The Division of Reproductive Health (DRH) within the Ministry of Public Health and Sanitation
(MOPHS) with assistance from FHI 360 and financial support from United States Agency for
International Development (USAID) undertook a review of adolescent and youth reproductive
health programs in the country through a desk review, a mapping of youth serving organizations
(YSOs), and interviews with stakeholders from the YSOs and development partners. The goal
was to identify the key organizations involved in adolescent and youth sexual and reproductive
health (AYSRH), compile a general inventory of their activities, and begin to assess the degree
to which they are using evidenced-based interventions that are ready for national scale-up. This
review was designed to enhance the DRH’s ability to coordinate AYSRH activities in the
Kenya has multiple policies and guidelines that favor provision of information and services to
young people, but these documents are not integrated well into services. Multiple ministries are
involved in the process, adding to the challenges in this field. In addition to the MOPHS, the key
ministries and government agencies with interest in AYSRH are Ministry of Medical Services
(MOMS), Ministry of Youth Affairs and Sports (MOYAS), Ministry of Education (MOE),
National Coordinating Agency for Population and Development (NCAPD), National AIDS and
STD Control Program (NASCOP), and Kenya Institute of Education (KIE) among others.
Out of the 67 YSOs and 13 development partners identified in the review, 45 organizations and
nine development partners responded with information through a telephone interview or email.
The findings reiterated the fact that many young people are sexually active and are at risk of
adverse reproductive health outcomes that subsequently affect achievement of life goals and
optimum contribution to national development. Many youth initiate sexual intercourse early,
have multiple partners and often do not use protection during sex. In general, young people are
unlikely to seek health services, and when they do they are likely to get inadequate services.
This health system has been slow to evolve to accommodate the needs of this age group both
from program and service delivery perspectives. Some service providers lack the skills and
positive attitudes needed to serve youth.
Most YSOs operate within the highly populated areas of the country with Nairobi having the
highest concentration of implementers (26 out of the 45 interviewed). They mainly target in- and
out-of-school youth aged 10-24 years, in both rural and urban areas. The main program
approaches they use to reach youth include peer education, edutainment, service delivery
(including outreach services), youth support structures, mass media, ICT, edusports, life skills
education, mentorship, adult influencers, and advocacy for policy review or change. These
approaches are usually not implemented singly but in combination, such as peer education with
mass media and service delivery.
In the survey, the YSOs identified the following main gaps in AYSRH in terms of program and
There are many well-established reasons that support the rationale for integrating or linking
sexual and reproductive health (SRH) and HIV services in developing countries with generalized
HIV epidemics - primarily in sub-Saharan Africa. Yet the evidence base for the impact of
integrated service delivery on health outcomes and costs remains weak. Partly this is a result of
There is an emerging body of literature addressing the challenges of using randomized controlled
trials to assess the impact of public health interventions. Particularly in cases such as the Integra
Initiative, where the causal chain (between intervention and outcome) is long, and where there
are is a broad range of outcomes that need to be explored, and where there is already some a
degree of integration occurring in some clinic settings, attempting to conduct a randomized
controlled trial is not appropriate. Consistent with evaluation designs described by Habitat and
colleagues, the Integra design includes evaluation of performance and impact to try to make two
types of causal inference: adequacy and plausibility.
Evaluation of adequacy will assess whether the expected changes in provision, service utilization
and cost-effectiveness have occurred in intervention facilities. Evaluation of impact will assess
the plausibility that changes in service, health and behavioral outcomes are due to the Integra
Initiative. The case for such plausibility will be built from the following strands of evidence:
Comparing findings in 'intervention' facilities with those in facilities chosen as
'comparison' sites prior to the evaluation
Exploring a dose-response relationship between the measured extent of integration and
the study outcomes
Measuring changes in performance over time, to demonstrate a logical sequence between
the intervention (integration) and outcomes.
Measuring change in each step of the logic model - a prerequisite for any attribution to
Triangulating findings from a mix of research methods to capture a range of perspectives
and insights from different disciplines.
The study will employ a controlled pre- and post-test quasi-experimental, or non-randomized,
design and utilizes multiple research methods (cohort study, community survey, clinic
assessments, costing tools and qualitative interviews). Since the research is being conducted in
real-life health delivery settings where programmatic contamination is possible due to ongoing
health programme interventions over the study period, the control group will be referred to as a
'comparison group', for which outcomes will be compared over time up to two years after