Kenya Adolescent Reproductive Health Programme (KARHP)

KARHP relied on community- and peer-based, face-to-face interaction and mobilisation; 2 of the sites received community and health interventions, as follows:

The community-based intervention addressed out-of-school youth and their parents with the aims of increasing knowledge of sexual and reproductive health and promoting parent-child communication. A large group of peer educators was selected with the participation of the community, and trained to provide information to youth and to make referrals to health centres for more information and services. The peer educators reached youth through group discussions, drama presentations, outreach meetings, condom demonstrations and distribution, one-on-one counselling, video shows, and distribution of other information, education, and communication (IEC) materials. The most frequent topics discussed during these contacts were sexually transmitted infections (STIs), relationships, drug use, teen pregnancy, and contraceptives.

In addition, employees of the Department of Social Services in each location were trained to reach parents and the rest of the community, as well as to act as the local supervisors of the peer educators. Eighty leaders from several local churches and Islam were recruited and trained as project partners. The religious leaders used their weekly services/gatherings to discuss youth RH issues and to encourage community discussions. In addition, the religious leaders acted as counsellors to young people in their congregations. They also allowed the peer educators to use their facilities for their outreach activities.

As part of the health-facility based intervention, 38 service providers from public and private health facilities were trained to deliver youth-friendly RH services. In addition, the facilities set up and equipped a separate facility within the health centre where youth could meet with service providers and obtain information and services. There were also peer educators in each of these 'youth-friendly' rooms, as well as IEC materials.

Two additional sites also received a school-based intervention that included peer education, guidance and counselling, referrals for health services, and the implementation of a 34-hour Life Skills curriculum. Seventy-four teachers skilled in counselling from 27 schools were trained in adolescent RH; they then recruited and trained about 600 peer educators. The latter carried out several types of outreach activities in schools, including organising discussion events, contests, educational video viewing sessions, and one-on-one counselling. The peer educators were often the first contact for students requiring assistance and information. The teachers held life skills training sessions (with modules on reproductive health, sexuality, and HIV/AIDS) for the different classes, and by the end of the project, each teacher averaged 12 sessions of the curriculum and had counselled at least 26 schoolchildren. In addition, each school launched KARHP clubs, which provided a forum for students to meet and discuss RH.

Youth, Reproductive and Sexual Health.

Kenya's Western Province was chosen because in 1999 it had above-average levels of reproductive health problems among adolescents, a relatively poor infrastructure, and fairly densely populated rural areas. Two out of the 8 rural districts in the province were chosen - Vihiga and Busia - to provide some variation in the characteristics of the study sites, although both districts are largely populated by the Luhya ethnic group, thus giving some degree of cultural homogeneity.

Organisers explain that in Kenya, at the time the project was launched, there was a lack of systematic education programmes for in- and out-of-school adolescents, controversy surrounding (and opposition to) provision of services to adolescents, and a pervasive concern that provision of sexuality education and contraceptive services would lead to promiscuity. According to FRONTIERS, highly placed policy makers and some religious organisations were actively opposed efforts to introduce Family Life Education (FLE) into schools; they say that this is still largely the case in early 2004.

In addition, FRONTIERS claims, Kenyan adolescents who are sexually active face many barriers to accessing services, thereby reducing their ability to protect themselves. Guidelines for provision of RH services, and especially contraceptives and condoms, to unmarried adolescents are deliberately ambiguous and open to conflicting interpretation.

While the project was underway, the Kenyan government mandated that schools provide students with information on HIV/AIDS. Teachers in the school intervention areas reported that their training in the life skills curriculum enhanced their ability to carry out this mandate. FRONTIERS and PATH are working with the Kenyan government to institutionalise successful aspects of the intervention, replicate the project in other areas of Western Province, and document improvements made during the process of scaling up.

The USAID-funded project was part of a larger 4-country operations research study designed to test a set of approaches to providing RH services and information to adolescents; Bangladesh, Mexico, and Senegal were the other sites.

The project has been expanded from the original pilot/research project, to cover more districts, although the key intervention activities remain the same. The scaling up process started in 2004, and included an effort to get the government to take up the project as one of its regular programmes.