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Expanding Health Access: ASRH Development Impact Bond Empowers Girls in Kisumu & Kakamega

Picture a classroom in Kakamega County with 20 teenage girls. Statistics suggest that at least three of them will experience teenage pregnancy. In a similar classroom in Kisumu County, two girls face the same challenge. These numbers, drawn from the 2022 Kenya Demographic and Health Survey highlight the prevalence and urgent reality of teenage pregnancy. In 2022, more than half of all AIDS-related deaths among adolescents aged 10-19 years occurred in just ten counties, including Kisumu and Kakamega. The two counties are among those with the highest burden of teenage pregnancy and new HIV infections among adolescents in Kenya.

A groundbreaking innovative financing initiative is changing the lives of young people in these counties. The Adolescent Sexual and Reproductive Health Development Impact Bond (ASRH DIB) program, a collaborative effort between the United Nations in Kenya, the Ministry of Health, and development partners is building an ecosystem that aims to empower adolescents to take control of their health and futures. The program mobilizes private and public sector financing to support the provision of youth-friendly sexual and reproductive health services in counties with the highest burden of teenage pregnancy and HIV infections in Kenya.

By ensuring access to quality services including family planning, HIV prevention, testing, and care services, the program is helping to ease the burden of teen pregnancy and HIV that continues to threaten the future of adolescent girls in both Kisumu and Kakamega.

Photo Credits: UNFPA/Zipporah Gathiti, and UNAIDS

Among those championing adolescent sexual and reproductive health in Kisumu County is Dr. Gregory Ganda, the County Executive Committee Member for Medical Services, Public Health, and Sanitation. Dr. Ganda understands the gravity of the HIV/AIDS epidemic in Kisumu and the devastating impact it has on young people. He views HIV testing as a major milestone towards prevention and has made it a priority to increase access to testing and counseling services. "The Tiko platform has played a key role in making services like HIV testing and family planning more accessible to adolescents and young people,” he says. As a policymaker, Dr. Ganda has been instrumental in fostering the public-private partnership needed for the implementation of the Adolescent Sexual and Reproductive Health Development Impact Bond. In Kisumu and Kakamega counties, 30 public health facilities have so far been onboarded onto the Tiko platform.

At Chiga sub-county hospital in Kisumu, clinical officer Faith Moraa leads a team of nurses in providing youth-friendly sexual and reproductive health information and services. Faith has been working to improve the hospital's youth-friendly center, which is currently in a dilapidated state and not in use. “A well-renovated center will attract more young people to access healthcare,” she says. The ASRH Development impact bond includes a Facility Incentivization Programme (FIP), which provides small incentives to health facilities that demonstrate responsiveness to the unique needs of young people. Under Faith’s leadership, Chiga Sub-County Hospital has been able to unlock 24,700 Kenya Shillings (USD 190) from the facility improvement fund, which will be used to purchase staff uniforms.

Alice Sarreto , is a program manager at Tiko, a non-profit organization leveraging technology to improve access to youth-friendly sexual and reproductive health services for girls living in multi-dimensional poverty. She has witnessed firsthand how the program is breaking down barriers and empowering young people to access the services they need. Alice coordinates a team of Tiko mobilizers who conduct community outreach to sensitize vulnerable girls on the importance of practicing good health-seeking behavior. Through the Tiko platform, girls are connected to an ecosystem of healthcare providers and pharmacies offering services within their communities, free of charge. The program also utilizes "Rafiki," a peer-to-peer education model that trains adolescents from vulnerable communities to mobilize their peers. This approach has been instrumental in increasing awareness and uptake of HIV testing, family planning, as well as general guidance and counseling services. "We're seeing a real shift in attitudes," she explains. "Adolescents are becoming more comfortable talking about sexual health, and they're taking advantage of the services available to them."

After learning about her own sexual and reproductive health from a Tiko community mobilizer, 17-year-old Eunice Adhiambo was inspired to empower other girls in her community. Eunice has become a peer educator, actively encouraging girls to learn about their HIV status and how to prevent unwanted pregnancies. “Girls my age face many challenges, particularly poverty, and pressure from men and boys who offer money in exchange for sex,” she says. Eunice believes that knowledge is power and strives to provide her peers with the information they need to make informed decisions about their bodies and futures.

As more adolescent girls are empowered to seek services, the program has also invested in improving the skills and capacity of healthcare providers including nurses, medical officers, pharmacists, and clinical officers, who are trained in the provision of person-centered services tailored to the unique vulnerabilities of adolescents and young people.

At Simba Upepop sub-county hospital in Kisumu, Edith Nyongesa, the Nursing Officer in Charge, has similarly been providing sexual and reproductive health services to young clients. Girls who are served by Edith use the Tiko platform to rate the quality of service. “I feel proud when my services are rated highly by the clients, and the reward I receive serves as a motivation to continue supporting adolescent girls across their reproductive health journey,” she says.

17-year-old Tracey Esther Akinyi learned about the Tiko platform from a community health promoter and has been accessing services at Chiga Sub-County Hospital. Having recently completed high school, she is eager to enroll in a higher learning program. “At the hospital, I get counseling on family planning and other reproductive health issues that I find hard to discuss with family and friends,” she says. Each time Tracey accesses and rates the services provided at the hospital, she receives a reward for her positive health-seeking behavior in the form of Tiko miles.

Tiko miles can be redeemed at local shops that are part of the Tiko ecosystem to purchase essential items like sanitary pads.

In Kakamega County, 16-year-old Faith Juma dreams of going back to school, having dropped out after becoming pregnant at 15. Now living with her 9-month-old child’s father, she relies on services provided with funding from the Development Impact Bond to access family planning services. As teen parents, both are determined to build a better future for their child, by preventing further pregnancies. “This will allow us to focus on our education and career aspirations,” she says.

18-year-old Mary Kambua also credits the program with empowering her to prevent unwanted pregnancy. Her dream is to become a teacher, and she plans on enrolling in a teacher’s training program once funds become available. “Being able to learn about family planning and access contraceptives has been empowering for me. Every girl should have that opportunity,” she says.