Contextual challenges of implementing adolescent and youth-friendly health services in Uasin Gishu county Kenya: a qualitative analysis

Abstract

Objectives: Substantial gaps in the implementation of adolescent and youth-friendly health services (AYFHS) have been identified in Uasin Gishu (UG) county, Kenya, across all eight domains of the WHO global standards, particularly with respect to adolescent health literacy, community sup- port, provider competencies, and equity and non-discrimi- nation. To respond, we undertook a qualitative analysis to explore contextual challenges of implementing AYFHS from the perspectives of adolescents and young adults (AYA) aged 10-24 years, policymakers, caregivers of AYA, healthcare providers, peer mentors, and community leaders. Methods: We used a hybrid inductive/deductive thematic analysis to explore contextual and systems-level de- terminants of implementing AYFHS in UG county, Kenya. Results: Our analysis generated four major themes: 1) pri- orities of political leadership and health systems manage- ment; 2) financial challenges; 3) human resources andfacility infrastructure; and 4) social-cultural barriers. Par- ticipants perceived political will, leadership, and health systems management to be obstacles to implementing AYFHS. Further, participants stated that financial challenges were a leading barrier to the implementation of AYFHS in the county, and that dispersion of funds from the county government to facilities was inadequate. Intersecting with the political-economic context, participants discussed limited human resources, poor facility infrastructure, and supply issues as determinants of implementation. Lastly, social-cultural norms in association with sexual and repro- ductive health discussed as a substantial issue. Conclusions: Addressing implementation determinants of AYFHS, including political, economic, and social-cultural barriers, can enable adoption and facilitate implementation and scale of AYFHS that are a fundamental component of living healthy and productive lives for AYA in Kenya.