Articles about Kenya

1 December 2021, World AIDS Day. Stanley Ngara, from Kenya, is commonly known as the ‘King of Condom’. Stanley spends his days educating people about safe sex practices and distributing condoms. He distributes condoms -for free- to different groups of people among them youth, sex workers, boda boda riders, university students, market traders and even drug users. Stanley is passionate about raising awareness on issues of sexual reproductive health and rights (SRHR), including HIV and AIDS. IPPF Africa Region met Stanley during one of his regular outreach activities in his home area of Kiambu County, located in Kenya’s Central region, and brings you his story. IPPF supports champions like Stanley, who are committed to raising awareness on different SRHR issues in their communities. On this World AIDS Day 2021, we celebrate Stanley and all other SRHR champions who are making significant contributions in the society, more so towards the attainment of the health goals in their countries. See the long version of Stanley's story: Meet Kenya’s Celebrated 'King of Condoms', Stanley Ngara This feature was co-produced by IPPF Africa Region and Darbrun Production Company (Nairobi). See also: “I Wish I Should not Have to Choose Between Condoms and a Meal”, says Kiandutu Slum’s Shoe Fixer

Transgender people are increasingly visible in both popular culture and in daily life. Unfortunately, discrimination, stigma and violence towards Transgender persons increases simultaneously and remains widely unreported. Violence affects people of all sexual orientations and gender identities, including Transgender persons. It is often said that one’s sexual orientation, gender identity or expression (SOGIE) is a “non-issue”, however, the violence meted upon said persons is undeniably a big issue as it affects their quality of health and life. According to a Trans Murder Monitoring Report published by Transrespect Versus Transphobia, 375 trans and gender-diverse people were reported murdered between 1 October 2020 and 30 September 2021 globally. Kenya is no exception to this kind of global data. According to The Gay And Lesbian Coalition Of Kenya (GALCK), “Some members of the lesbian, gay, bisexual, transgender and queer (LGBTQ) community are better protected from violence and discrimination by the constitution. This is because laws that outlaw discrimination on grounds of sex and gender protect transgender and intersex individuals. However, the law does not adequately address the needs of Kenya’s transgender and intersex community. Members of this community experience challenges accessing health care and changing their names and gender in legal documents”. Kenya is considered among the most progressive African countries. But the country's High Court in 2019 upset activists by upholding a colonial-era law that punishes homosexual acts with up to 14 years in prison. In its 2020 Annual report, the National Gay and Lesbian Human Rights Commission reported receiving 329 reports of LGBTI rights violations between July 2019 and June 2020; and the GALCK reported an increase of these cases since the pandemic started with up to 10 attacks per month on the LGBTQ community. This is clear evidence that Sexual and Gender Minority groups in Kenya, continue to experience abuse and violence simply because of who they are and because of their sexual orientation and gender identities. LGBTQ persons in Kenya and across the world have often been on the receiving end of violence, they suffer stigma, discrimination, physical and verbal abuse, assault, harassment, eviction from their home and communities, loss of job, suspension, or expulsion from school, etc. All transgender persons have a right to equality and freedom from discrimination of all forms. All transgender persons require equal protection against any form of violence. The right to equality includes the full and equal enjoyment of all human rights and fundamental freedoms. Transgender persons do not want special rights. Basic human rights are not special rights; the right to get and keep a job based on merit is not a special right, the right to be served food in a restaurant is not a special right; the right to have a roof over one’s head is not a special right; the right to walk down a street and not be attacked because of who you are and whom you love is not a special right. The Government of Kenya should ensure its laws and systems protect Transgender persons just like any other citizen of Kenya against all forms of violence and discrimination. The Government of Kenya should commit to end all forms of violence and discrimination against transgender persons, by publicly condemning any major instances of homophobic and transphobic violence that occur in the counties and in the country in general. We are all beautiful, we deserve love and we all have the right to live with dignity and respect. As we just marked and celebrated the Transgender Day of Remembrance, celebrated every 19th of November, which memorializes victims of transphobic violence, and as we continue to celebrate Transgender Awareness month until the end of November; we remember those in the transgender community who have lost their lives due to violence brought by hate and ignorance and we honor, celebrate, and advocate for the respect of the rights of transgender and gender diverse communities.   Alvin Mwangi,  Sexual Reproductive Health and Rights Advocate and IPPF Africa Region Intern in the Programs Department

The COVID-19 pandemic has caused disruptions in various sectors, including education, where schools remained shut down for extended periods. This led to adolescents and young people staying at home. It also led to a notable increase in young people’s use of digital technology according to a report by the Media Council of Kenya released on Friday 18th December 2020, 55 percent of those surveyed indicated that their media use has increased during the period of the pandemic [1]. Their uses included connecting and engaging with each other on various online platforms, on a variety of topics, amongst which includes. information on their sexual and reproductive health and rights. (SRHR)   Among Kenyan adolescents and youth, some of the most discussed sexual and reproductive health issues include teenage pregnancies, early child marriage, female genital mutilation (FGM), sexual and gender-based violence (SGBV), access to affordable contraceptive information and services, including condoms, menstrual hygiene, sex, sexuality, safe abortion services, Post Abortion Care (PAC), drug and substance abuse, HIV/AIDS, and other Sexually Transmitted Infections (STIs).   Before the pandemic, most students would normally receive information on these different issues through peer education programs or during Comprehensive Sexuality Education (CSE) lessons in their schools; although in Kenya, the Competency-Based Curriculum is not yet fully comprehensive as it only includes certain aspects of CSE. For instance, for grades 1, 2, 3 contents around hygiene is mentioned.  CSE involves giving age-appropriate and culturally sensitive sexuality education to adolescents and young people. It provides information pertaining to reproductive health, for instance body changes, friends and relationships, culture, human rights, teenage pregnancies, protection against STIs and HIV, self-esteem, life skills, future dreams and plans, Gender based violence (GBV), among many others. Speaking about sex should not be seen as a taboo, for sexuality education is not only about sex, but also social and health issues that young people continue to face.    Access to verified, quality and comprehensive information is one of the most sustainable and best ways to ensure we reduce some of the negative outcomes when it comes to reproductive health and health in general. In fact, CSE seeks to give students, the knowledge, attitude, skills, and values to make informed appropriate and healthy choices about their sexuality and lifestyle.  CSE in Kenya, just like in other African countries, has been and continues to be subjected to opposition, myths and stereotypes which have led to a total misunderstanding of what it entails. Access to safe abortion for rape and defilement of survivors is still not fully recognized within the 2010 Constitution of Kenya, amongst other policies and guidelines[2].   Key stakeholders, including State authorities, parents, local leaders, religious authorities, but also media influencers followed by young people, should acknowledge that young people are engaging in sexual activities and are vulnerable to teenage pregnancies and many other reproductive health challenges. The Ministries of Education and Health should ensure access and provision of age appropriate CSE, more so during challenging times such as pandemics, where many young people are at home owing to the disruptions. Some of the recommendations include the availing of information as they work through community systems, online platforms, health facilities, churches, and media to speak on Sexual Reproductive Health and Rights and CSE.  Adolescents and youth should be protected, and they should be empowered enough to enable them to make well informed choices and decisions about their health and general well-being. Through CSE, they will be able to make decisions about their own bodies, own these decisions and choose to be safe and healthy.  Alvin Mwangi   Sexual Reproductive Health and Rights Advocate and IPPF Africa Region Intern in the Programs Department   [1] https://mediacouncil.or.ke/media-center/mck-newsroom/news/covid-19-pandemic-increased-use-media-among-kenyan-audiences-status [2] According to the Constitution Of Kenya , Article 26 (4)  It provides that under the provision ,’’ an abortion is not permitted unless , in the opinion of a trained health professional , there is need for emergency treatment , or the life or health of the mother is in danger , or if permitted by any other written law ‘’  

Monica Mwai is a 22-year-old final year university student at Moi University in Eldoret, Kenya. Set to graduate next year, she is studying Linguistics, Media and Communication. In this article, Monica takes us through her journey as a young campus girl, focusing on her experiences with sexual and reproductive health information and services. Joining university was my first go at adulting. I had a new-found freedom, accompanied by lots of new experiences. Away from the constant, glaring watch of my parents, I was both excited and scared – yet to learn how to be a responsible adult, but expected to act like one. But with time I got the hang of it, mostly through trial and error. Popularity of Condoms As a 17-year-old freshman girl, I was still trying to understand my body. Then boom! I realized that I needed to understand contraceptives too. At that time, my knowledge was limited to condoms which were readily accessible in the campus hostels. However, they often ran out fast because their demand always exceeded the supply. I later learnt of the existence of other contraceptive methods from a friend who had attended a camp on sexual health and awareness. From the brief information she shared, I became curious to learn more about contraceptives and turned to the internet for information. However, I found some of the terminologies difficult to understand. Furthermore, different websites provided different information on the same contraceptive method which left me confused. I briefly consulted my mother who gave me some information, but I was afraid to ask too much. I feared she would ask why I was so curious, considering she was not always as open-minded as I hoped she’d be. Peer Discussions on Sex Matters To my relief, the topic came up among my peers. At least I was not the only one curious about learning more. We would regularly have discussions on sex and contraceptives while in our hostel rooms. During these discussions, we would talk about what we knew, which was not always accurate as our information was mainly gotten from older relatives (mostly cousins), television shows, radio, YouTube channels or from search engines. Sharing information among peers was easy because our experiences were all relatable. Most of us preferred condoms because of their numerous benefits – their quick availability in shops and chemists, minimal side effects, effective in preventing unplanned pregnancies, HIV and other sexually transmitted diseases. However, some of our friends who were in stable relationships shared how, tired of frequent pregnancy scares, they had opted for long-term methods, such as implants. Judged for Being Young and Unmarried Interestingly, most of us talked about our reluctance to visit a health center for contraceptive information because we feared being judged, mostly because we were young and unmarried. With time however, I realized that it was necessary for me to get more accurate information from a professional, so I overcame that fear and visited a health centre near the university. I was disappointed when I learnt they did not offer contraceptive services, and neither did they refer me to a place where I could get these services. Fortunately, a friend informed me of a mobile outreach clinic that was happening near the university and took me there. At the mobile clinic, we found nurses who answered all our questions and helped clarify some of the misinformation we had. They were so nice and friendly, which put us at ease. I was now able to differentiate the different types of contraceptives, benefits, potential side effects and the efficiency level of each. We were further advised that contraceptives do not offer 100% guaranteed protection. Parents’ 'Sex Talk' With their Children From my experiences, information on sexual reproductive health is not easily available to young people, yet it is necessary. The problem starts with the community, parents and guardians who have made talking about sex with their children a taboo. This leads to children not being able to freely consult them, and they end up seeking information from their peers and other unreliable sources where they get misled and end up making bad choices. Parents should be educated on the role they play in enabling a sexually responsible generation. Need for Comprehensive Sexuality Education Age-appropriate sexual education should also be ingrained into the school curriculum. And it is also important to include boys in this conversation! To reach young people effectively, the channel for message delivery should be well thought-out. Social media campaigns and fun, catchy, educative adverts work well with young people. Youth-Friendly Services Sexual reproductive health and services should be readily available to both married and unmarried youth. Some service providers are a major barrier to young people’s access to reproductive health information by their attitude. They should be more youth-friendly, open to questions and ready to offer information. I graduate next year and after four years of campus, I honestly don’t think I know enough as there is always something new to learn every day. Adulting is a tough but a very interesting journey with new experiences but with a lot to process. However, I appreciate being young and learning from my different experiences - both positive and negative. These experiences are enabling me to thrive as a healthy, empowered young woman. For more updates on our work, follow IPPF Africa Region on Facebook, Twitter, Instagram and You Tube.

Story by Maryanne W. Waweru l Photos by Moctar Menta Mwangi Peter, 38, is a cobbler in Kiandutu slum, Thika, Kiambu County, in Central Kenya. On a bright Tuesday September morning, we meet him meticulously repairing a pair of beige-colored ‘Safari Boots’—a favorite shoe brand for men in that part of the country. With his hands, he carefully weaves the nylon thread in and out of the boots’ worn-out soles. It’s a job he has been doing for many years. He is Kiandutu’s ‘shoe fixer’. Mwangi is one of the estimated 2.2% of Kenyans living with a form of disability, according to an analysis of the 2019 census report released by the Kenya National Bureau of Statistics (KNBS). With a physical impairment, he walks with an artificial leg, which he says is long overdue for replacement because he has never gotten funds to do so. “It costs so much money to replace it, and despite working hard for over two decades, I have never been able to save enough,” says Mwangi, who dropped out of school in Grade three as his parents were unable to cover the school fees. It would cost Mwangi about 70,000 shillings ($634) to replace his artificial leg.   Senior Bachelor But that’s not the only thing that Mwangi has been unable to do because of lack of funds. “I’m in my late thirties yet I don’t have a family of my own. People say that I should be married with big children. However, marrying a wife and raising children costs money, which I don’t have. I will marry when I become rich,” he says. Mwangi once had a ‘pregnancy scare’ when one of the women he was in a relationship with told him she was pregnant. “She however told me she would not go ahead to have my baby because she didn’t want her child to be born into poverty like me. So she procured an abortion. No woman agrees to marry me or have my baby because they say I’m poor,” he says, a forlorn look on his face. Multiple Relationships Mwangi has an interesting, active dating life. “I don’t have one particular girlfriend, but I have different women that I see. They come to my place and spend the night, then leave in the morning.” Even though he is aware of the risks associated with unprotected sex such as sexually transmitted infections (STIs) including HIV, as well as unplanned pregnancies, Mwangi does not always use protection with his different women. “I know about condoms because they discuss them on radio and television. I even learn more about them when I go for my HIV tests every two years at the local health center, but I don’t use them all the time as is required,” he admits.   Condoms or a Basic Meal? Mwangi says that on the few occasions he uses condoms, he purchases them from a nearby kiosk at 30 shillings ($0.27) for a pack of three, an amount he can’t always afford. While Mwangi knows he can get condoms for free at the local government health facility, he cites time limitations. “For me to walk to the health center, I would have to close my business. That is money that I cannot recover. I wouldn’t have enough for my meal that day if I lost those hours,” says Mwangi, who makes an average of 300 shillings ($2.7) a day from his business. Bringing Services Closer to the Community Thankfully, there are community health workers and mobilizers who regularly distribute condoms in the neighbourhood. One of them is Stanley Ngara, popularly known as ‘condom king’. “Stanley passes by here often and leaves me with some condoms. I get very happy when he does so,” Mwangi says, as he clutches the glittering, red-packed condoms he has just received from the condom king. “I will try use a condom with the next woman I’ll have sex with. But I would also urge health workers to be more considerate to people like me who face various challenges when it comes to our sexual health. Condoms should be distributed more frequently in the community for free. They should also go around doing HIV tests regularly without us having to leave our jobs for the hospital to get tested. Bringing the services where we are is more practical and convenient for us,” he says. On this World Contraception Day, it is important to remember the plight of persons living with disability (PLWD) such as Mwangi, who often live below the poverty line. Approximately 67% of PLWD in Kenya live impoverished lives. Their quality of life is poorer, with lower educational achievements which contributes to fewer economic opportunities. They also suffer poorer health, including their difficult access to sexual and reproductive health services. This is a challenge that IPPF, through its Member Associations, continually tries to address through its various programmes across sub-Saharan Africa, such as WISH2ACTION, BMZ and COVID-19 innovative response projects. For more updates on our work, follow IPPF Africa Region on Facebook, Twitter, Instagram and You Tube.

By Maryanne W. Waweru Pounika Theoneste is a 21-year old university student studying Law. He is also a volunteer with the Youth Action Movement (YAM) member in IPPF’s Member Association in the Central African Republic -Association Centrafricaine pour le Bien-Etre Familial (ACABEF). We caught up with him at the International Conference on AIDS and STIs in Africa (ICASA) taking place in Kigali, Rwanda (2 - 7 December 2019). He spoke to Maryanne W. Waweru about his experiences as a young volunteer with ACABEF's YAM program.  "I decided to become a YAM member two years ago. My interest in doing so arose from the need to increase my knowledge about sexuality issues. While growing up, I didn’t receive much information from my parents about issues of sex and reproductive health, so when I heard about ACABEF’s youth program, I decided to join it so that I could learn more,” he says. Since joining in 2017, Pounika has been trained as a peer youth educator, and has been empowered to educate fellow youth. He is a peer educator with the JeuneS3 project, which aims to deliver Sexual Reproductive Health and Rights (SRHR) information and services to young people in vulnerable contexts, more so women and young girls. His participation in the JeuneS3 project has also seen Pounika receive training in radio journalism and radio production. Each week, he and his fellow youth advocates produce a show targeting young people with SRHR information. This includes information about health centers where they can get youth-friendly services. The shows are produced by the youth, for the youth. Pounika and his team also produce radio broadcasts for ‘Listening Clubs. This involves going to the community and mobilizing young people to come together to listen to the shows produced by Pounika and the team. “During the ‘Listening Club’ outreaches, we are always accompanied by a health service provider. After listening to the episodes, the youth ask many questions, which our team competently answers,” he says. Pounika believes his volunteer activities with ACABEF are helping him even as he pursues his career goals. “I hope to become a reproductive health rights advocate in the future, and the opportunities that I have gotten by being a YAM member are helping me work towards my goal. This exposure has broadened my understanding of the challenges that young people face regarding their sexual and reproductive health, the gaps that exist, and the solutions that can bring change. My work with YAM is also helping me gather insights and perspectives into how the development, improvement and implementation of policies that affect young people and their reproductive health are instrumental in this,” he concludes. If you are young person and would like to join the Youth Action Movement, see where we work and get in touch. You can also reach us through @YAM Africa Maryanne W. Waweru is the Governance and Compliance Officer, IPPF Africa Region. For more updates on our work, follow us on Facebook and Twitter

By Maryanne W. Waweru Cotonou, BENIN:  Over 150 youth drawn from the Youth Action Movement (YAM) and other youth organizations from Francophone African countries are gathered in Cotonou, Benin, for the second edition of the regional forum aimed at sharing best practices on Sexual Reproductive Health and Rights (SRHR), especially among adolescents and young people. The youth are drawn from over 20 countries. Discussions at the forum are centered around the identification of effective strategies and responses that have proven successful in advocating for the Sexual Reproductive Health and Rights (SRHR) of adolescents and young people in Africa, and disseminating them to different stakeholders. This year's theme is titled: “Sexual and Reproductive Health and Rights for Adolescents and Youth: Government Priority”. The experiences shared, opportunities identified and solutions proposed by the young people at the forum will help inform policy and SRHR programs in the sub-Saharan region, more so Francophone Africa. IPPF Africa Region and its different partners greatly value youth engagement and their direct involvement in the design of and implementation of health programs, especially those pertaining to sexual reproductive health and rights. Their voices and meaningful participation are instrumental in the achievement of improved health outcomes. The regional forum has been organized by the Benin chapter of the Youth Action Movement (YAM), and is supported by the Embassy of Netherlands in Benin and IPPF. Other participants in the forum include representatives from different government ministries, donor agencies, non-governmental organizations, civil society organizations, religious leaders and other stakeholders. The regional forum is timely, taking place ahead of the high-level ICPD25 Summit to be held in Nairobi, Kenya from 12 – 14 November 2019. This year marks the 25th anniversary of the International Conference on Population and Development (ICPD) first held in Cairo. At the conference, 179 governments adopted a Programme of Action that underscored that fact that reproductive health, women’s empowerment and gender equality are key to sustainable development. ICPD25 is aimed at mobilizing political will and financial commitments needed to accelerate the full implementation of the ICPD Programme of Action. These commitments will be centered around achieving zero unmet need for family planning information and services, zero preventable maternal deaths, and zero sexual and gender-based violence and harmful practices against women and girls. Maryanne W. Waweru is the Governance and Compliance Officer, IPPF Africa Region. For more information about the work of IPPF Africa Region, follow us on Facebook and Twitter.

The Evangelical Association of Malawi (EAM) is taking the lead in campaigning for Malawi’s population growth management.  The church takes family planning messages to pulpits in churches with supportive scriptures from the bible to demystify the misconception that Family Planning (FP) disrupts procreation. It is projected that Malawi’s population is to reach over 42 million by 2050 if the current average of about four children per woman prevails, according to the United Nations Population Fund (UNFPA).  As Malawi’s population is rapidly increasing, the impact will be felt across diverse development sectors—requiring a multisectoral response to address the rapid population growth.  Pastor Howard Kasiya, The National Coordinator of the Health Commission, EAM told Kenyan journalists that one response is to engage faith groups in disseminating messages on the link between family planning, population dynamics, and development. “Religious leaders are essential tools for educating masses about benefits of family planning," he said. Pastor Kasiya was speaking during an interview conducted on the sidelines of a recent inter-faith leaders’ training conducted by Faith to Action Network, in Nairobi, to build their capacity to influence changes in policy and social norms in the State of African Women Campaign. EAM is implementing a project called “Encourage Responsible Parenthood” in Nsanje and Dowa districts, which focuses on building the capacity of church leaders to increase access to and demand for modern family planning methods.  Pastor Kasiya said consistent sensitization can significantly contribute to changing social norms around family planning and childbearing. Religious leaders equip young people with knowledge and empower them to make responsible sexual and reproductive health choices, access youth-friendly health services, and transform societal attitudes and practices to address population growth and development.      So far, they have reached out to about three hundred (300) religious leaders from its member churches and organizations through capacity-building regional meetings. Representatives were trained on how to effectively disseminate sexual and reproductive health information in the context of Biblical scriptures to congregants in their respective catchment areas. Nearly 70 religious leaders drawn from 72 denominations under the Evangelical Association of Malawi in Nsanje district, have been trained on how to reach their congregants with accurate sexual and reproductive health information including family planning and youth-friendly health services.  The main aim of the training is to motivate the clergies and give them the capacity to counter some myths, misconceptions, and prejudices that the church and congregants have been having towards issues of sexual and reproductive health rights (SRHR) and family planning. Currently, youth are facilitating dialogue on issues of youth-friendly health services and family planning among young people in the church and community, reaching over 2,500.  They also conduct HIV testing and counselling in churches, in a bid to break fear and stigma about congregants going to VCT Centers, an exercise that is normally spearheaded by church leaders. “What is very important is that we present all these from a biblical perspective, with supportive scriptures from the Holy Bible, as an obligation to God” Concluded Pastor Kasiya. Achieving this kind of commitment from faith leaders has not been easy. There has been constant training and capacity building of religious leaders, such as the one provided by Faith to Action Network with financial support from the European Union, to make faith actors effective amplifiers of the message that optimum health and wellness are a key part of God’s plan for humankind. EAM is among the faith-based organizations that is working within the State of African Women Campaign Project and the RightByHer Campaign to contribute to realizing and extending women’s rights as enshrined in Africa Union (AU) policies in African countries. The State of African Women Campaign is a three-year project funded by the European Union and implemented by IPPF, Faith to Action Network, YWCA and OAFLAD among others.

Delivering Quality SRH Services through use of SMARTCARE: FHOK’s experience with eCMIS In 2010, Family Health Options Kenya (FHOK) which is IPPF's Member Association in Kenya shifted from service-oriented data collection to the use of client cards, then to a fully client-based system (CMIS) that involves data capturing and reporting. This electronic data management system is called ‘SMART Care’. The rationale for the use of the electronic data management system was that, with stakeholders demanding accurate client-related data, and FHOK geared at moving towards performance-based funding, its clinic systems therefore needed to be those that could efficiently support providers in managing client flow whilst providing quality care. The implementation of the SMART Care system began with a pilot that was initiated in five FHOK clinics distributed across the country. They were: Family Care Medical Centre Nairobi West Family Care Medical Centre Nakuru Family Care Medical Centre Ribeiro Family Care Medical Centre Mombasa Family Care Medical Centre Meru Methodology Formation of a CMIS team to spearhead resource mobilization, training and implementation of the system. They included: Director of clinic services, the Monitoring & Evaluation team, GCACI Project Manager, IT Manager, accountant, internal auditor and Procurement Manager Selling the benefits of the system and demonstrating incentives for those involved in its implementation to utilize the system. This included showing them the reports generated by the system, analysis of data entered into the system and a user-friendly graphical user interface Creating a sense of ownership and addressing the psychological fears of the service providers before implementing the system. Some of the fears included not knowing how to use a software, possible loss of data, investigations and the general ‘fear of the unknown’                                                                                               Inclusion of customized reporting tools to assist in reporting to the various partners i.e. FHOK internal reports, IPPF, Ministry of Health and other donors Conducting on-the-job training as opposed to offsite training as the trainees were able to practice with real clients and hence gained hands-on skills Regular checking of data by the clinic manager and the team at the head office during facilitative supervisory visits which continues to ensure that service providers are keen to capture the correct data which improves quality Integration with SMS system for appointment reminders and client follow-up Results Currently, 14 out of 15 FHOK clinics are utilizing the SMART care system to capture financial, programmatic data and stock management (commodities) data. The use of SMART Care has significantly helped FHOK avoid cases of stock-outs The SMART Care system has enhanced accurate and timely collection of data from different service delivery points, which has improved data quality The data generated is actively used for decision-making at both clinic and Head office level. For example, the clinic can review data client trends and put necessary strategies to improve performance or make changes There has been an increase in service statistics in most clinics since the installation of the system                                                                                                                Minimized loss of data as the service providers can use one data collection system instead of many registers It has helped in the management of human resources at clinic level. Previously, the clinics would use client cards, daily activity register, prescription pads and lab request forms. But with the paperless SMART Care system, operational costs have now reduced as the clinic manager can monitor and analyze what is happening in the clinic from his/her office here has been reduction in the loss regarding follow up on clients as the system automatically sends Short Text Messages (SMS) to clients to remind them of their appointment Most of the FHOK clinics extended their operating hours after review of the system which showed some clients preferred to attend the services after working hours Reliability and accuracy of the information collected as it is easier to retrieve data and even verify “SMART Care has significantly reduced the workload of our service providers when it comes to capturing of essential data in real time, and consequent generation of reports. Through SMART Care, consumer specific reports -MoH, FHOK, IPPF and donor reports are readily generated at the end of each month by our health personnel within a very short time. The system has gone a long way in ensuring quality data and enhancing compliance to reporting timelines within FHOK,” says Esther Muketo, Director, Resource Mobilization at FHOK. ‘If I didn’t receive an SMS reminding me of my appointment, I wouldn’t have remembered to come for my family planning resupply” One FP client told a provider Conclusion The SMART Care system is one that can be adopted by other Member Associations as it saves immensely on time and money. It has enhanced accurate and timely collection of data from different service delivery points which has in turn improved data quality. Reduced workload is a huge incentive to service providers doing different reports for the different FHOK partners, including the Ministry of Health. Operation costs have reduced and the Clinic Manager can now monitor and analyze what is happening in the clinic from the comfort of his/her seat. FHOK's social franchising model was identified as one of the Member Association’s Good Practices during the 3rd Cycle of Accreditation. A Good Practice is an activity or practice that  has been proven to work and yields positive results. The  sharing of Good Practices by IPPF Member Associations offers learning experiences for their counterparts. See other Good Practices from our Member Associations: Social Franchising for Reproductive Health Services: The Experience of Family Guidance Association of Ethiopia (FGAE) Implementation of The Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial in Eswatini Partnerships for Improved Maternal Health: The Planned Parenthood Association of Ghana (PPAG) Experience Partnership with Armed Rebel Groups in the Provision of SRH Services in Crisis Situations: The Central African Republic (CAR) Experience Leading Efforts to End Child Marriage: The Case of Senior Chief Theresa Kachindamoto of Malawi Mobile Clinics in Cape Verde: Taking Services Closer to the People Awarding the Best Performing Clinics: Lesotho Planned Parenthood Association (LPPA) What’s in a Game? ABUBEF’s use of Playing Cards for Youth SRHR Education For more information about the work of IPPF Africa Region, follow us on Facebook and Twitter.

Liz Akoth* is 18 years old. She is currently attending a local secondary school within Shauri Yako, Homa Bay County, Kenya. She fervently dreams of becoming a nurse, one day. Will she realize her dream? Is a question that bothers her almost every morning she wakes up and night when she retires to bed. Sadly, the young ambitious girl will be forced to drop out of school because of her pregnancy. Her HIV status also makes her anemic. Her jaundiced eyes tell it all. “Please adhere to medication and follow the diet I gave you,” advised her nurse during her recent antenatal Care visit. Liz was impregnated by her 30-year-old boyfriend who lives in Rongo, an adjacent town. He not only made her pregnant but also infected her with HIV. When she shared the news about the pregnancy with the boyfriend, he told her to stop bothering him for he had already married another woman.  She later learned about her HIV status during her first clinic visit to Family Health Options Kenya (FHOK), Homa Bay Centre. She again shared the news with the now ex-boyfriend.  He insulted her and accused her of having ‘brought’ him a disease. He threatened to harm her if he ever came across her again. Her parents evicted her from their home for the embarrassment she had caused them. She is currently living with her brother, though she mentioned that life there is not easy. She appears quite strong on the outside but one would never know what goes on inside. But hers is a life of optimism and resilience. She hopes to give birth and re-enroll back to school in February 2019. She however said that if she had learned earlier about contraceptives, especially condoms, she would never have had sex without one. “If I knew the importance of condoms, I would not be pregnant and HIV positive. I would have used one.” The statistics HIV prevalence is high in Homa Bay County, Kenya. With a prevalence of 36%, it is one of the highest rates in Kenya according to the National Aids Control Council (NACC). According to the latest Kenya Demographic Health Survey (KDHS) report, teenage pregnancy in Homa Bay County stands at 33% and national prevalence at 18%. Driving factors Dinah Odoyo, Nurse at FHOK residing in Homa Bay attributed the high prevalence facts to the following factors: Non-adherence to antiretroviral therapy (ART) - Many residents living with HIV enroll and collect ART, but they do not take the drugs. They throw them away instead. This is because they do not want friends or family to know their HIV status. Sex for Fish - Homa Bay has a large share of Lake Victoria compared to other counties around the Lake. Many residents fish for a living. Shortage of fish forces businesswomen to have sex with fishermen to acquire whatever they have caught. The women enter sexual deals with particular fishermen for assurance of regular fish supply. The high HIV prevalence among fisher folk is due to the unprotected sexual interactions. Traditional birth attendants (TBAs) - Many expectant women give birth with the help of traditional birth attendants. More than 60 per cent of women in Shauri Yako, Misita and Sofia estates in Homa Bay Town deliver children their at the homes of TBAs instead of hospitals.  Poverty and Orphanage - Many homesteads lack either or both parents, leaving children to fend for themselves. Many children engage in sexual activities to get money for food and shelter. Other key drivers of high HIV prevalence, according to the Homa Bay Multisectoral AIDS Strategic Plan, are boda boda (motorcycle) riders and wife inheritance cultures. Sospeter Aloka, guidance and counseling teacher at Ogande Mixed Seconady school said that top disciplinary cases he struggles to manage are boy-girl relationships, teenage pregnancy and gender-based violence. He is however unable to manage out of school relationships where men, mostly bicycle riders and traders prey on the school girls.  He confirmed that in 2015 alone, 6 girls in their first year of secondary school got pregnant and dropped out of school. He also confirmed that the school was aware of 5 girls who disclosed their HIV status and that he has made it his responsibility to closely monitor their adherence to ART. He said, as teachers they realize that the students are sexually active. In Homa Bay County, most of the adolescents have sexual debut as early as at 13 years of age. He therefore advises those who cannot abstain to practice safe sex. He concluded by saying; “To win this war will require collective responsibility; teachers, parents and churches both need to talk to the adolescents and lead them to the right path” Said Sospeter. Advocacy Efforts Roselyne Atieno, FHOK trained Social worker works within Aruja Community in Homabay. She serves about 530 households and visits a minimum of 20 households every day. She also coordinates 10 Community Health Volunteers (CHVs) who operate within her jurisdiction.  Their main roles include; data collection, community education and sensitization, counselling for teenage mothers, psychosocial support, referral, follow-ups and creating linkages.  She said that community sensitization is key. “Young people are sexually active, but their parents do not want to talk to them, they too do not have knowledge about the risks that they face. We reach out to all these groups and provide not only appropriate information, but also necessary services” said Roseline Dinah Odoyo, who doubles up as the Facility in Charge said that FHOK focuses a lot on young people and adolescents and their reproductive health. “In fact, the clinic is quite youth friendly. It is a Youth Centre. Young people trickle in to learn more about how their sexuality and how they can practice safe sex” Said Dinah. Interestingly, a condom dispenser is hooked at the gate. “The condom dispenser at the gate supplies young people and the community around with condoms. It is refilled twice a week” Said Dinah She believes that young people are their own change agents. She has trained 20 youth volunteers- three quarter of whom are HIV positive-to speak to their peers within the community. “Young people prefer getting information from their friends and tend to do what their friends tell them. These trained lot speak to their friends about how to protect themselves from unplanned pregnancies and STI’s and advise those who are infected to adhere to medication” She added. Dinah also holds outreaches to reach the entire community with messages around contraceptives, cancer awareness, HIV-Aids among other STI’s. “I work with community leaders, religious leaders, teachers from the guidance and counselling department, parents, young people through a Social Behavior Change Communication (SBCC) program. Our main aim is to make these people understand the changes that adolescents undergo (puberty) for the guardians to know how to handle them and for the adolescents to understand how to handle themselves. We make them understand that these changes are normal and not a trigger to engage in sex, and if they do, they risk getting unplanned/unintended pregnancies and STI’s” She said. She concluded by saying that their main aim is to reduce risky sexual behaviors.  “When we reduce risky sexual behaviors, there will be less unplanned/unintended pregnancies and decline in unsafe abortion as well as reduced incidences of sexually transmitted infections” said Dinah.  Laws and Policies on Adolescent SRH Article 43 (1) of the Constitution of Kenya (2010) states that ‘every person has the right to the highest attainable standard of health, which includes the right to health care services, including reproductive health care’.  The National Adolescent Sexual and Reproductive Health Policy, 2015, shall support access to and provision of high quality and affordable adolescent-friendly SRH services at all levels of health service provision.