Young people constitute the largest segment of Kenya’s population, with about 40% aged between 18 and 34 years. They represent a critical demographic in human capital, which whilst still sub-optimally tapped, portends opportunity for future economic development.
Conversely, this demographic also holds the potential risk of political and socio-economic disruptions if not adequately catered for, especially in reproductive health. Research has shown that sexual activity amongst the continent’s youth remains highest globally. It is estimated that up to 52% of females and 73% of males in sub-Saharan Africa have had some degree of sexual experience by the time they turn 19 years. Considering Kenya’s progress towards middle-income economy status, globalisation, and exposure to liberal ideologies, sexual activity among the youth is projected to increase in future.
Thus, there is merit in investing substantively in enhancing access to Sexual and Reproductive Health (SRH) information and services to young people. This is not necessarily to tame their sexual habits and police their morality, but to secure their demographic dividend, and assure productivity in future. Access to contraceptive services for young men and women, for instance, means they can properly plan and space their children, hence better ability to care for them and provide critical needs such as food, medication and education. It also means the youth will effectively take charge of their reproductive health and properly plan their future.
In fact, research has proven that there exists positive correlation between improved sexual reproductive health and key sustainable development goals on poverty eradication, universal access to basic education, improving maternal health, and promoting gender equity.
Although Kenya has made progress in increasing access to contraceptive services and commodities, a high unmet need for family planning (estimated at about 18% nationally) still exists, with significant disparities between youths and the rest of the population. This has been largely attributed to inadequate access to commodities and over-dependence on donor funding. Also, because majority of the Kenyan population rely on out-of-pocket mechanisms for their health needs, the question of affordability arises. This is further complicated by the government’s user fee policies limiting access by low-income segments of the population to contraceptive commodities.
The government has also failed to follow through on commitments to enhance delivery of sexual and reproductive health rights to youth. At the Family Planning Summit in London in 2017, it renewed commitment to increase access to contraceptive services to curb rapid population growth and drive development. Top on the list was: working with partners to increase uptake of modern contraceptive methods, expanding youth-friendly contraceptive services focusing on adolescent girls, and scaling up delivery of services for hardest-to-reach-groups.
Also, at the 2019 ICPD 25+ conference in Nairobi, Kenya joined other countries in committing to universal access to sexual and reproductive health and rights by working towards zero unmet need for family planning information and services, and universal availability of quality accessible, affordable and safe modern contraceptives.
The Government of Kenya committed to revise and implement a national family planning costed plan and ensure all 47 counties have budget lines for it by 2020. It also committed to increase domestic financing for family planning by doubling the earmarked $7 million budget in 2016/17 fiscal year. Further, it planned to ensure that family planning is fully implemented under NHIF by end of 2018 and to increase proportion of health facilities offering youth-friendly services from 10% to 30% by 2020.
Admittedly, budgetary allocation for family planning, contraceptives and general sexual reproductive health has significantly increased. The budget line for "Family planning services/ Reproductive Maternal Neo-natal Child & Adolescent Health-RMNCAH" has increased from 0.8% (Ksh 466 million) in 2016/17 to 3.9% (4.3 billion) in 2020/21. Also, county governments allocated Ksh 11.2 billion for Reproductive Health & Maternal Health (RMNCH). It is important to note that despite increased budget allocations, these resources still fall short of the commitment to fully implement the national family planning costed plan - FP-CIP (2017 – 2020), which requires an estimated Ksh 32 billion annually.
Unfortunately, the Covid-19 pandemic has further exacerbated these inadequacies. As in every other sector, the pandemic has impacted reproductive health outcomes in Kenya, especially for young people, ranging from limiting access to commodities and services to raising affordability and equity issues, among others.
For instance, pharmacies recorded significant drops in contraceptives sales, due to supply chain disruptions arising from the pandemic. In 2020, 52% of women and 32% of men were unable to access SRH services for fear of contracting Covid-19 at the health facilities. Community-based care outlets were shut down; disrupting access to SRH services for millions of women and girls, especially sex workers. In terms of resource availability, the pandemic shifted focus from reproductive health services in the country as priority was placed on its response.
Moving forward, health sector stakeholders need to critically examine implications of Covid-19 on access to family planning, contraceptives and overall SRH services for young people. Effort is needed to ensure that Covid-19 response mechanisms (both containment measures and resource allocation) do not limit or roll-back progress.
To adequately and more sustainably respond, the government can facilitate better health outcomes for young people in family planning and reproductive health by increasing financing (at national level and counties) and implementing incremental policy changes. Initiatives like scaling up the voucher system in providing RH services, including family planning, especially in rural and hard to reach areas can also increase access to, and uptake of, contraceptive services among youths.
Through actions by county and national governments, more youth empowerment centres can be established and equipped to provide a one-stop-shop for age-appropriate and youth friendly reproductive health information.
At policy level, the government must increase collaboration amongst multiple stakeholders to increase participation of public, private, and civil society organizations. More action is also necessary to tackle barriers to some contraceptive methods, especially in remote locations. Lastly, reforms are necessary at Kenya Medical Supply Agency to end stock-outs and improve efficiency in the supply chain for all medical commodities, including contraceptives.
However, public sector resources alone are unlikely to meet Kenya’s growing demand for modern contraception. Policymakers should consider how government resources could be targeted at those least able to tap the private sector, especially young people, most of whom pay for the services out-of-pocket. More partnerships with development partners are also needed to secure increased financing for FP commodities and services.
More importantly, budget tracking is necessary to promote transparency and provide evidence for advocacy. This should go hand-in-hand with capacity development and education on the budget making targeting process for personnel of organisations (like those doing social audits) that advocate for budgetary increases.
This article was first published on The Standard on Saturday 6th March 2021