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Published by Mwangi Mureithi, 2019-11-13 17:29:50

Jilinde Annual_Impact Report_FA

Jilinde Annual_Impact Report_FA

Building evidence for sexual
and reproductive health
services and rights

Impact report 2018/2019



TABLE OF CONTENTS

Abbreviations 4

ICRHK at a Glance 7

Geographical Coverage 8

ICRHK Approach 8

ICRHK Core Values 9

Message from Country Director 11

ONGOING INTERVENTION PROJECTS 14

Linkages across the Continuum of HIV Services for Key Population Affected by HIV
(LINKAGES) Project 16

Bridge to Scale (Jilinde) Project 16

“Jilinde” the ICRHK Way 17

First Time Young Mothers (FTYMs) Project 17

Female Sex Workers (FSWs) Project in Kilifi and Mtwapa Towns 19

The ‘160 Girls’ Project 21

ICRHK Taking up the Baton with the “160 Girls” Project 21

The Approach 22

ICRH Kenya 2018/2019 Impact report 3

The Numbers by end of 2018! 23

Commercial Sexual Exploitation of Children (CSEC) Project 23

Breaking Barriers through Counselling! 24

The Approach 25

Amplify Change Project 26

Do You Know Your Sexual And Reproductive Health Rights? 26

Inspiring Change through the Community 27

Sexual Violence Measurement Study 28

What the Numbers Say! 28

MIXED-METHOD IMPLEMENTATION RESEARCH (Qualitative and Quantitative Studies) 29

The Social Network Analysis (SNA) 30

RANDOMIZED CONTROLLED TRIALS 32

Adolescent/Youth Reproductive Mobile Access and Delivery Initiative for
Love and Life Outcomes (ARMADILLO) 34

The ARMADILLO Approach 34

Notable Impact of ARMADILLO 35

MEASUREMENT STUDIES 36

4 Building evidence for sexual and reproductive health services and rights

ABBREVIATIONS

AGYW Adolescent Girls and Young Women
ANC Antenatal Care
Civil Society Organizations
CSOs Drop-In Centre
DIC Female Sex Worker
First Time Young Mother
FSW Human Immunodeficiency Virus
FTYM International Centre for Reproductive Health-Kenya
Internally Displaced Persons
HIV Kenya Demographic and Health Survey
ICRHK Kenya National Bureau of Statistics
Kenya National Commission on Human Rights
IDPs Key and Vulnerable Populations
KDHS Lesbian, Gay, Bisexual, Transgender and Intersex
KNBS
KNCHR

KVP
LGBTI

ICRH Kenya 2018/2019 Impact report 5

MSM Men who have Sex with Men
NASCOP National Aids and STI Control Program
Public Legal Education
PLE People Living With HIV
PLHIV Performance Monitoring Accountability 2020
PMA 2020 Pre-exposure prophylaxis
Population Services Kenya
PrEP The Social Network Analysis
PSK Sexual and Reproductive Health
SNA Sexual and Reproductive Health Rights
SRH Traditional Birth Attendant
SRHR United Nations Population Fund
TBA World Health Organization
UNFPA
WHO

6 Building evidence for sexual and reproductive health services and rights

ICRHK AT A GLANCE

International Centre for are based on the best available
Reproductive Health scientific evidence which
(ICRH)-Kenya (ICRHK) is are critically monitored by
an independent, local non- scientists. Both the research and
governmental organization the interventions undertaken
(NGO) established in the year are shared and embedded
2000. ICRHK is affiliated to in continuous dialogues and
the ICRH global group, with feedback with the communities
independent country offices in concerned. Over the last 18
Belgium and Mozambique. years, ICRHK has partnered
with various organizations
ICRHK currently has a total of to implement high-quality
81 staff engaged in 12 different sexual and reproductive health
research and intervention (SRH) programs. Through this
projects. The staff are collaboration and experiences,
experienced in program design ICRHK has established robust
and implementation, and carry and efficient systems for
out field large-scale community programmatic and financial
interventions for behaviour management of donor funding.
change in high-risk groups.
The teams are multidisciplinary
composed of researchers,
clinical teams and the social
scientists. ICRHK interventions

ICRH Kenya 2018/2019 Impact report 7

Geographical Coverage ICRHK Approach

ICRK Kenya programs are ICRHK designs and implements
mostly is in the coastal area. innovative evidence-based and
From 2000 to 2014, ICRH cost effective interventions
projects were within Mombasa, based on research in the field
Kwale, Taita Taveta and Kilifi of sexual and reproductive. The
Counties. From 2014, ICRH interventions are implemented
expanded to 11 other Counties, with a continuous engagement
Nairobi, Kitui Nyamira, Siaya, of stakeholders. The
Kakamega, Kericho, Uasin engagement ensures delivering
on promises, engaging in policy
Gishu, Kiambu, Migori, dialogues that are rooted
Bungoma, Nandi, West in scientific evidence and
Pokot. promoting positive change
for outputs that are locally
ICHRK offices/ and globally relevant in sexual
headquarters are in
Mombasa, at the Technical reproductive health.
University of Mombasa,
Prof. Ali Mazrui Building in

Tudor.

8 Building evidence for sexual and reproductive health services and rights

ICRHK Core Values

ICRHK is guided by the following core values:

Respect for human life | Innovation and creativity |
Integrated approach | Teamwork | Professionalism, |
Partnership | Commitment to continuous learning |
Integrity, Fairness, Transparency and Accountability.

Our vision

“To be a center of excellence in sexual and
reproductive health research and interventions”

Our mission

“To contribute to improved health status of Kenyans by
designing and implementing innovative, evidence-based
and cost-effective interventions and conduct research
capable of influencing public policy and practice in the
field of sexual and reproductive health”

ICRH Kenya 2018/2019 Impact report 9

MESSAGE FROM PROF.
MARLEEN TEMMERMAN

I am glad to present to you the tablished the International Cen- nity shelters, adolescent and
ICRH Kenya 2018/2019 impact tre for Reproductive Health as a young people’s health, and SRH
report. Through this report, center for excellence in Sexual for key populations.
we take stock of how our work and Reproductive Health (SRH) Over these 25 years, we have a
has impacted the communities in 1994. We were inspired by the well-built ship. We have trained
that we serve, and look for- deliberations during the confer- hundreds of local staff in re-
ward to continuing this service. ence and the rallying call at the search and project manage-
I am particularly excited this conclusion of the International ment to run this ship. We look
year because the global ICRH Conference on Population and forward to the future with hope
community turns 25 years old! Development (ICPD) in Cairo, and anticipation of even more
For one quarter of a centu- Egypt in 1994. Interestingly, it is successful times ahead. We are
ry, we have striven to provide also from this conference that eager to contribute to improved
high-quality sexual and repro- the resulting program of action maternal, neonatal and chil-
ductive health services to mar- served as the steering docu- dren’s’ health, reduced sexual
ginalized and underserved com- ment for the establishment of and gender based violence and
munities, conduct high-quality the United Nations Population HIV/AIDS in Kenya. We are eager
cutting-edge research to inform Fund (UNFPA), the United Na- to lend our experience, exper-
local and global policies and tion’s sexual and reproductive tise and enthusiasm in advo-
from these studies, built proj- health agency. Birthed from the cating for progressive sexual
ects that leave significant im- same process, ICRH and UNFPA and reproductive health policies
pact on communities. have collaborated to research and laws that will ensure equity,
To provide a brief history, my and run programs on sexual and equality and better access to
colleagues and I in Belgium es- gender-based violence, mater- SRH services. 

10 Building evidence for sexual and reproductive health services and rights

MESSAGE FROM THE
COUNTRY DIRECTOR

I am delighted to present the while at the same time blazing
International Centre for Repro- ahead to change and improve
ductive Health Kenya (ICRHK) the SRH environment in the
Impact Report for 2016 to 2018! country. As we continue to grow,
This report highlights the vari- we continue to learn, and this
ous projects, studies and trials has only been possible through
ICRHK has undertaken in the collaboration, hard work, per-
past four years leading up to severance and determination of
the end of 2018. Here you will the various stakeholders in-
find the impactful ways ICRHK’s volved, I would like to take this
work has had on thousands of opportunity to thank our donors
beneficiaries and on the wider whose financial support con-
Kenyan health sector. tinues to ensure that our good
work flourishes and has the
Having been operational since greatest positive impact pos-
2000 in Kenya, ICRHK is steadi- sible on the health of Kenyans.
ly growing, taking up large- Together with that, the direction
scale interventions and thus and support of the ICRHK board
implementing high-quality of directors has held steadfast
sexual and reproductive health in keeping the organization
(SRH) programs, targeting the committed to its’s vision and
most vulnerable and key high mission. I cannot forget to men-
risk populations. Our work has tion the hard work and dedica-
touched on the lives of many,

ICRH Kenya 2018/2019 Impact report 11

tion of the ICRHK staff all over report, I invite you to reflect on
Kenya, who with their unwav- the wide range of interventions,
ering loyalty, continue to be at research and collaboration
the frontline, fighting to ensure ICRHK has been and continues
Kenya’s SRH services attain to be involved in throughout the
the highest standard possible. years. Whether discovering us
Finally, I would like to extend for the first time or you are a
my sincerest gratitude to our long-term friend, we hope you
various beneficiaries, who have stay with us for many years to
warmly welcomed us into their come.
communities with great will-
ingness to take part in ICRHK’s Enjoy the reading!
projects, while continuing to
play an active role in the work Dr Griffins Manguro
being done. ICRHK Country Director

Looking to the future, our mis-
sion is stronger than ever, and
as you read through this impact

12 Building evidence for sexual and reproductive health services and rights

ONGOING
INTERVENTION
PROJECTS

ICRH Kenya 2018/2019 Impact report 13

Linkages across the Continuum of HIV
Services for Key Population Affected by HIV
(LINKAGES) Project

Kenya’s widespread HIV pandemic Estimated prevalence of HIV:
is varied amongst the general
populace, with key at-risk groups 4.8% among the general
such as men who have sex with population
men (MSM), women, sex workers
(male and female), and people who 29.3% among female sex
inject drugs being more vulnerable workers (FSW)
to infection.
18.2% among men who
Peer supervisor demonstrating use of have sex with men (MSM)
female condom to peers at a Mangwe
To combat this perturbing
epidemic, ICRHK through the
USAID-funded Linkages across
the Continuum of HIV Services
for Key Populations Affected
by HIV (LINKAGES) Project, has
implemented a comprehensive HIV
prevention, care and treatment
program, since 2016, targeting sex
workers and MSM, in Mombasa,
Kwale and Taita Taveta Counties
in Kenya.

14 Building evidence for sexual and reproductive health services and rights

Fighting HIV through strategic, targeted
and accessible care and treatment

As the LINKAGES implementing partner, ICRHK achieved the following by 2018:

1 201 Integrated Clinical Outreaches: 4 Sexual reproductive health (SRH) services
2 5 e.g. Sexually Transmitted Infections (STI)
3 • 8,186 FSWS and 1,190 MSM received Screening and Treatment, family planning
HIV Testing Services (HTS) & cervical cancer screening:

• 61 FSWS and 17 MSM diagnosed • 4,106 FSWS were screened for STIs with
HIV positive 199 FSWS diagnosed and treated,

Drop-in & Service Centres: • 604 MSM were screened for STIs with 32
diagnosed and treated
• 3,621 FSWS and 1,446 MSM received
HTS at drop-in centres Structural interventions including Sexual
and Gender-Based Violence (SGBV)
• 52 FSWS and 5 MSM diagnosed HIV management & follow-up:

Hotspot Based Peer Education • 101 SGBV cases (88 FSWS & 15 MSM)
reported and addressed
• Ongoing use of mobile technology
(Ujumbe SMS & WhatsApp) to reach
more peers with information by the
peer educators and outreach workers

ICRH Kenya 2018/2019 Impact report 15

Did You Know? Bridge to Scale Impact of Jilinde on Key and

Current studies show (Jilinde) Project Vulnerable Populations
that PrEP has up to
90% effectiveness in The Bridge to Scale Project (“Jilinde” From its inception, Jilinde has proven
preventing HIV among translated from Swahili−to protect that peer education and continuous
people at continuous yourself) is a pioneering HIV prevention demand creation efforts significantly
high risk of HIV scale-up that aims to demonstrate and play a role in ensuring PrEP up-take
infection if taken document an acceptable, affordable, amongst peers. Remarkably, more FSWs
daily! and replicable approach to launch and compared to MSM continue to use PrEP
maximise the use of oral pre-exposure for longer durations (more than one
Key Achievement of prophylaxis (PrEP) and reduce HIV month), with 38% PrEP continuation
Jilinde at the Coast incidence among key and vulnerable rates recorded in the first month among
populations (KVP) [such as adolescent FSWs compared to no continuation rates
Starting in July 2016, girls and young women (AGYW), among MSM. Strategic implementation
a total of 4,317 FSW female sex workers (FSW), men who of the oral PrEP scale-up has indicated
and 917 MSM have have sex with men (MSM) including a fundamental need to innovate and
taken up oral PrEP in male sex workers, & people who strengthen existing PrEP continuation
ICRHK supported sites inject drugs] when implemented at a services to guarantee an increase in
by the end of 2018! population level in “real life” routine KVPs’ use of PrEP for longer periods of
service delivery. time, that is, beyond the third month.

Funded by the Bill and Melinda Gates
Foundation through the Jilinde
Consortium (JHPIEGO, Population
Services Kenya (PSK), National Aids
and STI Control Program (NASCOP),
ICRHK and Avenir Health), this timely
4-year project targets over 20,000
people who are at high-risk of HIV
infection in Kenya.

16 Building evidence for sexual and reproductive health services and rights

“Jilinde” the ICRHK Way “Every day in developing

ICRHK in liaison with NASCOP, is scaling up PrEP countries, an estimated 20,000
in Kenya through Jilinde to ensure demand
creation and service delivery. Focusing on the girls younger than 18 give
coastal region, ICRHK continues to create PrEP birth” (UNFPA, 2017)
awareness & demand by:
First Time Young Mothers
• Peer educators conducting hotspot group (FTYMs) Project
and one on one sessions
According to a Kenya Demographic and Health Survey
• PrEP initiation and refill services at the Drop- (KDHS) 2014 survey, nearly one in five girls aged 15-19
in Centres (DIC) & at Clinic Outreaches years in Kenya, has begun child bearing or already has
a child (Kenya National Bureau of Statistics, 2014). With
• Monthly PrEP support groups i.e. PrEP clubs adolescents aged 10 to 15 years comprising 24% of the
• Dissemination of glow-in-the-dark bags Kenyan population and a prevalent high adolescence
• Through the use of goodie bags among FSW pregnancy rate in the country, it is not surprising that
approximately 13,000 teenage girls drop out of school
to strengthen PrEP continuation every year due to pregnancy.

James Mwaughanga in Mombasa, cannot ICRH Kenya 2018/2019 Impact report 17
contain his excitement as he shares monthly
PrEP data with the Jilinde team. “Thank you so
much for Jilinde Data System, it has made my
work a lot easier’’, says James. He is a clinician
at Reach Out Trust Center drop in center in Voi,
Taita Taveta County. James discloses that he
had very little time recording client data due
to the high work load and targets.

Kilifi County in the coastal region of Kenya, has FTYMs’ Impact at a Glance
one of the highest pregnancy rates at 22% among
15-19 year old girls. As such, ICRHK through UNFPA by the end of 2018
funding, has implemented the First Time Young
Mothers (FTYMs) project in Mtwapa Town, Kilifi. • 1,400 FTYMs are currently enrolled and actively
This indispensable project aims at reducing the participating in the project where they are
high teenage pregnancy prevalence in Kilifi by: offered SRH services and incentivized to
• Providing accessible sexual and reproductive return for review and health management with
diapers, babywear, detergents, & sanitary pads.
health (SRH) services
• Optimizing SRH delivery services • 100% child welfare coverage up to 1 year has
• Documenting and sharing lessons learnt been achieved among the FTYMs with ma jority
of them enrolled at antenatal care (ANC)
among the FTYMs and other stakeholders clinics.
The underlying drivers of teenage pregnancy
include gender inequality, child marriage, poverty, • 99% hospital delivery achieved following
sexual violence, and poor education and job sensitization of traditional birth attendants
opportunities. (TBAs) who refer the girls to the hospitals
instead of delivering them at home.
A nurse at the Mtwapa Health Centre sensitizing on breast
feeding during a support group meeting for FTYMs • 90% family planning coverage with ma jority
opting for the 3-month injectable contraceptive
Depo-Provera©, which leaves no mark since
most of the male partners in the area do not
support the use of contraceptives.

• One-year post-delivery follow-up with FTYMs
to ensure that they are on family planning and
delay a second pregnancy while empowering
them with health information.

• Project stakeholders are engaged on quarterly
basis to review project progress and address
any teenage pregnancy cases that occur in
the area.

Female Sex Workers • High risks of HIV, STIs infections, Over 200,000 sex
unintended pregnancies, gender vi- workers in Kenya
(FSWs) Project in Kilifi olence and adverse birth outcomes

and Mtwapa Towns • HIV prevalence among FSWs na-
tionally is estimated to be at 29.7%
With over 200,000 sex workers in
Kenya (133,675 female sex workers • Unintended pregnancies for FSWs
[FSW], 13,019 men who have sex are similarly high at 25%
with men [MSM]) as mapped out
by National Aids and STIs Control In Kilifi County, where the FSWs project
Programme (NASCOP) in 2016, sex is being implemented by ICRHK, there
workers face immense challeng- exists a varied HIV prevalence amongst
es daily especially when it comes the general population. Currently it is
to their sexual and reproductive 3.8% with 33,319 people living with HIV
health (SRH). (PLHIV) (Kenya HIV Estimates Report
2018) and with an estimated popula-
tion of 6,696 FSWs (NASCOP mapping 133,675 13,019
2018), notably with Kilifi and Mtwapa female sex men who
towns having the highest numbers have sex
of FSWs in the county. Through the workers with men
United Nations Population Fund (UNF- [FSW]
PA)-funded FSWs project, ICRHK is pro- [MSM]
viding integrated and stigma-free SRH
services to FSWs in Kilifi and Mtwapa
towns to help mitigate and reduce
health challenges faced by FSWs,

Lessons learnt and experiences
gained during project implementation
are shared among stakeholders aimed
at improving other similar projects in
the country.

ICRH Kenya 2018/2019 Impact report 19

Impact of the FSWs Screening and Treatment, family planning &
Project by 2018 cervical cancer screening
• Increased provision of clinical outreach services:
• Bi-annual hotspot identification and • 25 outreaches conducted every month
validation to target FSWs beneficiaries: • 2 in reach activities conducted every month
• 2 themed hotspot events conducted • 2 support groups for FSWs living with HIV
per year
• 2,104 FSWs enrolled into the project formed who meet monthly
• Regular trainings for service providers on
• Peer-led community education mobilization:
• 10 FSWs in Kilifi and 20 in Mtwapa provision of quality key population (KP) friendly
identified and trained to provide health services.
talks • Continued and regular stakeholder
• Identified and trained 30 peer educators engagements.
• 871,055 male condoms distributed,
645,852 directly to FSWs through peer Peer supervisor demonstrating use of
educators and 225,203 through other female condom to peers at a Mangwe
outlets like dispensers

• HIV Testing, training & provision of
oral PrEP:
• 1,024 received quarterly HIV testing
• 51 FSWs diagnosed with HIV and linked
for care
• 450 HIV negative FSWs enrolled
oral PrEP

• Sexual reproductive health (SRH) services
e.g. Sexually Transmitted Infections (STI)

20 Building evidence for sexual and reproductive health services and rights

The ‘160 3 boys who had been defiled. The Scourge of
Thus the “160 Girls” Project was
Girls’ Project born! These victims of defilement Sexual Violence
and rape made legal history with
Envision a world where a young the Kenya High Court ruling that in Kenya
girl is denied her human right the police treatment of the “160
to seek justice after one of the Girls” petitioners’ claims violated 30Every a girl or
most appalling forms of violence their human rights, and that the mins woman is
that is rape. This was the case police treatment of defilement
for a young girl in Meru County, had created a climate of impunity raped in
Kenya, in 2013, who during a for defilement, which rendered Kenya!
community meeting, stood up and them indirectly responsible for the
bravely reported that she had harms inflicted by the perpetrators.
been raped and her perpetrator This set a notable benchmark in
freed. Following this, human rights protecting girls from rape as the
activists visited the Brenda Boone girls/ petitioners secured access
Hope (Tumaini) Centre in Meru, to justice for themselves and
a safe haven and rescue centre legal protection from rape for
that at the time had 157 girls and 10,000,000 girls in Kenya.

ICRHK Taking up the Baton
with the “160 Girls” Project

“160 Girls” is a legal advocacy ini-
tiative that aims to achieve justice
for the girls, and protection against
rape in Kenya by addressing the
root source of the problem relating
to police failure to enforce exist-
ing laws that prohibit the sexual
assault of girls. ICRHK continues to
monitor police treatment of de-

ICRH Kenya 2018/2019 Impact report 21

filement cases reported at the The Numbers
Gender based Violence Recovery by end of 2018!
Centre (GBVRC) based at the
Coast General Hospital Mombasa 100 Cases Recruited by
through a standard intake and ICRHK project paralegals
monitoring forms.
Case 14
The Approach Judgement Made

• Create Awareness to girl’s 13 Cases Still
student regarding defilement, in Court
police obligations &
community protection • Strengthen outreach and Cases Still at the 13
education as undertaken in Police Station
• Mobilize students to report stage 1 of the 160 Girls Public
defilement/sexual violence Legal Education (PLE) initiative 13 Cases who gave wrong
and provide tools to use phone number and cases
• Establish Justice clubs in with no contact number
The 160 Girls’ Justice Club and Paralegal Mary primary schools in regions that
performing Rose Ohon’s song on saying NO to rape are hotspots: Cases where phones 46
were not in service and
• Strengthen school going not being picked up
children’s’ & girls knowledge
and capacity on how to identify 1 Perpetrator released
and report defilement cases at the Police station
and ability to say no to rape
Schools with 6
• Enhance collaborative Established Justice
involvement of police officers in Clubs
the running of justice clubs at
schools

22 Building evidence for sexual and reproductive health services and rights

Commercial Sexual The Approach
Exploitation of Children
(CSEC) Project The following interventions were given;

Started in September 2016 with One on one Capacity building
support from Kindernothilfe, counselling, life sessions on
ICRHK has been implementing skills training child protection
Commercial Sexual Exploitation sessions, and with different
of Children (CSEC) project. The vocational training. stakeholders
three-year project covered the Identifying and including; local
larger Changamwe and Kisauni informing caregivers administrators, religious
Sub-Counties in Mombasa County. of the children who are in CSEC, leaders, paralegals, teachers,
Kenya. Its overall objective was community volunteers and school peer educators, community
to contribute to the reduction of different stakeholders including the volunteers, out of school peer
commercial sexual exploitation and police, officers from the children educators and bar owners. These
sexual abuse of children as well department, and the Ministry of stakeholders are in turn sensitised
as improve service delivery to the Education officers. children and adults in the
victims through institutional linkages surrounding communities leading
of both children and caregivers. Business skills to an increased number of CSEC
training of cases being reported.
caregivers to combat
poverty and reduce the
chances of their children getting
back to CSEC.

ICRH Kenya 2018/2019 Impact report 23

Breaking Barriers “I thank ICRHK for their support, I am
through Counselling! now aware of myself and confident
that I can make it in life” Amina, from
Amina, from Changamwe “I come sessions. During counselling, I Changamwe
from a poor family and due to our came to realize that survival sex
difficult situation and the absence has negative effects like one 2018 in
of financial support; I had to get can contract sexual transmitted summary
into begging on the streets of diseases, it can affect one’s
Mombasa town and later involved reproductive system and one can 635 children
myself in survival sex.” even get infected with HIV/AIDS. I identified
became self-aware of what I was
Living with her mother after her doing and I decided to change. 428 children received
parents’ separation, Amina (not This did not happen at once but counselling
her real name) succumbed to the it took place gradually. I have 280 services from
life of survival sex to financially now stopped survival sex. After Ministry of Health
support herself and her 3 siblings stopping, I started selling clothes female Counsellors
through school. Lack of financial so as to cater for my needs and
resources led to Amina not those of my siblings. 148
proceeding to secondary school,
and she continued to engage in I then decided to enrol in a male
survival sex as her primary source secondary adult class so that
of income. I could at least complete my
secondary education. I would
“I thank ICRHK for giving me like to complete my secondary
psychosocial support, which education and go to university
has made me change my to do accounting. I also assist
behaviour. After I was identified in linking other children who are
by a community volunteer, I was involved in survival sex to ICRHK
enrolled into the program after so that they can get assistance. “
verification by ICRHK staff. I then
went through 6 counselling

24 Building evidence for sexual and reproductive health services and rights

Amplify Change whole of Kenya, ICRHK through
the Amplify Change project aims
Project to empower people to realize their
sexual and reproductive health
At the national level, the Constitu- rights. Establishing the project in
tion of Kenya 2010 guarantees the Kilifi, Kwale and Taita Taveta Coun-
rights of an individual to the high- ties, was done through improved
est attainable standard of health, quality of data and analysis that
including reproductive health. It allows advocates to use evidence
underscores the importance of to support their work, while en-
prioritising the needs of vulnerable couraging increased participation
and marginalised groups in provi- of leadership and representatives
sion of health care. In addition to from marginalized groups such as
the Constitution, Kenya has a num- adolescents and youth; persons
ber of Acts of Parliament that seek with disabilities; people living with
to promote and protect sexual and HIV/AIDs; refugees and Internally
reproductive health rights (SRHR), Displaced Persons (IDPs); Lesbian,
which include the Sexual Offences Gay, Bisexual, Transgender and In-
Act 2003, the Children’s Act 2001, tersex (LGBTI) community; and sex
Prohibition of Female Genital Muti- workers.
lation Act 2011 among others (Ken-
ya National Commission of Human ICRHK continues to implement
Rights [KNCHR], 2012). and empower individuals about
their SRHR by:
Inspiring Change
through the Community • Training and sensitization
on sexual and gender-based
With the prevalence of teen preg- violence (SGBV) with local
nancy and the HIV epidemic not motorcycle (“boda-boda”)
only in the coastal region, but the and taxi operators; journalists;
senior police officers religious
leaders from different
denominations;

ICRH Kenya 2018/2019 Impact report 25

• Setting up of the Mombasa County Do You Know Your Sexual And
SGBV Technical Working Group. Reproductive Health Rights?

• Strengthened capacity for civil • Addressing gender-based violence,
society organizations (CSOs) to including sexual violence and female
advocate for SRHR. genital mutilation.

• Publishing of the ‘Facing Violence’ • Addressing the causes of unsafe abortion
booklet a multimedia project to including decriminalization of abortion.
unveil SGBV issues in Kenya (Read
more about Facing Violence at: • Challenging stigma, discrimination,
http://icrh.org/sites/default/files/
FacingViolence.pdf) • The right to fight against attitudes and
laws that undermine human rights,
• Locally develop new ideas including on grounds of gender or sexual
implemented and lessons orientation of LGBTI individuals.
learnt shared.
• The right to improved sexual health
of young people and girls, including
comprehensive sexuality education and
addressing child and early marriage.

• The right to access to comprehensive
reproductive health services for socially
and economically marginalized and
vulnerable groups.

• The right to decide if and when to have
children.

• The right to have information about
sexual health.

• The right to choose your own sexual
partner, and the right to sexual identity
free of fear and discrimination.

Sexual Violence
Measurement Study

Sexual violence is a public health progress in their attitudes towards
concern, a violation of human the police over one year, following
rights, and a marker of gender a police training exercise to be con-
inequality. In Kenya, it is estimat- ducted by the Kenya Police and the
ed that nearly two thirds of girls Equality Effect Organization.
experience sexual assault. Sexual
and gender-based violence (SGBV) Currently, the study has already
is higher among girls and women in
rural areas and urban slums. De- been conducted in one county, Kili-
spite the high prevalence of SGBV,
ma jority of survivors do not report Sfmei,xeuwaahsliuVlerieobmlaeensnectelinsMetuesdauysruvinreeyKmsweoanfltethS, etHuoSdmVy -
to the police according to recent Seaxbuaal yvioalenndceKisiaspuumbliuc hweailllthccoomncemrne, anvcioelation of human
data obtained from ICRHK SGBV trhiegahattnsr,elayanrld2ya0twm2oa0trhkoeirrdnoscfoegfegsnircdlsehreoxinpoeelqrsuiearnleicte-yo.sIepnxeuKaenln.aysas,aiut lits. estimated What the Numbers Say
Recovery Centre in Mombasa. Sexual and
• The study participants were
ICRHK is implementing the Sexual
Violence Measurement Study to gender-based violence (SGBV) is higher among girls and women in school-going boys and girls age
provide an estimate of the prev-
alence of sexual violence among mrreuRSacraGeejolncBratioVrtdyevaaeCotsrfaayassonuCebdrtvseauivnRirnobteerraespdndofasrorltoutnmeCmodostIC.araRDestHptetosKGhpreSteitGtneGoBeteVthrhnaeRedlehpHecigoorohl-visBcepepraryeiastvCcaeaceldolnertnVdrceiinoeiglnoetfonScGeBV, 12 to 17 years in Kilifi.
school-going children, and to as- • 10 schools and 2 police station
sess their attitude and confidence
in the police, which determines in Kilifi County.
their reporting these cases. By
conducting the study in 4 counties Mombasa. • 94 boys and 56 girls in total
–Kilifi, Kwale, Kisumu, and Homa-
bay −the aim is to look for changes were involved in the baseline
in specific attitudes or indicators of
Number of SGBV cases reported 65 73 70 survey for the study.
58 58
47 50 54 55 57 49 54 • Out of the 150 students, 27% o
them personally knew of rape
cases while 1% of the students

reported they had experienced

rape

• 41% of the students believe tha

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec if a girl or boy is raped, she/he

The Year 2018 brings shame to their family.

ICRHK is implementing the Sexual Violence Measurement Study • When it comes to reporting

(under the Grand Challenges initiative in collaboration with The cases of sexual violence/rape,

Equality Effect) to provide an estimate of the prevalence of seICxRuHaKlenya 2018/201494Im%pafcetlrtempoortre c2o7mfortable
confiding in a parent, while on
violence among school-going children, and to assess their attitude

What the Numbers Say!

• The study participants were school-
going boys and girls aged 12 to 17 years
in Kilifi.

• 10 schools and 2 police stations in Kilifi
County.

• 94 boys and 56 girls in total were
involved in the baseline survey for the
study.

• Out of the 150 students, 27% of them
personally knew of rape cases while
1% of the students reported they had
experienced rape

• 41% of the students believe that if a girl
or boy is raped, she/he brings shame to
their family.

• When it comes to reporting cases of
sexual violence/rape, 44% felt more
comfortable confiding in a parent, while
only 29% would report the incident to
the police.

The ICRHK research team conducting interviews

28 Building evidence for sexual and reproductive health services and rights

MIXED-METHOD
IMPLEMENTATION
RESEARCH

(QUALITATIVE AND
QUANTITATIVE STUDIES)

ICRH Kenya 2018/2019 Impact report 29

The Boresha Study Utilising both qualitative The Study Approach
and quantitative approach-
ICRHK, launched a three- es, Boresha was structured Formative Study: in depth interviews (IDIs) were
year (2016-2018) Boresha as a multi-level risk-reduc- conducted with sex workers and their clients of which
project that was studying tion intervention project resulted to two publications and the data analysed
the feasibility of conducting tailored to the local context has been used in presentations internationally at
HIV prevention interven- which is informed by theory the AIDS and Impact conferences. Biomarkers study
tions at entertainment ven- and prior work. It aimed to aimed to determine the usefulness of the SPERM
ues in Mombasa and Mtwa- understand the socio-cultur- HY-LITER and RSID-semen tests as biomarkers for
pa towns of Mombasa and al context of risk behaviour, non-condom use for anal sex among sex workers.
Kilifi counties. The project beliefs/understandings of
received technical support HIV and risk; barriers to and The Intervention: Aimed to test the intervention pack-
from ICRH-Belgium and HIV facilitators of risk-reduction; age developed for feasibility, acceptability, as well as
Center for Clinical and Be- and responses to interven- participant level of exposure and intervention con-
havior Studies of Columbia tion messages. tamination at control sites via process measures to
University. be used in a future study.

Two independent cross-sectional surveys were
conducted with each of the three target popula-
tions (FSWs, MSWs, sex workers’ clients). The first
cross-sectional survey was implemented 2 months
before initiating the venue-based intervention to
measure the prevalence of potential variables to be
used as outcome measures in an actual trial.

Post-Intervention: The second cross-sectional survey
was conducted 2-months after the intervention had
ended, to assess exposure to the piloted venue-based
intervention and acceptability, satisfaction with the
intervention, to assess exposure to HIV prevention
interventions and assess any ma jor changes in poten-
tial outcome measures or contextual factors among a
random sample of venue patrons.

30 Building evidence for sexual and reproductive health services and rights

The Social Network
Analysis (SNA)

Launched on March 2017, Social Upon completion in mid-2018, the
Network Analysis (SNA) was a SNA findings depicted a possibility
qualitative study on the impacts of failure by many counties to meet
of social norms and social network the global Family Planning 2020
effects on adoption of modern con- (FP2020) targets unless a demand
traception approaches within the creation intervention was made
rural parts of Kilifi, Kenya. The proj- while maintaining a flawless sup-
ect was funded by the Bill and Me- ply chain of the contraceptives for
linda Gates through George Wash- easy access by the communities
ington University and implemented within the urban and suburb vicini-
by ICRH-Kenya in collaboration ties of the respective counties.
with North Western University.

The SNA study was founded on
the Performance Monitoring and
Accountability (PMA2020) research
findings on the level of adoption of
modern contraceptives in various
counties in Kenya. However, Kilifi
County was the preferred project
area as it features trends of sites
with high, medium, and low levels
of prevalence on adoption of mod-
ern contraceptives as per the data
by PMA2020 ((PMA2020), 2015).

ICRH Kenya 2018/2019 Impact report 31

A total number of 21 focus pregnant after using modern Cultural & Social views and how
group discussions (FGDs) and contraceptives, they attribute they shape beliefs on the use of
10 Key informant Interviews the infertility to the use of con- modern contraceptives
(KIIs) were expected to be traception;
conducted in selected areas The main belief mentioned during the SNA study
within Kilifi. The following (4) Within the communities, is that contraception, especially when used at a
themes were concluded during the primary goal of marriage young age and/ or prior to bearing children, can
the study: is childbirth and thus commu- weaken a woman’s uterus or otherwise damage
nity approval is rigidly tied to her reproductive system, making it difficult or
(1) The belief that using mod- childbearing; and, therefore impossible for her to conceive or to carry a preg-
ern contraception at a young nancy to term in the future. The two methods that
age or before childbirth can (5) The social consequences are most widely used in the study communities—
make women infertile is wide- of infertility are devastating. oral contraceptive pills and injectables—were the
spread only methods implicated in the belief.
Read more on the SNA study:
(2) According to the above be- “She might use family planning and
lief, the most commonly used Sedlander, E., Bingenheimer, J. B., when they are removed from her body,
methods in the community Thiongo, M., Gichangi, P., Rimal, R. N., she is not able to conceive. Because
were linked to infertility; Edberg, M., & Munar, W. (2018). “They those drugs affect the inside and the
Destroy the Reproductive System”: uterus becomes thin such that it can’t
(3) When women observe Exploring the Belief that Modern carry a pregnancy.”
other women who cannot get Contraceptive Use Causes Infertility. SNA Study Participant
Studies in family planning, 49(4),
345-365.

32 Building evidence for sexual and reproductive health services and rights

RANDOMIZED
CONTROLLED
TRIALS

ICRH Kenya 2018/2019 Impact report 33

Adolescent/Youth Reproductive Mobile
Access and Delivery Initiative for Love and
Life Outcomes (ARMADILLO)

The Kenya government is Underlying Issues: In order to Funded by the World Health
prioritizing programming among accomplish these policy targets, Organization (WHO), ICRH-Kenya
young women through the Kenya strategic actions have been is implementing Adolescent/Youth
Adolescent Reproductive Health Policy identified for promoting the health Reproductive Mobile Access and
(2003). This policy aims at doubling of adolescents and youth including Delivery Initiative for Love and
the use of modern contraceptives the acknowledgement of their Life Outcomes (ARMADILLO) as a
from 4% to 8% among sexually active right to reproductive services and multisite study refining the existing
adolescents (aged 15-19 years) and increasing their access to these mHealth platform in Kilifi and
from 19.9% to 40% among youth (20- services as unintended pregnancy Mombasa Counties by:
24 years) by 2015. National guidelines among adolescents is a common
for family planning (FP) supports public health problem globally, and • Researching youth learning
the provision of FP services for is associated with significant health and information retention
adolescents and youth. risks and social costs following delivery of sexual
and reproductive health (SRH)
The ARMADILLO Approach information via mobile phones.

Stage 1: Stage 2: Stage 3: • Determining whether youth
given access to SRH information
Formative Research Effect of ARMADILLO on Coverage Study through their mobile phones
to inform youth on knowledge for action, to determine the are more knowledgeable about
SRH services via text attitudes and self-efficacy effectiveness of the contraception and better able
messages using quantitative and program to dispel contraception myths
qualitative methods and misconceptions than those
without access to SRH

34 Building evidence for sexual and reproductive health services and rights

Notable Impact of
ARMADILLO

Stage 1 of the ARMADILLO study
established that mobile phones
are currently part of young
people’s lives and reinforced the
fact SRH messages delivered
via text messages from a
trusted source will most likely be
acceptable to young people owing
to its confidential nature.

In-depth interviews were
conducted with a sub-sample of
intervention participants at the
end of the study, in order to assess
the system’s usability.

ICRH Kenya 2018/2019 Impact report 35

MEASUREMENT
STUDIES

36 Building evidence for sexual and reproductive health services and rights

Performance In the face of such an ambitious
objective, there is the need for
Monitoring and an effective monitoring system
to track annual progress on key
Accountability 2020 indicators around contraceptive
demand, supply and use.
(PMA2020) Performance Monitoring and
Accountability 2020 (PMA2020)
Maternal and child morbidity is a five-year project that uses
and mortality continues to be a innovative mobile technology to
public health problem with many support low-cost, rapid-turnaround,
sub-Saharan Africa countries. As nationally representative surveys
such, family planning (FP) use to monitor key indicators for family
remains a central intervention planning and water and sanitation.
in addressing maternal/child ICRHK, the Ministry of Health,
morbidity and mortality as well as National Council for Population
HIV/AIDS. In July 2012, the London and Development, in collaboration
Summit reinvigorated FP as a with Kenya National Bureau of
health development issue of global Statistics, University of Nairobi, Moi
importance, particularly in the low University, Technical University of
resource settings. A significant Mombasa and Jaramogi Oginga
commitment of resource was made Odinga University of Science
to advance family planning and and Technology, lead PMA2020
thereby provide access to modern in Kenya. The project was made
contraceptives to an additional possible by generous support from
120 million women of reproductive the Bill & Melinda Gates Foundation.
age in 69 low in-come countries
by 2020.

ICRH Kenya 2018/2019 Impact report 37

The Key Results of PMA2020‘s Approach
PMA2020/Kenya
Access the PMA2020/Kenya Publications at:
Trainings: Stakeholders engagement: https://www.pma2020.org/research/country-reports/kenya

• 169 Data Collectors Trained • 2 National dissemination
• 4 staff participated in a Conducted

data translation workshop • 9 County Disseminations
in Baltimore conducted
• 3 Staff participated in
data visualization and • 2 Costed Implementation
communication training Plan (CIP) review meetings
• 5 staff participated (Migori County & Bungoma
Training Design & County)
Facilitation Bootcamp
Data Access and Use:
Data Collection:
• 2 Data use workshop
• 1 FP Round of data conducted
collection
• 1 Data Interrogation
• 1 Nutrition Round of data workshop Conducted
collection
• 1 Writing workshop
• 3 PMA Agile Rounds of data Conducted
collection
• 1447 Datasets downloaded

• 2 Masters students using
PMA Data

• Engaged 6 Health
Journalist in a field work
activity to generate data
stories

38 Building evidence for sexual and reproductive health services and rights

Performance Monitoring 10-49 in sub-selected households,
and to caregivers of children under
and Accountability five in all selected households, with
one form per child. Data collection
(PMA2020/Kenya) Nutrition was conducted between May and
August 2018. The final sample
The Performance Monitoring and included 8,046 households (95.2%
Accountability PMA2020/Kenya response rate), 4,508 eligible
Nutrition survey in 2018 used a households (56.0% eligible rate),
multi-stage stratified cluster design 2,471 females (98.96% response
with urban-rural and 11 selected rate), and 4,563 children under 5
counties as strata. A sample of (99.8% response rate).
151 enumeration areas (EAs) was
drawn by the Kenya National PMA2020/Kenya Nutrition is
Bureau of Statistics for the Kenya led by the Ministry of Health in
Round 6 PMA2020 family planning collaboration with International
survey and these EAs were used Centre for Reproductive Health
for nutrition survey. In each EA, Kenya (ICRHK), National Council for
56 households were randomly Population and Development, and
selected. The household survey Kenya National Bureau of Statistics.
was administered to all consenting Overall direction and support is
households selected. provided by the Bill & Melinda
Gates Institute for Population and
Twenty-five percent of households Reproductive Health at the Johns
were then randomly sub-selected. Hopkins Bloomberg School of
The female-child questionnaire Public Health.
was administered to all women age
Access the PMA2020/Kenya Nutrition Report
at: https://www.pma2020.org/research/
country-reports/kenya

ICRH Kenya 2018/2019 Impact report 39

PMA Agile

PMA Agile is a component of the Performance Monitoring for Action project and aimed at the subnational level
(state, county or city). It builds on the PMA monitoring and evaluation platform and conducts continuous tracking
of family planning service delivery and consumption through quarterly public and private health facility surveys
and semi-annual client exit interviews. A phone follow-up survey is conducted with consenting female clients four
months after their interviews. PMA Agile monitors the urban areas of three counties in Kenya, Kericho, Migori and
Uasin Gishu, and is conducted by the International Centre for Reproductive Health-Kenya (ICRHK), in collaboration
with The Bill and Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg
School of Public Health.

40 Building evidence for sexual and reproductive health services and rights

PMA Agile/Kericho PMA Agile/Migori PMA Agile Uasin Gishu

1,973 clients (73% female) were interviewed at 2,011 clients (75% female) were interviewed at 1858 clients (80% female) were interviewed at
the 106 public and 98 private facilities. the 101 public and 104 private facilities the 100 public and 109 private facilities.

Female clients interviewed at public and Over 80% of female clients interviewed at Youth clients reported high levels of
private facilities were more likely to choose public and private facilities report ever being explanation on how to use contraceptive
their contraceptive method themselves (69% told when to return for a follow-up visit. methods, from private facilities, ranging
and 53%, respectively), than as a decision from health centers (79%), hospitals (78%), to
made with their partner and/or provider pharmacies (56%).

A relatively high percentage of young clients More non-contracepting male clients Female clients interviewed at both public and
(18-24 years) report providers explaining how interviewed at private facilities (64%) intend to private facilities report relatively high levels
to use contraceptive methods at private use family planning in the future, compared of satisfaction with such services as clarity of
facilities. Among pubic facilities, youth clients to just 20% of those interviewed at private FP information, polite treatment, and range of
reported receiving an explanation about facilities. services compared to other facilities.
methods primarily from health centres (30%).

Less than 10% of female clients surveyed Among female clients interviewed at Migori At the follow-up interview, 50% of female
at private facilities aged 18-24 years and 35 facilities, 97% consented and completed a clients were still using the method they
years or older were told what to do if they follow-up interview four months later. reported at baseline, 15% had switched
experienced side effects related to their methods, and 13% had stopped using a
contraceptive method. These rates were method; 8% began using a method and 14%
higher among clients of all age groups remained non-users
interviewed at public facilities and those
interviewed at private facilities between 25
and 34 years old (53%).

Injectables and implants were the most common methods used among clients interviewed at both public and private facilities in all 3 counties!

ICRH Kenya 2018/2019 Impact report 41






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