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Published: March 15, 2024

Designed by young people, for young people: expanding youth-led sexual and reproductive health

Too often, adolescents and youth are sidelined in decision-making about their own health. “We know that young people may find it difficult to access sexual and reproductive health (SRH) services,” says Sam Oyugi, Lwala’s head of adolescent & youth programs. “Public health experts are always looking for new ways to reach youth, but in most cases, young people themselves are not consulted. We wanted to create something new– services designed by young people, for young people.”

In Migori, like in many other Kenyan counties, youth access to SRH services is impacted by a lack of knowledge, negative attitudes of health care providers, and stigmatizing cultural and religious beliefs. Yet when young people have the skills and space to lead, they can transform care for themselves and their peers.

For many years, Lwala has partnered with government and youth to improve access to SRH services, innovating and iterating on our model in Rongo Subcounty. We deploy a cadre of young people to serve their peers, and we promote high-quality comprehensive sexual education in schools. We also provide information and access to a range of modern contraceptive methods, delivered through health facilities and other youthfriendly access points. At the center of this work is the leadership and knowledge of young people.

Expanding youth-led sexual and reproductive health services in Migori County

Over the past year, Lwala has expanded this model beyond Rongo to five additional subcounties in Migori– Awendo, Nyatike, Uriri, Suna East, and Suna West. We recruited and trained 433 youth peer providers (YPPs), aged 18 to 24, who provide information to their peers on SRH, as well as distribute condoms, oral contraceptive pills, and emergency contraception. We work with YPPs and other young people to plan gatherings during school holidays–called “Better Breaks”–where they can access SRH information and services. Additionally, YPPs connect their peers to services at the community level through the “Roving Provider Initiative.” Finally, we are supporting over 100 health facilities to improve services for young people.

As a result of this work, we’re reaching more young people than ever with the sexual and reproductive health services they deserve–in expansion geographies, family planning visits have increased by 56% from 2022 to 2023, compared to a 24% increase in subcounties where Lwala has not yet expanded.

“I aspire to be an effective leader tomorrow, so I don’t want to be seen and treated only as a beneficiary. Instead, I want to actively participate in finding solutions to help young people in our generation achieve their dreams." - Vincent Owino, Lead Youth Peer Provider, Rongo Subcounty

Underneath this data lies stories of youth-led change, and below are three examples that showcase the unique ability of young people to understand each others’ problems, figure out a solution, and advocate for change.

Improvements in youth-friendly services at Kochola Dispensary in Rongo

The health-seeking behavior of young people is heavily influenced by their health providers. If young people feel judged or disregarded at health facilities, then they will be reluctant to return for future health care services.

To improve youth-friendly services, staff at Kochola Dispensary in Rongo Subcounty teamed up with YPPs. Together, they established a “YPP desk,” where young people are received by their peers upon arrival. They also identified and designated an area for youth-friendly care to improve the privacy and comfort of young clients.

At the same time, all staff at Kochola underwent an orientation to youth-friendly care, and YPPs played a crucial role in bringing the perspective of their peers to the table. “My perception of young people was altered when I began working with YPPs,” says Dorcas Adongo, a Clinical Officer and youth-friendly champion at Kochola. “I realized that when you demonstrate interest, care, and understanding of their needs, they open up and allow you to serve them." Due in part to this work, family planning visits among youth at Kochola have increased 140% from 2022 to 2023.

Reaching young people with nighttime services in Nyatike

In Nyatike Subcounty, young people face unique challenges in accessing SRH services due to its vastness, difficult terrain, and a rainy season that creates impassable roads. Nyatike is located in Migori County's gold belt along the shores of Lake Victoria, where mining and fishing are the main economic activities for a young workforce. It’s difficult to see a health provider during the day because of work, and at night, there is increased sexual activity near mining centers and beaches, posing risks to young people.

In response, youth peer providers decided to build upon the Roving Provider Initiative, which is being deployed in other subcounties. Under this initiative, YPPs leverage their connections with health facilities, calling on trained health providers to come to a safe space in their community where they can provide methods like injectable contraceptives and implants to youth. But in Nyatike, “we needed to tailor our intervention to address the distinct factors influencing the lives of youth,” says Churchil Adawo, Facility In-Charge at the nearby Otati Health Facility. So now the Roving Provider Initiative is offered at a time that works for young people in the community–at nighttime. “We joined forces with YPPs and the subcounty team, and now we have seen a higher adoption of family planning methods,” says Churchil.

According to Benard Okeyo Nyasaya, Nyatike’s Adolescent and Youth Coordinator, after hours support– at facilities and through the Roving Provider Initiative– are specifically targeting young people who may have foregone health care due to busy schedules or concerns about privacy, stigma, and embarrassment. “The convenient location of services and staff who are trained to provide destigmatized care make young people feel more comfortable and at ease,” he says. This is supported by data: between 2022 and 2023, Nyatike saw a 178% increase in contraceptive uptake (as measured by couple years of protection).

School breaks as an entry point for SRH services in Awendo

School holidays are often the riskiest time for young people engaging in unprotected sex. Through Better Breaks, Lwala and YPPs create space for young people to engage in leadership and leisure activities. During these gatherings, they can also access SRH counseling and services, such as pregnancy tests, contraceptive methods, and test kits for HIV.

In particular, we’ve seen great buy-in from YPPs and other young people in Awendo–they have mobilized their peers and planned creative activities to share SRH information, including a fashion show with SRH messaging. In December 2023, they organized and executed a three-day Better Breaks event. More than 1,500 young people attended each day, where they were provided with reproductive health information and services tailored to their needs.

All of this progress underpins one of Lwala’s deeply held principles: services for young people should be designed by young people. “Our involvement only helps build better programs,” says James Otieno, a 23-year-old Better Breaks organizer from Awendo Subcounty. “We understand the problems of our peers, and we can offer new perspectives–while challenging old assumptions. With the leadership of young people, we can design the solutions that we need.”

Agency, health, and wholeness of life.

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