ICRHK manages the UNFPA project portfolio, focusing on three core areas: Sexual Reproductive Health (SRH), Gender Based Violence (GBV) prevention and response, and maternal and child health services for adolescent first-time young mothers (FTYM). Additionally, it extends HIV services to key populations, particularly female sex workers in the operational counties. Collaborating with UNFPA and the Ministry of Health’s division of reproductive and maternal health, ICRHK strengthens reproductive health commodity security and supply-chain management to guarantee the secure last-mile delivery of services.
The KP (Key Population) Female Sex Workers project
The KP program implemented in Kilifi County provides comprehensive SRH services to female sex workers who may experience a higher risk of HIV infection, sexual and gender-based violence, and other adverse SRH outcomes related to cervical cancer screening, and access to family planning. Services are provided at the safe spaces, also known as drop-in centres (DICs) operated within the county government structures. The partnership with the county government enables the linkage and referral of services to government public health facilities for TB management, and ANC services among others. SRH commodity supply (family planning), data reporting and management, and support supervision to ensure the quality of services is provided by the sub-county officers.
Supply Chain Management and Last Mile Assurance
The Ministry of Health, Division of Reproductive and Maternal Health in collaboration with UNFPA, and ICRHK has been working towards strengthening the reproductive health commodity security, to increase the effectiveness of the supply chain management and ensure last-mile assurance, thereby increasing equitable access to family planning for all. ICRHK under UNFPA works to support the Ministry of Health functions, both at the County and National levels.
First Time Young Mothers (FTYM) project
The FTYM project is designed for adolescent first-time young mothers who are pregnant for the first time or have delivered their first child. The project is implemented with the Mtwapa sub-county hospital, formerly known as Mtwapa Health Center, and is focused on providing an individualized care model to the mother and child, with the goal of reducing the risk of maternal mortality and improving maternal and child outcomes. It targets increasing hospital versus home deliveries, optimizing child welfare clinic attendance, immunization, post-partum FP (PPFP) uptake and other social outcomes for the mother, child and the community. The individualized care package includes mentor mother care follow-up for PMTCT mothers, peer-to-peer referral, and CHV referral home-based follow-up.
The GBVRC program
Implemented at the Coast General Teaching and Referral Hospital, the Gender-Based Violence (GBV) and Recovery Center provides an integrated model of services for sexual violence survivors. Clinical response services and linkage, within the hospital occurs, in addition to counselling services, especially psychosocial support with emphasis on child therapy based on the fact that the majority (over 80%) of survivors are children below 18 years. A legal support system consisting of community paralegals is attached to the centre, and they link survivors to the police gender desks and also help to follow up cases in court. Between May 2007 and March 2023, the centre provided SGBV responses to 9,640 survivors.
The Costing Study- First Time Young Mothers (FTYM) project
The overall objective of this study was to estimate the unit expenditure for FTYM services delivered at the Mtwapa Sub-County Hospital, formerly Mtwapa Health Center. The analysis was undertaken from a program perspective using step-down costing methods. The unit expenditure per person per year is the cost of providing one FTYM with SRH and HIV services for a full 12 months.
The overall unit expenditure per FTYM per year was $404.119 (equivalent to Ksh 40,419). The largest cost drivers were supplies which represented 59.2% of all costs, followed by meetings and personnel costs which accounted for 17.10% and 13.3% of all costs respectively. We further analyzed expenditure data by visit.
The mean unit expenditure per visit for the FTYM services ranged from $3.73 to $100.48 per visit. The largest cost driver in the FTYM program was supplies which represented 59.2% of all costs. This was followed by meetings and personnel costs that accounted for 17.10% and 13.3% respectively of all costs. We found considerable variation in the unit expenditure per month with the highest unit expenditure being 100.48 and the lowest $3.73.
The findings did not find a clear relationship between scale and unit expenditure although the month that the highest number of FTYM visits (391), exhibited the least unit expenditure. We did not establish a consistent pattern of the effect of scale (number of FTYMs) and the unit expenditure. While the study provided an important characterization of the costs of the FTYM’s program services, further research and analysis of these data is required to examine the determinants of costs, including whether the extent of integration has an impact on the costs