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

Abstract

BackgroundDespite 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.MethodsWe 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.FindingsSeveral 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.ConclusionIn 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.

Priority-setting to integrate sexual and reproductive health into universal health coverage: the case of Malaysia

“…stakeholderswas critical to gain political support for controversial issues such as SRH. 66 Negative framing of sensitive SRH issues could result in significant stigmatisation and affect the level of prioritisation. 67 In our study, while internal framing had demonstrated success in generating consensus on the importance and provision of OSCC and abortion services, both services did not seem to be included in other parts of the health planning process, including costing and budgeting, operational planning, and monitoring and evaluation mechanisms.…”

“…stakeholders – was critical to gain political support for controversial issues such as SRH. 66 Negative framing of sensitive SRH issues could result in significant stigmatisation and affect the level of prioritisation. 67 …”

“…The findings of our study were similar to a study on the prioritisation of adolescent SRH services in Kenya, where the divisions between internal and external framing of SRH services for adolescents led to the low prioritisation of such services. 66 Reluctance to discuss and address these issues or restrictions to accessing certain SRH services for people who do not conform to socially accepted norms of behaviours has posed constraints and challenges in prioritising and integrating SRH services in UHC in most countries, including Malaysia.…”

Barriers and facilitators regarding the implementation of policies and programmes aimed at reducing adolescent pregnancy in Ghana: an exploratory qualitative study

“… 30 31 This lack of political will, fuelled by partisan politics, often has its roots in traditional socio-cultural norms that hinder family planning and other pregnancy prevention interventions for adolescents. 32 33 The lack of political will led to inadequate government financial support for SRH programmes. The inadequacy of financial support worsened with the impact of COVID-19, which affected support from donor agencies who otherwise might have supported SRH programmes.…”

“…At the regional and national levels, ASRH has been considered a low priority among politicians and government, which reflects attitudes among political leaders and decision-makers in sub-Saharan Africa more broadly 30 31. This lack of political will, fuelled by partisan politics, often has its roots in traditional socio-cultural norms that hinder family planning and other pregnancy prevention interventions for adolescents 32 33. The lack of political will led to inadequate government financial support for SRH programmes.…”