Rafiki Centre for Excellence in Adolescent Health, western Kenya
Adolescence is an influential period of development and a critical time for laying the foundation of good health; during this life stage, adolescents establish practices and relationships that can be protective against, or put them at risk of, poor health outcomes. To grow in good health, adolescents need age-appropriate comprehensive sexuality education, and opportunities to develop life skills in a safe and supportive environment. As well, they require accessible, appropriate, acceptable, equitable, and effective health services. This is especially the case in sub-Saharan African countries, like Kenya, where adolescents carry a higher burden of disease and face more hurdles to accessing and using health services than many of their counterparts in resource-rich contexts.
Young people in Kenya urgently need health services that are responsive to their circumstances and “adolescent-friendly” to prevent unwanted health outcomes, such as acquiring HIV, undesired pregnancy, and to support their overall mental health and well-being. Investing in adolescent health in Kenya is an investment in empowering young people to transform their communities and make vital contributions to the progress, growth, and development of nations.
The Moi Teaching and Referral Hospital (MTRH)-Rafiki Centre for Excellence in Adolescent Health, was established in 2016 in Eldoret, a city of about 475,000 people, in partnership with the Academic Model Providing Access to Healthcare (AMPATH) Kenya. The Rafiki (Swahili for “friend”) Centre is a combined adolescent medicine and research clinic that aims to become a “one-stop shop” for the provision of reproductive health, mental health, chronic disease management, HIV prevention and treatment services, and life skills for adolescents at no cost to young people in this region of western Kenya. As explained by Hilda, an adolescent peer mentor at Rafiki, “Rafiki offers the best friendly services in Kenya that accommodates all issues that we face as adolescents. Also, the staff at Rafiki value confidentiality, they are non-judgmental.”
Mount Sinai partners with AMPATH Kenya, Moi University, and Moi Teaching and Referral Hospital to advance adolescent health in western Kenya.
Currently, the Rafiki clinic primarily delivers HIV-related services, including peer support groups and educational sessions, to young people living with HIV and those who are in street situations, serving nearly 1,400 young people annually. The Director of the MTRH-Rafiki Centre for Excellence in Adolescent Health, Irene Marete, MBCHB, MMED, remarked “The health care workers in the clinic have over time bonded with the young people due to the friendly health services they offer, at the same time maintaining professionalism in their work.”
The Arnhold Institute for Global Health has established a 10-year strategic plan to grow adolescent and youth-friendly services in western Kenya. Starting with the Rafiki Centre for Excellence, efforts are ongoing to expand the existing infrastructure to provide comprehensive and integrated care to all adolescents free-of-charge, regardless of HIV, housing status, or other characteristics. Comprehensive and integrated youth-friendly services, encompasses providing holistic care across clinical specialties, including primary care, infectious disease, sexual and reproductive health, nutrition, and psychiatry, among others.
Longer term, the Institute envisions the Rafiki Centre as a “referral” point in the health system, with additional adolescent health service delivery points throughout the over 300 clinic sites in the AMPATH catchment areas. Dr. Marete envisions that “the Rafiki clinic will become a ‘one stop shop’ offering high-quality adolescent health care services—the first of its kind in Kenya.” Some young people, such as Whitney Biegon, a peer researcher at Rafiki, already consider it a full-service clinic: “One-stop shop is what comes to my mind when I think of Rafiki Centre, where adolescents and young adults can access care and treatment services, co-curricular activities as well as networking with fellow adolescents in their free time. We believe that young people are our future, hence empowering them to greater lengths is paramount under one umbrella.”
To advance this vision, there remains significant need and work to be done to ensure that the Rafiki Centre becomes the first of many places for adolescents and youth to get the care they so direly need in western Kenya free of charge. In partnership with our collaborators in Kenya, the Institute is up to the challenge and prepared to advocate, research, and lead with care to ensure young people can get the health services they need to achieve good health.
Ashley Chory, MPH, is the Global Youth Health Senior Program Manager at the Arnhold Institute for Global Health; she is responsible for overall strategic leadership for the Department and Institute’s Global Adolescent Health programs.
Lonnie Embleton, PhD, MPH, is an Assistant Professor and Adolescent Health Advisor at the Arnhold Institute for Global Health at Mount Sinai and for the Department of Global Health and Health System Design. She is responsible for conducting research addressing the health and needs of adolescents and youth, specifically underserved and marginalized people.