An analysis of community based health approaches in the delivery of integrated sexual, reproductive health and HIV services for adolescents with disabilities in Siaya County, Kenya.

Abstract

There is evidence of widening health disparities among vulnerable groups and inadequacies in the public health care system in sub-Saharan Africa (SSA), including Kenya. In particular, adolescents with disabilities (AWDs) confront many challenges in accessing health services. Their increasing primary care needs and rights in terms of sexual and reproductive health (SRH) is beyond the capacity of the conventional health system. While the Community Based Health Care (CBHC) approach has improved basic health services for maternal and child health as well as HIV and AIDS interventions, its capacity and utility to address the SRH and HIV interventions required by AWDs is not adequately studied in Kenya. Furthermore, debates persist on the overall quality of services provided through such primary health care systems. This study therefore investigated the CBHC approach as an option for improving AWDs‘ access to and use of Kenya‗s state-run adolescent SRH and HIV services in Siaya County of rural Kenya. The descriptive qualitative case study design used systems theory that featured Urie Bronfenbrenner‗s bio-ecological (Person-Process-Contexts-Time) and the World Health Organisation‘s (WHO‘s) (building blocks) health systems assessment frameworks as the main models to conceptualize, design, collect, analyze and interpret the data. Qualitative methods of data collection were used to explore purposively selected CBHC programs, and included semi-structured interviews, focus group discussions, observations, case narrations and record reviews. The study exposed serious institutional level inadequacies of the existing CHBC approaches, which were largely mediated by the disabling operating environment in the county health system. These ranged from poor staffing, inadequate financing, inadequate family support and community care, and unresponsive policy and legislation frameworks that lack enforcement mechanisms. Furthermore, the study found challenges associated with personal attributes including age, gender, type of disability, schooling and awareness of risks and available community-based services. Sexual and xii gender- based violence against the backdrop of an irresponsive justice system dominated the plight of AWDs in the county. As a result of analysing these factors, the evidence suggests a need to address the unique challenges surrounding the multi-dimensional issues that mediate access to and use of healthcare for adolescents living with disabilities to achieve equitable access to SRH & HIV services. In particular, the government should foster positive mechanisms of supporting community- based programs through co- financing with donors to expand the resource base for effective health services delivery, including SRH and HIV services for AWDs. Moreover, responsive policies and legal frameworks that were inclusive in approach to community care for AWDs would need to be clearly enunciated and enforced by the government and its stakeholders. Lack of data related to AWDs should be addressed to facilitate effective programming.