Strengthening Use of Research Evidence for Adolescent and Youth Sexual and Reproductive Health (enSURE)

The Strengthening evidence for action and accountability on sexual and reproductive health for young people in Eastern and Southern Africa (enSURE: Adolescent and Youth SRH) project sought to strengthen the generation, translation, and use of research and related evidence in formulation of policies and programmes. This would result in improved sexual and reproductive health (SRH) outcomes among adolescents and young people aged 10-24 years in East and Southern Africa focusing on Kenya and Malawi.

African policymakers face challenges with accessing and using evidence for decision-making in general. This challenge is particularly pronounced among policymakers responsible for adolescent SRH policy decisions due to the complexity of the issue and divergent views and interests. This is further complicated by inadequate data and evidence on adolescent SRH because most health management information systems in Africa do not include specific adolescent health indicators. The enSURE programme was implemented to address these gaps in Kenya and Malawi and lessons from this process would then be used to inform regional actions.

The project was focused on young people 10-24 years comprising adolescents 10-19 years and youth 20-24 years.

 The programme was implemented using 3 main approaches:

1. Generating and Synthesising Evidence: the project generated evidence to inform national policy and programme decisions and enhance commitment and resource allocation to adolescent SRH. This was done primarily through synthesis of evidence on appropriate cost-effective interventions that had potential to be adapted at country and regional levels and analysis of data from existing national datasets to understand adolescent SRH attitudes, behaviours, practices and access to SRH information and services in Kenya, Malawi and Sub-Saharan Africa.
2. Evidence-based advocacy and policy engagement: This strategy targeted key audiences at both national and regional levels. At national level, the main target of our advocacy strategy were officials in the Ministries of health, education, gender and youth, the population secretariats, and Members of Parliament, as well as major non-governmental organisations working on adolescent SRH in each country. We also engaged the mass media in advocacy activities. At the regional level, we targeted regional networks (e.g. NEAPACOH).
3. Capacity Strengthening: We strengthened the capacity of mid-level policy actors in health to use evidence for decision making to improve young people’s SRH outcomes. Specific activities comprised strengthening skills of reproductive health officials to generate monthly reports from the health information management system and use it to inform adolescent SRH programme and resource allocation decisions.

Some of the major contributions of the project to policy and practice shifts with far reaching impact were in the:

• Formulation of 2015 Adolescent Sexual and Reproductive Health (ASRH) policy in Kenya, which prioritised comprehensive sexuality education and contraceptive services for all adolescents
• Formulation of the 2015 Youth Friendly Health Services (YFS) standards in Malawi
• Adoption of a new Marriage Act in Malawi that raised the legal age of marriage from 15 years (with parental consent) to 18 years
• Development and integration of adolescent SRH indicators in the District Health Information Systems (DHIS) in Kenya and Malawi, which increased availability of relevant adolescent SRH data for decision-making
• Initiation of the development of an integrated Adolescent Health Policy, which was informed by a research-to-policy symposium, the “2015 National Adolescent Health Symposium”, co-organised with the Kenya Ministry of Health and other partners. The symposium, which focuses on discussing the policy and programme implications of the latest evidence on adolescent SRH was a first of its kind and is now held biennially

The project developed fact sheets that highlighted the status of key reproductive, maternal and child health interventions in 6 counties in relation to the national status. The data was drawn from the 2009 and 2014 Kenya Demographic and Health Survey, the Kenya AIDS Indicator Survey (KAIS, 2007), the UN and other national and global studies. You can find these fact sheets here.

The project also developed a policy brief

In addition, the project developed fact sheets highlighting the status of adolescent sexual and reproductive health for 46 counties in relation to the national trends. The data was drawn from the 2014 Kenya Demographic and Health Survey, 2012 Kenya AIDS Indicator Survey and the 2014 Basic Education Statistical Booklet. You can find these fact sheets here.

The enSURE programme collaborated closely with the Ministries of Health in Kenya and Malawi and other institutions addressing adolescent sexual and reproductive health (SRH) through participating on the National Adolescent Technical Working Group (TWG) in Kenya and the National SRH TWG and its related sub technical committees such as YFHS, FP and Safe motherhood in Malawi. Therefore, programme implementation was guided by regular consultations and deliberations with the Ministry of Health and the Adolescent SRH TWG/sub-Committee.