A Health Systems Approach To Sexual And Reproductive Health Service Utilization By Adolescent Girls In Kajiado County, Kenya

Abstract

Adolescent girls in Kenya face significant barriers in accessing sexual and reproductive health (SRH) services, particularly in pastoralist communities such as Kajiado County, in the subcounties of Kajiado Central, Kajiado South, Kajiad East, Kajiado West and Kajiado North, where cultural norms, stigma, and weak healthcare infrastructure exacerbate these challenges. This study aimed to assess the factors influencing SRH service utilization among adolescent girls in Kajiado County and to identify actionable strategies for improving adolescent SRH outcomes. This study adopted a cross-sectional study design, utilizing both the qualitative and quantitative data. Exploratory design was used for the objectives setting and deducing the findings from Objective results. Specifically, the study sought to: (i) evaluate adolescents’ level of SRH knowledge, (ii) identify individual and socio-cultural factors affecting service utilization, (iii) examine the practice of patient-centeredness in SRH service delivery, (iv) assess the role of financial interventions in access to care, (v) explore the influence of health referral systems on service uptake, and (vi) propose a digital health platform for enhancing service utilization. A cross-sectional design with a mixed approach was employed, integrating quantitative surveys with 422 adolescent girls aged 10–19 years and qualitative insights from key informant interviews (KIIs) ,In-Depth Interviews and focus group discussions (FGDs) to strengthen on the Qualitative Data. Stratified random sampling ensured socio-demographic representation. Quantitative data collected from the 422 adolescents were double entered into STATA at the Data Management Centre of Kenya Methodist University to ensure accuracy and qualitative interview transcripts were managed and coded in Nvivo software for thematic analysis. Quantitative data was analyzed using descriptive statistics, correlation, and logistic regression, while qualitative data was thematically analyzed and triangulated with quantitative findings. Ethical approval was obtained from the Institutional Scientific and Ethics Review Committee (ISERC). For participants below 18 years, informed consent was obtained from parents/guardians alongside adolescents’ assent, ensuring compliance with child protection and ethical research standards. The results revealed that while 67.3% of adolescents had basic SRH awareness, only 41.8% demonstrated comprehensive knowledge, especially regarding contraceptive use and reproductive rights. Key determinants of service utilization included age, education, and socio-economic status, with older adolescents and those with secondary education more likely to access services (p < 0.05). Barriers included financial constraints (72.5%), privacy concerns (56.7%), and judgmental provider attitudes. Despite existing referral systems, only 38.2% of adolescents had ever been referred for SRH services. The study co-created innovative solutions with community stakeholders, including strengthening adolescent-friendly clinics, scaling up community-based SRH education, providing financial support mechanisms, and proposing a digital health platform to improve accessibility. The Digital Health Platform has actually made huge strides towardsthis development,with the website and an Instagram page resulting to a 15% increase in it's utilization by the Adolescent age.With more than 2,000 followers on the Instagram page,it has had more than 2500 visits over the past six months, resulting in a considerable impact.The link to further information around the digital health system(Youth Wellness Connect) is herein attached:https://www.youthwellnessconnect.co.ke/ These findings highlight the urgent need for system-level interventions and community-driven strategies to enhance SRH service uptake among adolescent girls in Kajiado County, offering practical lessons for similar pastoralist settings in Kenya and beyond.