The struggling national EduAfya health plan is under intense pressure to deliver contraceptives and safe sex related care to students.
A recent review in four counties, has recommended it be revised to cover issues of sex diseases, unwanted pregnancies and abortion.
“EduAfya should address student health issues holistically …. including STIs, unwanted pregnancies and abortion,” recommends the review.
The review by the Bill Gates funded ThinkWell group was carried out in four counties in coastal, eastern, and western Kenya.
ThinkWell in a briefing tell of engaging widely with groups, individuals and institutions involved in EduAfya including Marie Stopes Kenya and Population Services Kenya.
Through county visits, the group says it established that most providers are not offering reproductive health services to students under EduAfya.
In some instances, the brief says providers indicated that they did provide adolescents, including students, with contraception but not under EduAfya.
“One private provider acknowledged that the facility offered students contraception and claimed this service on EduAfya. This was the only provider that reported doing this from the visited counties.”
EduAfya, a Sh4 billion-per-year initiative was launched in 2018 to provide about three million public secondary school students with health care through the National Hospital Insurance Fund (NHIF).
EduAfya is part of the Universal Health Coverage (UHC) that Kenya is unsuccessfully struggling to rollout.
The group has also recommended that a policy requiring students to produce approval letters from head teachers before accessing services be reviewed.
While assuring students’ security, ThinkWell says the requirement may infringe on students’ privacy and confidentiality.
“A process that ensures the security of the student while also allowing them greater privacy would be preferable,” suggests the group.
A similar concern has also been raised by the Institute of Development Studies of the University of Nairobi.
“Reasons for seeking care should remain private and confidential so that students can seek more sensitive services should they require them,” say Job Kinyua Muriithi in a study for the varsity.
Muriithi had tracked the performance of EduAfya in Kiambu County, reporting the requirement for school or parental consent as an infringement on privacy and a deterrent against seeking some crucial health services.
Both the ThinkWell and Muriithi reports tell of a scheme that has failed to fully take off despite noble objectives.
“The scheme has low uptake in Kiambu, low awareness among students, schools, medical facilities and even among teachers and parents,” says Muriithi in his study.
The low registration is largely blamed on pupils’ lack of requisite documentation such as birth certificates and a national student’s number.
“The utilisation of the facility is low among students in Meru County,” says Silas Muguna Mbaabu a senior official with the county government.
Challenges facing the scheme in Meru, Mbaabu and a team from Kenya Methodist University say include poor communication and insufficient guidelines from the NHIF.
Other challenges, the team in a study published in the International Journal of Professional Practice say include few NHIF-accredited health facilities, inability to readily obtain students’ national numbers and low financing.
By Gatonye Gathura