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Background: In Kenya, street-connected children and youth (SCY) have poor health outcomes and die prematurely
due to preventable causes. This suggests they are not accessing or receiving adequately responsive healthcare to
prevent morbidity and mortality. We sought to gain insight into the health systems responsiveness to SCY in Kenya
through an in-depth exploration of SCY’s and healthcare provider’s reflections on their interactions with each other.
Methods: This qualitative study was conducted across 5 counties in western Kenya between May 2017 and
September 2018 using multiple methods to explore and describe the public perceptions of, and proposed and
existing responses to, the phenomenon of SCY in Kenya. The present analysis focuses on a subset of data from
focus group discussions and in-depth interviews concerning the delivery of healthcare to SCY, interactions between
SCY and providers, and SCY’s experiences in the health system. We conducted a thematic analysis situated in a
conceptual framework for health systems responsiveness.
Results: Through three themes, context, negative patient-provider interactions, and positive patient-provider
interactions, we identified factors that shape health systems responsiveness to SCY in Kenya. Economic factors
influenced and limited SCY’s interactions with the health system and shaped their experiences of dignity, quality of
basic amenities, choice of provider, and prompt attention. The stigmatization and discrimination of SCY, a
sociological process shaped by the social-cultural context in Kenya, resulted in experiences of indignity and a lack
of prompt attention when interacting with the health system. Patient-provider interactions were highly influenced
by healthcare providers’ adverse personal emotions and attitudes towards SCY, resulting in negative interactions
and a lack of health systems responsiveness. |
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