Youth friendliness of reproductive health services: an Assessment of health facilities within Kisumu municipality
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The need for reproductive health services for youth is critical because of their high numbers, reduced age at first sex, multiple sex partners and other risky sexual behaviour leading to the possibility of unplanned pregnancies and sexually transmitted infections (STIs), including HIV. The provision of youth friendly health services plays a key role in the promotion of health and wellbeing in youth. The main objective of this study was to assess the youth friendliness of sexual and reproductive health services in health facilities within Kisumu Municipality. The specific objectives were to: identify the youth-friendliness of the . reproductive health services provided at the various health facilities, assess youths' perceptions towards youth friendly services and compare the uptake of services from health facilities within Kisumu Municipality. Quota sampling was used to identify health facilities which were further stratified into different categories and purposive sampling was used to identify eleven facilities. Service utilization and information on service quality was collected through in-depth interviews (twenty two managers and service providers) and reviews of monthly records and registers. A sample size of 246 youth was found to achieve the desired accuracy at 0.05% level and this number was proportionately distributed among the targeted health facilities. Observation was used to assess facility environment and quality of services provided. Qualitative data was analysed manually and emerging themes presented in narrative form. Quantitative data was analysed using SPSS to produce descriptive statistics presented in form of tables and figures. Findings indicated that only half of the 11 health facilities visited provided all 13 essential sexual and reproductive health services. HIV counselling and testing, pregnancy testing and STItreatment were the only services available in all the facilities. Only a quart25% of the health facilities had screening for sexually transmitted infection services while sexual abuse care services were only available in 40% of the facilities and similarly a low number of facilities (27%) provided life skills training which is key for youth. 54% of the responses defined youth friendly services as those that are provided for youth at hospitals, other organizations and youth centres to educate and treat them or services that are free or affordable. A quarter of the responses cited revealed that youth did not know what constitutes youth friendly services. When asked about health seeking behaviour, 23% of the responses cited reported that some youth did not visit health facilities because they had fear of the unknown or feared knowing their HIV status especially for those with multiple partners, inability to pay for services (21%) and ignorance or low risk perception (12%). The majority (62%) of youth reported that they go to hospital to seek medical attention when they are sick. Public health facilities recorded a higher frequency of youth clients (2401) compared to the privately-run facilities (1502). In terms of facility characteristics, the mean score of public health facilities is not significantly different from that of private health facilities (p=0.3065). For staff characteristics a paired t-test indicated that the mean score of public health facilities is significantly less than that of private health facilities (p=0.048) and similarly for management characteristics the mean score of public health facilities is significantly less than that of private health facilities (p=0.045). Private health facilities had higher scores (67%) in terms of satisfaction as compared to public health facilities which scored 47%. It is recommended that health facilities should provide a wider range of services and create awareness of services to promote uptake. Staff including nonmedical staff should receive further training in reproductive health and how to communicate effectively with youth. In addition, structural factors such as privacy, facility hours, waiting areas, fees and youth involvement need to be addressed in order to improve uptake of services by youth. This evaluation will help inform the work of policy makers and programme planners in designing more friendly youth services.