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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: https://doi.org/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

1. Temmerman M, Khosla R, Bhutta ZA, Bustreo F. Towards a new Global Strategy for Women's, Children's and Adolescents' Health. BMJ: British Medical Journal. 2015;351:h4414. Epub 2015/09/16. doi: 10.1136/bmj.h4414 26371228.

2. Hindin MJ, Tuncalp O, Gerdts C, Gipson JD, Say L. Monitoring adolescent sexual and reproductive health. Bull World Health Organ. 2016;94(3):159. Epub 2016/03/12. doi: 10.2471/BLT.16.170688 26966323; PubMed Central PMCID: PMC4773942.

3. United Nations. The Global Strategy for Women’s Children’s and Adolescents’ Health 2016–2030 New York: United Nations, 2016.

4. United Nations. Sustainable Development Goals. New York: United Nations 2015.

5. United Nations Population Fund. Review of Adolescent and Youth Policies, Strategies and Laws. Dakar, Senegal: UNFPA WCARO—West and Central Africa Regional Office, 2017.

6. Shiffman J, Smith S. Generation of political priority for global health initiatives: a framework and case study of maternal mortality. Lancet (London, England). 2007;370(9595):1370–9. Epub 2007/10/16. doi: 10.1016/s0140-6736(07)61579-7 17933652.

7. Rudan I, Kapiriri L, Tomlinson M, Balliet M, Cohen B, Chopra M. Evidence-Based Priority Setting for Health Care and Research: Tools to Support Policy in Maternal, Neonatal, and Child Health in Africa. PLOS Medicine. 2010;7(7):e1000308. doi: 10.1371/journal.pmed.1000308 20644640

8. Klein R. Puzzling out priorities. Why we must acknowledge that rationing is a political process. BMJ (Clinical research ed). 1998;317(7164):959–60. Epub 1998/10/09. doi: 10.1136/bmj.317.7164.959 9765158; PubMed Central PMCID: PMC1114037.

9. Williams A. QALYS and ethics: a health economist's perspective. Social science & medicine (1982). 1996;43(12):1795–804. Epub 1996/12/01. doi: 10.1016/s0277-9536(96)00082-2 8961422.

10. Youngkong S, Kapiriri L, Baltussen R. Setting priorities for health interventions in developing countries: a review of empirical studies. Tropical Medicine & International Health. 2009;14(8):930–9. doi: 10.1111/j.1365-3156.2009.02311.x 19563479

11. Ham C. Priority setting in health care: learning from international experience. Health Policy. 1997;42(1):49–66. Epub 1997/09/04. doi: 10.1016/s0168-8510(97)00054-7 10173493.

12. Klein R. Puzzling out priorities: Why we must acknowledge that rationing is a political process. BMJ: British Medical Journal. 1998;317(7164):959–60. doi: 10.1136/bmj.317.7164.959 9765158; PubMed Central PMCID: PMC1114037.

13. Buse K. Keeping a tight grip on the reins: donor control over aid coordination and management in Bangladesh. Health Policy Plan. 1999;14(3):219–28. Epub 2000/01/06. doi: 10.1093/heapol/14.3.219 10621239.

14. Goddard M, Hauck K, Smith PC. Priority setting in health—a political economy perspective. Health economics, policy, and law. 2006;1(Pt 1):79–90. Epub 2008/07/19. doi: 10.1017/S1744133105001040 18634704.

15. Daniels N, Sabin J. Limits to health care: fair procedures, democratic deliberation, and the legitimacy problem for insurers. Philosophy & public affairs. 1997;26(4):303–50. Epub 2001/10/20. doi: 10.1111/j.1088-4963.1997.tb00082.x 11660435.

16. Cappelen AW, Norheim OF. Responsibility, fairness and rationing in health care. Health Policy. 2006;76(3):312–9. Epub 2005/08/23. doi: 10.1016/j.healthpol.2005.06.013 16112248.

17. Donaldson C, Bate A, Brambleby P, Waldner H. Moving forward on rationing: an economic view. BMJ: British Medical Journal. 2008;337. doi: 10.1136/bmj.a1872 18845596

18. Kapiriri L, Martin DK. Priority setting in developing countries health care institutions: the case of a Ugandan hospital. BMC Health Services Research. 2006;6(1):127. doi: 10.1186/1472-6963-6-127 17026761

19. Youngkong S, Kapiriri L, Baltussen R. Setting priorities for health interventions in developing countries: a review of empirical studies. Tropical medicine & international health: TM & IH. 2009;14(8):930–9. Epub 2009/07/01. doi: 10.1111/j.1365-3156.2009.02311.x 19563479.

20. Bryant PL, Butler LG, Reyes AP, Kuhns P. Al-27 field-swept and frequency-stepped NMR for sites with large quadrupole coupling constants. Solid State Nuclear Magnetic Resonance. 2000;16(1–2):63–7. doi: 10.1016/s0926-2040(00)00055-2 WOS:000086895000008. 10811430

21. Schwandt T. Interpretive Political Science. 2012 2017/11/11. London: SAGE Publications Ltd. Available from: http://sk.sagepub.com/navigator/interpretive-political-science.

22. Blumer H. Symbolic interactionism: Perspective and method. 1969. In: Symbolic interactionism: Perspective and method [Internet]. New Jersey: University of California Press; [1–21].

23. Cruz EV, Higginbottom G. The use of focused ethnography in nursing research. Nurse researcher. 2013;20(4):36–43. Epub 2013/03/26. doi: 10.7748/nr2013.03.20.4.36.e305 23520711.

24. Schwandt T. The SAGE Dictionary of Qualitative Inquiry. 2007. Epub 3. doi: 10.4135/9781412986281

25. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International journal for quality in health care: journal of the International Society for Quality in Health Care. 2007;19(6):349–57. Epub 2007/09/18. doi: 10.1093/intqhc/mzm042 17872937.

26. Nations U. International conference on population and development, Cairo 5–13 September, 1994. Programme of action. New York: United Nations, Dept. for Economic and Social Information and Policy Analysis, 1995.

27. Nations U. Resolution adopted by the General Assembly [on the report of the Ad Hoc Committee of the Whole (A/S-27/19/Rev.1 and Corr.1 and 2)] S-27/2. A world fit for children 2002. 11 October 2002 Twenty-seventh special session. United Nations, 2002.

28. (CRC) UCotRotC. General comment No. 4 (2003): Adolescent Health and Development in the Context of the Convention on the Rights of the Child, 1 July 2003, CRC/GC/2003/4. 2003.

29. Nations U. Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW). 1979.

30. UN. Sustainable Development Goals 2015 [cited 2019 11 February 2019]. Available from: https://www.un.org/sustainabledevelopment/sustainable-development-goals/.

31. Rights ACoHaP. The Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa. African Commission on Human and Peoples' Rights, 2003.

32. Union A. Common Africa Position on the Post-2015 development agenda. Addis Ababa, Ethiopia: African Union 2014.

33. Kenya National Bureau of Statistics KMoH, Kenyan National AIDS Control Council, Kenya Medical Research Institute, Kenyan National Council for Population and Development, The DHS Program, ICF International. Kenya Demographic and Health Survey 2014. ICF International, 2015.

34. Ministry of Health. Kenya HIV County Profiles 2016. In: Council NAC, editor. Nairobi: National AIDS Control Council; 2016.

35. Smith SL, Shiffman J, Kazembe A. Generating political priority for newborn survival in three low-income countries. Global public health. 2014;9(5):538–54. Epub 2014/04/29. doi: 10.1080/17441692.2014.904918 24766101.

36. Dare AJ, Lee KC, Bleicher J, Elobu AE, Kamara TB, Liko O, et al. Prioritizing Surgical Care on National Health Agendas: A Qualitative Case Study of Papua New Guinea, Uganda, and Sierra Leone. PLoS Med. 2016;13(5):e1002023. Epub 2016/05/18. doi: 10.1371/journal.pmed.1002023 27186645; PubMed Central PMCID: PMC4871553.

37. Higginbottom GM. Sampling issues in qualitative research. Nurse researcher. 2004;12(1):7–19. Epub 2004/10/21. doi: 10.7748/nr2004.07.12.1.7.c5927 15493211.

38. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006;3(2):77–101. doi: 10.1191/1478088706qp063oa

39. Creswell J. Qualitative Inquiry & Research Design: Choosing Among Five Approaches. Second Edition ed. Thousand Oaks: Sage Publications; 2007.

40. Thorne S. Interpretive Description. Morse J, editor. Walnut Creek, Ca: Left Coast Press, Inc.; 2008. 272 p.

41. Erasmus E, Gilson L. How to start thinking about investigating power in the organizational settings of policy implementation. Health Policy Plan. 2008;23(5):361–8. Epub 2008/07/31. doi: 10.1093/heapol/czn021 18664526.

42. Mwisongo A, Nabyonga-Orem J, Yao T, Dovlo D. The role of power in health policy dialogues: lessons from African countries. BMC Health Serv Res. 2016;16 Suppl 4:213. Epub 2016/07/28. doi: 10.1186/s12913-016-1456-9 27454227; PubMed Central PMCID: PMC4959373.

43. Kingdon J. Agendas, Alternatives and Public Policies. New York: Longman; 2003.

44. Sawyer SM, Azzopardi PS, Wickremarathne D, Patton GC. The age of adolescence. The Lancet Child & adolescent health. 2018;2(3):223–8. Epub 2018/09/01. doi: 10.1016/s2352-4642(18)30022-1 30169257.

45. Klettke Bianca & Mellor David. At What Age Can Females Consent to Sexual Activity? A Survey of Jury-Eligible Australians,. Psychiatry, Psychology and Law. 2012;19(2):198–208. doi: 10.1080/13218719.2011.559901

46. Pringle J, Mills KL, McAteer J, Jepson R, Hogg E, Anand N, et al. The physiology of adolescent sexual behaviour: A systematic review. Cogent social sciences. 2017;3(1):1368858. Epub 2017/12/05. doi: 10.1080/23311886.2017.1368858 29201945; PubMed Central PMCID: PMC5692360.

47. Pelletier DL, Frongillo EA, Gervais S, Hoey L, Menon P, Ngo T, et al. Nutrition agenda setting, policy formulation and implementation: lessons from the Mainstreaming Nutrition Initiative. Health Policy Plan. 2012;27(1):19–31. Epub 2011/02/05. doi: 10.1093/heapol/czr011 21292709.

48. Kingdon J. Agendas, Alternatives and Public Policies. Boston and Toronto: Little, Brown and Company; 1984.

49. Schneider A, & Ingram H. Social Construction of Target Populations: Implications for Politics and Policy. The American Political Science Review. 1993;87(2):334–47. doi: 10.2307/2939044

50. UNICEF. Collecting and reporting of sex and age disaggregated data on adolescents at the sub-national level NewYork: UNICEF, 2017.

51. Shiffman J, Sultana S. Generating political priority for neonatal mortality reduction in Bangladesh. American journal of public health. 2013;103(4):623–31. Epub 2012/12/15. doi: 10.2105/AJPH.2012.300919 23237181; PubMed Central PMCID: PMC3673247.

52. Hopkins J, Collins L. How linked are national HIV and SRHR strategies? A review of SRHR and HIV strategies in 60 countries. Health Policy Plan. 2017;32(suppl_4):iv57–iv66. Epub 2017/12/02. doi: 10.1093/heapol/czw119 29194540; PubMed Central PMCID: PMC5886072.

53. Finnemore M, & Sikkink K. International Norm Dynamics and Political Change. International Organization. 1998;52(4):887–917. doi: 10.1162/002081898550789

54. Gneiting U, Schmitz HP. Comparing global alcohol and tobacco control efforts: network formation and evolution in international health governance. Health Policy Plan. 2016;31 Suppl 1:i98–109. Epub 2016/01/07. doi: 10.1093/heapol/czv125 26733720; PubMed Central PMCID: PMC4954560.

55. Quissell K, Walt G. The challenge of sustaining effectiveness over time: the case of the global network to stop tuberculosis. Health Policy Plan. 2016;31 Suppl 1:i17–32. Epub 2015/08/19. doi: 10.1093/heapol/czv035 26282859; PubMed Central PMCID: PMC4954557.

56. Smith SL, Rodriguez MA. Agenda setting for maternal survival: the power of global health networks and norms. Health Policy Plan. 2016;31 Suppl 1:i48–59. Epub 2015/08/15. doi: 10.1093/heapol/czu114 26273062; PubMed Central PMCID: PMC4954555.

57. Kapiriri L. Priority setting in low income countries: the roles and legitimacy of development assistance partners. Public Health Ethics. 2012;5:67–80. doi: 10.1093/phe/phs004

58. Shawar YR, Shiffman J. Generation of global political priority for early childhood development: the challenges of framing and governance. Lancet (London, England). 2017;389(10064):119–24. Epub 2016/10/09. doi: 10.1016/s0140-6736(16)31574-4 27717613.

59. Charli Carpenter R. Setting the Advocacy Agenda: Theorizing Issue Emergence and Nonemergence in Transnational Advocacy Networks,. International Studies Quarterly,. 2007;51(1):99–120.

60. Smith SL, Shiffman J. Setting the global health agenda: The influence of advocates and ideas on political priority for maternal and newborn survival. Social science & medicine (1982). 2016;166:86–93. Epub 2016/08/21. doi: 10.1016/j.socscimed.2016.08.013 27543685; PubMed Central PMCID: PMC5034850.

61. Nations United. Official List of MDG Indicators. In: Millennium development goal indicators New York: United Nations Statistics Division, Department of Economic and Social Affairs; 2015 [cited 2019 8June2019]. Available from: http://mdgs.un.org.ucsf.idm.oclc.org/unsd/mdg/host.aspx?Content=indicators/officiallist.htm

62. Chandra-Mouli V, Lane C, Wong S. What Does Not Work in Adolescent Sexual and Reproductive Health: A Review of Evidence on Interventions Commonly Accepted as Best Practices. Global health, science and practice. 2015;3(3):333–40. Epub 2015/09/17. doi: 10.9745/GHSP-D-15-00126 26374795; PubMed Central PMCID: PMC4570008.

63. Erik Beekink. Projections of Funds for Population and AIDS Activities, 2013–2015. The Hague www.resourceflows.org: UNFPA/NIDI-led Resource Flows Project 2014 [30 jan 2018]. Available from: www.resourceflows.org.


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