Adolescent sexual & reproductive health in Kenya
Kenya committed to the Family Planning 2020 global partnership in 2012 and has recently exceeded its 2020 target of 58% modern contraceptive use by married women. However, specific attention is needed to expand equitable access to quality care, especially when it comes to adolescent girls who are facing conservative social norms that prevent them from receiving effective communication and access to adolescent-friendly sexual and reproductive health (SRH) services.
In Kenya, 98% of all adolescent girls know about at least one modern contraceptive method, but 23% of girls aged 15-19 who wish to have access to contraception have an unmet need. As a result, 17% of all women who sought post-abortion care in public facilities were adolescent girls of 19 years or younger, of whom 45% going through unsafe abortion experienced severe complications. In addition, an estimated 13,000 adolescent girls drop out of school every year due to unplanned pregnancy.
The Government of Kenya is willing to address this issue and is working towards achieving the revised targets of increasing modern contraceptive prevalence rate among adolescent women, aged 15-19 (married/in-union), from 40% in 2017 to 55% by 2025 and reduce teenage pregnancy from 18% in 2017 to 10% by 2025.
Terms of the bond
Status: Deal structuring with aim to launch in April 2020
Target population: adolescent girls (15-19yo) from 15 counties in Kenya
Target number of beneficiaries: 193,000 – 218,000 adolescent girls
Selected & potential impact metrics: SRH service uptake, Contraceptive prevalence rate, Adolescent birth rate
Duration: 18 months
Amount: up to $6.6M
Expected return: up to 2%
Outcome funders: The Department of International Development (DFID)
Investors: Children’s Investment Fund Foundation (CIFF)
Service provider: In Their Hands
In Their Hands (ITH) is a teen-centered programme aiming to incentivize adolescent girls to use subsidized sexual and reproductive health (SRH) services, thereby reducing the incidence of unintended pregnancies among Kenyan adolescent girls. The programme uses behavioral economics in the form of nudges, such as reward vouchers for the girls, to promote positive health behaviors and allows girls to also rate the quality of the services received, contributing towards offering a safe space and quality care to adolescent girls.
The Development Impact Bond (DIB) focuses on financing the scaling-up of the ITH programme in Kenya, with the objective of expanding availability and uptake of sexual and reproductive health services among adolescents in Kenya. This first tranche of the DIB will last for 18 months and stands for a proof of concept to leverage funds for a second tranche reaching a total DIB duration of 5 years.
The impact bond will foster innovation by transferring delivery risk to the investor, with targets defined as to incentivize the service provider to improve its operational efficiency, increasing consistent use of SRH services and diversifying enrollment and distribution channels which are key to improve further ITH’s cost-effectiveness and provide increased value for money to the outcome funder.
The ITH DIB integrates short-term (SRH uptake), intermediate (contraceptive prevalence rate) and long-term (adolescent birth rate) payment outcomes, with each outcome having a financial weight that is aligned with the service provider’s ability to inluence the outcome, while still providing important insights on how much impact the ITH intervention has on long-term behaviour change indicators given the comprehensive impact measurement and reporting frameworks put in place.
“Kenyan teenagers have never been better connected, better informed or as well educated as they are today. And while 97% of them know about contraception, Kenya’s rates of teenage pregnancy and new HIV infections are among the highest in the world. In Their Hands (ITH) is a teen-centered movement that aims to normalise adolescent sexual health and increase uptake of teenage-friendly health services through nudges. Structuring a Development Impact Bond to finance the scale-up of ITH required to carefully think about what success means, ensuring that the payment metrics would help the programme go beyond what it is currently achieving while also focusing on consistent use of services to best achieve its ultimate goal of reducing unintended pregnancies among adolescent girls.”
Aline Buysschaert, Manager, KOIS Brussels
The expected impact
>193,000 adolescent girls using SRH services
12.3% of sexual and reproductive health service visits realized by returning girls
15 counties (Bungoma, Busia, Homa Bay, Kajiado, Kakamega, Kilifi, Kisii, Kisumu, Migori, Mombasa, Nairobi, Nakuru, Siaya, Uasin Gishu, Vihiga)
Sources: http://www.familyplanning2020.org/kenya; From Paper to Practice: Sexuality Education Policies and Their Implementation in Kenya”, 2017, Estelle M.Sidze et al..; The Guttmacher Institute; Barriers to modern contraceptive methods uptake among young women in Kenya: a qualitative study”, 2015, Rhoune Ochako et al.