Interaction of Health and Education Institutions in the Roll-out of in-school Adolescents Health Scheme Eduafya- a Study of Kiambu County, Kenya

Abstract

The development of sub-Saharan Africa is closely linked to the well-being of its young people. The World Health Organisation notes that Universal Health Coverage cannot be achieved without the inclusion of adolescents’ health. Adolescents (10-19 years) comprise a quarter of Kenya’s population. Under the “Big 4 Agenda”, the Government of Kenya rolled out a comprehensive health insurance scheme for public secondary school students in 2018, as part of UHC. This study assessed the implementation of the scheme through a systems perspective. The roles played, and interaction of primary stakeholders – schools, health facilities and National Health Insurance Fund (NHIF) in Kiambu County were examined. The research was part of a larger IDS study which sought to assess the roll-out of adolescents’ universal health scheme in Kenya and implications for their access to and use of sexual and reproductive health services. This study entailed a review of secondary data (NHIF’s data and reports), as well as primary data collection from schools, health facilities and NHIF officers. Phone interviews were held with 41 schools and 54 respondents comprising of schools heads and person’s incharge of student health in schools using a semi-structured questionnaire. To understand the role that schools and health facilities played in the implementation of the Eduafya scheme and how their interactions influenced access and use of adolescent health services, ten key informants were interviewed. Qualitative data was analysed through thematic and content analysis, and while quantitative data were subjected to descriptive analysis through SPSS. Results showed a gap in enrolment of students to the scheme as 2,637,667 students against a target of three million were enrolled in the first year. The difference in enrolment was attributed to incomplete registration of students in NEMIS, mainly due to students’ lack of required registration documents like birth certificates. The design and planning for roll-out of the scheme was top-down and primarily driven by the government. It involved three central institutions – MoE, MoH and NHIF at the top level. The study also found informational asymmetries on the awareness of the scheme among school representatives, health service providers and NHIF officers. Additionally, health facilities lacked robust health information systems to facilitate data demand and use; lack of standardised Eduafya guidelines and weak communication strategy; and confidentiality and privacy issues in the scheme’s implementation. The study recommends that NHIF, schools and health facilities address barriers affecting enrolment in the scheme; and conduct regular sensitisation and feedback meetings between NHIF, schools and health facilities to incorporate their views and experiences in improving the scheme. In addition, bolstering the capacity of health facilities to adequately handle adolescent health, including data demand and use.