities (youth clubs,
mass media mobile applications) sports groups, IGAs)

edutainment activities rights & empowerment activities not applicable

couples communication & decision-

making

Other (please specify)

40
* 42. Please select all delivery settings that your institution uses to deliver contraception services.
mobile clinic outreach community-based outreach (e.g. via community health
workers)
public sector clinic services
drug shop/pharmacy (direct or via partnerships)
private sector services
not applicable
social franchise services

Other (please specify)

* 43. Please select all past, present and future activities aimed at increasing young people's demand to access
HIV testing.
community mobilization aspirational programming in-school activities (e.g. youth clubs,
interventions life skills , CSE- if linked to services)
peer mobilization
digital health approaches (e.g. out-of-school activities (e.g. youth
mass media mobile applications) clubs, sports groups, IGAs)

edutainment activities rights & empowerment activities not applicable

couples communication & decision-

making

Other (please specify)

* 44. Please select all delivery settings that your institution uses to deliver HIV testing services.
mobile clinic outreach social franchise services not applicable

public sector clinic services community-based outreach (e.g. via

community health workers)
private sector services
drug shop/pharmacy (direct or via
partnerships)

Other (please specify)

41
* 45. Please select all services available to young people through your project/programme.
STI testing injectables services aimed specifically at
contraceptive continuation
STI treatment oral contraceptives
integrated health services (e.g.
HIV testing DMPA-SC FP/HIV integration)

IUD insertion emergency contraception referral for HIV treatment

IUD/implant removal post abortion services referral for HIV prevention

implant insertion pregnancy testing non-health integrated services (e.g.
income generation activities)

not applicable

Other (please specify)

* 46. Please check all activities your project/programme implements that build an enabling environment for
AYSRHR.
community engagement (e.g. increase community/youth social and/or gender norm change
parents, traditional/religious/political understanding of AYSRHR rights (e.g. adult/youth partnerships,
leaders) challenging harmful
supporting youth cultural/religious/gender norms)
address cost barriers groups/organizations to influence
local/political decision-making research and evaluation
policy/advocacy to change
policy (e.g. age/marital consent, full media/journalism not applicable
method choice) or
increased/targeted budget
allocations

Other (please specify)

* 47. Select all AYSRHR high impact practices that are applied in this project/programme.
age disaggregated data collection & targeted age-appropriate SBC consistent capacity building in youth-
use approaches responsive health care
(in design, implementation, (i.e. applying adolescent
improvement & evaluation) development) meaningful youth engagement/youth
leadership
integrated/multi-component ALL contraceptive method mix is
information and/or services available & accessible (including Positive Youth Development (PYD)

removals) approaches
offering more than one YFHS
service delivery channel free or subsidized services and
commodities

Other (please specify)

42
* 48. Please select ways that young people are meaningful partners in your organization's
AYSRHR programming.
young designers employed in human-centered design peer mobilizers

young researchers collect, analyze, report on data youth surveys inform program adaptations

young people as mystery clients N/A (young people are not decision-making partners)

Other (please specify)

43
WHO TA Mechanism Data Collection Tool:
Mapping JKP AYSRHR Programming

8. AYSRHR Project/Programme #2: Results

Please tell us a bit about the project/programme results you have seen thus far.

* 49. What is the average number of young people your program reaches monthly?
less than 50 500-1,000 more than 5,000

50-100 1,000-2,000

100-500 2,000-5,000

Other (please specify)

* 50. Of the monthly average of young people reached, what percentage are AGYW vs. ABYM?

AGYW being reached:

ABYM being reached:

* 51. What is the average number of young people who receive contraceptive services monthly?
less than 50 500-1,000 more than 5,000

50-100 1,000-2,000 not applicable

100-500 2,000-5,000

Other (please specify)

* 52. What is the average number of young people who receive HIV testing monthly?
less than 50 500-1,000 more than 5,000

50-100 1,000-2,000 not applicable

100-500 2,000-5,000

Other (please specify)

* 53. Is your project/programme on track to achieve your overall targets?

Very likely Unlikely

Likely Very unlikely

Neither likely nor unlikely

44
 * 54. What are the major challenges associated with your project/programme's inability to meet expected
outcomes?
funding gaps or reallocations geographic area challenges (e.g. inaccessible health sites)

programming interruptions due to COVID-19 workforce challenges (e.g. too few providers, training
deficiencies, healthcare worker bias)
young people not closing referral loops
inefficient contraceptive/HIV testing supply
young people are not returning for services

Other (please specify)

* 55. What are the major facilitators associated with your project/programme's ability to meet expected
outcomes
continuous or increased funding seconded government health staff, facilities, equipment

meaningful youth engagement longitudinal programme (ongoing rather than on a 3-5 yr

cycle)
positive social norms and supportive environment
strong government, donor, partner coordination
adaptive implementation - or strong and nimble M&E
programming location makes it easier to meet young people
digital data tracking, analysis and use where they are

flexible donor/government agreements/expectations

Other (please specify)

* 56. Were you required to reduce or eliminate programming components due to COVID-19?
Reduced
programming
Reduced Reduced
Reduced due to
Reduced programming programming programming
programming realignment of We increased
due to funding due to due to new
due to donor funding to new programming
constraints request government outcome target
request requirements
populations and
outcomes

demand generation

service delivery

building an enabling
environment
meaningful youth
engagement
implementing multiple
high impact practices

Other (please specify)

45
* 57. Do you have another AYSRHR project/programme?
Yes

No

46
WHO TA Mechanism Data Collection Tool:
Mapping JKP AYSRHR Programming

9. AYSRHR Project/Programme #3

Please describe a third (3rd) project/programme your health-serving institution has managed in the
last 5 years. (Each project will be added on a separate page.)

Adolescent and Youth Sexual and Reproductive Health and Rights (AYSRHR) activities to be mapped
in this activity include demand generation, service delivery and interventions that build an enabling
environment for young people to be able to access and continuously use high quality contraceptive
services and HIV testing.

* 58. Please provide the name of a third (3rd) AYSRHR project/programme you have implemented in the last
(5) years?

* 59. What is your target population for this specific project/programme?

VYAs (Very Young Adolescents): ALL Young People: Ages 10-24 yrs Unmarried Adolescents
Ages 10-14 yrs
AGYWs: Adolescent Girls and Married Youth
Mid-to-Late Adolescents: Ages 15- Young Women
19 yrs First Time Parents
ABYMs: Adolescent Boys and Young
Youth: Ages 15-24 yrs Men

Other (please specify)

* 60. Does this project/programme focus exclusively on young people as a target population or as part of a
community-health activity?
This particular project/programme is focused exclusively on young people

Young people are including as part of a community-wide health initiative

* 61. How is/was this specific project/programme funded?

Donor Other government Ministries

Ministry of Health Philanthropy/Membership donations

Other (please specify)

47
* 62. Is/Was this project/programme time-bound or ongoing?
Time-bound

Ongoing

Other (please specify)

* 63. What stage of implementation are you in?

Start Up

Midway

End of Project/Programme

Concluded within the last 5 years

* 64. What is the annual project/programme budgetary ceiling?

$5,000 - $10,000 $100,000 - $500,000 +$5,000,000

$10,000 - $50,000 $500,000 - $1,000,000

$50,000 - $100,000 $1,000,000 - $5,000,000

Other (please specify)

* 65. In which sub county is this project/programme serving young people?

Kilifi
Kilifi Ganze Malindi Magarini Kaloleni Rabai Matuga

Lunga Changa Jomvu Kisauni Nyali Likoni Mvita Mwatate

Lam
u
East

Taveta Voi Wunda Bura Galole Garsen Lamu

Wes

48
* 66. Select the expected AYSRHR outcomes of this specific project/programme.
Adol Girls & Young Adol Boys & Young
10-14 yr olds 15-19 yr olds 20-24 yr olds
Women (AGYW) Men (ABYM)
Increase contraceptive
uptake among young
people
Increase HIV testing and
counseling among young

people

Reduced HIV prevalence

among young people
Increased AGYW rights
and empowerment
Increased male (ABYM)
engagement
Improved rates of
contraceptive

continuation

Improved enabling
environment and/or social
norms for AYSRHR

Other (please specify)

49
WHO TA Mechanism Data Collection Tool:
Mapping JKP AYSRHR Programming

10. AYSRHR Project/Programme #3: Technical Background

Please describe the technical components of the third AYSRHR project/programme described above.

Note: In an effort to target results, the mapping analysis will only ask questions related to AYSRHR
interventions that drive demand, deliver services or build an enabling environment including
improved gender norms, to achieve one or all of the following outcomes: increased contraceptive use,
reduced adolescent pregnancies and/or increased HIV testing among young people.

Other critical AYSRHR initiatives and outcomes that can support but do not directly influence the
above outcomes, such as health systems strengthening, improved supply chain, improved gender
norms, youth employment, or services that aim to influence other infectious diseases or other
reproductive health (e.g. HPV), or HIV outcomes (e.g. improved adherence), are not the current focus.
If these components are part of a full package of services offered by your project/programme, they
can be written in as additive components.

* 67. Please enter the name of AYSRHR project/programme #3

* 68. Please select all past, present, and future activities aimed at increasing young people's demand for
contraception.
community mobilization aspirational programming in-school activities (e.g. youth clubs,
interventions life skills, CSE- if linked to services)
peer mobilization
digital health approaches (e.g. out-of-school activities (e.g. youth
mass media mobile applications) clubs, sports groups, IGAs)

edutainment activities rights & empowerment activities not applicable

couples communication & decision-

making

Other (please specify)

50
* 69. Please select all delivery settings that your institution uses to deliver contraception services.
mobile clinic outreach community-based outreach (e.g. via community health
workers)
public sector clinic services
drug shop/pharmacy (direct or via partnerships)
private sector services
not applicable
social franchise services

Other (please specify)

* 70. Please select all past, present, and future activities aimed at increasing young people's demand for HIV
testing.
community mobilization aspirational programming in-school activities (e.g. youth clubs,
interventions life skills, CSE- if linked to services)
peer mobilization
digital health approaches (e.g. out-of-school activities (e.g. youth
mass media mobile applications) clubs, sports groups, IGAs)

edutainment activities rights & empowerment activities not applicable

couples communication & decision-

making

Other (please specify)

* 71. Please select all delivery settings that your institution uses to deliver HIV testing services.
mobile clinic outreach community-based outreach (e.g. via community health
workers)
public sector clinic services
drug shop/pharmacy (direct or via partnerships)
private sector services
not applicable
social franchise services

Other (please specify)

51
* 72. Please list all services available to young people through your project/programme.
STI testing injectables services aimed specifically at
contraceptive continuation
STI treatment oral contraceptives
integrated health services (e.g.
HIV testing DMPA-SC FP/HIV integration)

IUD insertion emergency contraception referral for HIV treatment

IUD/implant removal post abortion services referral for HIV prevention

implant insertion pregnancy testing non-health integrated services (e.g.
income generation activities)

not applicable

Other (please specify)

* 73. Please check all activities your project/programme implements that build an enabling environment for
AYSRHR.
community engagement (e.g. increase community/youth social and/or gender norm change
parents, traditional/religious/political understanding of AYSRHR rights (e.g. adult/youth partnerships,
leaders) challenging harmful
supporting youth cultural/religious/gender norms)
address cost barriers groups/organizations to influence
local/political decision-making research and evaluation
policy/advocacy to change
policy (e.g. age/marital consent, full media/journalism not applicable
method choice) or
increased/targeted budget
allocations

Other (please specify)

* 74. Select all AYSRHR high impact practices that are applied in this project/programme.
age disaggregated data collection & targeted age-appropriate SBC consistent capacity building in youth-
use approaches responsive health care
(in design, implementation, (i.e. applying adolescent
improvement & evaluation) development) meaningful youth engagement/youth
leadership
integrated/multi-component ALL contraceptive method mix is
information and/or services available & accessible (including Positive Youth Development (PYD)

removals) approaches
offering more than one YFHS
service delivery channel free or subsidized services and
commodities

Other (please specify)

52
* 75. Please select ways that young people are meaningful partners in your organization's
AYSRHR programming.
young designers employed in human-centered design peer mobilizers

young researchers collect, analyze, report on data youth surveys inform program adaptations

young people as mystery clients N/A (young people are not decision-making partners)

Other (please specify)

53
WHO TA Mechanism Data Collection Tool:
Mapping JKP AYSRHR Programming

11. AYSRHR Project/Programme #3: Results

Please tell us a bit about the project/programme results you have seen thus far.

* 76. What is the average number of young people your program reaches monthly?
less than 50 500-1,000 more than 5,000

50-100 1,000-2,000

100-500 2,000-5,000

Other (please specify)

* 77. Of the monthly average of young people reached, what percentage are AGYW vs. ABYM?

AGYW being reached:

ABYM being reached:

* 78. What is the average number of young people who receive contraceptive services monthly?
less than 50 500-1,000 more than 5,000

50-100 1,000-2,000 not applicable

100-500 2,000-5,000

Other (please specify)

* 79. What is the average number of young people who receive HIV testing services monthly?
less than 50 500-1,000 more than 5,000

50-100 1,000-2,000 not applicable

100-500 2,000-5,000

Other (please specify)

* 80. Is your project/programme on track to achieve your overall targets?

Very likely Unlikely

Likely Very unlikely

Neither likely nor unlikely

54
 * 81. What are the major challenges associated with your project/programme's inability to meet expected
outcomes?
funding gaps or reallocations geographic area challenges (e.g. inaccessible health sites)

programming interruptions due to COVID-19 workforce challenges (e.g. too few providers, training
deficiencies, healthcare worker bias)
young people not closing referral loops
inefficient contraceptive/HIV testing supply
young people are not returning for services

Other (please specify)

* 82. What are the major facilitators associated with your project/programme's ability to meet expected
outcomes
continuous or increased funding digital data tracking, analysis and programming location make it easier
use to meet young people where they are
meaningful youth engagement
seconded government health staff, flexible donor/government
positive social norms and supportive facilities, equipment agreements/expectations
environment
longitudinal programme (ongoing
adaptive implementation - or strong rather than on a 3-5 yr cycle)
and nimble M&E
strong government, donor, partner
coordination

Other (please specify)

* 83. Were you required to reduce or eliminate programming components due to COVID-19?
Reduced
programming
Reduced Reduced
Reduced due to
Reduced programming programming programming
programming realignment of We increased
due to funding due to due to new
due to donor funding to new programming
constraints request government outcome target
request requirements
populations and
outcomes

demand generation

service delivery

building an enabling
environment
meaningful youth
engagement
implementing multiple
high impact practices

Other (please specify)

55
* 84. Do you have another AYSRHR project/programme?
Yes No

Other (please specify)

56
WHO TA Mechanism Data Collection Tool:
Mapping JKP AYSRHR Programming

12. Conclusion & Thank You

57
Next Steps

We want to thank you for taking the time to fill in the AYSRHR data collection tool. The information you have shared will be analyzed and
presented in a national AYSRHR programming map that will support the WHO and Kenya MoH/JKP to further investigate programming
strengths, gaps, and overlaps to improve AYSRHR outcomes.

A second phase of analysis will be a literature review of AYSRHR programmatic reports, reviews, and evaluations written over the last 5
years to identify factors that have facilitated or obstructed AYSRHR demand generation and service provision and synthesize
recommendations to strengthen AYSRHR demand generation and service provision. We require your support.

Please attach links to your program reports, reviews, and evaluations.

Please also list a point of contact to follow up on survey responses or further discuss AYSRHR programming during our key informant
interviews.

* 85. Please link all program reports, evaluations, reviews written about your AYSRHR projects/programmes
here. If not available online, please list a point of contact to obtain the reports.

86. Please list any additional comments that have not yet been addressed.

58
59