Challenges to generating political prioritization for adolescent sexual and reproductive health in Kenya: A qualitative study


Autoři: Maricianah Atieno Onono aff001;  Claire D. Brindis aff002;  Justin S. White aff002;  Eric Goosby aff002;  Dan Odhiambo Okoro aff005;  Elizabeth Anne Bukusi aff001;  George W. Rutherford aff002
Působiště autorů: Center for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya aff001;  Institute of Global Health Sciences, University of California, San Francisco, California, United States of America aff002;  Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, United States of America aff003;  Adolescent and Young Adult Health National Resource Center, San Francisco, California, United States of America aff004;  Nairobi country office UNFPA, Nairobi, Kenya aff005
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226426

Souhrn

Background

Despite the high burden of adverse adolescent sexual and reproductive health (SRH) outcomes, it has remained a low political priority in Kenya. We examined factors that have shaped the lack of current political prioritization of adolescent SRH service provision.

Methods

We used the Shiffman and Smith policy framework consisting of four categories—actor power, ideas, political contexts, and issue characteristics—to analyse factors that have shaped political prioritization of adolescent SRH. We undertook semi-structured interviews with 14 members of adolescent SRH networks between February and April 2019 at the national level and conducted thematic analysis of the interviews.

Findings

Several factors hinder the attainment of political priority for adolescent SRH in Kenya. On actor power, the adolescent SRH community was diverse and united in adoption of international norms and policies, but lacked policy entrepreneurs to provide strong leadership, and policy windows were often missed. Regarding ideas, community members lacked consensus on a cohesive public positioning of the problem. On issue characteristics, the perception of adolescents as lacking political power made politicians reluctant to act on the existing data on the severity of adolescent SRH. There was also a lack of consensus on the nature of interventions to be implemented. Pertaining to political contexts, sectoral funding by donors and government treasury brought about tension within the different government ministries resulting in siloed approaches, lack of coordination and overall inefficiency. However, the SRH community has several strengths that augur well for future political support. These include the diverse multi-sectoral background of its members, commitment to improving adolescent SRH, and the potential to link with other health priorities such as maternal health and HIV/AIDS.

Conclusion

In order to increase political attention to adolescent SRH in Kenya, there is an urgent need for policy actors to: 1) create a more cohesive community of advocates across sectors, 2) develop a clearer public positioning of adolescent SRH, 3) agree on a set of precise approaches that will resonate with the political system, and 4) identify and nurture policy entrepreneurs to facilitate the coupling of adolescent SRH with potential solutions when windows of opportunity arise.

Klíčová slova:

Adolescents – Global health – Health care policy – Child health – Kenya – Political aspects of health – Pregnancy – Public policy


Zdroje

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2019 Číslo 12