Access to Healthcare by Young People in Thika district (Kenya):Socio-demographic differentials in financial access and the impact on health seeking behaviour
Rajab, Jamilla Ajema
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Background: The health problems of adolescents in Africa are associated with socioeconomic conditions characteristic of the region. Adolescents are not adequately accessing and utilizing available health services due to lack of guidelines and orientations and they lack necessary economic and social means to empower them to make informed decisions to protect their health. This has been recognized as is charted out in the World Health Organization strategy for adolescent health for the African region (1). In Kenya, attention to adolescent health gained attention after the International Conference and Development (ICPD) in Cairo in 1994. A Reproductive Health Strategy with adolescent health as one of the key components was adopted as a follow up. With the development of the Adolescent Reproductive Health and Development Policy in 2003 (ARHD Policy) a concerted effort began to systemically address issues affecting young people in Kenya. Addressing risk factors that affect the health of adolescents and the youth is critical for a wide range of policies and programs because the action of this cohort will shape the size, health and property of the world's future population. Broad objective: The study was design to explore socio-demographic differentials in (age, sex, living arrangement, schooling, marital status and residence) financial access to health care by young people and the influence on health seeking behaviour specifically to determine the extent to which financial access is a barrier to healthcare among young people. Study Design: This study was conducted in Thika District, Central Province Kenya. It comprised a baseline household survey using structured interviewer filled questionnaire for the 15 to 24 age group for a total sample of 800 respondents and two limited Focus Group Discussions for vulnerable out of school adolescents, living on the street and in an institution for the homeless. Outcome Measures: The mam outcome measures were social demographic characteristics, age, gender, schooling status, marital status and living arrangement. The health seeking behaviour; morbidity patterns in last 6 months of the study, usual source of healthcare, condom use, HIV testing, antenatal care, abortion, information on morning after pill and cervical smear among females were described. Data on willingness to pay for health care, condom, HIV test, abortion and cervical smear were collected. Correlation analysis was undertaken using gender, schooling status, living arrangement, marital status and rural or urban residence to determine any statistical significant differentials in source of healthcare and willingness to pay for health services, condom use, access and willingness to pay for condoms, HIV testing and the willingness to pay for HIV test. Results: The study demonstrated the diversity in social demographic characteristics of the youth as reported in other studies. Public health facilities were the preferred source of healthcare. Majority of the youth (94.7%) were willing and able to pay for healthcare. Condom use (60%) and antenatal care (91.6%) prevalence were similar to figures quoted in other surveys in Kenya. Adolescents in this district had a higher rate of ever being tested for HIV (30%) than reported for other surveys in the country. Knowledge of cervical smear and morning after pill was low (16.7% and 30% respectively) among the young females and the study demonstrated that administered questionnaires may not be a suitable method to obtain information on abortion. Correlation analysis demonstrated gender differentials in utilization (M>F p0.01) and source of healthcare, condom access (F>M pO.006) and willingness to pay for condom (M>F p<0.05), HIV testing (F>M p<0.05) and willingness to pay for test (F>M p<0.002). There were also statistically significant differentials in schooling status in condom use (in school > out of school p< 0.05). Married youth accessed condoms from formal facilities more than the unmarried youth (p,0.05) and were significantly more likely to be tested for HIV (p 0.02). Rural youth were more likely to use condoms than urban young people (p 0.006). Conclusions: Public health facilities form the major source of healthcare for the youth in Thika District. Financial access may not be a significant barrier to health care among the adolescents and young people in this District but social demographic differentials are evident especially for gender in utilization of public facilities, HIV testing, condom use and access. Differentials were also demonstrated within marital status and HIV testing. Urban youth were more likely to use condoms than rural youth. Interventional programmes designed to improve financial access to healthcare in Thika district will need to take these differences into consideration for optimum impact.