Abstract
This paper presents the results of an implementation research of a pilot intervention, mainstreaming meaningful youth participation in a health care management system in Western Kenya with the aim to address adolescent sexual and reproductive health and rights (SRHR). This qualitative case study included 29 key informant interviews and 13 focus group discussions conducted in five community health units across four counties. The results demonstrate positive attitudes towards the principle of youth participation, yet, also a mismatch between the aspirations of young people to be active decision-making agents and the actual roles and responsibilities assigned to them. This paper further identifies factors that inhibit and enable effective youth participation at multiple levels; individual (such as education, discipline, migration, gender); organisational (such as guidelines and structures, financial support, and political interference) and societal (norms seeing SRHR as taboo and young people as unequal to adults), and formulates recommendations to address these.
Highlights
Over the last two decades, youth participation has grown in prominence across international sexual and reproductive health and rights (SRHR) programmes (Villa-Torres & Svanemyr, 2015; Miedema et al, 2011)
Some studies describe meaningful youth participation (MYP) as ‘decision-making by young people that involves meaning, control, and connectedness’ (Oliver et al, 2006), while others emphasise the importance of young people being able to ‘participate on equal terms with adults, or work independently in organisations and in all stages of programming and policy-making: design, implementation, monitoring and evaluation (CHOICE for Youth and Sexuality & YOUACT, 2018)
The five research sites were: Shibembe and Mutoma in Kakamega County, Madibo in Busia County, Omia Malo in Siaya County and Gem Nam in Kisumu County. These sites were purposively selected since they were the forerunners of the 170 Community Health Units (CHUs) in integrating youth participation in their Community Health Committees (CHCs)
Summary
Over the last two decades, youth participation has grown in prominence across international sexual and reproductive health and rights (SRHR) programmes (Villa-Torres & Svanemyr, 2015; Miedema et al, 2011). Perhaps the most well-known typology analysing the ‘meaningfulness’ of participation is Hart’s (1992) seminal ‘Ladder of Participation’ which builds on the work of Arnstein (1969) to acknowledge young people and adults’ differing experiences of societal power and control (Arnstein, 1969; Hart, 1992). CHOICE for Youth and Sexuality and YOUACT’s (2018) ‘Flower of Participation’, specific to youth SRHR programmes, directly adopts Treseder’s five types of participation as five ‘petals’ and reintroduces Hart’s three forms of nonparticipation; manipulation, decoration and tokenism as ‘leaves’ The CHOICE model crucially recognises that different forms of participation can and do exist within the same programme
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