Youth Guidelines 2016

MINISTRY OF HEALTH
NATIONAL GUIDELINES
FOR PROVISION OF ADOLESCENT AND
YOUTH FRIENDLY SERVICES IN KENYA
Second Edition
2016
NAIROBI
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system, or otherwise, without prior permission from the publisher. The contents are the responsibility of the
Reproductive and Maternal Health Services Unit.
TABLE OF CONTENTS
i. Acknowledgements 3
ii. Foreword 4
1.0 Introduction 10
1.1 Background 10
1.1.1
Situation analysis 10
1.1.2
Legal and Policy context 12
1.1.3
Rationale for Revision
12
1.2 Purpose of the guidelines 14
1.2.1
Goal 14
1.2.2
Objectives 14
1.3 The Intended Audiences and Targeted Beneficiaries 15
1.3.1
Intended Audiences 15
1.3.2
Targeted Beneficiaries 15
1.4 The Guiding Principles 16
2.0 Characteristics and Standards of Adolescent and Youth Friendly Services 17
2.1 Characteristics of adolescent and youth friendly services 17
2.2 Standards for quality adolescents and youth friendly services 19
3.0 Strategies, Approaches And Service Delivery For Adolescent And Youth Friendly
Services 21
3.1 Strategies and Actions 21
3.2 Approaches for service delivery 27
3.3 Service delivery for adolescents and youth 27
3.3.1
Essential package 27
3.3.2
Service delivery models 28
3.3.3
Service delivery points 33
3.3.4 Recommendations for reaching vulnerable sub-population of young people 33
4.0 Implementation framework 39
4.1 Introduction 39
4.2 Stakeholders 37
4.3 Roles and Responsibilities of the stakeholders 40
4.4 Monitoring and Evaluation 46
Annexes 49
References 54
3 NATIONAL GUIDELINES FOR PROVISION OF ADOLESCENT AND YOUTH FRIENDLY SERVICES IN KENYA
ACKNOWLEDGEMENTS
The review of the National Guidelines for Provision of Adolescents and Youth Friendly Services in Kenya
(2005) involved consultations with a wide range of stakeholders through consultative meetings, literature
review, and reviews of the various drafts of the guidelines.
The Ministry of Health through the Division of Family Health feels greatly indebted to individuals and
organizations who contributed in one way or another to this elaborate review process. We particularly thank
the Reproductive Maternal Health Services Unit for overseeing and guiding the review process.
Specifically the Division of Family Health would like to thank Ms. Leah Rotich, Director General, Ministry
of Education , Science and Technology, Dr Josephine Kibaru-Mbae, Director General, National Council for
Population & Development and Dr. Kigen Bartilol, Head of the Reproductive and Maternal Health Services
Unit, who gave invaluable inputs and guided the process to successful completion.
Special thanks to Dr. Jeanne Patrick, ASRH Programme Manager and programme officers Anne Njeru, Mary
Magubo and Clifton Katama for coordinating and spearheading the review process.
We also wish to acknowledge contributions of the taskforce members who worked together with the
ASRH Technical Working Group and adolescent and youth sexual and reproductive health stakeholders
throughout the review process. The taskforce team included representatives from the Reproductive and
Maternal Health Services Unit (RMHSU), Neonatal and Child Health Unit (NCAHU), Health Promotion Unit
(HPU) and NASCOP and partner institutions.
We also thank GOAL-Kenya, CSA and UNFPA for their technical and financial support to the review process.
FOREWORD
Adolescents and youth comprise 24% of Kenya’s population. This youthful population has implications on
the social, economic and political agenda of the country. A young population provides opportunities for
the country’s development if the right investments are made towards attainment of educational and health
goals, including all round preparation for responsible adulthood. At the same time, a youthful population puts
great demands on provision of health services, education, water and sanitation, housing and employment.
The Government of Kenya recognises that the provision of comprehensive and high-quality reproductive
health services to adolescents and youth requires a multi-sectoral integrated approach from all sectors of
government, development partners and other stakeholders for the country to attain the Vision 2030, African
Youth Charter (2006) and Post-2015 Development Agenda through Sustainable Development Goals (SDGs).
The first edition of the National Guidelines for provision of Youth friendly services in Kenya was developed
in 2005. The review of these national guidelines was necessitated by significant changes that have been
observed in the provision of adolescents and youth sexual reproductive health at the national and
international levels. The Guideline were reviewed to align with the emerging SRHR realities including the
National Adolescent and Sexual Reproductive Health (ASRH) Policy (2015), The World Health Organisation’s
Global Standards for Quality Health Care Services for Adolescents, the Global Strategy for Women’s, Children’s
and Adolescents’ Health (2016-2030), Sustainable Development Goals (SDGs) and the Constitution of Kenya
(2010) with its attendant devolved governance structure.
The transformational changes in the Kenyan Health System with the devolved governance structure provide
a unique window of opportunity to address long standing inequalities and inefficiencies in the provision
of adolescent and youth friendly services in the health sector. These guidelines provide a useful guidance
for counties to set priorities relevant to their context and mobilize collective effort involving both levels of
government, development partners, civil society and private sector to improve adolescent and youth health
outcomes.
The development of this second edition of AYFS Guidelines together with the 2015 National Adolescent
Sexual and Reproductive Health Policy, are clear proof of the Kenya government’s desire and commitment to
bring adolescent and youth sexual and reproductive health and rights issues into the country’s mainstream
health and development agenda. However, more focused effort is required to increase access to SRH
information and services among adolescents and youth and improve health outcomes.
These AYFS guidelines, evolved through an extensive consultative process involving key adolescent and
youth SRH stakeholders, Counties’ Departments of Health, Ministry of Education, Science and Technology,
Youth Serving Organisations among others. It outlines the standards for service provision of AYSRH services,
the essential package of services, service delivery models and service delivery points that should be
implemented and scaled up at the counties to improve the health outcomes of adolescents and youth.
All government sectors including education, law enforcement and protection agencies, transport and
agriculture among others have an important role in planning and delivering sexual and reproductive health
services to adolescents and youth. AYSRH needs are best met through involving adolescents and youth in
every phase of action: from assessing their needs to designing programmes, to launching and implementing
programmes and evaluating their impact
The Ministry of Health will enhance intergovernmental coordination mechanisms that ensure collective
response from both levels of Government and development partners to rapidly improve the health status
of adolescents and youth in Kenya.
Dr. Kigen Bartilol
Head, Reproductive Maternal Health Services Unit
ACRONYMS AND ABBREVIATIONS
AACSE Age Appropriate Comprehensive Sexuality Education
AYFS Adolescent and Youth Friendly Services
AYSRH Adolescent and Youth friendly Sexual Reproductive Health Services
CHMT County Health Management Teams
CPR Contraceptive Prevalence Rate
CSE Comprehensive Sexuality Education
FGM Female Genital Mutilation
HIV Human Immuno-deficiency Virus
HTC HIV Testing and Counselling
HTS HIV Testing Services Kits
ICPD International Conference on Population and Development
IEC Information, Education and Communication
JICC Joint Interagency Coordinating Committee
KAIS Kenya AIDS Indicator Survey
KDHS Kenya Demographic and Health Survey
KSPA Kenya Service Provision Assessment
MOEST Ministry of Education, Science and Technology
MOH Ministry of Health
NACADA National Campaign against Alcohol and Drugs Abuse
NCPD National Council for Population and Development
PAC Post-Abortion Care
RMHSU eproductive and Maternal Health Services Unit
RH-ICC Reproductive Health – Inter Agency Coordinating Committee
SARAM Service Availability and Readiness Assessment Mapping
SCHMT Sub-county Health Management Team
SDG Sustainable Development Goals
SGBV Sexual and Gender-Based Violence
SRHR Sexual Reproductive Health and Rights
TWG Technical Working Group
WHO World Health Organisation
DEFINITION OF TERMS
Abortion: The termination of pregnancy by the removal or expulsion from the uterus of a foetus or embryo
before viability. An abortion can occur spontaneously, in which case it is often called a miscarriage; or it
can be purposely induced. The term abortion most commonly refers to the induced abortion of a human
pregnancy.
Adolescent: Any person aged between 10 and 19 years.
Adolescent and youth friendly services: Are Sexual and Reproductive Health services that are accessible,
acceptable appropriate, effective and equitable for adolescents and youth.
Age appropriate: It is the suitability of information and services for people of a particular age, particularly
in relation to adolescent development
Age Appropriate Comprehensive Sexuality Education (AACSE): An age-appropriate, culturally relevant

approach to teaching about sexuality and relationships by providing scientifically accurate, realistic and
non-judgmental information. Sexuality education provides opportunities to explore one’s own values and
attitudes and to build decision-making communication and risk reduction skills about many aspects of
sexuality.
Child: An individual who has not attained the age of eighteen years as per the Kenya constitution 2010.
Child Abuse: Child maltreatment, sometimes referred to as child abuse and neglect, includes all forms
of physical and emotional ill-treatment, sexual abuse, neglect and exploitation that results in actual or
potential harm to the child’s health, development or dignity. Within this broad definition, five sub-types can
be distinguished — physical abuse, sexual abuse, neglect and negligent treatment, emotional abuse and
exploitation
Child marriage: This is a situation where marriage, cohabitation or any arrangement is made for such
marriage or cohabitation with someone below the age of 18 years.
Confidentiality: The right of an individual to privacy of personal information, including health-care records.
This means that access to personal data and information is restricted to individuals who have a reason and
permission for such access. The requirement to maintain confidentiality governs not only how data and
information are collected (e.g. a private space in which to conduct a consultation), but also how the data are
stored (e.g. without names and other identifiers) and how, if at all, the data are shared.
Female genital mutilation (FGM): Comprises all procedures involving partial or total removal of the female
genitalia or any other injury to the female genital organs or any harmful procedure to the female genitalia,
for non-medical reasons and includes: clitoridectomy, excision and infibulations; but does not include a
sexual reassignment procedure or a medical procedure that has a genuine therapeutic purpose.
Health: A state of complete physical, mental and social well-being and not merely the absence of disease
or infirmity.
Humanitarian setting: A humanitarian setting is one in which an event or series of events has resulted in
a critical threat to the health, safety, security or well-being of a community or other large group of people.
The coping capacity of the affected community is overwhelmed and external assistance is required. This
can be the result of events such as armed conflicts, natural disasters, epidemics or famine, and often
involves population displacement. In these guidelines, the terms “humanitarian settings”, “crisis settings” and
“emergency settings” are used interchangeably.
Life Skills Education: A structured programme of needs- and outcomes-based participatory learning that
aims to increase positive and adaptive behaviour by assisting individuals to develop and practice psycho
– social skills that minimize risk factors and maximize protective factors. Life skills education programmes
are theory and evidence-based, learner-focused, delivered by competent facilitators and appropriately
evaluated to ensure continuous improvement of documented results.
Marginalized and Vulnerable adolescents and youth: These are adolescents and youth at high risk of
lacking adequate care and protection. For the purpose of the Policy, the term includes orphans and street
children as well as adolescents and youth with disabilities; adolescents and youth living with HIV and AIDS;
adolescents and youth living in informal settlements; adolescents and youth in the labor market; adolescents
and youth who are sexually exploited; adolescents and youth living below poverty line and children affected
by disaster, civil unrest or war as well as those living as refugees.
Non State Actors: A non-state actors are entities that are not part of any state or a public institution. Non-state
actors range from grassroots community organizations to non-governmental organizations, philanthropic
foundations and academic institutions
Peer Education: The process whereby specially trained adolescents undertake informal or organized
educational activities with their peers (those similar to themselves in age, background or interests). These
activities, occurring over an extended period of time, are aimed at developing adolescents’ knowledge,
attitudes, beliefs and skills and at enabling them to be responsible for and to protect their own health.
Peer Educator: An adolescent or youth who was specially trained to perform or reach their peers with
targeted information/behavioural messages/ education.
Post-Abortion Care: The physical, social and psychological care and support given to a person after an
abortion
Reproductive Health: A state of complete physical, mental and social well-being, and not merely the
absence of disease or infirmity, in all matters relating to the reproductive system, its functions and processes.
Service delivery points: The designated place where the essential adolescents and youth friendly service
package can be offered
Sexual, reproductive health and rights: The exercise of control over one’s sexual and reproductive health
linked to human rights and includes the right to:
• Reproductive health as a component of overall health, throughout the life cycle, for
both men and women;
• Reproductive decision-making, including voluntary choice in marriage, family

formation and determination of the number, timing and spacing of one’s children
and the right to have access to the information and means needed to exercise
voluntary choice;
• Equality and equity for men and women, to enable individuals to make free and
informed choices in all spheres of life, free from discrimination based on gender; and
• Sexual and reproductive security, including freedom from sexual violence and
coercion, and the right to privacy.
Sexual health: A state of physical, emotional, mental and social well-being in relation to sexuality; it is
not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful
approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual
experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained,
the sexual rights of all persons must be respected, protected and fulfilled.
Sexual Offence: This violation of an individual’s sexual health rights which includes defilement, rape, incest,
sodomy, bestiality and any other offence prescribed in the Sexual Offences Act (2006).
Sexuality: A central aspect of being human throughout life and encompasses sex, gender identities
and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction. Sexuality is experienced
and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviours, practices, roles and
relationships. While sexuality can include all of these dimensions, not all of them are always experienced or
expressed. Sexuality is influenced by the interaction of biological, psychological, social, economic, political,
cultural, legal, historical, religious and spiritual factors.
State Actors: These include government ministries, departments and agencies.
Young People: Any persons aged 10 – 24 years as defined by WHO
Youth: Any person aged between 15 – 24 years as defined by WHO
For the purposes of this guideline, the terms will be used according to these definitions, with the terms
“adolescents and youth” and “young people” being used interchangeably
1. INTRODUCTION
1.1 BACKGROUND
According to the 2009 Kenya Population and Housing Census (KPHC), young people below the age of
25 constitute 66% of the total population in Kenya. Adolescents on the other hand make up 24% of the
country’s total population (9.2 million). Nonetheless, they experience some of the poorest reproductive
health outcomes in the country.
Data from KDHS (2014) indicates that, one in every five teenage girls between the ages of 15-19 have begun
child bearing; contraceptive prevalence rate among sexually active unmarried girls aged 15-19 years is 49%
and 64% among those aged 20-24 years; the age of sexual debut has dropped with 12% of young women
and 21% of young men aged between 15-24 years having had sexual intercourse before age 15, while 47% of
young women and 55% of young men between the ages of 18-24 years have had sexual intercourse before
age 18 years; comprehensive knowledge of HIV among youth stands at 57% for young women and 64% for
young men. The rate of condom use is 61% and 75% among young men and young women respectively.
Additionally, about 20,000 girls seek care for abortion related complications each year, while unsafe abortion
remains the leading cause of maternal mortality and morbidity especially among girls below 20 years. The
National AIDS Control Council (NACC) further estimates that 29,000 youth aged between 15-24 years get
infected with HIV every year while17% of all AIDS related deaths occur among adolescents and youth.
The negative health outcomes among adolescents and youth can be attributed to early sexual debut; risky
sexual behaviors such as unprotected sex and multiple sexual partners; sexual and gender based violence;
poverty; and harmful retrogressive cultural practices. Moreover, many young people lack comprehensive
and correct information on their sexuality largely because of the embarrassment, silence and disapproval
of open discussion of sexual matters by adults, including parents and teachers. Consequently, many are
unlikely to seek health services and when they do, they don’t get the required services either due to the
judgmental nature of health care providers, concerns around privacy and confidentiality, or low capacities
of the health care system.
1.1.1 Situation Analysis

Investing in adolescents and youth presents significant development and economic gains. The World Health
Organization report, Health for the world’s adolescents: A second chance in the second decade reiterates the
need to transform how countries’ health sectors respond to the health needs of adolescents. It emphasizes
the development and implementation of quality standards and monitoring systems as a key action to
achieve this transformation.
Adolescents and Youth-friendly services (AYFS) are meant to help young people overcome barriers to access
to quality sexual and reproductive health care services. AYFS providers should be able to respond to the
needs of young people, remove their fears, respect their concerns, confidentiality and provide the services
within an environment that suit their preferences.
While access and use of high-quality and comprehensive SRH services could prevent or mitigate many of the
poor health outcomes experienced among adolescents and youth, a wide range of barriers prevent young
people from accessing these services.
These include:
• Structural barriers, such as laws and policies requiring parental or partner consent,
distance from facilities, costs of services and/or transportation, long wait times for
services, inconvenient hours, lack of necessary commodities at health facilities, and lack of
privacy and confidentiality.
• Socio cultural barriers, such as restrictive norms and stigma around adolescent
and youth sexuality; inequitable or harmful gender norms; and discrimination and
judgment of adolescents by communities, families, partners, and providers.
• Individual barriers, such as young people’s limited or incorrect knowledge of SRH,

including myths and misconceptions around contraception; limited self-efficacy and
individual agency; limited ability to navigate internalized social and gender norms; and
limited information about what SRH services are available and where to seek services.
According to the Kenya Service Provision Assessment Survey (KASP, 2010), only 7 percent of all health
facilities provide youth-friendly services. The limited coverage of AYFS can be attributed to: limited number of
trained service providers on adolescents and youth friendly service provision; shortage of health personnel;
inadequate infrastructure for provision of AYFS; and limited resources to support the establishment of
adolescents and youth friendly facilities.
Provision of reproductive health services to young people continues to remain sensitive to a cross-section
of the public; staff remains ambivalent about providing RH services to young people. Additionally, making
reproductive health services adolescent and youth friendly requires additional training, staff time, and
funds. Studies have shown that Adolescent and youth friendly services can increase young people’s use of
SRH services when they include three major components: (1) training for health care providers on youth-
friendly service provision and core competencies for delivering adolescent reproductive health services (2)
improvements in facilities to increase access and quality of services for young people e.g. lowering user
fees, organizing services to improve client flow, and increasing privacy, (3) and community-based activities
to cultivate an enabling environment and increase demand. Furthermore, young people themselves
consistently prioritize privacy, confidentiality, and respectful treatment by providers as the most important
attributes of quality health services.
1.1.2 Legal and Policy Context
These Adolescent and Youth friendly Services Guidelines are in line with national, regional and international
legal instruments and commitments. Kenya is signatory to a number of regional and global commitments
including Maputo Plan of Action 2007-2010, Programme of action of the International Conference on
Population and Development (ICPD, 1994) and Ministerial Commitment on Comprehensive Sexuality
Education and SRH services for Adolescents and Young People in Eastern and Southern Africa (ESA, 2013).
The ICPD program of action makes emphasis on human rights based approach to the access of sexual and
reproductive health especially among women and girls.
The Constitution of Kenya (2010) expressly recognises in article 43 (1) that, “every person has the right to the
highest attainable standard of health, which includes the right to health care services, including reproductive
health care. In addition the country has enacted Children’s Act 2001, Prohibition of FGM Act (2011) Person
with Disability Act (2003), HIV and AIDS Prevention and Control Act (2006), Marriage Act (2014) all which
provide the legal framework to support provision of AYFS.
The National Adolescent Sexual and Reproductive Health Policy (2015) policy provides a framework to
enhance the SRH status of adolescents in Kenya towards realization of their full potential in national
development. Other policies that support AYFS include: Kenya Vision 2030, National Reproductive Health
Policy (2007), National Youth Policy (2007), Gender Policy in Education (2007), Kenya Health Policy (2012-
2030), Kenya Health Sector Strategic and Investment Plan (2013-2017), The Education Sector Policy on HIV
and AIDS (2013), and the National School Health Policy (2009).
Finally, the Sustainable Development Goals (SDGs) provides the impetus the country needs towards
realization of AYFS over the next 15 years. The SDGs’ transformative agenda positions the adolescents and
youth at the centre of development as envisaged in goals 3, 4, and 5. These goals express good health and
well-being; quality education and Gender equality respectively. In addition, the updated Global Strategy
for Women’s, Children’s and Adolescent health (2016-2030) whose 3 main objectives are to survive, thrive
and transform, does recognize adolescents’ right to health, education, well-being and their full and equal
participation in the society.
1.1.3 Rationale for Revision

Despite the existence of the National Guidelines for Provision of Adolescent Youth-Friendly Services (2005),
coverage of AYFS has remained unacceptably low at 7% which has led to poor AYSRH indicators. This has
been attributed to a number of factors including inadequate investment in: health infrastructure, training
service providers on youth friendly service provision, deployment of service providers, commodities and
supplies, awareness creation, monitoring and evaluation, as well as coordination.
These gaps, coupled with new developments brought about by the SDGs, Constitution of Kenya (2010),
Vision 2030, Education Sector policy on HIV and AIDS (2013) and National ASRH Policy (2015) among others
informed the revision of the National guidelines for provision of Adolescent and Youth Friendly Services
(2005).
The revised guidelines aim to provide a framework for the provision of comprehensive adolescents and
youth friendly sexual and reproductive health services including services related to issues that impact on
adolescents and youth have been included. It also outlines an implementation framework for coordination,
monitoring and evaluation. It is envisaged that these guidelines will reach every institution with the mandate
to facilitate or provide AYFS.
1.2 PURPOSE OF THE GUIDELINES
1.2.1 Goal
The goal of the guidelines is to improve availability, accessibility, acceptability and use of quality sexual and
reproductive health services by adolescents and youth seeking services.
1.2.2 Objectives
1. To define the essential package of health services to be provided to adolescents and
youth at service delivery points;
2. To standardize the provision of quality AYSRH Services at all levels;
3. To increase access to comprehensive sexual and reproductive health information and

services among adolescents and youth;
4. To strengthen collection and utilization of age and sex disaggregated data on sexual and
reproductive health among adolescents and youth.
1.3 THE INTENDED AUDIENCES AND TARGETED
BENEFICIARIES
1.3.1 The Intended Audiences
The National AYFS guidelines have been developed to provide information and guidelines on youth sexual
and reproductive health related services to those working for the betterment of the health and well being
of youth in the country. These groups include:
• Policy makers
• Service providers
• Program managers
• Educators
• State Actors
• Non state actors including local and international NGO’s, religious and community based
organizations
• Young people.
1.3.2 Targeted beneficiaries

In principle, all adolescents and youth in Kenya, living both in rural and urban areas, in and out of school
should benefit from any Sexual and Reproductive Health (SRH) programs and interventions. However, as
described in the National ASRH Policy (2015), there are certain groups of adolescents and youth that are hard
to reach, vulnerable and marginalised and may require special attention or considerations while providing
AYFS, and these include:
• Rural adolescents and youth
• Out of school adolescents and youth
• Orphans and street children
• Young people with disability
• Young people living with HIV
• The very young adolescents 10-14 years of age
• Married adolescent girls
• Young first-time mothers
• Young people who have migrated to the urban centres to escape early marriage and/or
seek employment i.e. including housemaids, houseboys
• Young people in humanitarian/emergency settings
1.4 THE GUIDING PRINCIPLES
The implementation of the National Adolescent and Youth Friendly Services Guidelines shall be guided by
the following principles:
• Every young person is unique and belongs to a heterogeneous group with different
needs, for health information and services based on a range of factors that include their
age, race, sex, gender, culture, life experiences, social situation, religion etc;
• Reproductive health services are the basic human rights for all people and adolescents
and youth have inherent sexual and reproductive rights, including the right to a full range
of reproductive health information and services;
• Gender inequities and differences that characterize the social, cultural and economic
lives of the young people influence their health and development. Thus, adolescents
and youth friendly reproductive and sexual health services must promote gender equality
and equity;
• The health needs of the young people are best addressed by a holistic approach that
takes into consideration their physical, mental and social well being;
• The management of the needs of young people SRH includes the promotion of healthy
sexual development, the prevention and treatment of SRH problems, as well as the
response to specific SRH needs;
• The participation of parents, community members and other stakeholders is crucial to

sustainable adolescents and youth SRH services and programs;
• The meaningful participation of adolescents and youth in the Planning, Implementation,

Monitoring and Evaluation of SRH services and programs meant to address their SRH
needs is essential to ensure that their needs are addressed fully and in an appropriate
manner.
2. CHARACTERISTICS AND STANDARDS
OF ADOLESCENT AND YOUTH FRIENDLY
SERVICES
This chapter outlines the characteristics and standards required for the provision of quality adolescent
and youth friendly services as described by the World Health Organisation.
2.1 CHARACTERISTICS OF ADOLESCENT AND YOUTH

FRIENDLY SERVICES
For the services to be adolescent and youth friendly, certain basic factors should be put in place. The
service providers should be non-judgemental and considerate in their dealings with adolescents and
youth and deliver the services in the right way. The service delivery point should provide and enable
adolescents and youth to obtain the health services they need. These services should be appealing to
adolescents and youth and respectful of them. Adolescents and Youth should be aware of what services
are being provided and feel able and willing to obtain the health services they need. Community
members should support the provision of health services to adolescents and youth. To ensure provision
of quality AYFS, the following five characteristics should be considered.
CHARACTERISTIC AND
NO. DETAILS
DEFINITION
1. Equitable All adolescents and youth including those living with HIV, those living
All adolescents with disability, sexually active, exploited adolescents, key populations,
and youth, without hard to reach adolescents and youth including those in emergencies/
discrimination, are able humanitarian situations, resource constrained and those with any other
to obtain the health characteristics that may put them at a disadvantage will receive the full
services they need.
range of health services they require.
Accessible All adolescents and youth should be able to receive health services free
All adolescents and of charge or are able to afford any charges that might be in place. Health
youth are able to obtain services should be available to all adolescents and youth during convenient
2. the health services that hours, after school or work hours, during weekend and holidays where
are provided. applicable. The physical infrastructure should be user-friendly.
Adolescents and youth should be aware of what health services are being
provided, where they are provided and how to obtain them. The location
of the facility should be such that young people find it easily and feel free
to get there.
3. Acceptable Policies and procedures should be in place that maintain adolescents
Health services are and youth privacy and confidentiality at all times except where staff are
provided in ways obliged by legal and medical requirements with consultation with the
that meet the diverse adolescent and / or youth.
expectations of At the point of service, policies and procedures will address registration,
adolescents and youth consultation, record-keeping, and disclosure of information.
clients. Service providers should be non-judgemental, considerate, and easy to
relate to.
Adolescents and youth should be able to consult within short notice,
whether or not they have a formal appointment. Referrals should take
place within a short and reasonable time frame.
Information that is relevant to the health of adolescents and youth should
be available in a variety of channels and in different formats. Materials
should be presented in a familiar language, easy to understand, eye-
catching and responsive to different disabilities and other needs.
Options for delaying pelvic examinations and blood tests until the
adolescent and youth are psychologically prepared should be created.
Adolescents and youth should be given the opportunity to share their
experiences in obtaining health services and to express their needs and
preferences. They should be involved in appropriate aspects of health-
service provision.
4. Appropriate The health needs and issues of all adolescents and youth will be
Health services that addressed by the health service package provided at the point of health
adolescents and youth service delivery or through effective referral linkages and networks. The
services provided should meet the special needs of marginalized groups
need are provided.
of adolescents and youth and those of the majority.
5. Effective
The right health services The points of service delivery should incorporate appropriate innovative
are provided in the right strategies to deliver the required health services.
way and make a positive Health-care providers should have the required competencies to work
contribution to the with adolescents and youth and provide them with the required health
health of adolescents services. Health service provision should be based on protocols and
guidelines that are technically sound and of proven usefulness.
and youth.
2.2 STANDARDS FOR QUALITY ADOLESCENTS AND
YOUTH FRIENDLY SERVICES
The eight standards outlined in the table below define the required level of quality in the delivery of
services for adolescents and youth. Each standard reflects an important facet of quality services, and in
order to meet the needs of adolescents and youth all standards need to be met. Measurable criteria of
the standards can be found in Annex 1.
Adolescents’and Standard 1:
youth health The service delivery point implements systems to ensure that adolescents and
literacy youth are knowledgeable about their own health, and they know where and when
to obtain health services.
Stakeholder Standard 2:
support The service delivery point implements systems to ensure that stakeholders
recognize the value of providing health services to adolescents and support such
provision and the utilization of services by adolescents and youth
Appropriate Standard 3:
package of The service delivery point provides a package of information, counselling,
services diagnostic, treatment and care services that fulfil the needs of all adolescents and
youth. Services are provided in the facility, through referral linkages, networks and
outreach including in humanitarian settings.
Providers’ Standard 4:
competencies Health-care providers demonstrate the technical competence required to provide
effective health services to adolescents and youth. Both healthcare providers and
support staff respect, protect and fulfil adolescents’ and youth rights to information,
privacy, confidentiality, non-discrimination, and non-judgemental attitude
Facility Standard 5:
characteristics The service delivery point has convenient operating hours, a welcoming and clean
environment and maintains privacy and confidentiality. It has the appropriate
and relevant equipment, medicines, supplies and technology needed to ensure
effective service provision to adolescents and youth.
Equity and Standard 6:

non- The health service providers and delivery point provides quality services to all
discrimination adolescents and youth irrespective of their ability to pay, age, sex, marital status,
education level, ethnic origin, social status, cultural background, disabilities or
other characteristics. The service providers and points of service shall ensure
human rights of adolescent and youth are upheld.
Standard 7:
Data and quality The service delivery point collects, analyses and uses data on service utilization and
improvement quality of care, disaggregated by age and sex, to support quality improvement. The
service providers are supported to participate in continuous quality improvement.
This data should be captured in the MoH Health information system/tools including
uploading data into DHIS as is appropriate.
Adolescents’ Standard 8:
participation Adolescents and youth are involved in the planning, monitoring and evaluation
of health services and in decisions regarding their own care, as well as in certain
appropriate aspects of service provision.
A checklist to assess standards and quality of AYFS service provision has been developed (See Annex 1).
3. STRATEGIES, APPROACHES AND
SERVICE DELIVERY FOR ADOLESCENT
AND YOUTH FRIENDLY SERVICES
3.0 INTRODUCTION
This section of the guidelines outlines the strategies, approaches and service delivery for adolescent and
youth friendly services. It includes the action points that will guide operationalization of the strategies. The
service delivery component entails approaches, models and service delivery points.
3.1 STRATEGIES AND ACTIONS

The strategies for the implementation of these guidelines have been identified as;
a) Capacity building to mainstream AYFS into service delivery at all levels
b) Coordination
c) Social mobilization
d) Networking, partnership and collaboration
e) Advocacy and policy dialogue
f) Meaningful adolescent and youth involvement
g) Parents and community involvement in provision of AYFS
h) Referral, linkage and follow-up
3.1.1 Capacity building to mainstream AYFS into service delivery at all levels
Health care providers and clinic staff play a key role in ensuring that adolescent and youth access health
care services. Service providers’ personal belief and negative attitudes of the service providers may hinder
young people from accessing health care services. In addition, the health care providers may lack knowledge
and skills needed to attend to young people. Health service providers report being torn between personal
feelings, cultural and religious values and beliefs and their wish to respect young people’s rights to accessing
and obtaining SRH services.
Training of service providers should address service provider attitudes and beliefs, and improve provider
knowledge of normal adolescent development and special characteristics of adolescent clients and skills—
both clinical and counselling.
Health service providers should receive both pre- and in-service training on but not limited to:
• Essential package for AYFS
• Value clarification and attitude transformation (VCAT) training on adolescent and

youth sexuality and provision of services such as contraception
• Characteristics of adolescent growth and development (including neurobiological,

developmental and physical) which impact health
• Privacy and confidentiality
3.1.1.1 Appropriate, relevant infrastructure and technology

Establish appropriate, relevant infrastructure and technology for AYFS as per the checklist (see annex 2). This
infrastructure should be able to accommodate persons living with disabilities.
3.1.1.2 Supply Chain Management System

Continuous supply of essential medical commodities is important in provision of Adolescent and Youth
Friendly Services. Essential commodities that should be availed on the AYFS service delivery points include
but not limited to:
• Supplies and medicines for Sexually Transmitted Infections management

• Pregnancy testing kits
• Contraceptives
• HIV Testing Services kits
• Condoms
• Post Abortal Care kits
• Sanitary pads
• Anti Retroviral drugs
• Post Rape Care kits
3.1.1.3 Institutional and legal framework development
Legal and regulatory changes and developments should be made to enable organisations, institutions and
agencies and service providers at all levels and in all sectors to enhance their capacities in the provision of
adolescent and youth friendly sexual and reproductive health information and services.
Key Activities/actions:-
1. Orientate service providers on reproductive health commodity and logistics

management
2. Support expansion and renovation of facilities to meet the standards of AYFS
3. Strengthen systems for effective commodity management and security
4. Train health care service providers on provision of AYFS including VCAT Training
5. Integrate AYFS training module in pre-service training curricular for all cadres of health
service providers
6. Sensitize health care providers on WHO’s Medical Eligibility Criteria for contraception, FP
Guidelines and 2010 Constitutional provisions with regards to reproductive health
7. Sensitize other key stakeholders on the need for AYFS
8. Provide orientation to teachers on AYFS
9. Support special considerations for adolescents and youth living with disabilities as well as
orphans and vulnerable/marginalized adolescents and youth.
3.1.2 Coordination
Provision of AYFS requires a multi-sectoral approach and therefore there is need for coordination at
national and county levels for effective service delivery. This shall be achieved through the ASRH TWGs
and Reproductive Health – Inter Agency Coordinating Committee (RH-ICC). The MOH shall collaborate with
MoEST for in-school adolescents through Joint Interagency Coordinating Committee (JICC). Reproductive
and maternal health services unit (RMHSU) shall provide leadership in implementation of these guidelines,
as per the ASRH policy. At the county level, planning and coordination of AYFS will be integrated in the
county health plans.
Key activities/actions
1. Conduct quarterly ASRH TWG meetings
2. Participate in biannual RH-ICC and JICC meetings
3. Support the strengthening of the school health programmes
4. Oversee and facilitate implementation of the guidelines at national and county levels
5. Regulate and coordinate AYSRH training, information sharing and service delivery
6. Coordination of Monitoring and evaluation activities at national and county level
7. Coordinate research, data management and dissemination
8. Resource mobilisation for AYFS
3.1.3 Social mobilization

Initiatives to create awareness about and generate demand for AYFS should be put in place in order to
increase access and utilization of reproductive health information and services. This will target all stakeholders
including the adolescents and youth, health service providers, National and County governments, Parents,
teachers, Civil Society Organization(CSOs), Professional bodies, Academic institutions, Religious leaders
among others.
Key Activities/actions:
1. Develop, print and disseminate culturally, disability friendly and age appropriate IEC
materials with key health messages for adolescent and youth
2. Develop, print and disseminate IEC materials with key messages for parents and guardians
of adolescents and youth to support young people to access services and tips on how to
communicate effectively with young people
3. Sensitize all stakeholders on AYFS
4. Develop communication strategies to publicize where, when and what adolescent and
youth friendly services are available
5. Use of different media, channels and platforms to mobilise adolescents and youth and
encourage parents to support access to SRH information and services
3.1.4 Networking, partnership and collaboration

In order to complement each other for effective service delivery, institutions and agencies should build
strong networks at all levels to mobilize support for adolescent and youth friendly services. Organizations
need to recruit and train local youth groups to provide outreach IEC support services and mobilize youth
and the public in support of adolescent and youth friendly services. Organizations should collaborate in
sharing best practices and building effective referral systems and linkages for AYFS.
Key activities/actions:
1. Mapping of partners supporting AYFS
2. Strengthen linkage and networking between partners
3. Strengthen public-private partnership to support the provision of AYFS
4. Documentation and sharing of best practices and lessons learnt
3.1.5 Advocacy and policy dialogue
Advocacy is critical to gaining institutional and political support both at the county and national level for
AYFS. Efforts should be enhanced to mobilize resource allocation towards AYFS and supporting policies
towards enhancement of AYFS. There is need to conduct policy dialogue among stakeholders on emerging
issues to AYFS from time to time. Policy dialogues shall bring diverse groups together for evidence-based
discussions on regulatory policy and planning issues and attempt to find practical solutions to complex
issues.
1. Advocate for increased resource allocation for AYFS at the national and county level
2. Support engagement of communities, civil society organization and the private sector in
the implementation of AYFS
3. Strengthen integration of the AYFS in existing health programs
4. Engage with policy makers, partners and other stakeholders
5. Development, print and disseminate of AYFS policy briefs
3.1.6 Meaningful adolescent and youth involvement

With strong involvement of adolescents and youth in the AYFS, we are able to improve ownership and
sustainability of the programmes.
Key Activities/actions:
1. Engage adolescents and youth as partners in the design, planning, implementation and
evaluation of AYFS programs
2. Involve adolescents and youth in health care worker trainings
3. Support networks of adolescents and youth health peer educators and champions
4. Identify and involve marginalized and vulnerable adolescents and youth on AYFS
5. Develop dialogue platforms for adolescents and youth that will utilize current
technological advancements
6. Engage young people, as appropriate, in service delivery, including: as facility-based

adolescent client-advocates, HIV care coordinators working with young patients, CHVs,
and appointing youth and adolescent members of Health Facility Committees
3.1.7 Parents and Community involvement in provision of AYFS
The involvement and participation of parents and community members in the provision of AYFS ensures
sustainability of AYFS programs in their respective localities.
Creation of referral and linkage mechanisms should be emphasised to ensure that key actors like youth,
parents, community members and health service providers work together in the provision of AYFS.
The representation of parents and community leaders could be drawn from community groups or
associations like parent/teachers associations, prominent individuals, religious groups/organisations etc.
3.1.8 Referrals, linkages and follow-up

Referrals, linkages and follow up are key in ensuring that adolescents and youth access holistic health
services in a timely manner. This is necessitated by situations where service delivery point is not able to
offer comprehensive AYFS (e.g., mental health services, drug and alcohol counselling) and hence the need
for referral and other linkages. An effective referral system will ensure adolescents and youth get the best
possible care closest to them. It also makes utilisation of service delivery points and healthcare services cost
effective. A good referral system should ensure adolescents and youth receive optimal care at the appropriate
level; hospital facilities are utilised optimally and cost effectively; and specialized services can be accessed
in a timely way. The role that the community outreach services, CHVs, CHEWs and schools could play in
reaching the rural youth and the hard to reach adolescents and youth should not be underemphasized.
Creating an effective referral system and linkage between the various service delivery points that provide SRH
services to the adolescents and youth require putting various components in place for instance availing the
essential services and commodities at different service delivery points ; familiarizing the service providers at
various service delivery points with the standard operating procedures to guide their decisions and actions
in referring and receiving adolescent and youth clients; creating an effective two way communication system
between the different service delivery points and popularizing the available types of SRH information and
services to the adolescents and youth.
1. Develop/ review and disseminate AYFS referral directory at national and county level
2. Strengthen a functional referral system for AYFS
3. Orientate service providers on effective referral mechanisms
4. Develop and implement system to monitor and evaluate the quality of the referral
system
3.2 APPROACHES FOR SERVICE DELIVERY
Two broad categories of approaches have been identified.
a) Targeted Approach
The targeted approach refers to a situation where services are designed and planned for adolescents
and youth alone and are offered in settings that meet only the needs of the adolescents and youth and
do not include other groups. Such services may be clinical, non-clinical, or a combination of both.
b) Integrated/Mainstreamed Approach
A situation where adolescents and youth receive services as part of the general public, but special
arrangements are made to make the services more acceptable to them and all service providers are
sensitized on adapting service delivery to adolescents’ and youth needs as part of their definition
of quality care. This mainstreamed approach can be adapted at any level of health facility, including
primary health care facilities.
3.3 SERVICE DELIVERY FOR ADOLESCENTS AND YOUTH

Reaching all adolescents and youth with SRH services and information demands availing a wide range
of SRH services and information at different service delivery points and making the existing formal and
informal service delivery points adolescent and youth friendly. The type of SRH services and information
intended to be provided varies and involves different service delivery points both within and outside the
public health system. This section outlines the essential package of services and information that should be
provided at the different service delivery points.
Adolescents and youth are a heterogeneous group with different characteristics that influence their SRH
needs. A one-size-fits-all service delivery model may not be able to serve all cohorts and sub-populations of
adolescents and youth, so different service models should be identified and used according to the context
and the targeted sub- population(s) of young people. The establishment of appropriate and effective
referral systems and linkages between the different service delivery points ensures that adolescents and
youth access a wide range of different promotive, preventive, curative and rehabilitative services rendered
at the different service delivery points.
3.3.1 Essential package

The essential package for adolescent and youth friendly service provision has been identified as;
1. Counselling on Sexual Reproductive Health, including growth and development,

relationships, and sexuality
2. Information and education on SRH for adolescent and youth including links to reliable
online information and SMS hotlines
3. Pregnancy testing
4. Sexually Transmitted Infections (STIs) Counselling, Screening and Treatment
5. Reproductive and urinary tract infection testing and treatment
6. Contraception counselling and provision of full range of contraceptive methods,
including long-acting reversible methods
7. Counselling and treatment of irregular or painful menstruation, screening for anaemia
8. Post Abortion Care (PAC)
9. Sexual and gender-based violence (SGBV) counselling, services, and referrals to
additional multi-sectoral response services
10. Antenatal and Post-natal care
11. Screening services e.g. breast, cervical cancer screening
12. Other Reproductive Health services e.g. prenatal counselling, HPV screening and
vaccination and HIV services e.g. prevention of mother to child transmission of HIV
services, Voluntary Medical Male Circumcision (VMMC) etc.
13. HIV Counselling and Testing , Linkages to care and support; and initiation of ART for
eligible adolescents and youth
14. Nutritional counselling and Screening services including advice on physical activity
15. Personal Hygiene and Sanitation
16. Life skills, values clarification, goal setting, communication skills, decision making
skills, and financial literacy
17. Mental health services as appropriate
18. Counselling on Drugs and Substance Abuse including alcohol and tobacco use and
abuse
19. Stress management
20. Referral, linkages and follow-up.
3.3.2 Service delivery models

There is growing recognition, most notably in the WHO’s 2014 report, Health for the world’s adolescents,
that it is time to shift from small-scale AYFS initiatives and mainstream to adolescent-responsive health
systems. To move in this direction requires a shift in the way AYFS are conceptualized and designed from a
one-size-fits-all AYFS model to a highly adapted and contextualized model of AYFS that is appropriate to the
systems of a country and the needs of its diverse adolescent and youth population.
Adolescents and youth are a complex and heterogeneous population with different characteristics that
influence their needs and vulnerabilities, including but not limited to : age e.g. 10-14, 15-19, 20-24; sex;
life stage e.g. unmarried, married, parenting; type of relationship e.g. casual serial partnerships, multiple
concurrent partnerships, monogamous marriage, polygamous marriage; behaviours that might make them
a key population for HIV e.g. young men who have sex with men, young injecting drug users ; health status
e.g., young people living with HIV; education level, schooling status (in or out of school); employment status;
vulnerability status (e.g. living with a disability, street-based/ homeless, refugee, illiterate); access and control
over financial resources; household composition (e.g., living with both parents, single parent household,
orphans, adolescent-headed household); geographic local (urban, rural, slums, peri-urban). However, all
adolescents share common neurobiological and psychological characteristics including cognitive/brain
development lagging behind physiological development, “hot” emotions and challenges in projecting future
outcomes and anticipating consequences. Life stage does not accelerate these developmental processes
(e.g., marriage does not accelerate cognitive development). These characteristics make young people less
likely to receive services such as FP than their older counterparts—even if they are married, or parents.
A one-size-fits-all AYFS delivery model is rarely able to serve all cohorts and sub-populations of adolescents
and youth, so different service models should be identified and used according to the context and the
targeted sub- population(s) of young people but all health services can be improved when adolescent-
sensitive approaches are used when a provider finds him/herself with a young client.
There are four service delivery models identified in these guidelines.
• Community - based: Services and information are offered to adolescents and youth
within the community/non-medical settings e.g. in youth centres, outreaches, churches,
youth groups, community based groups, support groups, peer-mentorship.
• Clinical based: Services and information are offered to adolescent and youth within/
based on health facility setting. This includes; public, private, social franchise, faith-based,
and NGO health facilities.
Institutions of higher learning e.g. universities, colleges and vocational training centres
that have clinics within their setting can adapt clinical based model.
• School based: Services and information are offered to adolescents and youth within the
school setting.
• Virtual based: Services and information are offered to adolescents and youth within
the virtual space or digital platforms e.g. in eHealth, mHealth, tele-medicine, warm/ hotlines.
These AYFS guidelines outlines and recommends the services and information that can be offered through
a variety of service delivery models namely, clinical-based, community – based, school-based and virtual
based models.
Adolescent and Youth Friendly Information and services that can be
offered at the different service delivery models
Community Clinic School Virtual
Based Model Based Model Based Model based Model
1. Counselling 1. Counselling services 1. Life skills training on; 1. Information and
services - Goal setting counselling on;
- Sexuality
- Sexuality - Decision making - Sexuality
- Growth and development
- Negotiation skills - Growth and
- Growth and - Relationships development
development - Moral values
- Prevention of unintended - Relationships
- Relationships pregnancy - Assertiveness
- Prevention of
- Prevention of - Abstinence - Communication skills unintended
unintended
- Post abortion care - Self esteem and self pregnancy
pregnancy awareness - Delay of first
- STI, HIV and AIDS
- Abstinence - Financial literacy and pregnancy
- Drugs and substance use
- Post abortion care and abuse planning and investing - Abstinence
- STI, HIV and AIDs - Contraception - Relationship skills - Post abortion care
- Drug and substance (listening, conflict - STI, HIV and AIDs
- Career
use and abuse resolution, etc)
- Financial awareness and - Drug and substance
- Contraception planning use and abuse
2. Counselling services on; - Contraception
- Career - Relationship skills
- Sexuality - Career
- Financial awareness (listening, conflict
and planning resolution, etc) - Growth and development - Financial literacy and
- Relationship skills - Sexual and gender based - Relationships planning
(listening, conflict violence management - Prevention of pregnancy - Relationship skills
resolution, etc) - Nutrition - Delay of first pregnancy (listening, conflict
resolution, etc)
- Nutrition - Parenting skills - Abstinence
- Nutrition
- Parenting skills - Male involvement in RH - Unsafe abortion
- Parenting skills
- Importance of male - Ante natal and postnatal - STI, HIV and AIDS
involvement - Importance of male
care - Drugs and substance use involvement
- Ante natal and - Stress management and abuse
postnatal care - Ante natal and
- HPV Vaccine - Contraception postnatal care
- Sexual and Gender
- Voluntary Medical Male - Career - Sexual and Gender
Based Violence
Circumcision - Sexual and gender based Based Violence
prevention and
- Safer sex violence prevention and
management
management
- Stress management - Pre-conception counselling - Nutrition
- Stress management
- HPV Vaccine - Parenting
- HPV Vaccine
- Safer sex - Male involvement in RH
- Safer sex
- Voluntary Medical - Personal hygiene and
- Voluntary Medical
Male Circumcision sanitation
Male Circumcision
- Pre-conception - Pre-conception
counselling counselling
- Personal hygiene and
sanitation
2. Screening and 2. Screening and 3. School health talks/ 2 .Referral to HIV Testing
treatment of treatment of education sessions services sites/locations
Reproductive tract Reproductive tract - Personal hygiene
3. Provision of IEC
infections including infections including - Sexuality materials
UTIs UTIs
- Growth and development
3. HIV Testing and 3. HIV Testing and - STI and HIV Prevention, care 4. Information and
counselling, counselling, and treatment education on SRH and
- SGBV including Rape HIV
management and management and
referral including referral including - Communication skills
eMTC 5. Referral for
eMTC - HIV Stigma and
Comprehensive SGBV
Discrimination reduction
4. Information and 4. Information and services
- Other RH and HIV issues
education on SRH education on SRH
and HIV and HIV 6. Mobilisation for
outreach activities
5. Provision of IEC 5. Provision of IEC 4. School health services
Materials Materials 7. Referal to curative
- Vitamin A supplementation
services
- Deworming
6. Antenatal care 6. Antenatal care
including linkage for including linkage for - Immunisation 8.Training in livelihoods
skilled delivery skilled delivery - Personal hygiene and
sanitation 9. Training on Sexual
7. Post-natal care 7. Post-natal care - HIV Testing services Reproductive Health
outreach Rights
8. Post- Abortal Care 8. Post- Abortal Care
- HPV Vaccination
10.Referral to Antenatal
9. Screening services; 9. Screening services;
and post natal care
Breast, cervical Breast, cervical 5. SGBV counselling and service delivery points
cancer screening, cancer screening, referral including linkage for
skilled delivery
10. Comprehensive 10. Comprehensive 6. Training on Sexual
SGBV services SGBV services Reproductive Health Rights 11. Referral to mental
health service delivery
11. Provision of 11. Provision of 7. Recreational facilities (in and points
contraceptives contraceptives outdoor)
12. Sensitization of
12. Conduct community 12. Conduct community 8. Host outreach activities parents, guardians
and school based and school based of adolescents on
9. Sensitization of parents, what to expect in
outreach activities outreach activities
guardians of adolescents the second decade,
on what to expect in the adolescent growth
13. Recreational facilities 13. Recreational facilities
second decade, adolescent and development,
(In and outdoor) (In and outdoor)
growth and development, SRH needs of
SRH needs of adolescents adolescents and the
14. Curative services for 14. Curative services for
and the need for parents to need for parents to
minor illnesses minor illnesses
help young people access help young people
services access services
15. Training in livelihoods 15. Training in livelihoods 10. Referral, linkage and 13. Referral, linkage and
follow up to clinical follow up to clinical
16. Training on Life Skills 16. Training on Life Skills based and community based and community
based and virtual based and virtual
17. Psychosocial Support 17. Psychosocial Support models models
groups groups
18. Mental Health 18. Mental Health

Services as Services as
appropriate appropriate
19. Sensitization of 19. Sensitization of

parents, guardians parents, guardians
of adolescents on of adolescents on
what to expect in what to expect in
the second decade, the second decade,
adolescent growth adolescent growth
and development, and development,
SRH needs of SRH needs of
adolescents and the adolescents and the
need for parents to need for parents to
help young people help young people
access services access services
20. Training on Sexual 20. Training on Sexual

Reproductive Health Reproductive Health
Rights Rights
21. Referral, linkage and 21. Referral, linkage and

follow up to school follow up to school
based, clinical based based, clinical based
and virtual models and virtual models
3.3.3 Service delivery points
Adolescent and Youth services can be offered at various service delivery points. These include but not
limited to:
• Static delivery points: - Health facilities, pharmacies and drug stores, standalone clinics (public
or private), Comprehensive Care Centers (CCCs), Youth Centres, clinics in institutions of higher
learning, Huduma Centres, Religious Institutions, youth empowerment centres and school clinics.
• Mobile Outreach delivery points: - Mobile clinics (i.e., a full range of services offered in a
specially equipped van/bus); satellite clinics (i.e., a full range of services offered in an existing non-
health space/tent on a routine basis); and other non-routine outreach events (e.g., immunization
days in communities, community dialogue days, Maternal and Child Health days).
• Digital Platforms: - Help lines, social media, web based platforms, call centres.
• Community Based delivery points:- Community units, peer support groups, organized youth
groups, youth clubs, households and other community outlets.
• Other non-health settings: - Vary from place to place to reach large population of young people
where they are and reach some of the most vulnerable adolescents and youth in society. These
include schools, workplaces, churches, prisons, military facilities, areas where young injecting drug
users (IDUs) gather, or areas where young sex workers live or work.
3.3.4 Recommendations for reaching vulnerable sub-populations of young

people
This section provides some additional recommendations and considerations for reaching specific vulnerable
sub-populations of adolescents and youth. The selection of AYFS delivery model(s) must be made with
the consideration of the desired health outcomes and behaviours as well as the specific sub-population
of adolescents and youth that the AYFS are aiming to reach and serve. The vulnerable sub-populations of
young people considered in these guidelines are: young first-time parents and young married couples/girls;
Young people living with HIV (YPLHIV); Very young adolescents (VYAs); Young people living with disability;
and Adolescents and Youth in Humanitarian settings. In addition, this section also presents the Minimum
Initial Service Package (MISP) for Reproductive Health in Humanitarian/emergency situations.
(i) Young first - time parents and young married couples/girls

Young first- time parents or young women who are pregnant or mothers for the first time and their
partners are often overlooked yet, they have important SRH needs, particularly for maternal health
services and for contraceptive services to delay or limit subsequent pregnancies. They face social
and gender barriers in accessing facility-based services, including high opportunity costs i.e. their
household responsibilities may prevent them from seeking services, limitations on their mobility,
and inability to negotiate with partners and/or in-laws to allow them the time and resources to seek
health services.
Early marriage greatly increases vulnerability of adolescent girls, and teenage pregnancy increases
risk of maternal morbidity and mortality, GBV, and has a known negative impact on newborn and
child health. SRH interventions should emphasize the importance of delaying first pregnancy until
the age of 18, and in case of pregnancy, delaying second pregnancy
To make RH services more “friendly” to young first-time parents and young married couples/girls several
strategies may be used to reach them: These include but not limited to;
• Services brought to the community level through community-based service delivery points,
CHVs and community based distribution of contraception may be more accessible to first
time parents given limitations on the mobility of young mothers, and also allow for
engagement with couples and fathers on their new parenting roles and responsibilities.
• Integrate AYFS into maternal health services to increase contraception counselling during
antenatal care and postpartum contraception counselling and provision for young mothers.
Antenatal and postpartum visits often provide the best opportunity to discuss family planning.
Research has demonstrated the importance of providing family planning counseling to the
mother during pregnancy and in the early postpartum period, as well as ensuring access to
contraception, including long-acting and reversible contraceptive methods, as part of developing
a life-long reproductive plan. Maternal health services can be an entry point for reaching young
married women and girls in a way that is not threatening to other family members.
• Integrate family planning services into child health care services especially immunization services
to reduce missed opportunities among these young women and their partners. A child health
visit could be an important opportunity to screen young women or couples for SRH needs.
Capitalizing on their presence within the health care facility to offer family planning information
and a method of their choice reduces their chances of an unintended, closely spaced pregnancy.
Evidence shows that when service providers help adolescent mothers discuss FP and the
importance of delaying pregnancy with their husbands and in-laws the FP uptake is higher.
• Support groups for young parents can be formed and held throughout the pregnancy and
through the first year of their parenthood to help them overcome their isolation, and share
information
• Support young mothers’ opportunities to stay in or return to school after marriage and/or
childbearing
• Involve and work directly with parents, in-laws, and other family gatekeepers to support
reproductive health decision making among first-time parents. Parents play an important role in
influencing the timing of marriage and childbearing among their children and daughters- and
sons-in-law. Support and conduct outreach activities to mothers-in-law about the health and well-
being of young mothers, as these older women have great influence on the reproductive lives of
young wives
• Strengthen referral and linkage of pregnant adolescents and first-time parents to reproductive
health services. Many married first-time parents are isolated within their homes and communities
and face multiple barriers to accessing facility-based services. This makes targeted community-
based outreach and home visits, especially in the postpartum period, important strategies for
reaching first-time parents and linking them with contraceptive services.
• Community-based education should be done to reach both members of the couple and their
families. Where feasible, outreach efforts should include education for and advocacy with
community leaders.
(ii) Young people living with HIV (YPLHIV)

With increasing access to treatment, a large number of children born with HIV is now entering adolescence.
Adolescents and youth continue to bear a high incidence of new HIV infections. In addition, YPLHIV face
various challenges including stigma and discrimination from their peers and the community that hinder them
from accessing RH services and other health services. With the population of perinatally and horizontally
infected adolescents and youth growing rapidly, there is an urgent need to address the comprehensive SRH
and psychosocial needs of YPLHIV, including counselling on contraception and healthy pregnancy.
When considering provision of services for YPLHIV, the clinical - based and community -based models with
integrated AYFS may be appropriate as they allow young people to receive comprehensive and integrated
services, including HIV treatment, care, and support as well as other SRH services. In addition, the following
strategies may be employed as appropriate;
• Service provider capacity building to address the needs of YPLHIV
• Linkages Psychosocial support groups and legal services
• Management and treatment of HIV related infections
(iii) Very young adolescents (VYAs)

There is growing recognition that the period of early adolescence (10-14 years) offers a window of
opportunity to form more equitable gender norms before inequitable norms are cemented, prevent early
and forced marriages, and improve health information and linkages with services before their first sexual
experiences or at the age when they are having initial sexual experiences. To support healthy growth and
development, all VYAs, both those who have experienced sex and those who have not, need comprehensive
and age-appropriate sexuality education, including information on their bodies and puberty. Some VYAs
also need SRH services ranging from counselling and treatment for irregular or painful menstruations to a
full range of contraceptive and maternal health services for those at risk of unintended pregnancy or who
are pregnant and at risk of maternal morbidities and mortality.
Studies have shown that VYAs do not access services easily through most of the AYFS models or service
delivery points. In addition, VYAs face additional barriers to seeking services that current AYFS models and
delivery points are not addressing, including an inability to travel alone to a clinic, challenges with providers
or policies related to the their ability to consent to services and/or policies that require parental or spousal
consent, laws and policies around age of consent for sex, and additional fear and stigma surrounding sexual
activity at an early age.
It is important to consider the context and needs of VYAs when determining the health outcomes and target
population for the provision of AYFS. The following strategies to reach VYAs may be used depending on their
context.
• Community-based service delivery for newly married girls;
• Linking services with existing programs for VYAs, such as girls’ groups/ safe spaces programs,
literacy programs, or other recreational programs for VYAs;
• Service delivery at schools or close referral systems with accompaniment for the VYA to services;
• Supporting a routine health visit for young girls (e.g. the 12-year-old check up) to address a range
of health issues, including vaccinations, menstrual health and hygiene;
• Engaging with male parents and other influencers who shape VYAs health and development;
• Building the capacity of service providers to deliver ASRH information and services.
(iv) Young people living with disability

Young people with disabilities (YPWD) have distinct health needs as well as socio-economic challenges.
These YPWD often have an unmet need for SRH services, as a result of exclusion from SRH programming,
negative attitudes of service providers, lack of capacity of health providers to meet their needs, long queues
at health facilities, distant health facilities, high costs of services involved, unfriendly physical structures and
often (mis)perceived as not being sexually active.
The YPWD are as sexually active as young people without disabilities, but they are three times more likely to
experience sexual violence, putting them at increased risk of unwanted pregnancy, STIs and HIV. YPWD have
less access to health (including mental health and psychosocial support) and legal services. Adolescents with
disabilities are at increased risk of other human rights violations such as sexual violence and exploitation,
forced sterilization, forced abortion and forced marriage.
Addressing the SRH needs of YPWD through provision of AYFS and VCAT training of health service providers
to change their attitudes, religious and traditional value systems are among the common strategies used to
improve and increase access to good quality and comprehensive SRH services among the YPWD.
The following strategies to increase access to disability friendly SRH services and information may be used
depending on their context.
• Provision of SRHR information that is disability friendly, easily accessible and acceptable for the
different kinds of disabilities (e.g. Braille, audio formats or qualified interpreters) and information
where they can access services
• Peer approaches - Have peers who can accompany disabled youth to SRH service delivery points
• Provision of SRH services to YPWD in service delivery points with disability friendly infrastructure
(e.g. ramps or locations at ground floor) and disability-friendly services
• Strengthen referral mechanisms for YPWD
• Utilisation of Evidence - based interventions to meet the SRH needs of YPWD.
(v) Adolescents and Youth in Humanitarian settings

In humanitarian/emergency settings or in crisis situations, adolescents and youth are vulnerable sexual
violence and exploitation. Some adolescents, including younger ones, may resort to selling sex to meet their
own or their families’ needs. The crisis situation may leave adolescents and youth without access to health
care including SRH information and services. These circumstances expose them to increased risk of sexual
exploitation and abuse, unwanted pregnancies, unsafe abortion, mental health and psychosocial problems,
STIs and HIV infection.
The sub-groups of adolescents that are at particularly high risk and require special attention in emergency
situation include;
• The very young adolescents (10 – 14 years)
• Pregnant adolescents, and/or marginalized adolescents
• Adolescents separated from their families (parents or spouses)
• Adolescent heads of household
• Survivors of sexual gender-based violence (SGBV)
• Adolescent girls selling sex.
Regardless of the source of their vulnerability, all at-risk sub-groups of adolescents and youth require
particular attention and targeted interventions to ensure that their SRH needs are met during times of
crisis. Special considerations should be made when providing SRH information and services in emergency
settings as most of the existing service delivery models may not be suitable for emergencies. However,
they can be adapted to the emergency context. The Special considerations for provision of AYSRH include;
protecting adolescents and youth rights to reproductive health (RH) information and services; providing
protection from discrimination, abuse and exploitation. Local, national and international laws should be
followed to the maximum extent possible. In all situations, however, it is important that the best interests of
the adolescents and youth are prioritized.
To reach adolescents and youth during emergency situations, RH interventions must take innovative
approaches to make services acceptable, accessible and appropriate for adolescents and youth, taking cultural
sensitivity and diversity into consideration. It is imperative to develop and use health and humanitarian
risk assessment approach to identify priority needs and subsequent target the interventions. Community
members and parents should be involved in AYSRH interventions to ensure success and sustainability of the
programs.
The Minimum Initial Service Package (MISP) for Reproductive Health

The Minimum Initial Service Package for Reproductive Health is a set of priority interventions that is designed
to reduce mortality, morbidity and disability among populations affected by crises, particularly women and
girls.
The MISP contains guidelines for providing coordinated RH services during the earliest phases of an
emergency (natural disaster or man-made) and guides the planning for comprehensive RH services when
the situation has stabilized.
The MISP has five objectives:
• To ensure SRH coordination;
• To prevent and manage the consequences of sexual violence;
• To prevent excess newborn and maternal morbidity and mortality;
• To reduce HIV transmission;
• To plan for the provision of comprehensive SRH services.
The implementation of the Minimum Initial Service Package (MISP) for Reproductive Health in Crisis Situations
requires coordination among humanitarian actors at the local, regional, national and international levels.
Effective coordination will help to ensure that resources are used efficiently, that services are distributed
equally without gap or duplication, and that information is shared among all of the actors involved.
See annex 3 for the Minimum Initial Service Package (MISP) for Reproductive Health
4. IMPLEMENTATION FRAMEWORK
4.1 INTRODUCTION
The implementation of these guidelines takes into account that the country is now under a devolved system
of governance. However it shall be implemented in line with existing national policies and strategies through
a multi-sectoral approach that includes collaboration and partnerships with state and non-state actors
including adolescents. Specific functions have been assigned between national and county governments
drawing from the fourth schedule of the Constitution of Kenya to facilitate progressive realization by all to
the right to health.
The implementation of the guidelines shall be managed and coordinated by the Ministry of Health (MoH).
At the County, Sub-County and Community levels, management and coordination shall be done by:
• County Health Management Teams (CHMT)
• Sub-County Health Management Teams (SCHMT)
• County Hospital Management Teams
• Primary Care Facility Management Teams
• Community Units.
Collaboration and partnerships shall be realized through the Joint Interagency Coordinating Committee
(JICC); Health Sector Coordinating Committees (ICC and TWGs); County Health Stakeholders’ Forum;
Sub-County Health Stakeholders’ Forum and Community Health Committees.
4.2 STAKEHOLDERS
• National Government-Ministry of Health (including NACC and NASCOP)
• County Government (Department of Health & Department of youth)
• Training & Research institutions (Universities, training colleges & KEMRI)
• Ministry of Education, Science & Technology (MoEST)
• Ministry of Devolution & Planning (Including the NYS, NYC, NCPD and Youth & Gender
Directorates)
• Ministry of Public Service, Youth and Gender
• Ministry of Interior and Coordination of National Government (NACADA & prisons services
department including Borstal institutions)
• Ministry of Transport and Infrastructure
• Ministry of Labour, Social Security and Services (National Council for Children Services,
Directorate of Children Services, National Council for Persons with Disability)
• Ministry of Information, Communication and Technology

• Service delivery points management teams including KNH and MTRH
• Service providers
• Development partners
• NGOs, FBOs, CBOs and private sector
• Community-Families, adolescents & youths
• Media
4.3 ROLES AND RESPONSIBILITIES OF THE STAKEHOLDERS

A multi-sectoral approach will be embraced in the rolling out of these guidelines in-line with the sectors
core functions. The roles of some of these sectors have been highlighted below;
4.3.1 The Ministry of Health at national level, shall;

• Oversee and facilitate the implementation of this guidelines at National and County levels
• Support availability of adequate capacity in terms of equipment and commodities
• Develop/review the standardised training materials for provision of adolescent and youth
friendly services
• Finance, regulate and co-ordinate AYFS training, information sharing & service delivery
• Disseminate policies, guidelines and standard operating procedures (SOPs) for provision of
adolescent and youth friendly services
• Develop IEC Materials for adolescents and youth SRH
• Mobilize and allocate resources for provision of adolescent and youth friendly services
• Play an oversight role on AYFS provided and supported by stakeholders such as

development and implementing partners
• Coordinate and disseminate research and innovation findings related to adolescent and
Youth Friendly Services
• Develop and revise the national policies and guidelines that guide the YFS provision as
appropriate to county managers and request county level action
• Develop or review as appropriate the norms, standards and SOPs and make them known and
available in the counties
• Advocate with county managers to ensure ownership support of key policies
• Establish and coordinate inter linkages among development partners and other stakeholders
• Ensure sustainability of the provision of adolescent and youth friendly services
• Collating, analysing and archiving national data to stimulate local action
• Monitoring and evaluation of AYFS provision
• Document and disseminate best lessons learnt and best practices
• Develop or review as appropriate checklists for basic amenities, drugs, supplies and technology
• Work with counties to determine needs in drugs, supply and technology and ensure the
needs are met
• Advocate with counties to ensure equitable use of the drugs, supplies and technologies in the
care of the adolescents.
The Ministry of Health shall collaborate closely with the MoEST for in-school adolescents who form the
largest proportion of adolescents. The Joint Interagency Coordinating Committee (JICC) shall be the key
mechanism for involving other ministries and development partners in coordinating resource mobilization
and allocation.
4.3.2 The Department of Health at county level shall;

Health is a devolved function and the County governments are responsible for health service delivery at the
county level. Within the devolved governance structure, the county governments shall allocate resources
towards implementation of the AYFS Guidelines. In addition the county governments shall;
• Adapt and implement the guidelines for provision of adolescent and youth friendly services
• Ensure decision support tools (guidelines, protocols , algorithms and job aids ) are available in
health care facilities and providers know how to use them
• Advocate with facilities managers to ensure ownerships and support for key policies
• Support facility managers to implement key policies and translate them into facilities SOPs
• Ensure that there is adequate capacity in terms of staffing, infrastructure and supplies for provision
of adolescent and youth friendly services
• Train service providers on provision of adolescent and youth friendly services
• Mobilize and allocate resources towards provision of adolescent and youth friendly services
• Plan, coordinate, implement and provide supportive supervision all adolescent and youth friendly
services.
• Allocate funds for the provision of a comprehensive package of services in adolescents work plan
• Ensure provision of equitable, accessible, acceptable, appropriate and effective adolescent and
youth friendly services
• Ensure availability of IEC materials
• Establish mechanisms for coordination of AYFS at the county level e.g. through establishing and or
strengthening TWGs
• Provide avenues for partnership and public participation in adolescent and youth friendly services
• Ensure collaboration with key departments within and outside the department of health and
encourage relevant agencies to mainstream adolescent and youth friendly services in their core
functions
• Facilitate generation and provision for disaggregated data for decision making
• Conduct data synthesis and monitoring and evaluation activities at County level and use national
and county data to stimulate local action
• Document best lessons learnt and best practices.
4.3.3. The Ministry of Education, Science & Technology (MoEST) shall;

• Integrate or include Comprehensive Sexuality and Life Skills Education in the education
curriculum
• Ensure that the National ASRH policy and guidelines are factored in during curriculum review
• Build the capacity of teachers in provision AYFS including CSE and harmonize with the health
service providers
• Build linkages with the Ministry of Health for school based health talks and service provision
• Ensure provision of the adolescent and youth friendly services within the institutions and
create linkages and referral as appropriate
• Mainstreaming adolescents and youth sexual reproductive health and rights in all learning
institutions
• Mobilize the stakeholders in education sector to ensure provision of AYFS
• Sensitize learners to access and utilize adolescent and youth friendly services
• Strengthen the school health programmes.
4.3.4 The Ministry of Public service, Youth and Gender Affairs shall;
• Mobilization of out-of-school youth to access these adolescent and youth friendly services
• Support provision of adolescent and youth friendly services at different levels, including youth
empowerment centres and other youth empowerment platforms
• Advocate for resource allocation at all levels to ensure provision of adolescent & Youth
Friendly Service
• Strengthen youth empowerment platforms to effectively respond to AYSRH needs.
4.3.5 The Ministry of Interior and National Government Coordination

(NACADA, Prisons Services Department) shall;
• Provide age and sex disaggregated data on drug & substance among adolescents and youth
• Develop and distribute IEC materials in the service delivery points
• Integration of AYFS into the prisons health services.
4.3.6 The Ministry of Labour, Social Security and Services (National

Council for Children Services, Directorate of Children Services,
National Council for Persons with Disability) shall;
• Protect adolescents against harmful/unlawful practices e.g. child marriages, FGM and child
labor
• Protect adolescents against child marriages and trafficking
• Create mechanisms for collaboration and linkages for AYFS provision
• Ensure greater livelihood opportunities for adolescents in line with existing laws.
4.3.7 The Ministry of Transport and Infrastructure

• Create awareness of SRH issues among motorcyclists (Boda Boda) and public transport/Matatu
industry
• Create mechanisms for collaboration and linkages with AYFS centers or Youth empowerment centers
• Protect adolescents and youth against drugs and substance abuse.
4.3.8 The Ministry of Information, Communication and Technology
• Support utilization of ICT in delivery of ASRH information
• Regulate media content on sexual and reproductive health information.
4.3.9 The Service Delivery Points Management shall;

• Communicate national laws and policies, SOPs and latest revisions to service delivery point
staff
• Identify AYFS Advocates
• Identify community resources and build partnerships for advocacy and service provision for
adolescents and youth
• Advocate with service delivery point staff, other sector services and the wide community to
ensure their ownership and support for the implementation of key Adolescent SRH and AYFS
policies
• Develop and adapt as appropriate local SOPS to implement key policies
• Supply staff with information and training materials, practice guidelines and other decision
support tools
• Ensure an adolescent and youth health focus on facility reports
• Monitor and evaluate the implementation of quality standards in the service delivery point
and use data to stimulate action
• Plan capacity building activities for facility staff
• Ensure staff participation and continuous professional education in adolescent & youth health
care and in supportive supervision
• Inform CHMT about facility needs to enable funds allocation for key activities
• Put in place a procurement system to ensure availability of commodities for delivery of

required package of services
• Mainstream interventions that address the needs of the persons with disabilities and other
marginalized/ vulnerable populations.
4.3.10 The Service Providers shall;

• Provide adolescent and youth friendly service in line with the guidelines
• Provide feedback on provision of adolescent and youth friendly services
• Collect and report on age & sex disaggregated data for adolescent and youth friendly services
provision
• Participate in M&E and research around AYFS
• Create awareness of adolescent and youth friendly services.
4.3.11 The Adolescent and Youth shall;

• Champion adolescent and youth health interests through existing relevant structures at all levels
• Participate meaningfully in research and programme implementation for adolescent and youth
friendly services
• Participate in decision making and planning processes of AYFS provision
• Participate meaningfully in creating awareness for adolescent and youth friendly services
• Access and utilize the adolescent and youth friendly services
• Provide feedback on adolescent and youth friendly service provision
4.3.12 Communities, Families and Individuals shall;

• Create awareness on AYFS availability for youth and adolescents
• Support youth and adolescents in accessing and utilizing of AYFS
• Resource mobilization for AYFS support
• Participate in planning, implementation and M & E of AYFS provision at all levels.
4.3.13 The Development Partners shall;

• Support the provision of adolescent and youth friendly services
• Support the capacity development of adolescent and youth friendly service providers
• Support dissemination of the guidelines for the provision of adolescent and youth friendly services
• Meaningfully involve adolescents and youth in the implementation of the AYFS guidelines
• Advocate and mobilize resources for implementation of the AYFS guidelines
• Provide technical assistance for the implementation of the AYFS guidelines.
4.3.14 Training and Research Institutions
• Enhance adolescent content in nursing and medical curricula at both pre- and in-service levels
Conduct continuous research on AYFS and generate information for decision making including
guidelines/ policies revision and/or development.
4.3.15 NGOs, CSOs, FBOs, CBOs and Private sector

• Support provision of AYFS and information to adolescents and communities
• Support research and AYFS policy formulation and dissemination
• Support sustainable program seeking to empower adolescents and youth
• Meaningfully involve adolescents and youth in policy formulation, program design,

implementation, research and M&E
• Advocate and mobilize resources for AYFS guidelines dissemination and implementation
• Support special and targeted interventions aimed at empowering marginalised and vulnerable
adolescents and youth
• Support capacity building of service providers on provision of AYFS
• Support establishment of AYF service delivery points.
4.3.16 Media
• Advocate and create public awareness on matters related to AYFS
• Regulate media content for adolescents and Youth.
4.4 MONITORING AND EVALUATION

Monitoring and evaluation should form an integral part of Adolescent and Youth Friendly Service provision.
The Ministry of Health (MOH) shall provide overall strategic leadership in monitoring and evaluating the
implementation of these guidelines with technical assistance from a technical working group. MOH in
collaboration with the county governments and other stakeholders will work in a coordinated manner to
ensure effective monitoring and evaluation of the AYFS provision. In addition, the national and county level
health management teams will ensure that the data collection tools for AYSRH services are available and
used appropriately.
A well- designed monitoring system has the potential to assist the management to improve and sustain
the quality of services for adolescents and youth. It also helps to keep the program on course. An M&E
framework for assessing the implementation and impact of these guidelines shall be established based
on the goals, objectives and strategies set. The indicators identified shall be used by service providers to
monitor and assess the delivery of services to adolescents and youth. The M & E processes at all levels will
ensure that youth and adolescent who are the ultimate consumers of AYFS meaningfully participate in the
implementation of the guidelines. Key feedback mechanisms shall be established to the ensure interests of
adolescent and youths are well taken care of.
The M & E processes will capture the heterogeneity of adolescents and youths and track the indicators along
the following variables;
• Age (10-14yrs, 15-19yrs, 20-24yrs)

• Sex (Male, Female)
• Location
• Type of client (New, Revisit)
• Service sought
• Service rendered
• Service referred
• Commodities provided.
Monitoring and evaluation plan of these guidelines shall be guided by the indicators and targets below;
Baseline Target
Indicator Source of Data
2015 2020 2025 2030
1. % Service delivery points 10.0 30.0 50.0 70.0 SARAM
offering AYFS SARAM 2013
2. % of Teenage pregnancy among
18.0
adolescent women aged 15.0 12.0 9.0 KDHS
(KDHS 2014)
(15-19 yrs)
3. Current use of any
contraceptive 40.2
among adolescent women (KDHS 2014) 50.0 55.0 60.0 KDHS
(15-19 years) (%)
4. Current use of any
contraceptive 53.5
(KDHS 2014) 57.0 63.0 70.0 KDHS
method among married
adolescent women
(20-24 years) (%)
5. Comprehensive knowledge 17.4
25.0 30.0 50.0 KAIS
about HIV among 10-14 year (KAIS 2012)
olds (percent)
6. Knowledge of HIV prevention Girls 49.0

among adolescent girls and boys Boys 57.7 65.0 75.0 90.0 KDHS
15-19 year olds (percent) (KDHS 2014)
7. HIV incidence among 15-19 year 0.9

0.7 0.5 0.1 KAIS
olds (percent) (KAIS 2012)
8. SGBV among adolescent women 4.2 3.0 2.0 1.0 KDHS
15-19 yrs (percent) (KDHS 2014)
9. Age at sexual debut among (KDHS 2014) 14.0 16.0 18.0 KDHS
10-14 years olds
ANNEXES
1. Checklist for Standard and Quality of Provision of Adolescents and
Youth-Friendly Services
Indicate yes or no for the following components with clear explanations on why in the comments column.
This can be filled by observation, interview or examination.
CHARACTERISTIC
Equitable YES NO COMMENT
Policies and procedures that ensure services are offered to all

adolescent and youth clients without discrimination in place
Service providers administer the same level of care and
consideration to all adolescent and youth clients without
discrimination
Accessible
Cost of services are free or affordable
Services are available and provided at convenient hours for all

adolescent and youth clients
Community informed on the benefits and availability of

adolescents and youth friendly services
Signage available and visible at the point of service delivery

with range of services and operating hours
Adolescents well-informed about the range of available services

and how to obtain them.
Facilities are conveniently located for ease of access to

Acceptable
Adolescents and youth are able to consult with service providers

at short notice, whether or not they have a formal appointment.
Service provider spend adequate time with adolescent and

youth clients
Service providers are respectful and non-judgmental to

Referral and follow-up done in short and reasonable time frame
CHARACTERISTIC
YES NO COMMENT
Materials provided in a familiar language, are easy to understand,

eye-catching and responsive to different disabilities and other
needs of adolescent and youth clients.
Policies and procedures are in place that guarantee adolescent and

youth client of privacy and confidentiality.
Service delivery point is appealing and clean
Adolescents and youth are actively involved in designing, assessing

and providing services.
Adolescents and Youth involved in decision making on youth

friendly services provision
Service providers are friendly and responsive to adolescent and

youth clients
Service providers ensures privacy and confidentiality to adolescent

and youth clients
Appropriate
Package that fulfils the needs of adolescents and youth clients

available
Referral, linkages and follow-up systems and procedures available
Effective
Service providers have the required competencies to work with and

provide adolescent and youth with all the services required and
address any other concerns and needs
Service providers are trained to provide adolescent and youth

friendly services
Service delivery point has the relevant and appropriate equipment,

supplies and technology to provide services.
Service providers use evidence-based protocols and guidelines to

provide services.
2. Checklist for appropriate and relevant infrastructure and technology
for Provision of Adolescents and Youth-Friendly Services
• Adequate/separate space, comfortable, secure surrounding.
• Should be attractive to young people
• Should offer auditory and visual privacy (a door that closes, or music to cover sound)
• Should be thermally neutral (not too hot or cold)
• Should be clean
• Should have proper lighting
• Should have access to soap and clean water
• Should have a mirror
• Should have clean toilet facilities and a shower if possible
• Should have a table and a desk
• Should have seats
• IT section, to include computers, internet connectivity and IEC materials
• Should have a call number that can be use by young people to reach the facility.
3. The Minimum Initial Service Package (MISP) for Reproductive Health
MISP SERVICES FOR REPRODUCTIVE HEALTH
Focus Area MISP SRH Services Planning for Comprehensive SRH Services
Family - Source and procure - Establish comprehensive family planning programming to

Planning contraceptive supplies. ensure that a broad mix of free FP methods is available
and - Ensure contraceptives are - Provide community IEC materials directed toward
contraception adolescents and youth
available for any demand.
- Involve adolescents, parents and community leaders in
- Health staff should be aware
development of IEC strategy for FP in the community
that adolescents requesting
contraceptives have a right - Train staff in adolescent and youth -friendly FP service
to receive these services, provision
regardless of age or marital
- Train CHVs in Community Based Distribution CBD for
status.
FP education, condom and oral contraceptive pill (OCP)
distribution and referrals to health centres.
- Promote the use of dual protection (prevention of
pregnancy and prevention of STIs, including HIV)
Gender-Based - Coordinate and ensure health

Violence sector prevention of sexual - Expand medical, psychological, social and legal care for
(GBV) violence survivors
- Provide clinical care for - Prevent and address other forms of GBV, including domestic
survivors of sexual violence violence, forced/early marriage, female genital cutting,
trafficking, etc.
- Provide adolescent and youth-
friendly care for survivors - Provide community education on prevention of GBV
of sexual violence at health
- Involve adolescent leaders, parents and community leaders
facilities
in the development of strategies to prevent GBV in the
- Identify and network with community
other multi-sectoral
- Raise awareness in community about the problem of GBV,
referral networks for young strategies for prevention, and help available for survivors
survivors of GBV
- Sensitize uniformed men about GBV
- Encourage adolescent
and its consequences
participation GBV prevention
- Establish peer support groups
- Increase awareness in
community about the problem
of sexual violence, strategies
for prevention, and care
available for survivors
- Engage CHVs to link young
survivors of sexual violence to
health services
Focus Area MISP SRH Services Planning for Comprehensive SRH Services
Maternal and - Establish 24/7 referral system - Provide antenatal care

Newborn for obstetric emergencies
- Provide postnatal care
Care
- Provide midwife delivery
- Train skilled attendants (midwives, nurses and doctors)
supplies, including newborn in performing Emergency Obstetric and Newborn Care
(EmONC)
resuscitation supplies
- Increase Access to basic and comprehensive
- Provide clean delivery
packages EmONC
- Provide adolescent-friendly - Raise community awareness about the risks of early
services at health facilities motherhood and the importance of skilled attendant
(facility) delivery
- Coordinate with sectors to
identify pregnant adolescents - Integrate mental health and psychosocial support services
in the community and link for adolescent mothers
them to health services
- Engage CHVs to link
young mothers to health
services
- Encourage facility-based
delivery for all adolescent
mothers
- Provide access to free condoms - Establish comprehensive STI prevention and treatment
STIs,
services, including STI surveillance systems
Including - Ensure adherence to
HIV - Collaborate in establishing comprehensive HIV services as
standard precautions
Prevention appropriate
and - Assure safe and rational
- Raise awareness of prevention, care and treatment services
Treatment
blood transfusions for STIs, including HIV among adolescents and youth
- Provide syndromic treatment - Train staff to provide adolescent-friendly STI and HIV-related
services
available for clients presenting
for care as part of routine - Train CHVs in CBD for distribution of condoms,to provide
clinical services education on STI/HIV prevention and testing and treatment
services available and to provide referrals for services
- make treatment available for
patients already taking anti- - Establish programs, including peer education, to
retrovirals (ARVs) including for adolescents most-at-risk for acquiring and transmitting HIV
prevention of mother-to-child
transmission
(PMTCT) as soon as possible.
- Ensure that adolescent-friendly
health services are available
for adolescents presenting to
facilities with symptoms of STI
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Task force Members
Dr. Kigen Bartilol Head - RMHSU
Dr. Jeanne Patrick RMHSU
Dr. Anne Ng’ang’a RMHSU
Anne Njeru RMHSU
Clifton Katama RMHSU
Damaris Mwanzia RMHSU
Mary Magubo RMHSU
Alice Mwangangi RMHSU
Ruth Muia RMHSU
Joyce K. Onyango RMHSU
Martin Matingi NCAHU
Rose Mwongera DPPHCF
Phares Nkari HPU
Lenet Bundi NASCOP
Margret Mwirigi MOEST
Lucy Odicho Rift Valley Provincial General Hospital
Nancy Ngetha KNH-Youth Center
Susan Gitau Machakos Level 5 Hospital
Kigen Korir UNFPA
Johnstone Kuya SRHR-Alliance
Peter Onyancha NOPE
Vilmer Nyamongo CSA
Angela Tatua Family Health Options-Kenya
MaqC Eric Gitau UNICEF
Philip Mbithi I Choose Life
Isaac Mulinge GOAL
Chelimo Keter LVCT
George Kahuthia C4C consortium
Hannah Wanja Youth Advisory Panel
Linda Obura I Choose Life
Dr. Job Makoyo PS Kenya
Susan Mutugu PS Kenya
Vincent Amusavi AMREF Kenya
Howard Akimala DSW Kenya
Juliana Odindo NEPHAK
Francis Mutua Youth Advisory Panel
Joy Millo Adolescent Representative
David Mutaha Adolescent Representative
External Reviewers
Pamela Onduso Pathfinder
Dr Gathari Ndirangu JHPIEGO
Manya Dotson JHPIEGO
Dr Solomon Marsden FHI 360
The review and revision of the national guidelines for provision of Adolescent and youth friendly services in
Keanya was supported by the Reproductive and Maternal Health Services Unit (RMHSU)-MOH, Center for the
Study of Adolescence (CSA), GOAL-Kenya and United Nations Population Fund (UNFPA).These National
Guidelines have been printed with support from Network for Adolescents and Youth of Africa (NAYA) and Sexual
Reproductive Health and Rights (SRHR) Alliance - Kenya.
Reproductive Maternal Health

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MINISTRY OF HEALTH

Dr. Kigen Bartilol

Head, Reproductive Maternal Health Services Unit

Adolescent: Any person aged between 10 and 19 years.

Age Appropriate Comprehensive Sexuality Education (AACSE): An age-appropriate, culturally relevant

• Reproductive decision-making, including voluntary choice in marriage, family

State Actors: These include government ministries, departments and agencies.

Young People: Any persons aged 10 – 24 years as defined by WHO

Youth: Any person aged between 15 – 24 years as defined by WHO

1.1.1 Situation Analysis

• Individual barriers, such as young people’s limited or incorrect knowledge of SRH,

1.1.3 Rationale for Revision

2. To standardize the provision of quality AYSRH Services at all levels;

3. To increase access to comprehensive sexual and reproductive health information and

1.3.2 Targeted beneficiaries

• Rural adolescents and youth

• Out of school adolescents and youth

• Orphans and street children

• Young people with disability

• Young people living with HIV

• The very young adolescents 10-14 years of age

• Married adolescent girls

• Young first-time mothers

• Young people in humanitarian/emergency settings

• The participation of parents, community members and other stakeholders is crucial to

• The meaningful participation of adolescents and youth in the Planning, Implementation,

2.1 CHARACTERISTICS OF ADOLESCENT AND YOUTH

Equity and Standard 6:

3.1 STRATEGIES AND ACTIONS

a) Capacity building to mainstream AYFS into service delivery at all levels

d) Networking, partnership and collaboration

e) Advocacy and policy dialogue

f) Meaningful adolescent and youth involvement

g) Parents and community involvement in provision of AYFS

h) Referral, linkage and follow-up

• Essential package for AYFS

• Value clarification and attitude transformation (VCAT) training on adolescent and

• Characteristics of adolescent growth and development (including neurobiological,

• Privacy and confidentiality

3.1.1.1 Appropriate, relevant infrastructure and technology

3.1.1.2 Supply Chain Management System

• Supplies and medicines for Sexually Transmitted Infections management

1. Orientate service providers on reproductive health commodity and logistics

2. Support expansion and renovation of facilities to meet the standards of AYFS

3. Strengthen systems for effective commodity management and security

7. Sensitize other key stakeholders on the need for AYFS

8. Provide orientation to teachers on AYFS

1. Conduct quarterly ASRH TWG meetings

2. Participate in biannual RH-ICC and JICC meetings

3. Support the strengthening of the school health programmes

6. Coordination of Monitoring and evaluation activities at national and county level

8. Resource mobilisation for AYFS

3.1.3 Social mobilization

3. Sensitize all stakeholders on AYFS

3.1.4 Networking, partnership and collaboration

1. Mapping of partners supporting AYFS

2. Strengthen linkage and networking between partners

3. Strengthen public-private partnership to support the provision of AYFS

4. Documentation and sharing of best practices and lessons learnt