Community coordinators protecting adolescents in the counties

Adolescence is generally a moment of transition from childhood to adulthood that is heralded by rapid physical, cognitive, social, and emotional development. It is a period where the young people are taking a deep dive into self-discovery and identity, letting out their adventurous spirit and ideally creating memories that should bring a smile to their face decades later. 

While these young ones are cruising through this transition without a care in the world, their caregivers are often going through moments when they feel like they are passengers in a car that is speeding by too fast, and they have little control over it. These are the moments when the popular Kenyan phrase, “Their syllabus is going too fast”, sounds just about right. 

Throw in technology, social media, changing family dynamics, and the ever-changing social goalposts, and it is quite the rollercoaster to be raising an adolescent in this generation. 

As parents and guardians caring for their adolescent children work to adjust to the ever-changing “syllabus”, there are people within our county health departments, working daily to keep up with the overall public health concerns of our adolescents at large. 

The rarely mentioned Adolescent and Youth Sexual and Reproductive Health (AYSRH) Coordinators are individuals who straddle the divide between the adolescents and the system to ensure they remain safe. 

With devolution, the county departments that were established mirrored the national level ministries, taking the cue from the existing systems to set up subnational governance structures to deliver on the mandate of devolved functions. This means that aside from the political appointments of the county executive committee members, the chief officers and the county directors, the rest of the department members are technical people heading various units in the department. In the department of health, the county health director and his unit heads form the county health management team (CHMT). These are the officers who keep the health system of a county running. 

One of the key persons in the CHMT is the county reproductive health (RH) coordinator. The majority of the county RH coordinators across the country have traditionally been nurses. These tough-as-nails individuals have been tasked to oversee the coordination of reproductive health programmes in the county. They are responsible for preparing the annual work plans and budgets to ensure quality maternal and child health services and family planning. 

This means that they must spearhead the development of favourable policy frameworks for reproductive health; advocate for the allocation of resources for their unit; provide oversight over program implementation; ensure quality assurance; conduct monitoring and evaluation; and manage partner and stakeholder engagement while at it. 

For many years, they were responsible for adolescent sexual and reproductive health, too. With such a full plate, it is no wonder the adolescents were falling through the cracks. This is where the AYSRH coordinators came in. These new additions to the team have brought a whole new menu to the table. 

The county AYSRH coordinators now have teams at the sub-county levels. They are the foot soldiers on the ground regarding matters of adolescents and youth. Within their jurisdictions, they work very closely with community health promoters (CHPs). They know where all the pregnant adolescents are, what their distribution is, whether there are emerging hotspots of concern based on the data coming in, and what factors in their community are driving these outcomes. 

Three years ago in Mombasa, the AYSRH coordinator described their strategy, where there was nothing in the county that was done for adolescents without them being firmly in the driver’s seat. In response to the adolescents, the County piloted designer youth-friendly clinics. The location of the clinics was determined by the users. They gave input on the kind of healthcare provider the clinic should have: a youth-friendly person who understood them, and they also guided what services they thought they needed. The clinics were a resounding success, with the remarkable reduction in adolescent pregnancies in the populations served in just two years. 

In counties like Migori, Homa Bay, Vihiga, and Kilifi, where development partners in adolescent health have worked for a while, the AYSRH coordinator offices are held in high regard. These are the officers who spearhead adolescent-friendly policy implementation frameworks, ensuring that the AYSRH programs are budgeted for, funded and money is actually disbursed. 

The incorporation of the CHPs in primary health care has enormously supported the AYSRH coordinators’ work. Being in touch with the communities, CHPs are the first to know what is happening to the adolescents in their locales. They will report adolescent pregnancies in a timely manner and activate a cascade that ensures the young girl gets into antenatal care as early as possible. After delivery, they keep tabs to ensure the young mother is supported in breastfeeding and the baby is vaccinated and well nourished. They follow through to ensure that reintegration back to school happens.

In the same vein, the CHPs can document incidences such as outbreaks of contagious diseases, including sexually transmitted infections, report into the health information system, support contact tracing, and arm the AYSRH coordinator with the data they need to respond to the threat. 

With a focus on adolescent-responsive systems, AYSRH coordinators, together with their RH coordinators, have supported trainings and mentorship for healthcare providers who work with adolescents to ensure they are adolescent-friendly, they provide non-judgmental care, and they can identify the subtle signs of sexual and gender-based violence.

And finally, as team leaders, the AYSRH coordinators provide oversight functions to their teams, ensuring service quality is maintained, the data collected is accurate, and that the adolescent programs are serving the needs of the target population. 

Every community is different, and every county is unique when it comes to the needs of its people. AYSRH coordinators are most effective when they are not only passionate about their work, but are also drawn from the communities they serve. That way, even the adolescents identify with them. Let us celebrate these gallant officers who are parenting our adolescents on a public health scale! 

Dr Bosire is a gynaecologist/obstetrician