Strategies Influencing Provision of Adolescent and Youth Friendly Services Within the Public Health Facilities in Migori County

Abstract

The focus of leadership and governance in a health system is to guarantee the availability of policy guidelines along with oversight, alliance-building, control, focus to system design and accountability. Joint efforts are needed to prioritize on an all-inclusive Adolescent and Youth Friendly Services (AYFS) package that is embracive of community activities. Migori county has a population of 1,116,436 people with 37% of this being young people between 10-24 years. The Kenyan government provides guidance to ensure inclusion of Adolescents and Youth (AY) matters in the country’s development agenda by developing National Guidelines for Provision of AYFS in 2016.All government sectors and stakeholders have an important role in provision of AYFS. Migori county strategic plan sates that 80% of the public facilities should be providing AYFS, however, as of 2022, only 62(39%) were providing AYFS. This study sought to determine strategies influencing the provision of AYFS within public health facilities. Specific objectives were to determine the influence of capacity building, coordination of actors and activities, networking of relevant stakeholders and community involvement, on provision of AYFS within public health facilities in Migori County. It was a cross sectional study and targeted 159 public health facilities and 455 health care providers. A sample of 114 Health facilities was selected from which a sample of 213 providers was drawn using Taro Yamane formula. Data was collected from the 213 providers using a structured questionnaire, a checklist from 114 health facilities, while qualitative data was collected from three facilities in charges using Key informant interviews (KII) guide. Statistical Package for Social Sciences (SPSS) Version 24.0 was used to analyze quantitative data while NVivo 9 software was used for transcribing and coding the qualitative data. Majority 153 (74%) of the respondents were in the profession of nursing and majority 148(71%) had worked at their current workstation between 1-5years. Bivariate analysis showed a positive and significant association between all the independent variables and the dependent variable. Capacity building (p=0.001, r=.548) Coordination (p=0.001, r=.482), Networking by stakeholders (p=0.001, r=.390), and Community Involvement (p=0.001, r=.460), positively and significantly influenced provision of AYFS. Multivariate analysis was undertaken, and the study model explained 56% of the variations in provision of AYFS. Logistic regression shows that capacity building (p=0.001), Coordination of AYFS (p=0.028), and Community involvement (p=0.002) had a significant association with provision of AYFS. The study therefore revealed that capacity building, coordination of actors and activities and community engagement all together influences provision of AYFS. This study recommends training institutions, to include a module(s) on AYFS in pre-service curriculum. Coordination of AYFS to be improved through school outreaches to share AY health matters including building the capacity of teachers on AYFS, along with communication of AYFS laws and policies. To strengthen AYFS networking, county department of health ought to map all relevant stakeholders, build partnership for advocacy, promote proprietorship and brace for execution of key AYFS policies and standards. Communities through their representatives should be engaged in the planning, implementation, and monitoring of AYFS provision with inclusion of the AY.