The Reproductive and Maternal Health Services Unit of the Ministry of Health (RMHSU MoH) in collaboration with AFIDEP has convened a Task Force to revise the national Reproductive Health (RH) Monitoring and Evaluation (M&E) tools to report adolescent SRH data.
The Task Force is made up of representatives from 15 key institutions working in adolescent Sexual and Reproductive Health programmes and/or with expertise in M&E including the Ministry of Health (national and county officials), public and private health facilities (Kenyatta National Hospital and Family Health Options of Kenya) and key development partners.
The Task Force met for a two-day intensive meeting from April 21 – 22, 2015 to review and identify gaps with regards to the current national adolescent SRH. This is the first of a series of workshops planned to systematically revise the national RHM&E tools.
“The workshop is a critical step towards accelerating the pace of improvement of the adolescent sexual reproductive health (SRH) outcomes, which remains unimpressive based on the latest Demographic and Health Survey released in April 2015,” said Dr Kigen Bartilol, Head – RMHSU MoH while opening the meeting.
Mary Magubo, Programme Officer, – RMHSU MoH, also said that adolescent SRH policymakers and programme implementers have for a long time complained of lack of routine data to inform policy direction, planning and programme implementation.
“MoH and AFIDEP have partnered to spearhead the revision of RH M&E tools to address this gap,” she said.
Violet Murunga, AFIDEP’s Senior Knowledge Translation Officer said the initiative aligns well with AFIDEP’s mission which is to promote the use of research evidence in decision making processes and optimise the capacity of policymakers to do so.
“As an institution we are delighted to be at the center of these deliberations that are looking towards improving the sexual and reproductive health outcomes of adolescents,” she said.
Identified gaps in data collection and recommendations
The Task Force identified several cross-cutting gaps and challenges in all the RH M&E tools. They noted that all the RH M&E tools do not appropriately provide for daily summaries of adolescent SRH data to be reported. In addition, while the RH M&E monthly reporting tool includes data on a few adolescent SRH indicators, reporting has been poor owing to health system-wide challenges including health workers non-compliance of reporting requirements due to lack of time to manually analyse the data.
The Task Force agreed that challenges will be best addressed through a system-wide approach that includes the establishment of an electronic platform for reporting health data.
During the workshop, the Task Force identified a limitation on the Family Planning (FP) Register in terms of the data reported on counselling for family planning methods which focused only on natural methods. Therefore, members suggested that counselling services be extended for all modern contraceptives in addition to natural methods.
Consideration was also made to include marital and school going status on the tool but these indicators were eventually excluded as the Task Force concluded that they are likely to negatively affect responses from adolescent clients who prefer privacy.
On the Antenatal Care (ANC) Register tool, the Task Force recommended the addition of counselling services for Human Papillomavirus (HPV) as this is an important intervention for adolescents to prevent Cervical Cancer in their later years. They also recommended that daily summaries of parity among adolescents be reported.
The Task Force noted the need to review the Prevention of Mother to Child HIV Transmission (PMTCT) tool to ensure that it reflects services provided to adolescent.
On the Maternity Register, the Task Force recommended the addition of an indicator for the maternal deaths reports. It was noted that not all maternal deaths are audited yet the tool only captures audited maternal deaths. In addition, it was recommended that daily summary reports for 3 complications (antepartum haemorrhage – APH, pre-eclampsia, eclampsia and obstructive labour) among adolescents be reflected on the tool.
Post-abortal care (PAC) was suggested for inclusion on the tool but it was noted that there is a tool under the Obstetrics and Gynecology (OBGYN) department which reflects PAC. It was agreed that the tool will be reviewed to see if it reports adolescent PAC data.
On the Postnatal Care (PNC) Register, the Task Force recommended the addition of exclusive breastfeeding as an indicator. This is because adolescents tend not to practice exclusive breastfeeding which is a requirement to ensure good infant health and wellness. In addition, it was recommended that the tool should also report daily summaries of 3 complications (fistula, sepsis and postpartum hemorrhage – PPH) and provision for family planning among adolescents.
At the end of the reviews, the Task Force identified a number of other relevant M&E data tools from other programmes that address factors that influence adolescent SRH, which should be reviewed to harmonise all the tools to report adolescent SRH data. Key issues identified include sexual and gender-based violence (SGBV) including rape and female genital mutilation (FGM) and PMTCT and PAC (highlighted above).
The Task Force will meet again on 11th and 12th May to revise the RH M&E tools based on the recommendations from this meeting.
The initiative is sponsored by Strengthening Use of Research Evidence for Adolescent Sexual and Reproductive Health (enSURE) programe and funded by the Norwegian Agency for Development Cooperation (NORAD).