Inclusive Reproductive Health For Deaf Adolescents

Globally, adolescent’s health is gaining momentum after being overlooked historically by the health and development communities. Adolescents are now being recognized as a critical demographic cohort full of promise and potential. According to recent UN figures, 1.8 billion adolescents aged 10-19 years old make up more than 16 per cent of the world’s population[1] with 10–14-year-old females and males accounting for 8 % each respectively[2]. With an expected rise in the population to about 95 million people by 2050, decreasing birth rates and falling dependency rates, Kenya is set to be one of the countries that will benefit from the demographic dividend if managed effectively. To fully secure the opportunities apparent in the demographic dividend, the rights of adolescents to the highest attainable standard of health must be upheld according to the Constitution 2010 and Children’s Act 2021. 

In Kenya, efforts to improve health systems have focused on increasing access to Adolescent and Youth Friendly Service (AYFS) provision and the expansion of service delivery in response to the Reproductive Health (RH) issues. The National Adolescent Sexual and Reproductive Health Policy in Kenya (ASRH Policy 2015) and its implementation framework (2017-2021) advocated for delivering Comprehensive Sexuality Education, ensuring access to quality Adolescent SRHR services including HIV testing,STI treatment and management, contraceptives and SGBV

Despite this progress,inadequate capacity of healthcare workers to provide timely and responsive services to young deaf adolescents has contributed to poor SRH outcomes. At the community level, the prominence of culture, religion and tradition in ASRH issues continues to limit ASRH.In school some messages conveyed to students are focused on abstinence, emphasizing that sex is immoral for young people. The teachers in special schools hold beliefs that making contraceptives available encourages  deaf adolescents to have sex.Together, these norms and practices continue to limit constructive conversation about ASHR. At the family level, parents, caregivers/family members shy away from discussions on sexuality education, supporting Young Deaf Adolescents to access SRH information and services due to religious and cultural beliefs.Very young adolescence is a critical window of opportunity for investment to promote health and positive development. However, if these young adolescents’ SRHR needs go unaddressed, they face risks (high rates of HIV transmission, unsafe abortion, pregnancy,STIs,) resulting from unmet needs for SRH services.It's estimated that about 1800 Deaf girls drop out of school annually due to early and unintended pregnancy with Kilifi (21.8%),Nairobi(33.3%),Siaya (17.2%)emerging as hotspots.They bear the brunt of the HIV epidemic due to limited access to information, services, stigma and discrimination.29%of all new HIV infections are among adolescents.Further, they also experience other SRHR related issues;GBV and harmful traditional practices.7%of females and 3% of males in this age group have experienced GBV and 4% and 1%,respectively, had the experience by age 15. Six percent of  Deaf adolescents who have ever been pregnant have experienced some form of physical violence during pregnancy.

The innovation targets 3 counties of Kenya( Kilifi,Nairobi,Siaya) with the highest proportion of young Deaf adolescents but with low access to disability responsive SRHR information, services and commodities.

The innovation Improves SRHR for Young  Deaf Adolescents by using the socio-ecological model to address SRHR needs of Young Deaf adolescents at individual level by addressing their cognitive, emotional and biological factors that influence their attitudes and behaviors towards access to SRHR information, commodities and services. Their health seeking behaviours and attitudes intersects with the health systems especially the health care providers who sustain or bar young Deaf adolescents' uptake of services. At the family level, we will focus on improving awareness and strengthening relationships with parents, caregivers, siblings, and intimate partners since they have effect on adolescents SRH outcomes including abilities to articulate and realize their goals.We will engage community level influencers to provide social support in cultivating an enabling environment for young Deaf adolescents to access SRHR information and services. Religious and community leaders, teachers, health care providers and peers have influence on young Deaf adolescents’ attitudes, beliefs and decisions. They also play a critical role in forming and reinforcing social and gender norms. Lastly, we will collaborate with actors using the multi-stakeholders and multi-sectorial approaches to meaningfully contribute to improved systems, policies and strategies particularly in health, education and child protection to ensure availability of high quality, confidential and non-judgemental, non-discriminatory  SRHR service delivery to young Deaf adolescents. Leveraging the teachers training on psychology and health care and with support from the county health department, we will use the dispensarization approach classify Deaf adolescents  into 3 categories based on their SRHR risk profile (i) healthy, (ii) at risk and (iii) affected. The healthy category will receive promotive SRHR including mental healthcare services, adolescents at risk of adverse SRHR outcomes will receive preventive and responsive interventions and those affected will be offered rehabilitative health services. Secondly, our project will segment young Deaf adolescents based on their needs such as deaf adolescent mothers who need responsive and risk sensitive SRHR services, deaf adolescents of single parents who are more vulnerable than those from both parents and young adolescents  in children institutions. We will use the Human Rights Based Approach (HRBA) principles: We view human rights as the primary frame for the health and development work that we do. In this project we will ensure that our interventions are aligned to the rights of children as stipulated to the Children’s Act 2021. We will leverage on existing partnerships with agencies such as NGEC, Gender Directorate, Directorate of Children’s services and Kenya Rights Commission to advance the protection and promotion of rights of young deaf adolescents. Additionally, this project will be anchored on the principle of leave no one behind by targeting counties which have poor VYAs SRHR outcomes by strengthening inclusion. We will leverage our experience in reaching PWDs through its participatory approaches including review of the health information system and data collection tools to ensure inclusion of key VYAs indicators, use of Washington Group of Questions to promote disability inclusion, embedding of social inclusion and gender in county planning and design of SRHR services for YDAs

The innovation primarily serves young Deaf adolescents(YDAs) between the age of 10-14 years old who bear the burden of poor SRHR outcome due to inaccessible SRHR information, services and commodities. They will benefit from improved accessibility to inclusive, high quality, non-judgemental and non-discriminatory sexual and reproductive health information, services and commodities at individual, and community levels in the target counties of Kenya-Offering disruptive solutions that will yield (i)Behavioural transformations(behaviour change+behaviour formation) (ii)health systems strengthening to address SRHR expedited lasting change.

The proposed outcomes take into account the engagement and support of multi-sectoral input to fulfill their responsibilities. Further, our outcomes have placed a high premium on young deaf adolescents’ behaviour and attitudinal change as they transition from early adolescence(10-13 years)to mid-adolescence(14-16 years) and their (key enablers);community members; female and  male including health service, parents, religious leaders, educational institutions who benefit from improved capacity, facilities of hospitals, technical capacity of health staff, to continue providing inclusive, accessible, non-discriminatory SRHR services, and commodities  to young persons with disabilities beyond the project enabling YDAs access SRHR information, services and commodities at the family, community, county and national levels beyond

The Deaf Empowerment Society of Kenya has with time developed eclectic experience in disability and inclusion, language, social value, participants behavior and attitudes.The key staff have a combined 52.5 years (An average of 7.5 years) experience in SRHR, and disability socio-economic development. The Founder and CEO Ireri  and Co-founder Joy Kanana have a disability themselves living among the disabilities, are more capable for smooth delivery of this disability-specific innovation because they have excellent understanding of the underserved population the innovation serves and they're  the Team Lead in the innovation and were key in working with young deaf adolescents in ideation and design of this SRHR innovation, as well as  identifying key partners and stakeholders, developing scaling and sustainability model and providing overall direction and leadership to the team.

With over 3 years working in the field, DESK has created a name that people trust and respect. DESK hires outreach workers and trains disabled Educators/ToTs  from within the communities DESK wish to serve, which further reinforces its commitment to representing and serving the disability community members more effectively and efficiently.

DESK team has been working with various organizations of persons with disabilities and young deaf people for several years now and has established excellent relationships  and connections with Deaf children, parents, communities, and schools, as well as education and health officials at county and national levels. This experience, together with expertise developed over many years in this field, lead us to believe that the design and delivery of the innovation will be a success which would have a significant impact on the SRHR of the population we serve.

Additionally, Deaf children, adolescents, and youth are not just beneficiaries of the innovation, they contribute to the design and implementation and we regard them as project participants. They were  consulted during the pilot project about lessons and approaches to inclusive SRHR that appear most useful and sensitive. Additionally, the varying needs of young deaf adolescents, by age, vulnerability, poverty, disability type, were acknowledged and specific attempts will be made to address their differing SRHR needs during the delivery of the innovation

DESK periodically provides refresher courses to staff, structured supervision, recognition and ongoing mentorship. DESK further has strong finance and human resource processes and systems to enable program staff and organization to meet donor expectations and cost-effectively deliver the innovation. DESK offers upward mobility, whereby many of the regular staff were previously educators. Three senior staff at DESK have worked since its inception; this has helped with program continuity and institutional memory.

The innovation serves approximately 5,500 young deaf adolescents(50% of whom are female)  as they transition from early adolescence(10-13 years) to mid-adolescence(14-16 years) and  their enablers(2300) to access SRHR information, services and commodities at the family, community, county and national levels.

The innovation strategies will use the Human Centred Design to design desirable interventions with the young Deaf adolescents(YDA) as they transition from early adolescence(10-13 years) to mid-adolescence(14-16 years) and their enablers to access SRHR information, services and commodities at the family, community, county and national levels. This innovation will leverage experience from the SRHR project implemented  delivered Comprehensive Sexuality Education (CSE) through different channels designed using HCD. Therefore, we will prototype, pilot and scale CSE delivery channels targeting young deaf adolescents including visuals, and print comic targeting young deaf adolescents and digital delivery channel dubbed Deaf eLIMU Plus mobile app and  open-source software games for Young Deaf adolescents to allow young Deaf people to instruct their peers about health issue presented via video-clips in Kenya sign language to communicate common statements about SRH health issues.

We envision that the prototyping, piloting will generate insights to inform iteration and scale up of the proof of concept. Secondly, the Kenyan government introduced the Competency-based Curriculum (CBC) in 2017 where the VYAs (10-14 year olds) have been categorised within the middle-school education. Parents and teachers have a critical role in ensuring the curriculum is offered effectively to the adolescent. Therefore, we will anchor our program by collaborating with trained health teachers in special needs schools to advocate for health days within the school calendar where  young deaf adolescents can be offered ASRH information and referred for services. Additionally, during these health days, we will collaborate with teachers and adolescents with disabilities to participate in edutainment and games, festivals and competitions that will integrate SRHR  information and service provision. At the community level, we will leverage on the existing Nyumba Kumi structure that was originally established by the Government to strengthen security to be a channel of ASRHR information delivery to parents, care givers and authority figures. We will partner with parents, care givers and authority figures as champions for ASRHR who will support to create an enabling environment for the young Deaf adolescents  to realize their SRH needs. We will also develop the first ever disability-friendly WhatsApp Chatbot to reach parents, guradians/caregivers  of young Deaf adolescents with meaningful ASRH information and resource materials. Thirdly, we will ensure that young deaf adolescents  are at the core of the innovation’s design, execution, evaluation and policies/strategy development and dissemination at the county and national levels.

Impact goals for the next year

Develop an age-appropriate Disability-responsive Comprehensive Sexuality Education and life skills materials ( posters & print comic magazines )for young deaf adolescents engagement, discussion and learning(Indicators:type of SRHR materials developed)

Train 200 young deaf adolescent champions as CSE educators to deliver life skills sessions to  their peers in school and community (Indicators:#of young deaf adolescents trained on ASRH disaggregated by gender)

Map high burden teenage pregnancies schools and empower teachers/ Peer champions to Integrate Life Skills and Social Emotional Learning psychosocial interventions sessions(Indicators:# of special needs schools mapped,%of teenage pregnancies, LSSELP interventions sessions integrated )

Conduct 6-monthly  review meetings/forums with CSE Educators to  strengthen the capacity of educators, address challenges and provide support supervision in collaboration with health management teams(Indicators:#of review meetings/forums with CSE educators held, Meeting notes)

Conduct training needs assessment on provision of deaf adolescent - friendly SRH services among health care providers( Indicators:Comprehensive Assessment report)

Map out and link Deaf adolescents to SRH service delivery points/channels for SRHR services(Indicators:Service delivery points mapped,% of deaf adolescents successfully linked to delivery channels)

Identify and train 150 parents/community champions on SRH  to support community engagements(Indicators:# of champions trained on ASRH disaggregated by gender)

Support quarterly intergenerational parent community dialogues that challenge social norms and impede access to SRH(Indicators: Dialogue schedule, Dialogue agenda)

Conduct inclusive stakeholder engagements through media including young persons with disabilities to disseminate SRH messages targeting parents and caregivers(indicators: # of inclusive stakeholders engagements conducted, Media recording (audio and video),% of parents/caregivers reached)

Produce and distribute SRHR IEC materials(Intervention protocol, information booklet, guidelines) for HCWs, health teachers' counsellors, caregivers to enable them provide gender responsive and disability friendly services(Indicators: type of tools produced, distribution plan)

Impact Goals for the next 5 years

50,000+ young deaf adolescents exhibit knowledge, positive attitudes and Life Skills as a result of responsive Comprehensive Sexuality Education and life skills materials and 70% report to have better capacity in making informed SRHR choices(Indicators: Skills acquisition assessment report, Rate of behavioral and attitudinal change, Case studies, Testimonials from Adolescents)

5900 health care providers have  demonstrated adequate capacity and competency on disability-responsive AYFS provision, APOC, ART and SGBV and report to have  provided deaf-adolescent responsive, high quality, non-discriminatory SRH services (ART, SGBV, HIV Testing, contraceptives ) to young deaf adolescents( Indicators: Checklist for Friendliness of ASRH service at the health facilities to deaf clients, Client exit interviews reports)

15000+ care givers/parents/champions exhibit preparedness and empowerment to communicate positively and pro-actively SRHR skills  providing an enabling  environment for YDAs for them to access SRHR information and services(Indicators: Case studies, Testimonials from Adolescents and champions)

15000+ parents and care givers demonstrate SRHR skills  to support SRHR needs of YDAs through production and dissemination of disability sensitive  and gender-sensitive SRHR messages and IEC materials and young deaf adolescents report to access inclusive, equitable, high quality, and non-discriminatory SRHR service(Indicators: Case studies, Change in norms, Testimonials from Adolescents and parents)

The innovation ’s Theory of Change (ToC) asserts that 50,000 young deaf adolescents will have increased Knowledge, Positive attitudes and Life skills to make positive SRHR choices if we support age-appropriate knowledge and value-based life skills education to make informed and healthy decisions about their sexuality by providing adolescent-centred and participatory activities. Therefore the innovation will  use Life skills education toolkits to close gaps in knowledge and explore attitudes that teachers or facilitators may have about puberty, sexual and reproductive health, gender, sexuality and other relevant topics. 

The innovation’s ToC stresses that a community-wide approach where community members deaf have the knowledge, skills and support to young deaf adolescents to access SRHR information, services and commodities ; As a primary caregiver and one of the most important sources of information for young adolescents, parents should be prepared and empowered to communicate positively and proactively with their adolescents. Teachers and adult relatives including siblings may also be critical resource people for young adolescents in providing SRH  information and providing enabling environment for them to access SRHR and mental healthcare services. However, these young adolescents’ influencers shy away and express feeling uncomfortable or lacking the knowledge to discuss SRH including puberty, sex, gender and other topics.  Therefore, our the innovation will empower parents, caregivers and authority figures to understand and embrace the SRHR needs of young deaf adolescents 

Further, the innovation's ToC stresses that strengthening health system to respond to SRHR needs of young deaf adolescents.The target 3 counties still face numerous challenges in ensuring efficient child protection mechanisms. Implementation of comprehensive child protection legal framework and strategies is limited, low health systems responsiveness to VYAs for SRHR needs especially due to capacity gaps among health care providers, health care workers attitude and stock-outs of essential SRH commodities that hinder VYAs access to SRH services. Additionally, poor adherence to procedures and standards on prevention of SGBV, limited budgets to support child protection mechanisms, weak structure and capacity among child protection officers, undefined linkages between Justice and Social and psychological support and limited data and monitoring system, including data on violence against children and young adolescents  are some of the major structural challenges. Therefore, our innovation will prioritize strengthening health and child protection systems to provide integrated health services to the very young adolescents and implement innovative positive youth development approaches that promote social inclusion in accessing SRH  information and services.Thereafter, the innovation will train  health care providers on AYFS provision, APOC, ART and SGBV in order to provide adolescent responsive, high quality, non-judgemental, confidential, non-discriminatory SRH services, information and commodities to young deaf adolescents in all target counties.

Currently DESK has a team of 12 employees. Of the 12, 10 are full time staff, and 2 are part time staff. We have two contractors supporting the team in disability friendly SRHR program design, materials development, community engagement, and outreaches, MEL, procurement, organizational capacity strengthening and development,

We at the Deaf Empowerment Society of Kenya(DESK) have been actively working on our innovation for close to 3 years now. For the past years, we have made significant strides in improving SRHR outcomes for deaf people 

DESK's core strength is its excellent understanding of the people it serves and its practical approach to finding solutions to problems experienced by the Deaf.This strength is rooted in the fact that most of its staff is composed of disabled professionals with lots of anecdotal memoirs and testimonies of rights abuses, personal experiences and relevant education background which is harnessed throughout solution

DESK strives to model the ethics it values as a mission-driven to better integrate and promote a Diversity, Equity, and Inclusion (DEI) approach in all its undertakings. 

1. Assess and track DEI data: DESK regularly gathers and track data on the diversity of its staff, board, and leadership. This can help identify areas of improvement, and track progress over time.
2. Develop an DEI policy: DESK has developed and, is  implementing an EDI policy that outlines its commitment to promoting diversity and inclusion within the work place
3. Prioritize DEI in hiring: DESK prioritizes diversity when hiring new staff and leadership. This includes actively seeking out diverse candidates(PWDs, youth, women), removing barriers to entry, and providing training and support for new hires from underrepresented groups including persons with disabilities, women and youth
4. Foster a culture of inclusion: DESK creates a workplace culture that values and promotes diversity and inclusion. This includes providing orientation/training for staff, creating employee resource groups for underrepresented communities, and promoting open and inclusive communication.
5. Engage with diverse communities: DESK actively engage with the diverse communities it works with and serve. This includes building relationships and connections with organizations of persons with disability, community organizations, CSOs, seeking out feedback from diverse stakeholders, and ensuring that its programs and services including SRHR/GBV are accessible and relevant to diverse communities including PWDs, women, youth, older people)

Our business model: 

Our business model is centered around delivering value to underserved young deaf adolescents aged 10-14 years old in Kenya while engaging, educating and linking young deaf adolescents aged 10-14 years  to inclusive, high quality, non-judgemental and  non-discriminatory,  sexual and reproductive health and rights information, services and commodities using the socio-ecological model and the human development model. 

Key Customers and Beneficiaries: 

1-The primary beneficiaries will include  young Deaf adolescents between the age of 10-14 years old  who will benefit from improved accessibility to inclusive, high quality, non-judgemental and non-discriminatory sexual and reproductive health information, services and commodities at individual, and community levels in the target counties of Kenya 

2-Community members; female and  male including , healthcare providers, parents and caregivers, religious leaders, educational institutions who will benefit from improved capacity, facilities of hospitals, technical capacity of health staff, justice and police to continue providing inclusive, accessible, non-discriminatory SRHR services to persons with disabilities beyond the project.

Products and Services:

-Age-appropriate and disability-responsive  Comprehensive Sexuality Education(CSE) curriculum and life skills materials ( posters & print comic magazines, CD/DVD, )for VYDAs engagement, discussion and learning

-SRHR IEC materials and creative educational tools (Intervention protocol, information booklet, guidelines) for HCWs, health teachers' counsellors, caregivers  to enable them provide gender responsive and disability friendly services

-Capacity building Workshops: 1) health care providers capacity building on AYFS provision, APOC, ART and SGBV in order to provide deaf-adolescent responsive, high quality, non-discriminatory SRH services, 2) capacity building of parent/community champions  to create an enabling environment for the young Deaf adolescents  to realize their SRH needs engagements, 3)Training of YDA champions as CSE educators to deliver life skills sessions to  their peers/ VYDAs in school and community , 4)empowerment of Special Needs Teachers/ Peer champions to Integrate Life Skills and Social Emotional Learning psychosocial interventions sessions 

- Deaf eLIMU Plus mobile app and  open-source software games for Young Deaf adolescents to allow young Deaf people to instruct their peers about health issue presented via video-clips in Kenya sign language to communicate common statements about SRH health issues.

-Disability-friendly WhatsApp Chatbot to reach parents, caregivers  of young Deaf adolescents with meaningful ASRH information and resource materials

Revenue Model: DESK operates as a non-profit organization. We generate revenue through a combination of grants, donations, and partnerships with philanthropic organizations, NGOs, and governmental bodies at local and international levels. These funds are used to cover operational costs.  Additionally, DESK generates revenue through other avenues such as(provision of consultancy services to public and private sectors, sale of our products (magazine, comic books, DVD/CD, branded T-shirts)  Event charges(entry fee, registration fees, membership fees)

DESK strives to maximize impact and reach while maintaining its own financial stability

DESK currently has 3,000 members registered in its database. After 5 years, the project postulates 10,000 PLWD will be members of the centre with an annual membership fee of $5. Within 5 years an estimated membership revenue of $50,000 per year excluding any social value and revenue domino effect. An estimated further $15 on training per member and access to premium services and support will be generated per member per year, thus $150,000.

The database will also form a platform to engage Government, service providers and companies wishing to target Persons with disabilities through analyzing health product demands and inducing demands. Within 5 years, an estimated 100 companies will be partners and 20 leverage the database and network to access the beneficiaries. A projected $500 will generated per company per year, thus $50,000.

One SRHR and Talent show fair for young persons with disabilities (PWDs)will be organized per year. Within the fifth year an estimate 2000 will be in attendance with an entry of $3 per day and 100 exhibitors and merchandisers each $100. This will generate an additional $16,000/year.

DESK will give consultancy services for PWD and non-PWD seeking health care, Kenya sign language, counseling ,and mental health support and sell products(DVD/CDs, posters and print comic magazines) at a fee. The charges will go into funding strengthening the capacity of other young deaf people and offering mentorship support. Additionally, the hub will offer consultancy services to CSO, DPOs, private organizations and county and national governments on PWD social welfare and welling support services and bid for consultancy services on marginalized groups, including undertaking research. 30% of generated profits will go to strengthening capacities of additional VDA and Organizations of Persons with disabilities on SRHR, advocacy, research and development to maximize our reach and impact, and 60% will go to organization's operations and administration 

Further, we explore meaningful synergies and partnerships  with foundations and philanthropic organizations whose missions align with ours who in turn  provide long-term funding for our innovation

Most importantly, by having a sustainable means of expanding our reach and  impact, donors and funders are eager to invest because they can clearly measure their impact on a per dollar basis enabling DESK to maintain its own self-sustainability model