INCEPTION REPORT FOR THE WHO JKP AYSRH TA MECHANISM

INCEPTION HELD AT THE REEF HOTEL, MOMBASA KENYA.

 INCEPTION MEETING FOR THE WHO AYSRHR TECHNICAL
ASSISTANCE COORDINATION MECHANISM FOR JUMUIYA YA
KAUNTI ZA PWANI (JKP) MEETING HELD AT THE REEF HOTEL
MOMBASA ON 18TH AUGUST 2021

PROJECT PURPOSE:
To improve equitable access to quality Sexual Reproductive Health & Rights Information and
Services for Adolescents & Youth in the six coastal counties in Kenya through support for
strategy development, harmonization and strengthened monitoring and evaluation

1.0 Background of the TA mechanism

In 2019, WHO SRH&R/HRP established the Adolescent and Youth Sexual and Reproductive
Health and Rights (AYSRHR) Technical Assistance (TA) Coordination Mechanism, as part of
the FP Accelerator Project. The mechanism received a request for support from the Jumuiya
ya Kaunti za Pwani (JKP, an economic block of six coastal counties in Kenya) to address the
coastal counties’ gap regarding adolescents and young people’s access to quality SRH&R
information and youth-friendly SRH&R services at the health facility and community levels.
Some of the key AYSRHR challenges in the Coastal counties include high rates of adolescent
pregnancies, unmet need for family planning (FP) and inadequate knowledge of contraception
among adolescents and youth plus other contextualized challenges.

The coastal counties have high rates of unmet need for contraception for all women of
reproductive age (43.9% compared to 58% nationally), and the knowledge of contraception is
reported to be much lower in the coastal counties compared to the national average especially
among the Youth and adolescents. Adolescent pregnancy is a major concern in Kenya.
According to DHIS2, the National average rate was 25% in 2020and the coastal counties that
make up the JKP (Kilifi, Kwale, Lamu, Mombasa, Taita Taveta, and Tana -River) equally have
high rates of adolescent pregnancies at 18% average for the region. In the region, Tana River
and Kwale Counties have the highest adolescent pregnancy rates at 39% and 28% in 2020
respectively as per the DHIS2, these are above the National average of 25% of all pregnancies
at 1st ANC. The adolescent pregnancy rates in Lamu County stood at 22%, with
Kilifi and Taita Taveta counties both at 15%. However in terms of absolute numbers, Kwale
county had the highest number of adolescent pregnancies in the Coastal region at 8,279,
followed by Kilifi county at 7,055 and Tana Rivera at 4,584 in 2020. Thus, it is envisioned that
the development of a regional AYSRHR strategy and complementary county-level

1
implementation plans would help to drive coordinated action to address these issues in the six
counties within the JKP.

The main purpose of the TA mechanism is to improve equitable access to quality SRHR
information and services for adolescent as well as youth in the six coastal counties. Therefore,
the objective of this mechanism is to deliver TA that the six Coastal counties need for
designing, implementing, monitoring, reviewing and documenting their AYSRHR programs,
in ways that are timely and effective while considering practical experiences in a similar
context, with back-up from evidence-based programs. The TA mechanism also envisions that
efficiency will be enhanced especially by working closely with experts located close to the
respective country/regions. Also, the need to use methods that are effective as well as
considering readily available resources would contribute to the development of national
capacity.
To achieve the aforementioned, the TA mechanism has been divided into 2 Stages with five
phases as follows:
Stage I (August to October ‘21):
Phase I: (August) Inception meeting preceded with methodology meeting, and a forum to
facilitate youth engagement in the TA process leveraging the existing JKP Innovation Lab
Phase II: (September) Desk review and stakeholder/resource mapping
Phase III: (September – October) FGDs, KIIs, and facility / community sites visits followed
by analysis and report of the findings.

Stage II: (From November 2021)

The second stage is anticipated to run from November 2021 with the following phases
Phase IV: Development, review, validation and finalization of a regional strategy
Phase V: Development, review, and finalization of county-level implementation plans

2
2.0 Inception Meeting:
2.1.1 Inception meeting participants
The inception meeting brought together key county ASRHR stakeholders and technical
assistance team to deliberate on the TA Mechanism. The meeting was important in sensitizing
the key stakeholders on the initiative, plus harnessing their expectations and in-put to the
process. The inception meeting was held on 18th August 2021 in a hybrid form with a total of
35 participants, of which 27 attended in person and eight persons attended virtually. The
participants were mainly drawn from the JKP Health sector group members, JKP Gender &
Youth sector groups, JKP University fraternity, Members of civil society and the JKP AYSRH
programs youth groups, the WHO representatives, and the TA mechanism partners (AKU &
EGPAF). All the six Jumuiya counties were well represented (attendance list in appendix 1.1.)
2.1.2 Introduction of the inception meeting
The inception meeting started at 9 00 am as indicated on the agenda (appendix 1.2.) when the
moderator Dr. Flaura Kidere (Researcher & project Coordinator for the JKP & Pwani
University Innovation Lab called the meeting to order. This was followed by opening prayers
from Dr. Saulo Juma (registrar for Research and Extension at the Technical University of
Mombasa). Thereafter, participants introduced themselves i.e. organization they represented,
roles played as well as their county of residence.
2.1.3 Background of TA mechanism
The inception meeting started with a brief background of the AYSRH TA mechanism where
Mr. Emmanuel Nzai, the CEO of the Jumuiya ya Kaunti za Pwani (JKP) informed members of
the genesis of the mechanism as well as the needs of the region as far as the TA mechanism is
concerned. This was followed by a detailed account by Prof. Marleen as to the process that
various partners took to ensure that the discussion to have the TA mechanism was fruitful. She
indicated that together with other partners, they were able to identify the sexual and
reproductive health challenges youths and adolescents face within the JKP (Six Counties in the
Coastal Region). Prof. Marleen also mentioned that this observation was key in assembling
various partners who came together to discussed how this mechanism would be useful in
reducing the identified challenges. These partners include the National Government, JKP
fraternity, the civil society, private health care providers such as the Aga khan foundation,
members of local Universities and a few CBOs dealing with youth groups within the region.

3
2.1.4 Official Opening of the inception meeting
The meeting was officially opened by the Chief Executive Committee member for Health from
the County Government of Mombasa, Dr. Nato who was representing the Deputy Governor of
Mombasa County. The CEC for Health in his opening remarks, stated that young people have
a bigger representation in Kenya and emphasized need to boldly address matters that affect
them. He also shared information regarding AYSRHR issues within the region, some of the
observations made included the following issues: Lack of finances, Limited number of youth
friendly facilities, Limited number of resourceful personnel, User friendly intervention among
others

The CEC for health therefore applauded the WHO/ JKP TA Mechanism initiative and generally
emphasized on the importance of enhancing inclusivity, especially Youths in such a process as
evidenced in the TA mechanism. He also indicated that the management of the County
Government of Mombasa has been working closely with the youth representatives within
Mombasa County so as to understand as well as address issues of sexual and reproductive
health and rights. He indicated that involving the Youth in AYSRHR matters between the years
2018 -2021 has enhanced the uptake of family planning services within Mombasa County. He
closed by promising to work together with the partners involved in the mechanism and all other
stakeholders in order to ensure that the TA mechanism achieves its objectives.

2.1.5 Brief on AYSRHR TA Coordination Mechanism: By Venkatraman Chandra-

Mouli, Bruce Dick & Ahmed Ali (WHO AYSRHR TA Mechanism Team)
Dr. Chandra, Scientist, Adolescent Sexual Reproductive Health, Department of Sexual
Reproductive Health & Research, World Health Organization, Geneva; led the presentation on
behalf of the team. Dr. Chandra informed members that WHO AYSRHR TA team are aware
of existing AYSRHR needs in the region, as well as the fact that many adolescents and youth
are not able to obtain and/or use the SRHR Information and services. He quoted key barriers
as being related to laws and policies, social norms regarding adolescent sexuality, health
providers’ attitudes and competencies.

Dr. Chandra also mentioned inadequacy of policies and strategies, monitoring and shared
learning as contributing factors to poorly designed, implemented and documented AYSRHR
programs. He further appreciated the fact that countries are increasingly showing interest in
improving AYSRHR programming and have been requesting for TA on the same. He reiterated
4
that the aim of this program is to deliver TA those countries need in designing / implementing
/monitoring /reviewing /documenting their AYSRHR programs in ways that are Timely,
effective and efficient. He also articulated the “Dos” and Don’ts” from lessons learnt and the
kind of support that the mechanism can provide. He reiterated the importance of the TA
mechanism emphasizing on contextual solutions and strategies. He further indicated that the
nature of the mechanism is mainly to provide technical assistance and not necessarily direct
funding.
On the other hand, Dr. Bruce from the WHO, Geneva reiterated Dr. Chandra’s sentiments while
emphasizing on need to ensure client led, timely, efficient and effective delivery of identified
activities within the TA mechanism.

2.1.6: The JKP ASRHR TA Mechanism Objectives, Methodology & Products: Presented
by the TA Team from EGPAF and AKU
Elizabeth Okoth (Senior Technical Advisor Pediatric & Adolescent Services - EGPAF)
presented on behalf of the team from the two TA partners EGPAF (Elizabeth Glaser Pediatric
AIDS Foundation) and AKU (Agha Khan University). The presentation outlined the objective
of the TA as follows:
1.To improve equitable access to quality SRH information and services for adolescents and
youth in the six coastal counties, with a focus on increasing uptake of contraception, through
support for strategy development, harmonization and strengthened M&E system.

She also indicated that the situation analysis to inform the TA for the JKP ASRHR will be
preceded with a protocol that will be approved by the Ethics and Review committee of Pwani
University. The assessment would include both qualitative and quantitative methods including
desk review, key informant interviews, focus group discussions, assessment of both facility
and community AYSRHR services, and data analysis of AYP services and outcomes, she
further espoused. Ms. Elizabeth also informed participants that the team would ensure that the
situation analysis activities will reach key stakeholders in ASRHR in the region for their
opinions.

The presentation outlined that EGPAF and AKU will facilitate the process for the development
of Coastal Region AYSRHR strategy, under the leadership of JKP. The study was said to be
using participatory approach with representation of multi-Sectoral stakeholders from across the
6 counties in the Coastal Region. The findings from the situation assessment would provide

5
useful information for the process. Also, the uniqueness of Counties and specific Adolescent
& Youth populations will be considered while strongly considering meaningful youth
involvement. The TA mechanism team representative also indicated that a monitoring and
evaluation plan will be in place for tracking appropriate milestones.

The presentation also outlined the support for County Specific Implementation plans. This will
be facilitated by EGPAF and AKU under the leadership of the County Governments, led by
County MoH, and through a multi-sectoral Task-Force. The JKP representatives and the Youth
representatives will be involved in the Taskforce. The findings from the County specific
situation assessment will be useful to the process as well as the uniqueness of specific
geographies and sub-populations of Adolescents & Youth within the county. Furthermore,
Monitoring & Evaluation to track milestones would be put in place.

The team also gave highlights of the two TA organizations as follows: EGPAF’s mission is to
end AIDS globally in children, youth and families. The organization focuses on HIV, FP,
reproductive, maternal, newborn, child and adolescents health, and TB programs, Health
systems strengthening, Community engagement, Advocacy, Strategic Information, Evaluation
and Research. EGPAF works in 19 countries and over 5,000 sites and has reached over 90,000
adolescent and youth with HIV and SRHR integrated services.

The Vision of Aga Khan University (AKU) Centre of Excellence in Women and Children’s
Health is: to tackle Women, Child and Adolescent Health Challenges through Research,
Science, innovation, Knowledge Translation and Capacity Building, in line with the
Sustainable Development Goals. The CoEWCH addresses some of the greatest public health
concerns affecting the region, including SRHR, maternal, newborn, child and adolescents’
health, gender and inequalities, from a rights-based perspective.

Aga Khan University is situated in 3 continents with 6 campuses.

6
 A picture of the TA mechanism partners

3.0 Presentation from JIL/ AYSRH program Youth representatives

Twelve Jumuiya innovation Lab Youths volunteering in AYSRH programs within the region
participated during the inception meeting. These included two from each county, composing
of one male and one female from each county. In providing their views, the twelve JIL/AYSRH
volunteers were represented by two Youths, one male Mr. Mwashighadi from Taita Taveta
County and one female namely Ms. Mwanamina Fakii from Kwale County. Some of the
AYSRH issues highlighted by the two were as follows:

a. Lack of Youth friendly centers in the JKP region

b. Lack of permanent rescue centers for SRHR related problems
c. Increased numbers of teenage and adolescent pregnancies in the country as an effect of
effect of COVID 19 and the negative impact on economic growth.
d. Need for SRHR Mentorships programs
e. Need for Policy advocacy

The two Youth representatives also informed members that different county Governments
have initiated different SRHR related programs to reduce challenges faced by girls although
these were considered insufficient given existing challenges faced within the region.

4.0 Plenary Session: Moderated by Dr. Anisa A. Omar - CECM Gender, Sports, Youth,
Culture and Social Services Kilifi County

7
The Moderator provided background, anchored on Vision 2030. She also linked it to the Kenya
constitution 2010 considerations that emphasizes the issues of quality and equity. She
articulated the need to advance the three main pillars (Economic, Social and Political pillars)
if rights to healthcare services are to be achieved. She highlighted the role these pillars play in
enhancing the rights of young people to health care services as stipulated in Kenya’s
Constitution of 2010 article 43.

Dr. Anisa also informed participants that Article 56 of the constitution emphasizes on
affirmative action based on “Rights Holders and Duty Bearers” and she elaborated what that
means. She further pointed out the link with health system strengthening building blocks and
their correlation to the ASRHR Strategies that shall be developed. She concluded that
devolution is an appropriate way to address the resourcing for different healthcare needs in the
region. Dr. Anisa further engaged participants’ responses through the following guiding
questions:
• What are some of the unique ASRHR issues in your counties that need to be prioritized?
• On policy implementation, what is ailing us?
Summary of responses and discussions from the plenary:
• The role of Innovation in development and implementation of AYSRH programs
• Multi-sectoral approach and meaningful youth engagement is needed at all stages
• Need to enhance capacity for AYSRHR responsive services by equipping the health
facilities and youth friendly centers, training of service providers at health facility and
community level, and embracing integration
• Policy advocacy in addressing AYSRHR issues
• Implementation, not just having a policy in place.
• Monitoring and evaluation. It needs to be measured.
Details of the output from plenary are shown in appendix 6.3

4.1 Commitment by policy makers

In response to issues that arose during plenary, members of the different sector groups present
reiterated their commitment to ensure that issues raised are addressed and AYSRHR challenges
and gaps are minimized. Specifically, there was a rallying call to do the following:

a. Improve access to quality youth friendly SRHR services

8
 b. Engagement of all key stakeholders including religious groups, political leaders,
educational institution, etc.

c. Good political will from those in authorities.

d. Enhanced legal framework

e. Address challenges to implementation, customize issues at hand, and allocate funds,

f. Timely implementation of policies.

g. Enhance publication of reports and disseminating widely to influence policy and

practice

h. Establishment of youth friendly service centers in all the counties.

i. Integrating youth friendly SRHR services in the health facility and community health
and social services while building the program / service delivery capacity and ensuring
the appropriate policy/ social environment

j. Use of peers and women leadership to empower girl child

k. Innovative when giving/sharing information to the public.

l. Avail resources to set the ball rolling – those in authorities

m. Trainings done should be used as implementation tools instead of leaving as theory

work.

n. Support women in marginalized areas to bring change (empowered women are

instruments of change)

While concluding this session, Dr. Anisa Omar commended participants for their active
participation and boldness to speak out issues and challenges faced within the region before
policy makers and practitioners in attendance.

4.2 Women Leadership Perspective

This component was presented by Ms. Josephine, a career counselor and a member of the civil
society. She informed members that school’s AYSRH interventions needed that those involved

9
exhibit high level of passion and competence and not just position held at school. She also
informed participants of the need to reduce IPV (intimate partner violence) and GBV (gender
based violence) as they are barriers to access to services, leading to lack of self-awareness. The
speaker also suggested that high fertility ratios, economic resource challenges, and lack of self-
esteem remain a challenge despite progress made. Nevertheless, Ms. Josephine commended
improvements made on cultural barriers, with more women now participating in leadership.
She further said that empowerment remains key so that women could be involved in policy
formulation to ensure that most of policies affecting women are pro-women. Models like
women-lifting women, girls-lifting girls also seem as emerging models.

Ms. Josephine further indicated that these developments have had ripple effect and multiplier
effect. The need to offer more leadership opportunities to women, mentorship and hand holding
was also emphasized. Men were also commended for their ability to mentor and support women
in leadership. The need for capacity building across board was also emphasized.

5.0 Way forward

Following commitment made by stakeholders and policy makers participating in the AYSRH
TA mechanism inception meeting, participants were informed that representatives of the two
TA mechanism organizations (AKU and EGPAF) would be visiting the six counties to
conduct Key informant interviews, FGDs, and sites visits for assessment of health facility and
community ASRHR services once appropriate logistics are in place. Dr. Flaura then urged the
CECs present to provide all the necessary support and information needed during the different
stages of the TA mechanism in order to ensure success of the AYSRS project. Flaura also
reminded the JIL/AYSRH program Youth’s representatives to prepare the ground for collection
of data especially amongst Youths targeted for focus group discussion. She further urged the
Youth representatives to also enhance preparedness for other forms of data collection
approaches that would require their input. These would include participation in interview and
filling in appropriate survey questionnaires it was further elaborated.

5.1 Closing Remarks

Closing remarks were offered by the Registrar of Research and Extension of Pwani University
Dr. Hemed Saha who was representing the Vice Chancellor of Pwani University. He
commended the TA initiative and acknowledged commitment shown by stakeholders and also

10
active engagement shown during the inception meeting. He also commended all stakeholders
for their contributions and commitment shown in enhancing the success of the AYSRH project.
Dr. Sha also noted that the TA can help the region realize the gains in ASRHR outcomes and
appreciated the success of the inception meeting. In conclusion, Dr Saha urged all players to
sustain the spirit to serve in this area as well as support the initiative to ensure its successful
conclusion. He ended by thanking all participants for their involvement in making the inception
meeting a big success. He thereafter declared the meeting officially closed.

The inception meeting ended at 1: 00 pm with a word of prayer from Elizabeth Okoth. Shown
below are the appendices

6.0 Appendices
Appendix 6.1 Inception Agenda

Project Purpose:
To improve equitable access to quality SRH information and services for adolescents & youth in the
six coastal counties in Kenya (Jumuiya ya Kaunti za Pwani), through support for strategy development,
harmonization and strengthened implementation, monitoring and evaluation

Inception Meeting: Reef Hotel - Mombasa, 18/8/ 2021

Agenda: Moderator: Dr. Flaura Kidere
• 08.30 - 9.00 AM: Arrival & Registration of participants - JKP Secretariat

• 9.00 – 9.20 AM: Prayers & Introduction – Dr. Flaura

11
• 9.20 - 9.40 AM: Welcome remarks. Background / Rationale for the TA request &
Coastal region ASRH situation overview - CEO JKP- Mr. Emmanuel Nzai & Prof
Marleen,

• 9.40 - 9.50 AM: Official Opening: H.E. Dr. Kingi, Deputy Governor, Mombasa County

• 9.50 - 10.05 AM: WHO AYSRHR TA Mechanism Overview: Dr. Chandra/Bruce,

WHO

• 10.05 - 10.20AM: TA objective, Methodology, & Main products: EGPAF & AKU
Rep

• 10.20 - 10.40: Youth Perspective: AYSRH JIL Youth Champions (Female & Male)

• 10:40 - 11.10 AM: Coffee break & Press conference: JKP

• 11.10 - 12.30 PM: Plenary session: Moderator - Dr. Anisa Omar

• 12.30 - 12.50 PM: Keynote, Women Leadership Perspective

- H.E Majala Mlagui, Deputy Governor, Taita Taveta County
- H.E Fatuma Achani, Deputy Governor, Kwale County

• 12:50PM – 12: 55 PM Closing Remarks: VC, Pwani University-Prof Rajab

• 01:00 – 2.00 PM Lunch, Logistics & Departure: JKP

Appendix 6.2 Photo of participants of the inception meeting

12
Appendix 6.3 Output of the plenary session
Clustered according to the seven Building Blocks of a Health Care System
1. Human Resource for Health
Need for Health care providers who are friendly
Shortage of staff that need to be resolved
Need to have trained staff in all the public health facilities that address youth
related issues.
2. Commodities and Technology
Provision of family planning services close to the youth
3. Health Information and Communication
Need for Behavioral change
Need to demystify the concept of YFS beyond being a site but a holistic view,
including youth friendly services being integrated at all health and social
services at the health facility and community
Male participation in AYSRH programs
Religion and cultural influence needs to be addressed full.
Need to understand issues affecting adolescents in schools
Managing Social media while implementing AYSRH programs
The A-Z information on what to be addressed and achieved by the targeted
people adolescents and youth.
Message Packaging and communication strategies
Lack of appropriate information

13
 Peer to peer communication.
4. Service Delivery & Infrastructure
Need for Youth friendly centers (stand-alone centers)
Need for Rescue centers where those who go through gender based violence
would get physical and moral support.
Need to remembers Person with disabilities i.e. need for language
interpretations
Equip health facilities with relevant equipment
Lack of rehabilitation centers
Pregnancy tests in schools
Lack of capacity for those entrusted to deal with AYSRH matters at school(
Capacity Building)
School programs – education of children on the effects of teenage pregnancies
and early marriages
Lack of facilities in most of the coastal counties and this need to be checked.
5. Leadership and Governance ( Social Accountability)
Need for Political will in order to make meaningful change
Marginalized areas to be looked into
Ensure human rights compliance without disregarding of challenges.

REPORT PREPARED BY:

Dr. Flaura Kidere & Dr. Anisa Omar,
Jumuiya Ya Kaunti Za Pwani, P.O BOX 90420-80100, MOMBASA
KENYA. Email: flaura.k@jumuiya.org ; f.kidere@pu.ac.ke ;
anisaomar61@gmail.com

14