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.
