Why Kenya has set aside money to increase teens uptake of contraceptives


31 Aug 2015 | by
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Why Kenya has set aside money to increase teens uptake of contraceptives

A while back You tube sponsored a In an attempt to reposition family planning and contraceptive services in Kenya, the Ministry of Public Health and Sanitation, the Ministry of Medical Services, and other partners developed their National Family Planning: Costed Implementation Plan for implementation from 2012-2016...................

A while back You tube  sponsored a In an attempt to reposition family planning and contraceptive services in Kenya, the Ministry of Public Health and Sanitation, the Ministry of Medical Services, and other partners developed their National Family Planning: Costed Implementation Plan for implementation from 2012-2016. The plan costs out activities needed to increase CPR from 46% to 56% by 2015, and then to 70% by 2030, all part of their FP2020 goals.23 One of the main strategies they are employing to meet this goal is increasing contraceptive use among youth. The CIP total cost is $256 million USD (26.6 Billion KES), which is broken out in five thematic areas. The thematic areas are human resources, commodity security, youth, demand creation, and integration and crosscutting issues. The youth thematic area accounts for 21.7% of CIP funds. What the CIP Gets Right Based on the current low level of contraceptive usage among youth, Kenya used research from Population Council to assess where young girls were accessing their contraceptives to fund appropriate interventions. The research showed that about 30% of girls aged 15-19 accessed their contraceptives from private health facilities.24 Based on this data, the Kenya CIP has outlined interventions to build the capacity of private pharmacies to provide short-term contraceptive methods. Females aged 15-24 had the highest rate of CPR change from 2003-2009 in Kenya.25 One of the suspected causes for this was media-based family planning messages on the radio. Based on this, Kenya has budgeted for increased youth focused family planning messaging through a behavior change communication strategy that will be youth owned and operated. The foreword of the CIP calls for advocates to use the CIP as an advocacy and monitoring tool for all family planning programs. At the end of the CIP budgeted period, advocates will be able to look back at this plan and see what has been attained, what areas still need additional attention and resources, and where their advocacy efforts were and were not successful or welcome. What the CIP Could Do Better Even though there are interventions in the CIP to build the capacity of private pharmacies to provide short-term methods, there are no line items to help pharmacies support a larger youth client base, either through pharmacist training in YFS or structural improvements. Additionally, there is no funding for improving contraceptive services at public facilities, where a large number of youth still access their contraceptives. The only money allocated to increasing the availability of youth friendly services is earmarked for workshops to determine where YFS should go and regional workshops to train service providers. These account for 0.3% of the total budget for youth interventions for 2012-2013. However, as these are the only workshops and the funding is only earmarked for one year, this will likely not be an adequate intervention to increase youth access. One of the interventions under the youth thematic area is to “increase availability of condoms as a dual protection against pregnancy and STIs, including, HIV”.28 While dual protection is important, only 7.6% of all sexually active women age 15-19 use male condoms whereas 13.5% use injectables.29 When breaking out the number to married and unmarried women, unmarried women are more likely to use male condoms, but married women still have high levels of unmet need for contraception.30 The CIP should be stressing access to a larger method mix than just condoms for young people, especially among married young women. Increasing method mix is part of the CIP; however, it is not included under the youth objectives, and there is no mention of this population in the plan. Given the high levels of provider bias, high unmet need will remain persistent for this group if specific interventions are not planned. As with other CIPs, there is a line item to train four peer educators per county. While activities are costed out for mapping how to facilitate cliniccommunity links with input from youth, it is unclear how the peer educators will engage with the larger community to ensure buy-in for adolescent family planning services, as many of the planned activities (such as transporting youth to clinics) will need to involve community support. One of the biggest omissions from Kenya’s CIP is their failure to include the 10-14 age group for budgeted youth interventions. Provider training, pharmacy access and school-based interventions would all benefit this target age group, and should be advocated for including in the next CIP development. Additionally, some objectives that are for family planning do not actually have family planning activities aligned with them. For example, under the advocacy objective “increased demand for FP by improving advocacy”, there is an activity to mobilize donor funds to purchase sanitary pads for girls 15-19 in schools within the 20 poorest counties. Sanitary pads should not be included in this objective, as it does not increase demand for family planning. While this activity is not costed, it detracts from the other activities in this objective such as including family planning issues on politicians’ manifestos, implementing the Adolescent Reproductive Health Policy, and cultivating In an attempt to reposition family planning and contraceptive services in Kenya, the Ministry of Public Health and Sanitation, the Ministry of Medical Services, and other partners developed their National Family Planning: Costed Implementation Plan for implementation from 2012-2016. The plan costs out activities needed to increase CPR from 46% to 56% by 2015, and then to 70% by 2030, all part of their FP2020 goals.23 One of the main strategies they are employing to meet this goal is increasing contraceptive use among youth. The CIP total cost is $256 million USD (26.6 Billion KES), which is broken out in five thematic areas. The thematic areas are human resources, commodity security, youth, demand creation, and integration and crosscutting issues. The youth thematic area accounts for 21.7% of CIP funds. What the CIP Gets Right Based on the current low level of contraceptive usage among youth, Kenya used research from Population Council to assess where young girls were accessing their contraceptives to fund appropriate interventions. The research showed that about 30% of girls aged 15-19 accessed their contraceptives from private health facilities.24 Based on this data, the Kenya CIP has outlined interventions to build the capacity of private pharmacies to provide short-term contraceptive methods. Females aged 15-24 had the highest rate of CPR change from 2003-2009 in Kenya.25 One of the suspected causes for this was media-based family planning messages on the radio. Based on this, Kenya has budgeted for increased youth focused family planning messaging through a behavior change communication strategy that will be youth owned and operated. The foreword of the CIP calls for advocates to use the CIP as an advocacy and monitoring tool for all family planning programs. At the end of the CIP budgeted period, advocates will be able to look back at this plan and see what has been attained, what areas still need additional attention and resources, and where their advocacy efforts were and were not successful or welcome. What the CIP Could Do Better Even though there are interventions in the CIP to build the capacity of private pharmacies to provide short-term methods, there are no line items to help pharmacies support a larger youth client base, either through pharmacist training in YFS or structural improvements. Additionally, there is no funding for improving contraceptive services at public facilities, where a large number of youth still access their contraceptives. The only money allocated to increasing the availability of youth friendly services is earmarked for workshops to determine where YFS should go and regional workshops to train service providers. These account for 0.3% of the total budget for youth interventions for 2012-2013. However, as these are the only workshops and the funding is only earmarked for one year, this will likely not be an adequate intervention to increase youth access. One of the interventions under the youth thematic area is to “increase availability of condoms as a dual protection against pregnancy and STIs, including, HIV”.28 While dual protection is important, only 7.6% of all sexually active women age 15-19 use male condoms whereas 13.5% use injectables.29 When breaking out the number to married and unmarried women, unmarried women are more likely to use male condoms, but married women still have high levels of unmet need for contraception.30 The CIP should be stressing access to a larger method mix than just condoms for young people, especially among married young women. Increasing method mix is part of the CIP; however, it is not included under the youth objectives, and there is no mention of this population in the plan. Given the high levels of provider bias, high unmet need will remain persistent for this group if specific interventions are not planned. As with other CIPs, there is a line item to train four peer educators per county. While activities are costed out for mapping how to facilitate cliniccommunity links with input from youth, it is unclear how the peer educators will engage with the larger community to ensure buy-in for adolescent family planning services, as many of the planned activities (such as transporting youth to clinics) will need to involve community support. One of the biggest omissions from Kenya’s CIP is their failure to include the 10-14 age group for budgeted youth interventions. Provider training, pharmacy access and school-based interventions would all benefit this target age group, and should be advocated for including in the next CIP development. Additionally, some objectives that are for family planning do not actually have family planning activities aligned with them. For example, under the advocacy objective “increased demand for FP by improving advocacy”, there is an activity to mobilize donor funds to purchase sanitary pads for girls 15-19 in schools within the 20 poorest counties. Sanitary pads should not be included in this objective, as it does not increase demand for family planning. While this activity is not costed, it detracts from the other activities in this objective such as including family planning issues on politicians’ manifestos, implementing the Adolescent Reproductive Health Policy, and cultivating champions

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