Youth-led social accountability among service providers optimizing sexual and reproductive health rights outcomes in Kilifi County, Kenya

Abstract


 Background: The demand side of the health system is gaining traction to improve health outcomes. Among adolescents and youths, this is needed, particularly in low- and middle-income countries (LMICs) where they account for the majority and demographic dividends require that they be healthy and productive to participate in national development. Unfortunately, at this transition age from childhood into adulthood, they experience many challenges such as malnutrition, poverty, school dropout rates, gender inequality, drug and substance abuse, mental ill-health, and menstrual hygiene and health challenges. Risky behaviors related to SRHR include unplanned pregnancies, gender and sexual orientation issues, gender-based violence, sexually transmitted infections, harmful cultural practices, and reproductive cancers.
 Methods: VSO PITCH Data for the youth accountability project addressed social accountability by service providers for youth-friendly information and services. The data tool used was the intersectional community scorecard collected through focused group discussion entries made at county health facilities by youth, service providers, and interface synthesis of satisfaction scores. These were uploaded onto a digital platform showing the number of FGDs, core indicators, satisfaction scores, reasons, recommendations, and action plans. This project was conducted in Kilifi County and two other counties. 
 Results: FGDs comprised 50% youth, 25% adults, 25% of mixed age range, and two persons with disability. All core indicators were unsatisfactory, <50%, and did not meet the global standard for quality healthcare services. The satisfaction score for the number of staff providers was grossly underserved at 10%, with the youth demanding that they serve their own. A satisfaction score of 30% was reported due to a lack of disability services, privacy, youth space, inadequate quality of care including test kits for HIV, and discriminated and stigmatized LGBTQ+ with back-biting after delivery of services. 
 Conclusion: Youth-led social accountability ensures service providers are responsive to the needs of adolescents and youth. The propulsion is by youth for youth who should be health literate on social accountability. More attention among service providers includes the provision of adequate competent staff, VCAT, compassionate and respectful care, and good interpersonal communication, meaningful engagement and reverse mentorship with adolescents and youth, and a focus on rights-based and intersectionality for better SRHR outcomes and youth development.