FORWARD The African Union has acknowledged the importance of leveraging the demographic dividend as a means for African nations to overcome their development challenges. Central to this endeavour is the effective utilization of the potential of adolescents and young people (AYP). Implementing programs aimed at identifying and nurturing the capabilities of adolescents and young people is crucial for achieving developmental milestones within a country. The Mombasa County Integrated Development Plan (CIDP) (2023 – 2027) underscores the imperative to empower adolescents and young people by fostering their skills and talents. The County Department of Health is pivotal in advancing the health objectives outlined in CIDP and this strategy. Providing opportunities and environments for adolescents and young people to address adverse health outcomes and related illnesses is integral to this effort. The drafting team considered various national policies and County initiatives aimed at tackling these issues. The successful execution of this 5-year strategy necessitates collaborative efforts from stakeholders across all sectors to ensure the needs of adolescents and young people are met and their rights are protected. I urge all stakeholders to adopt a unified and comprehensive approach to overcoming the challenges faced by adolescents and young people, thereby realizing the objectives of this strategy. HE. Abdullswamad Sherrif Nassir, Governor, Mombasa County Mombasa AYP Strategy 2024- 2029 i FORWARD The African Union has acknowledged the importance of leveraging the demographic dividend as a means for African nations to overcome their development challenges. Central to this endeavour is the effective utilization of the potential of adolescents and young people (AYP). Implementing programs aimed at identifying and nurturing the capabilities of adolescents and young people is crucial for achieving developmental milestones within a country. The Mombasa County Integrated Development Plan (CIDP) (2023 – 2027) underscores the imperative to empower adolescents and young people by fostering their skills and talents. The County Department of Health is pivotal in advancing the health objectives outlined in CIDP and this strategy. Providing opportunities and environments for adolescents and young people to address adverse health outcomes and related illnesses is integral to this effort. The drafting team considered various national policies and County initiatives aimed at tackling these issues. The successful execution of this 5-year strategy necessitates collaborative efforts from stakeholders across all sectors to ensure the needs of adolescents and young people are met and their rights are protected. I urge all stakeholders to adopt a unified and comprehensive approach to overcoming the challenges faced by adolescents and young people, thereby realizing the objectives of this strategy. HE. Abdullswamad Sherrif Nassir, Governor, Mombasa County Mombasa AYP Strategy 2024- 2029 i PREFACE The Mombasa County Adolescent and Young People (AYP) strategy. The strategy will be implemented over five years (2024 – 2029). This is a second edition that will provide a holistic approach to addressing the needs of adolescents and young people in Mombasa County. In developing this strategy, the County is cognizant of the critical role of adolescents and young people in achieving the County's development priorities. From the previous strategy, a significant improvement has been noted in terms of Service delivery to AYP. Establishment of comprehensive youth-friendly centers, meaningful involvement of AYPs in leadership, participation in health planning and programming, strengthening County leadership, and coordination of multisectoral engagement for AYP health and well-being. Significant progress has been observed in the past strategy implementation, e.g. in the reporting and handling of gender-based violence cases involving adolescents and young people (AYP). Mental health has been integrated into adolescent health services within the County, incorporating evidence-based interventions mental health interventions such as MindSKILLZ, interpersonal group psychotherapies, brief interventions and referral and linkage for specialized care. Despite a rise in new HIV infections among AYP, numerous interventions have been implemented to mitigate and prevent further transmission. These initiatives include Undetectable = Untransmittable (U=U) campaigns, education on pre-exposure prophylaxis (PrEP) utilization, life skills training, socio-economic empowerment programs for youth, and the establishment of a sustainable harm reduction business plan for individuals who use and inject drugs. The County has put in place bold steps to increase awareness and access to quality and affordable health services for all citizens, including AYP. To achieve this, the County recognizes the need for a multi-pronged and multi-layered approach in programming for AYP, requiring input from stakeholders across all sectors. This strategy has been developed to guide stakeholders who want to invest in and implement high-impact programmes with AYP in the County. All sectors (public and private) are invited to join us by creating opportunities for AYP, mainstreaming AYP in their policies, and investing in implementing this strategy. Dr. Swabah Ahmed Omar County Executive Committee Member Department of Health, Mombasa County ii Mombasa AYP Strategy 2024- 2029 ACKNOWLEDGEMENT The development of the Mombasa County Adolescent and Young People Strategy 2024-2029 was undertaken in a consultative and participatory series of meetings with external stakeholders and County officials. The process was initially started by collecting views of young people in all the sub-counties in Mombasa County (Public participation), engaging youth groups, monitoring & evaluation, and policy planning technical teams. The process involved a review of relevant documents and generating data from national policies and guidelines on various health issues. Special thanks to H.E. the Governor Mombasa County, the Deputy Governor and County Executive Committee Member (CECM) Education, CECM Health, CECM Youth, Gender, Sports and Cultural Affairs, CECM Trade, Investment and Tourism, CECM Transport and Infrastructure, CECM Agriculture, Livestock and Fisheries, CECM Environment, Energy and Solid Waste Management, Office of the County Attorney and Sub-County Administration for providing county leadership and technical guidance during the development of this strategy. Much appreciation goes to the adolescent health technical working group whose members were drawn from the Senior County Health Management Team, Sub-County Management Teams, our partners, Youth Advisory Champions of Health (YACH), youth lead organizations and youth representatives from all the County wards and civil society organizations. We want to thank SOS Children’s Villages Kenya, USAID Stawisha Pwani, LVCT Health, AHF, NAYA Kenya, for funding the process. Abdallah J. Daleno Dr. Shem Patta Chief Officer- Public Health Chief Officer-Clinical S ervices & Disease Prevention Department of Department of Health, Health, Mombasa County Mombasa County Mombasa AYP Strategy 2024- 2029 iii TABLE OF CONTENTS FORWARD i PREFACE ii ACKNOWLEDGEMENT iii EXECUTIVE SUMMARY 1 ACRONYMS 2 OPERATIONAL DEFINITION OF TERMS 4 INTRODUCTION 6 LANDSCAPE ANALYSIS 7 SITUATIONAL ANALYSIS 13 RATIONALE AND SCOPE 14 VISION/MISSION/GOAL 16 STANDARDS FOR QUALITY ADOLESCENTS AND YOUTH- 17 FRIENDLY SERVICES IMPLEMENTATION STRUCTURE 43 FINANCING AND RESOURCE MOBILIZATION 45 COMMUNICATIONS AND ADVOCACY 46 ANNEX 49 REFERENCES 54 EXECUTIVE SUMMARY The strategy for Adolescents and Young People (AYP) in Mombasa County, Kenya, addresses the distinct health and well-being needs of AYP and is grounded in various global and national contexts. The strategy aligns with global standards for quality health services and the Sustainable Development Goals (SDGs), emphasizing health and well-being for all. In Kenya, over half of the population comprises AYP, necessitating a targeted approach to cater to their unique needs. The challenges faced by AYP include teen pregnancies, substance abuse, gender-based violence, and mental health issues, compelling the development of a comprehensive strategy. Moreover, the strategy adheres to constitutional mandates and aligns with national and county policies, integrating it into broader policy objectives. The scope of the AYP strategy is comprehensive, encompassing various facets of health and well- being, including Sexual and Reproductive Health, Mental Health, HIV testing, Nutrition, Gender- Based Violence, and Drug & Substance Abuse. These interconnected areas form a holistic approach to AYP's well-being, recognizing that socio-economic factors are crucial in their lives. The strategy operates under guiding principles such as a rights-based approach, participatory engagement, responsiveness to AYP needs, the integration of information and services, and multi- sectoral collaboration. It acknowledges the fundamental rights and freedoms of AYP, the importance of their meaningful engagement, and the need for services and information to be responsive to their unique requirements. Multi-sectoral collaboration ensures a holistic approach to addressing AYP issues. The vision of the AYP strategy is to cultivate a healthy, empowered, and productive AYP, with a mission to provide leadership and an enabling environment for implementing evidence-based health services while fostering meaningful engagement. The goal is to improve health and well- being among AYP, considering diversities such as key populations, gender and sexual minorities, vulnerable and marginalized groups, and special populations. Globally, there is a growing recognition of the significance of targeted investments in adolescent health. The Global Strategy for Women's, Children, and Adolescents' Health (2016-2030) acknowledges the substantial contribution of such investments to the overall success of the 2030 agenda and the achievement of the SDGs. In Mombasa County, AYP accounts for a substantial portion of the population. Their unique health and socio-economic challenges necessitate a dedicated strategy. The scope of the strategy is comprehensive, covering various dimensions of health and well-being. Guiding principles ensure that AYP's rights and freedoms are respected and that their voices are included in the decision- making process. The vision, mission, and goals emphasize the need for an empowered and productive AYP population. This AYP strategy represents a vital step towards addressing the distinctive health and well-being needs of AYP in Mombasa County, ultimately contributing to their betterment and societal progress. Mombasa AYP Strategy 2024- 2029 1 ACRONYMS ADA Alcohol and Drug Abuse AFIDEP Africa Institute for Development Policy AGYW Adolescent Girls and Young Women ANC Antenatal Care ARV Antiretroviral ART Antiretroviral Therapy ASRH Adolescent Sexual Reproductive Health ATWG Adolescent Technical Working Groups AYP Adolescents and Young People AYPKP Adolescent and Young People Key Population AYPLHIV Adolescents and Young People Living with HIV CASCO County AIDS and STI Coordinator CBO Community-Based Organization CDH County Department of Health CECM County Executive Committee Member CHAs Community Health Assistants CHEWs Community Health Extension Worker CHMT County Health Management Team CHVs Community Health Volunteers CIDP County Integrated Development Plan CO Chief Officer CQI Continuous Quality Improvement DDIU Data Demand and Information Use DHIS District Health Information System DSD Differentiated Service Delivery EBIs Evidence-Based Interventions ECP Emergency Contraceptive Pill EMTCT Elimination of Mother-to-Child Transmission EPI Expanded Programme on Immunization FBO Faith-Based Organization FSW Female Sex Workers GBV Gender-Based Violence HCW Health Care Workers HEI HIV Exposed Infants HIV Human Immunodeficiency Virus HTS HIV Testing Services IDU Intravenous Drug users IEC Information Education Communication WHO World Health Organization KASF Kenya AIDS Strategic Framework KeHMIS Kenya Health Management and Information System KDHS Kenya Demographic Health Survey KENPHIA Kenya Population-based HIV Impact Assessment KEPH Kenya Essential Package for Health KICD Kenya Institute of Curriculum Development KNBS Kenya National Bureau of Statistics KMHAP Kenya Mental Health Action Plan MAT Medically Assisted Therapy MNS Mental Health Neurological Issues and Substance Use MoE Ministry of Education 2 Mombasa AYP Strategy 2024- 2029 MoH Ministry of Health MoU Memorandum of Understanding MOV Means of Verification MSM Men Having Sex with Men MSW Male Sex Workers NACC National AIDS Control Council NASCOP National AIDS and STI Control Programme NSDCC National Syndemic Disease Control Council NCD Non-Communicable Diseases NGO Non-Governmental Organization NSP Needles and Syringes Programme OSS Organizational Systems Strengthening OTZ Operation Triple Zero OVC Orphans and Vulnerable Children PAC Post Abortive Care PEP Post -Exposure Prophylaxis PNS Partner Notification Services PrEP Pre-exposure Prophylaxis PSS Psychosocial Support PTSD Post-Traumatic Stress Disorder PVC Post-Violence Care PWUD People Who Use Drugs PWID People Who Inject Drugs PWD People with Disabilities SCR Social Corporate Responsibility SDG Sustainable Development Goals SGBV Sexual Gender-Based Violence SRH Sexually Transmitted Infection STI Tuberculosis TB Sexual Reproductive Health UHC Universal Health Coverage U=U Undetectable =Untransmittable VMMC Voluntary Medical Male Circumcision YACH Youth Advisory Champions of Health YFC Youth Friendly Centres YCL Young Care Leaver YFS Youth Friendly services Mombasa AYP Strategy 2024- 2029 3 OPERATIONAL DEFINITION OF TERMS Adolescent and Young People (AYP): Adolescents are individuals aged 10-19 years, while "Young People" encompasses 20-24 years. Both groups are in the phase of human growth and development that occurs between childhood and adulthood. Adolescent psychosocial development: This concept refers to the quest for identity and answering the question of "Who am I?" between childhood and adulthood. Adolescents aim to accomplish four critical tasks on the path to becoming well-adjusted adults: 1) independence, 2) body image, 3) peer relations, and 4) identity. Adolescent rights: This pertains to the rights of adolescents to receive quality and appropriate prevention, treatment, and care. It includes the right to treatment and services free of discrimination, irrespective of factors such as race, colour, sex, language, religion, political or other opinions, national, ethnic, or social origin, property, disability, birth, or other status of the adolescent or their parents or guardians. Assent: Refers to a form of agreement or approval, typically given verbally or through actions, without necessarily implying complete understanding or legal consent. It may apply to situations where individuals, particularly minors or those lacking full capacity, express agreement without necessarily having the capacity to give informed consent. Care leavers: A care leaver is anyone who spent time in alternative care as a child. Such care could be in foster care, institutional care (mainly children’s homes), or other arrangements outside the immediate or extended family. Charitable Children’s Institution: A Charitable Children’s Institution (CCI) is an institution established by a person, corporate or non-corporate, religious organization, NGO or PBO. Registered CCIs have been granted approval by NCCS to manage a programme for the care, protection, rehabilitation, or control of children. Non-registered CCIs offer similar services but have not been granted approval by NCCS. Child: Any person under the age of 18 years. Communicable diseases: These are diseases that can be transmitted from person to person through direct contact with an infected individual or indirect contact with the individual's bodily fluids. Confidentiality: This involves the right of individuals to privacy of personal information, including health records. It dictates how data and information are collected, stored, and shared, restricting access to those with a legitimate need to know and permission from the client. Consent: Refers to the agreement or permission to receive or provide services and applies to individuals above 18 years of age, per Kenyan laws. It signifies that all parties involved have agreed and given their permission. Gender: Gender is a social and cultural construct rather than a biological one, and it is socially ascribed and assigned. Gender-based violence: Refers to violence that targets individuals based on their gender, including acts that inflict physical, sexual, mental, psychological, emotional, and economic harm, as well as other harmful cultural practices. 4 Mombasa AYP Strategy 2024- 2029 4 Health care systems: These encompass the people, institutions, and resources organized in line with established policies to improve the population's health while meeting their expectations and protecting them against the cost of ill health. Health provider: An individual trained to deliver preventive, curative, promotional, or rehabilitative health care services to individuals, families, or communities systematically. Informed choice: Refers to a choice made by an adolescent regarding their care, treatment options, follow-up options, or refusal of service for care. It's based on having adequate, appropriate, and transparent information about the nature, risks, alternatives, and implications for the adolescent's health and life. Key Populations (KP): This term is used to refer to young people whose sexual and other behaviours make them vulnerable to HIV and other sexually transmitted infections. Marginalized AYP: Refers to adolescent and young people who are economically disadvantaged, have limited access to education and training, lack productive employment opportunities, and may be socially and economically marginalized. Mental health: Mental health is a state of well-being in which individuals realize their potential, cope with life's stresses, work productively, and contribute to their community. MindSKIILZ: An interactive, evidence-based program that creates simple and powerful connections between soccer and life. MindSKILLZ equips adolescents with the knowledge, skills, and encouragement to live happy and healthy lives and become leaders within the community. Non-communicable diseases: These are medical conditions or diseases not caused by infectious agents, resulting in long-term health consequences that often require long-term treatment and care. Persons with disability: Individuals with physical, sensory, mental, psychological, or other impairments, conditions, or illnesses that have, or are perceived by, a significant portion of the community to have a substantial or long-term effect on their ability to carry out daily activities. Safe spaces: These are physical, emotional, social, and imaginative environments that promote young people's ability to make healthy life choices and enhance their overall well- being. Sexual Reproductive Health (SRH): SRH is a state of complete physical, mental, and social well-being concerning the reproductive system. It includes the ability to have a satisfying and safe sex life, reproductive choice, and protection from sexually transmitted infections. This includes adolescents and young people who inject/use drugs, male and female sex workers, MSM, MSW, transgender, and intersex individuals. Universal Health Coverage (UHC): UHC means that all people have access to a full range of quality health services they need without suffering financial hardship. It encompasses health promotion, prevention, treatment, rehabilitation, and palliative care. Vulnerable adolescents and young people: These are AYPs identified as being at greater risk of experiencing physical or emotional harm or achieving poor outcomes due to various factors in their lives. This includes orphans, AYPs living on the streets, young care leavers, those living with HIV, those with disabilities, those in informal settlements, and those in the labour market. Youth: Individuals in the age bracket of 18-35 years. Youth-friendly Centers: These are venues designed to serve adolescents and young people. Youth-friendly services: These are accessible and affordable services provided to young people in effective ways, respectful of their privacy and confidentiality, and meet their needs. Mombasa AYP Strategy 2024- 2029 5 INTRODUCTION Globally, the past decade has witnessed a growing acknowledgement of the pivotal significance of targeted investments in adolescent health. Such investments promise to deliver a triple dividend, benefiting not only adolescents themselves but also the immediate future adult population and generations to come (UNICEF, 2018). The Global Strategy for Women's, Children, and Adolescents' Health (2016-2030)1 recognizes the substantial contribution of this investment to the overall success of the 2030 agenda, including the realisation of the Sustainable Development 2 Goals (SDGs). The Global Accelerated Action for the Health of Adolescents Guidelines (2017) further underscores the central role of investing in adolescent health due to its anticipated far- reaching benefits.3 In Kenya, there is a population of 11,631,929 adolescents aged between 10 and 19 years, constituting approximately 24% of the total population (KNBS, 2019).4 This demographic underscores the urgent need for a comprehensive and integrated adolescent health strategy in the country. Adolescence is a critical phase of human development, marked by significant physical, emotional, and intellectual changes. It is during this period that individuals undergo transformations that set the stage for their future lives. Adolescence is also a time when social roles and expectations are established, influencing one's life (NIH, 2019)5 It is during adolescence that individuals form patterns of behaviour that have a profound impact on both their health and the health of their communities. This includes areas such as physical exercise, sexual and reproductive health, nutrition, mental health, HIV/STI prevention, drug and substance abuse, and menstrual hygiene management, among other critical aspects of well- being. (J Adolescent Health. 2016)6 Recognizing the unique challenges and opportunities presented during this phase of life, the development and implementation of an integrated adolescent health strategy for Mombasa County is not just a response to the needs of the present adolescent population but also an investment in the County's future. By addressing the diverse health and well-being concerns of adolescents, this strategy can pave the way for healthier, more informed, and empowered individuals who will contribute positively to society and the achievement of the nation's development goals. It recognizes the potential for long-term social and economic benefits extending beyond the current generation, making it an imperative component of Kenya's public health and development. 1.Adolescent Health 2.The Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030) 3.https://apps.who.int/iris/bitstream/handle/10665/255415/9?sequence=1 4.2019 Kenya Population and Housing Census Reports 5.Adolescent Development 6. Interventions for Adolescent Mental Health: An Overview of Systematic Reviews - ScienceDirect 6 Mombasa AYP Strategy 2024- 2029 6 LANDSCAPE ANALYSIS GLOBAL AND SUB SAHARAN AFRICA Communicable Diseases The statistics on communicable diseases, especially HIV, present a critical public health challenge. According to the World Health Organization's (WHO) global statistics (2021),7 38.4 million people are living with HIV worldwide. New HIV infections in the same year numbered 2.5 million. Regionally, in East and South Africa, an alarming 20.6 million people are living with HIV. Among this staggering figure, there were approximately 1.7 million adolescents (aged 10–19 years) living with HIV in 2019, with a substantial 90% of them in the WHO African Region. Adolescents make up about 10% of new adult HIV infections, with a hefty burden among adolescent girls, who account for three-quarters of these infections. Tuberculosis (TB) is another communicable disease that poses challenges for adolescents. About 1.8 million adolescents aged 10-24 years develop TB each year. However, the timely diagnosis, support, and successful completion of treatment remain significant barriers to addressing TB among adolescents. (WHO, 2021) Adolescents aged 10-14 years are also vulnerable to diarrheal diseases, lower respiratory tract infections, and meningitis, which are among the top five causes of mortality in this age group (Unicef,2023)8. Most of these infectious diseases can be prevented through vaccination. Notably, community-acquired pneumonia is a significant cause of both inpatient and outpatient admissions for adolescents. The causative agents are typically bacteria and viruses, with susceptibility influenced by individual immune characteristics, social factors, and epidemiological characteristics 9 of the community, as well as seasonal variations (Ngari m et al., 2021) In the specific context of Mombasa County, the prevalence of HIV is notably higher than the national average. The County's HIV prevalence in 2022 stood at 7.4%, compared to the national prevalence of 5.6%. Among females in Mombasa County, the prevalence was even higher, reaching 10.5%. Among those aged 15-19 years, it was 6%, and among those aged 20-24 years, it reached 10%. (HIV estimates, 2021)10 According to the national HIV estimates for 2022, Mombasa County has a total of 54,303 people living with HIV (PLHIV). Of this figure, 3% are male, while 5.4% are female. The number of new infections across all age groups was 1,243, and the mother-to-child transmission (MTCT) rate was 6.3%, with Prevention of Mother-to-Child Transmission (PMTCT) coverage at 101%. Among children aged 0-14 years, the number of PLHIV was 2,175, with 117 new infections. For adolescents aged 10-19 years, there were 3,490 PLHIV, and 211 new 7. Worldhealth statistics 2021: monitoring healthfor the SDGs, sustainable development goals 8. Youngpeople's health and well-being | UNICEF MiddleEast and North Africa RegionalOffice and Burnet Institute (2023) 9. Moítalityduíing and followinghospital admission amongschool-aged childíen: acohoít study 10. mombasa county- hiv & aids Mombasa AYP Strategy 2024- 2029 7 infections were reported. Among young adults aged 15-24 years, there were 4,898 PLHIV, and 419 new infections occurred (NSDCC,2023) It is crucial to highlight that a concerning 50% of new HIV infections happen among adolescents and young people (AYPs). This emphasizes the need for targeted and effective strategies to address HIV and other communicable diseases among this vulnerable demographic. Addressing these challenges requires a comprehensive and multi-pronged approach that includes prevention, treatment, education, and support to ensure the well-being of AYPs and the broader community. Adolescent sexual and reproductive health The global birth rate among adolescent girls aged 15 to 19 years is alarmingly high, standing at 41 births per 1,000. Pregnancy and neonatal outcomes in this age group are fraught with complications, underscoring the pressing concerns surrounding adolescent pregnancy. The consequences of adolescent pregnancy extend far beyond the physical challenges; they encompass susceptibility to violence, school drop-out, and reduced employment opportunities (WHO ,2022). It is important to note that any sexual activity with children below 18 years is legally defined as defilement, as per the Sexual Offences Act of 2006, marking it as a criminal offence (Sexual offences Act of 2006)1.1 In Kenya, the National Adolescent and Youth Friendly Services Guidelines (2016) have identified significant barriers that hinder young people's access to comprehensive Sexual and Reproductive Health and Rights (SRHR) services1.2 These barriers include structural obstacles, such as legal and policy requirements for parental or partner consent, the geographical distance from health facilities, the costs of services, transportation challenges, long waiting times, inconvenient service hours, the unavailability of necessary supplies at health facilities, and the lack of privacy and confidentiality (Youth friendly service guidelines 2016)1.3 According to the Population and Housing Census (KNBS, 2019), the female population in Kenya accounts for a significant portion, constituting 50.5% of the total population. As a result, a substantial number of women and girls in Kenya experience the challenges of menstruation every month. These challenges include inadequate, unsafe, and inappropriate sanitation and hygiene facilities. The situation worsens during menstruation, where access to private spaces for changing, washing, drying, and adequately disposing of menstrual items becomes crucial.14 Teenage pregnancy is a prevalent issue in Kenya, with a staggering 18% prevalence rate. This translates to one in five adolescent girls either being pregnant or already having a child, resulting in approximately 330,000 teen pregnancies annually. The rate of teenage pregnancy increases significantly with age, rising from 3% among girls aged 15 to a concerning 40% among girls aged 19 (AFIDEP, 2016).15 11 https://nsdcc.go.ke/ 12 Adolescent pregnancy 13. The Sexual Offences Act. 14. National Guidelines for Provision of Adolescence and Youth Friendly Services in Kenya 15. No Access - African Institute for Development Policy- AFIDEP 8 8 Unsafe abortion remains a leading cause of maternal morbidity and mortality in Kenya, with an 16 estimated rate of 30 induced abortions per 100 live births (Centre for Reproductive Rights, 2020). Studies have shown that adolescent mothers often receive inadequate antenatal care and skilled birthing assistance compared to adult women with similar backgrounds. The unmet contraceptive needs, early child marriage, and limited access to contraceptives serve as catalysts for adolescent pregnancies. (Mwaisaka, J. et al., 2021)17 In Mombasa County, numerous sociocultural and individual barriers compound the challenges related to adolescent sexual and reproductive health. Sociocultural barriers include restrictive norms and stigmas around adolescent and youth sexuality, inequitable or harmful gender norms, and discrimination and judgment of adolescents by communities, families, partners, and healthcare providers. Individual barriers encompass the limited or incorrect knowledge of sexual and reproductive health, including myths and misconceptions around contraception, limited self- efficacy and individual agency, and challenges in navigating internalized social and gender norms. Furthermore, many young people lack information about the availability of SRH services and where to access them. Currently, only a limited number of health facilities in Mombasa County provide comprehensive adolescent and youth-friendly services, and there is a pressing need to expand access to these services, considering the diverse barriers and challenges faced by adolescents in the region. Mental Health Adolescence is a phase characterized by numerous changes, and mental health outcomes during this period are influenced by many factors. According to the World Health Organization Atlas 2020 (WHO), mental health issues impact approximately 10–20% of adolescents and young people (AYP) worldwide. It is noteworthy that half of these mental health issues manifest by the age of 14. Furthermore, mental health disorders contribute significantly to the overall disease burden among AYPs, accounting for approximately 16% of this burden. Data regarding the prevalence of mental health, neurological issues, and substance use (MNS) in 18 Kenya and Mombasa is limited. However, the Kenyan National Commission of Human Rights has estimated that a considerable proportion of both outpatients (25%) and inpatients (40%) suffer from mental health conditions. Among these, the most frequently diagnosed mental illnesses in general hospital settings include depression, substance abuse, stress-related disorders, and anxiety disorders. (Kenya Mental Health Action Plan, 2021)19 Kenya was ranked fifth among African countries with a high incidence of depression cases. Globally, it is estimated that around two million Kenyans grapple with depression, and these numbers are steadily rising. Shockingly, approximately one in every four Kenyans is expected to 20 experience a mental health disorder at some point in their lives (KANGO, 2019) 16. Report: Lives at stake as more Kenyan women and girls opt for unsafe abortion despite constitutional protections 17. “Those are things for married people” exploring parents’/adults’ and adolescents’ perspectives on contraceptives in Narok and Homa Bay Counties, Kenya | Reproductive Health 18. Mental Health ATLAS 2020 19. Kenya Mental Health Action Plan 2021 – 2025 20. Mental Health Status in Kenya- KANCO Mombasa AYP Strategy 2024- 2029 9 The prevalence of mental disorders among school-going children in Kenya is estimated to be as high as 37.5%. The most commonly reported forms of mental disorders in this demographic are somatic complaints (representing 29% of cases) and affective disorders constituting 14.1% of cases (Ndetei D et., al 2016)2. 1A range of risk factors contribute to the development of mental disorders among adolescents. These include difficulties during the transition to school, instances of bullying, family instability due to divorce or separation, and households with unemployed heads. Moreover, the emerging issue of cyberbullying is a pervasive form of abuse that significantly impacts adolescents, further contributing to their mental health challenges. Addressing mental health concerns among adolescents in Mombasa is essential, and it requires comprehensive strategies that encompass prevention, early intervention, and treatment. One key approach is to implement preventive and promotive evidence based mental health interventions for adolescents in the County e.g. MindSKILLZ, an interactive, evidence-based program that creates simple and powerful connections between soccer and life. MindSKILLZ equips adolescents with the knowledge, skills, and encouragement to live happy and healthy lives and become leaders within the community. The sport-based program uses a positive approach to mental health, focused on reinforcing and enhancing adolescents' strengths and skills to cope with life's stresses. It is vital to address the various risk factors and challenges that adolescents face to foster better mental health outcomes in this vulnerable population. (Memiah P et al.2,2 2022) Non-Communicable diseases Non-communicable diseases are a significant public health concern, as they contribute to a staggering 71% of all global deaths. In Kenya, NCDs account for 27% of all deaths, and there is a 13% risk of premature death for individuals aged between 30-70 years. The impact of NCDs is substantial and multifaceted, with a wide range of risk factors contributing to their prevalence. The top five risk factors for NCDs in Kenya are as follows: Unhealthy diet: Poor dietary habits play a significant role in the development of NCDs. The consumption of high-calorie, low-nutrient foods contributes to obesity, diabetes, and cardiovascular diseases. Tobacco use: Tobacco use, including smoking and smokeless tobacco, is a significant risk factor for NCDs, particularly respiratory conditions and cancers. Physical inactivity: A sedentary lifestyle and lack of regular physical activity are closely linked to NCDs like obesity, diabetes, and cardiovascular diseases. Harmful use of alcohol: Excessive alcohol consumption can lead to various NCDs, including liver diseases and cardiovascular conditions. Air pollution: Environmental factors like air pollution can also contribute to NCDs, especially respiratory diseases. 21 The prevalence of mental disorders among upper primary school children in Kenya | Request PDF 22 https://doi.org/10.3390%2Fijerph19095366 10 A study conducted across six countries in Africa, including Kenya, Namibia, Swaziland, Zambia, and Zimbabwe, revealed concerning statistics related to NCD risk factors. In this study,a prevalence of 12.6% for tobacco use in the past month, 6.6% for risky alcohol use, and 10.5% for illicit drug use was reported. These behaviors were associated with a range of adverse outcomes, including poor retention in school, suicidal ideation, poverty, and sleeping problems. This highlights the need for comprehensive strategies to address NCD risk factors, especially among the youth population. Cancer is a particularly significant NCD in Kenya, ranking as the second leading cause of death among NCDs. The country experiences an incidence rate of 37,000 new cancer cases annually and a mortality rate of 28,000 deaths per year. Unfortunately, the survival rate for cancer in Kenya is notably lower, hovering around 20%, compared to high-income countries where it can reach 80%. This underscores the urgency of improving cancer prevention, early detection, and treatment efforts in Kenya to reduce the burden of this devastating disease. To combat the rising prevalence of NCDs in Mombasa County, comprehensive public health strategies are needed, including health education, lifestyle interventions, early screening and diagnosis, and access to quality healthcare services. Addressing the risk factors associated with NCDs is crucial to prevent their further proliferation and protect the health and well-being of the population at a younger age. Gender-Based Violence Gender-based violence (GBV) is a deeply rooted and pervasive issue that affects individuals across the globe, transcending boundaries of age, gender, and socioeconomic status. It encompasses various forms of violence directed at individuals based on their gender, and it often has profound and long-lasting physical, emotional, and psychological consequences. In the context of childhood and adolescence, the impact of GBV can be particularly devastating, a significant portion of both females and males experience various forms of violence. Among females, 32% reported experiencing sexual violence during their childhood, while 18% of males also reported such experiences. Sexual violence can manifest in many forms, including sexual abuse, harassment, and assault. It often leads to severe emotional trauma and long-term psychological consequences. Physical violence is alarmingly common during childhood, with 66% of females and 73% of males reporting such experiences. Physical violence can encompass acts such as physical abuse, hitting, or corporal punishment. It can result in physical injuries, emotional scars, and a lasting sense of vulnerability. A significant proportion of both females and males reported experiencing any form of violence during their childhood. This includes sexual and physical violence, emotional abuse, and any other violent acts. For females, 26% experienced violence, while for males, this figure stood at 32%. GBV during childhood and adolescence has profound and lasting effects on an individual's well-being and development. These consequences extend far beyond the immediate physical harm and can affect mental health, social relationships, and future life prospects. Survivors of GBV often grapple with psychological trauma, including symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD). The emotional scars can hinder an adolescent's ability to form healthy relationships, trust others, and engage in their education and personal growth. Mombasa AYP Strategy 2024- 2029 11 GBV can disrupt an adolescent's education, leading to school dropout or poor academic performance. The emotional distress and fear associated with violence can make it challenging for survivors to concentrate on their studies. Adolescents who experience GBV may withdraw from social activities and isolate themselves from their peers. The stigma and shame associated with being a survivor of violence can make it difficult for them to seek help or share their experiences with others. The physical and emotional consequences of GBV can have long-term health implications. Survivors may be at increased risk of engaging in risky behaviours, experiencing chronic health conditions, and facing challenges related to their sexual and reproductive health. Addressing GBV is a complex and multifaceted endeavour that requires the involvement of communities, governments, healthcare providers, educators, and advocacy organizations. Implementing programs that educate adolescents about healthy relationships, consent, and violence prevention as well as promoting gender equality and challenging harmful gender norms is also essential. Ensuring survivors have access to comprehensive support services, including counselling, legal assistance, and medical care and providing safe spaces and hotlines for reporting violence is crucial. Advocating for and enforcing laws and policies that protect adolescents from GBV includes legal measures against perpetrators and measures to empower survivors. Engaging communities in discussions about GBV and its consequences, raising awareness and reducing stigma are vital components of addressing this issue. In Mombasa, GBV is a deeply ingrained problem that affects individuals during childhood and adolescence, leaving profound physical and emotional scars. Addressing GBV requires a comprehensive and multifaceted approach encompassing prevention, support services, legal protections, and community engagement to ensure that adolescents grow and develop in a safe and supportive environment. 12 Mombasa AYP Strategy 2024- 2029 SITUATIONAL ANALYSIS Mombasa AYP Strategy 2024- 2029 13 RATIONALE AND SCOPE The Adolescent and Young People (AYP) strategy in Mombasa County is underpinned by a strong rationale and an expansive scope, affirming its pivotal role in addressing the distinctive health and well-being needs of this demographic. This comprehensive justification elucidates why this strategy is not merely necessary but a compelling imperative. One fundamental rationale for the AYP strategy is its alignment with global standards for quality health services. These standards emphasize that adolescents and young people should possess knowledge about their health and be aware of where to access health services tailored to their unique needs. Consequently, the strategy facilitates increased awareness of and access to health services designed explicitly for AYP. The United Nations Sustainable Development Goals (SDGs) are a universal blueprint for global development. Notably, SDG 3 (Good Health and Well-being), SDG 5 (Gender Inequality), SDG 10 (Reduced Inequalities), and SDG 17 (Partnerships for the Goals) collectively emphasize the imperative of enhancing health and well-being for all. The AYP strategy seamlessly aligns with these SDGs, thus contributing significantly to their attainment. Kenya's demographic landscape reveals a compelling rationale for the AYP strategy. A remarkable 51.2% comprises young people aged 10-24 years. Within this age bracket, adolescents aged 10-19 years constitute 19.4% of the population. In Mombasa County, AYPs account for 29% of the total population. This demographic composition underscores the necessity for precisely targeted strategies to cater to their unique health and socio-cultural requirements. Although the distribution of AYP in Kenya is relatively balanced between males and females, there is a slightly higher proportion of females (51.3%) than males (48.7%). This gender distribution highlights the significance of addressing gender- specific health concerns and promoting gender equality as an integral part of the strategy. The challenges faced by AYP in Kenya are multifaceted, encompassing high rates of teen pregnancies, drug and substance abuse, sexually transmitted infections, HIV infections and gender-based violence, elevated unemployment rates, and mental health issues. These challenges necessitate tailored and all- encompassing interventions that address their intricacies. The Constitution of Kenya 2010, Article 43 (1) (a), unequivocally enshrines the right of every individual to attain the highest standard of health, including reproductive health care. The AYP strategy upholds this constitutional mandate, ensuring that this fundamental right is realized for the AYP demographic. The AYP strategy is in complete alignment with various national and county policies and plans, including the National Reproductive Health Policy (2022-2032), Mombasa County Integrated Development Plan (2023-2028), National Adolescent Sexual and Reproductive Health Policy (2015), Mombasa Gender-Based Violence Policy (2023-2028), and Kenya Health Policy (2012-2030). This alignment underscores the strategy's integration into broader policy objectives. 14 Mombasa AYP Strategy 2024- 2029 The AYP strategy aims to address an array of health issues, including Sexual and Reproductive Health, Mental Health, HIV testing and counselling, Nutrition, Gender-Based Violence, and Drug & Substance Abuse. By addressing these interconnected facets of health, the strategy embraces a holistic approach to enhancing the well-being of AYP. Beyond health, the strategy recognizes the vital importance of addressing socio-economic factors that influence the lives of AYP. Empowering them with opportunities and resources is paramount for their holistic development and well-being. A central tenet of the strategy is meaningful and inclusive youth participation. Engaging AYP in the design, implementation, and evaluation of interventions is vital for a holistic response to their health needs. Mombasa County's AYP strategy is well-justified by demographic realities, global and national goals, and the pressing health and social challenges this population faces. By providing a targeted and comprehensive approach, the strategy aims to improve the health, well-being, and prospects of AYP, ensuring they have the opportunity to thrive and contribute positively to society. Mombasa AYP Strategy 2024- 2029 15 VISION Healthy, empowered and productive adolescents and young people To provide leadership and an enabling environment for MISSION implementing evidence-based health services and foster meaningful engagement in adolescents and young people. To contribute to improved health and well-being of GOAL adolescents and young people in their diversity in Mombasa County 1. To improve health outcomes for adolescents and young people 2. To improve the social and economic status of adolescents and STRATEGIC young people 3. To strengthen adolescent and young people participation and OBJECTIVE S leadership in health planning and programming at all levels. 4. To strengthen county leadership and coordination of multi- sectoral partners' engagement for adolescent and young people health and well-being GUIDING PRINCIPLES Youth-responsive programming: AYP programmes should be responsive to the needs of AYP and also consider the sociocultural context of AYP and the role of digital health. Meaningful and responsive involvement of AYP: AYP should be involved in the initiation, development, implementation, and evaluation of the policies and interventions targeting or affecting them. This will ensure that policies and interventions are AYP-friendly. Evidence-informed programming: Interventions should be informed by relevant information and data on the size, location, and characteristics (e.g., sex, age, education level, socio- economic background, marital status, schooling status, sexual diversity*, and drug use) of AYP. Note: *diversities - key population, gender and sexual minorities, vulnerable and marginalized, special populations Multi-sectorial collaboration: All relevant AYP stakeholders from all sectors should collaborate on the design, planning, implementation, and evaluation of AYP programmes. Integrated service delivery: AYP services should be integrated and linked to all services and service delivery points to increase access. Gender-responsive programming: Based on gender analysis, AYP programmes should consider gender equality concerns and address the needs in their design, implementation, and evaluation. 16 STANDARDS FOR QUALITY ADOLESCENTS AND YOUTH- FRIENDLY SERVICES The eight standards outlined below define the required level of quality in delivering services for adolescents and young people. Each standard reflects an essential facet of quality services to meet the needs of adolescents and young people. These standards are defined under the National Guidelines for providing Adolescent and Youth Friendly services in Kenya. Standard 1. Adolescents and youth health literacy: The service delivery point implements systems to ensure that adolescents and youth are knowledgeable about their health and that they know where and when to obtain health services. Standard 2. Stakeholder 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. Standard 3. Appropriate package of services: The service delivery point provides information, counselling, diagnostic, treatment, care services and referral linkage 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. Standard 4. Providers’ competencies: Healthcare providers demonstrate the technical competence to provide effective health services to adolescents and youth. Both healthcare providers and support staff respect, protect and fulfil adolescents' and youth's rights to information, privacy, confidentiality, non-discrimination, and non-judgmental attitude Standard 5. Facility 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 to ensure effective service provision to adolescents and youth. Standard 6. Equity and non-discrimination: The health service providers and delivery point provide quality services to all adolescents and youth irrespective of their ability to pay, age, sex, marital status, education level, ethnic origin, social status, cultural background, sexual orientation, gender identity, disabilities or other characteristics. The service providers and points of service shall ensure that the human rights of adolescents and youth are upheld. Standard 7. Data and quality improvement: The service delivery point collects analyses and uses data on service utilization and 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 appropriate. Standard 8. Adolescents' participation: Adolescents and youth are involved in the planning, monitoring and evaluating health services and decisions regarding their care, as well as in certain appropriate aspects of service provision. Company Name | Page x Mombasa AYP Strategy 2024- 2029 17 18 Mombasa AYP Strategy 2024 - 2029 Mombasa AYP Strategy 2024 - 2029 19 20 Mombasa AYP Strategy 2024 - 2029 Mombasa AYP Strategy 2024 - 2029 21 22 Mombasa AYP Strategy 2024 - 2029 24 Mombasa AYP Strategy 2024 - 2029 23 24 Mombasa AYP Strategy 2024 - 2029 Mombasa AYP Strategy 2024 - 2029 25 26 Mombasa AYP Strategy 2024 - 2029 Mombasa AYP Strategy 2024 - 2029 27 28 Mombasa AYP Strategy 2024 - 2029 Mombasa AYP Strategy 2024 - 2029 29 30 Mombasa AYP Strategy 2024 - 2029 Mombasa AYP Strategy 2024 - 2029 31 32 Mombasa AYP Strategy 2024 - 2029 Mombasa AYP Strategy 2024 - 2029 33 34 Mombasa AYP Strategy 2024 - 2029 Mombasa AYP Strategy 2024 - 2029 35 36 Mombasa AYP Strategy 2024 - 2029 Mombasa AYP Strategy 2024 - 2029 37 38 Mombasa AYP Strategy 2024 - 2029 Mombasa AYP Strategy 2024 - 2029 39 40 Mombasa AYP Strategy 2024 - 2029 Mombasa AYP Strategy 2024 - 2029 41 IMPLEMENTATION STRUCTURE The County Department of Health Services GBV/AYP unit shall provide leadership and coordination roles for smooth strategy implementation and monitoring. Roles and responsibilities: National government The national government will develop policies and guidelines for AYP health services. This includes offering pre-and in-service training on responsive youth service provision and related opportunities. Mombasa County departments County departments will provide a conducive environment for the healthy growth of adolescents and young people, advocating for their well-being. The County Department of Health will lead the dissemination, implementation, and monitoring of the strategy's performance. Additionally, they will allocate funds and facilitate resource mobilization for the strategy's implementation, strengthen the capacity of the health workforce and infrastructure, and enhance AYP engagement at all stages. Other Mombasa County departments Additional county departments will provide opportunities and link AYPs to skills development and employment opportunities by advocating for supportive policies within AYP programs. Adolescents and young people Youth Advisory Champions for Health (YACH) will coordinate youth champions in collaboration with county leadership to ensure the strategy's implementation and the inclusivity of all adolescents and young people in Mombasa County. YACH and county leadership will establish and strengthen youth networks across the sub-counties, promoting health interventions among their peers through peer-to-peer and other AYP-responsive approaches. AYPs will actively participate in research, policy, planning, design, dissemination, implementation, monitoring, and evaluation, with YACH playing a pivotal role in structuring its operations. Development partners The Department of Health Services will collaborate with development partners to support the strategy's implementation, formalizing this collaboration through Memoranda of Understanding (MoU). NGOs, CBOs, FBOs, and the Private sector Civil Society organizations play a crucial role in providing services and information. These non- state actors will work alongside the Department of Health Services to enhance access and utilization of health services for AYPs. They are encouraged to participate at all levels in Mombasa AYP Strategy 2024- 2029 43 the design, financing, dissemination, implementation, monitoring, and evaluation of interventions. Non-state actors should also provide technical support to enhance the skills of county staff, allocate resources to underfunded program areas, and document and share best practices through forums organized by the Department of Health. Furthermore, non-state actors are expected to ensure equity in service provision. Parastatals and corporates Parastatals and corporate entities will support resource mobilization, corporate social responsibility, and the integration of AYP-responsive policies in the workplace. They will create opportunities for employment, including scholarships, internships, and mentorships that AYPs can access. Youth groups/Organizations Youth groups and organizations will advocate for the strategy's implementation and explore innovative methods to reach AYPs, increasing access to health information and services through art, social media platforms, and other innovative approaches. Communities, families, and individuals Communities, families, and individuals will actively participate in planning, implementation, and resource mobilization, such as allocating safe spaces. They will also create a supportive environment for adolescent health programming and contribute to the strategy's successful implementation. Other corporate institutions Other corporate institutions will raise awareness and provide resources for the AYP strategy's implementation. They will also connect adolescents and young people to various opportunities. 44 FINANCING AND RESOURCE MOBILIZATION In Kenya health is critical to the welfare and prosperity of its people and health service provision is a fundamental right enshrined in Kenya’s constitution, which asserts that the right to health is a fundamental human right. Article 43 (1) (a) of the Constitution provides 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. These highest standards cannot be attained without financial investment in health resources, including human resources, infrastructure, medical supplies, and commodities, among others. Kenya runs a devolved government structure where counties are mandated to plan, prioritize, implement, monitor, and allocate resources and budgets for programmes and interventions Mobilizing more domestic funds is key in helping to ensure the sustainability of health programmes in the wake of reduced donor funding. Resource mobilization becomes an active role of all sectors in ensuring this strategy is adequately funded. The county government will develop a costed plan for this strategy that will inform development partners, implementing partners, and other investors on areas of investment. Annually, the county will review the resources allocated and used to implement activities under each strategic objective and review the costed plan for the following year. Mombasa AYP Strategy 2024 - 2029 45 COMMUNICATIONS AND ADVOCACY This section emphasises the need for communication and advocacy for the successful implementation of this AYP strategy among key stakeholders. The communication of this strategy to the relevant stakeholders will be key in getting buy-in and support for all the components captured within the scope of this AYP strategy. Dissemination will help increase the knowledge of the county citizens on the needs of AYP and their roles in the implementation of the strategy. In addition, communication will help enhance positive attitudes towards AYP seeking health services and information thus addressing stigma and discrimination that can impede uptake of services. The advocacy component will galvanise duty bearers to bring changes in order to support the goal of the strategy, i.e. to improve health outcomes for all adolescents and young people of Mombasa County. Key components in communicating this strategy will include: HIV, SRH, Mental Health, TB, cervical cancer, Disabilities, Drug and Substance Abuse and nutrition statistics of all AYP from ward, sub-county to county level. Gaps in service delivery and information such as IEC material for the disabled AYPs. Approaches in responding to health needs of AYP, including; marginalized and vulnerable AYP. Use of ICT in reaching AYP e.g. social media platforms, hotlines, digital health promotion. Role of different stakeholders in responding to the needs of AYP, youth advisory champions for health, youth groups and organizations. County leadership in HIV/SRH, Mental Health, Disabilities, NCDs, drug and substance abuse prevention and treatment, gender based violence, teen pregnancy prevention measures. 46 Audience Communication Needs Generate and provide evidence to justify resource allocation to AYP health programs. Developing county and sub-county level resource gap analysis to inform resource needs. Engage county healthand finance committees to prioritize and Implement robust and allocate funds for AYP health interventions. sustainable resource allocation Establish mechanisms for resource mobilization including Public plan. Private Partnerships Enhance efficiency and accountability in resource allocation and utilization Monitor utilization of funds allocated for AYP interventions. Coordinate and harmonize donor support for AYP healthprograms. Audience Communication Needs Awareness of AYP health needs, proposed interventions and Healthcare workers, strategies, roles of stakeholders, funding gaps, engagement and researchers, implementing accountability frameworks, strategies to reduce stigma and partners discrimination. Community gatekeepers such as Village Elders, Chiefs, Religious leaders, Awareness of AYP health needs, proposed interventions, their roles Parents / Guardians and in dissemination of AYP related information. Teachers etc. Youth led organizations and Proposed interventions and strategies, roles of AYPs, engagement partners channels, referral and reporting pathways Donors Proposed interventions and strategies, fundinggaps Update on progress and technical support required to implement the National government strategy, Integration of AYP strategy into National Health Policies Audience Communication Needs Awareness of AYP health needs, proposed interventions and CHMT, County Government strategies, roles of each department, enhance collaboration Departments between inter-related departments, funding gaps, accountability system Mombasa AYP Strategy 2024- 2029 47 Documentation of success stories and testimonies witnessing challenges are key in communicating the impact of this strategy. The communications team at county level will be responsible for training stakeholders on how to document stories of hardship and change and establish a mechanism for disseminating the stories using different platforms like blogging, social media engagements among others. In addition, all communication efforts will be linked to county ICT systems for accountability and visibility. The ICT team at county level will also support AYP to develop and implement digital and innovative communication approaches. The success or failure of this strategy will be determined by advocacy work undertaken at community, facility, countyand national level.AYP individuals, youth groups and organisations will be instrumental in aggressively advocating at grass root level with opinionleaders, MCAs, religious groups, facilities among others to reduce stigma and discrimination towards AYP seeking to access HIV/SRH services and other health services. In addition, they will be able to influence resource allocation and investment in AYP wellbeing. Concerted advocacy through youth advisory councils and other organised groups will amplify the voice of AYP in the relevant advocacyplatforms. Channels for advocacy by AYP shouldbe created at all levels to ensure feedback is provided on services and information received. Innovative approaches will be utilised by AYP to advocate for issues pertinent to their health at different levels. The use of different mobilisation strategies, including art and talents, media use, etc., will be used at the grassroots level to garner support. Community dialogues will be conducted through a peer-led approach, which will be used to address AYP-related challenges, create demand and improve uptake of health information and services. The County Department of Health will be able to advocate for the allocation of resources and funds for HIV/SRH, Mental Health, Disabilities, NCDs, drug and substance abuse prevention and treatment, Gender violence, and teen pregnancy prevention measures. The county will be able to use this strategy to incorporate AYP components into a sub-programme in the health department, plan activities, create work plans, prepare budgets and approach donors for funding support. Implementing partners will use this strategy to advocate for the provision of quality services and improved service standards across the board 48 ANNEX List of Reviewers Name Organization Dr. Swabah Omar Mombasa County Department of Health Abdallah J. Daleno Mombasa County Department of Health Dr. Shem Patta Mombasa County Department of Health Dr. Salma Swaleh Mohamed Mombasa County Department of Health Celina Kithinji Mombasa County Department of Health Zaitun Ahmed Mombasa County Department of Health Rashid Mwadzame Mombasa County Department of Health Dr. Jane Gitahi Technical Reviewer Robert Kimathi LVCT Health Annrita Ikahu LVCT Health Dr. Patrick Oyaro USAID Stawisha Pwani Jane Mutegi USAID Stawisha Pwani Dennis Mwambi Population Reference Bureau Robert Aseda NAYA Kenya Victor Rasugu NAYA Kenya Rose Nyaboke Ciheb Kenya Pauline Kedogo SOS Children’s Villages Finyange Reynold SOS Children’s Villages Taib Abdulrahman Reachout Centre Trust Mombasa AYP Strategy 2024- 2029 49 List of Contributors Name Organization Caroline Agutu Department of Health Mombasa Mwanakarama Athuman Department of Health Mombasa Austin Odaba Department of Health Mombasa Richard Chacha Department of Health Mombasa Razia Miraj Department of Health Mombasa Saadia Mohammed Department of Health Mombasa Kennedy Micheni Department of Health Mombasa Itahi Farah Department of Health Mombasa Njeri Macharia Department of Health Mombasa Amina Ibrahim Department of Health Mombasa Sarah Kiyanda Department of Health Mombasa Mulky Ahmed Department of Health Mombasa Omar Mwajama National Syndemic and Disease Control Council Lucy Mugambi AHF Linet Akoth AMURT-USAID Tujitegemee Madonna Gakii DAYO Everlyne Mtange DSW Benard Ochieng FHOK Kenya Elizabeth Okoth Grass Root Soccer Kalam Kaubu MSF Hakima Masud MSF Caroline Mugul MSF Ndinya Esther NAYA Kenya Thomas Omache one2one (LVCT Health) Leonidah Ayuma one2one (LVCT Health) Michelle Oluoch one2one (LVCT Health) Mercy Omao one2one (LVCT Health) Mercy Nzuki one2one (LVCT Health) 50 Faith Wandera PEMA Kenya Lucas Robert SEYA Youth Organization Christine Maina SOS Children’s Villages Felix Mweu SOS Children’s Villages Kahindi Garam SOS Children’s Villages Kizito Ochieng SOS Children’s Villages Evan Ouma Stretchers Youth Organization Dickson Okong’o Stretchers Youth Organization Rebecca Achieng Stretchers Youth Organization Christine Were Triggerise Richard Mathenge Triggerise Dr. Philip Masaulo USAID Stawisha Pwani Anthony Chazara USAID Stawisha Pwani Michael Gaitho USAID Stawisha Pwani Abel Omollo USAID Stawisha Pwani Cynthia Kawitha Manene USAID Stawisha Pwani Joel Omiyo Youth Advisory Champions for Health (YACH) Maryam Feisal Youth Advisory Champions of Health Bakari Kudoka Youth Advisory Champions of Health Emelda Okulu Youth Advisory Champions of Health Ismael Semboni Mohammed Youth Advisory Champions of Health Rodgers Benjamin Youth Advisory Champions of Health Samantha Halima Youth Champion Tyson Mbuvi Youth Champion Samuel Otieno Alpha and Omega Eunice Mtsonga BOMU Lovine Akinyi CYC Rajab Rashid DAYO Alfred Ambuka DAYO Abdalla Shuaib Hassan EPIC Youth Organization Zilpha Ugoh Ganjoni Youth Group James Mteri HAPA Kenya Salma Ali HISIA CBO Mombasa AYP Strategy 2024- 2029 51 Norah Mwangi ICRHK Elvis Mwinyi Impact for Youth Kenya. Abdalla Thuya Jomvu Big Family Rodgers Ouma KESCA Kilonzi Michael KESCO Ben Memba KESCO Rhoda Gakii KESCO Dorcas Waithera KWACHA Amina Bakari LKSC Geoffrey M. Arasa M.Y.O Delma M. Chihenyo Mentor Chica Initiative Evaline wanja Mentor Chica Initiative Mercy Aduda Mentor Chica Initiative Imee J. Japitana MSF Dagripina K. Toni MSF Feirunz Falz Mvita Youth Group Resnas lmran Otunga Mvita Youth Group Wilfred Gambo New Dawn Youth Africa Abigael Kaleji Niko Seti Youth Network Martha wanza Niko Seti Youth Network Phoebe Kioko Niko Seti Youth Network Clinton Ndege Pwani Youth Network Benson Karani Red Cross Amos Ngigi SEYA Youth Organization Julieh Waithera SEYA Youth Organization Judy Amina SRH Alliance Mustafa Mganga Sleak Organization Saumu Shaban Sleak Girls Organisation Fatuma Mohammed Sleak Girls Organisation Harrison Kessy Talent Ni Kazi CBO Mohammed Fadhili Tuimarike Cynthia Momanyi The Amplifiers Youth Organization (TAYO) Aisha Abdul Bakari USAPWA Mariam Mohammed USAPWA Mejuma Suleiman USAPWA 52 Rajab Abdallah USAPWA Kibwana Suleiman USAPWA CBO Maheer Yasin Youth Champion Mariam Ngoya Young Women ChristianAssociation Britney Akinyi Leave No Youth Behind CBO Sabrina Mapenzi Leave No Youth Behind CBO Maina Kennedy Likoni Rehabilitation School Mariam Musa Lend A voice Africa Dalmas Ogolla YEGB Franciscar Akoth Women reducing adolescent pregnancies (WRAP) CBO Abraham juma WRAP Edah mdzomba CWID Edith Yegon USAID Tujitegemee Saumu Hussein Pwani Youth Network Kibibi Ahmed TAYO Morgan Otieno DSW Naboth Mwambui KIOTA Ministry of Interior and National administration State Hellen Kiute department for correctional affairs - Probation and after care services Design and Layout Denis Osumo one2one (LVCT Health) Ashley Rarieya one2one (LVCT Health) Esther Karanja one2one (LVCT Health) Mombasa AYP Strategy 2024- 2029 53 REFERENCES 1. 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KANGO, 2019.Mental Health Status in Kenya. https://kanco.org/mental-health-status-in- kenya/ Ndetei David et., al 2016.The prevalence of mental disorders among upper primary school children in Kenya, January 2016.Social Psychiatry and Psychiatric Epidemiology 51(1) DOI:10.1007/s00127-015-1132-0 Mombasa AYP Strategy 2024- 2029 55 Mombasa County Government P.O. Box is 81599-80100 www.mombasa.go.ke