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Improving referral systems for adolescents with mental health disorders in Nairobi

By Simeon Kintu Paul Adolescent mental health challenges are considered a significant global concern. Adolescents and youth frequently face challenges that affect their mental and general well-being, yet support for addressing their mental health needs remains minimal. In their quest for psychological assistance, adolescents frequently encounter barriers such as stigma, discrimination, and inadequate referral mechanisms. These challenges often leave them without receiving the support they need, hence hindering their ability to thrive. Why are adolescents not receiving adequate support? In 2024, the African Population and Health Research Center launched the “Improving Referral for Adolescents with Mental Health Disorders in Nairobi” (RAMH) project. For a year, the study worked to develop a deeper understanding of the adolescent mental health ecosystem by establishing gaps in the referral pathways for adolescents with mental health disorders. The scope of work also included establishing awareness of the availability of adolescents and youth-friendly services (AYFS). The study established that in addition to knowledge gaps, adolescents also encounter barriers to accessing care due to stigma and financial constraints. The results indicate a pressing demand for accessible mental health services, informed community stakeholders, including religious leaders, and effective referral mechanisms between community stakeholders, guidance and counseling teachers, and professional mental health services providers to facilitate timely intervention. They also highlight the urgent need for more robust mental health support systems within the communities to ensure adolescents receive timely and effective care and support. Findings from the RAMH study reveal that the stigma surrounding mental health remains a significant obstacle to seeking care and support. Many adolescents and their families hesitate to seek help due to perceived or actual societal judgment, which perpetuates fear of speaking up (and help-seeking) and neglect. Additionally, the lack of knowledge regarding the mental health issues affecting them and the available psychosocial support services means that adolescents and their caregivers often do not know where to seek help. Even when they do, the referral systems are frequently unclear, underdeveloped, or unresponsive, hence creating further delays in accessing care. Studies show that teachers and religious or faith leaders are often the first point of assistance for many young people experiencing emotional and psychological distress. However, interviews conducted with religious leaders, guidance and counseling teachers, and resident school nurses revealed a substantial gap in knowledge and resources to address adolescent mental health challenges. This uncertainty stems from inadequate training, insufficient resources (youth-friendly centers), and a lack of clear referral pathways. These factors significantly hinder the ability of community stakeholders, guidance and counseling teachers, and professional mental health services providers to provide meaningful support to adolescents whenever they experience psychological distress. Why collaboration is key: The role of community stakeholders Strengthening the capacity of these ‘first-responders’ could help positively transform mental health outcomes for adolescents and society in general. For instance, faith leaders may be trained to recognize early signs of mental health challenges or psychological disorders and are equipped with the knowledge about available referral services. Ensuring community leaders have the expertise and resources to support adolescents is crucial in strengthening referral systems. Similarly, the government may establish a collaborative system where guidance and counseling teachers, school nurses, and professional mental health services providers work together to create a seamless support network. Such a collaborative approach would ensure that adolescents receive consistent and timely support, thus reducing the risk of falling through the cracks. Recommendations for Strengthening Mental Health Referrals Creating an enabling environment for mental health-seeking and care provision for adolescents requires the implementation of specific practical and actionable recommendations. Firstly, it is crucial to invest in training relevant community stakeholders, such as religious or faith leaders, and guidance and counseling teachers. These individuals often serve as trusted sources of support for adolescents and can play a crucial role in identifying mental health challenges early. Providing comprehensive training would equip them to recognize signs of psychological distress, offer initial guidance/support, and direct adolescents to appropriate professional care. In addition, establishing clear and structured referral mechanisms is very important. Adolescents and their families need simple, well-defined referral pathways to navigate the system and connect with professional mental health services. Such mechanisms ease the process for those seeking help and empower community stakeholders to make timely and effective referrals. Raising awareness within the community is another fundamental step. Public education/awareness campaigns can help demystify the stigma surrounding mental health, which often prevents adolescents and youth from seeking help/support. Such initiatives include school-based programs, media campaigns, community sensitization, and engagement with youth-focused organizations, including youth centers, to foster open discussions on mental well-being. These initiatives can foster a culture where mental health is openly discussed and prioritized, creating a safe space for adolescents and youth to reach out for help without fear of judgment. Equally important is ensuring that mental health services are both accessible and affordable. Currently, mental health services for adolescents in Nairobi, such as youth centers, remain largely underfunded, with limited resources allocated to specialized adolescent mental health programs. Findings from the RAMH Project indicate that many existing services are not easily accessible due to financial constraints, often discouraging adolescents and their families from seeking professional care. Additionally, inadequate (or lack of) funding affects the availability of trained mental health professionals and the development of structured referral systems. Addressing these gaps requires increased budgetary allocations to support subsidized services, mental health integration in schools, and improved referral networks (pathways). Policymakers are responsible for enacting policies and allocating resources that make quality care available to all adolescents, regardless of their socio-economic background/status. These policy actions may include subsidizing services, expanding mental health coverage in insurance schemes, or increasing care availability in underserved areas. Finally, collaboration among stakeholders is key. Partnerships between community leaders, healthcare providers, and policymakers can foster a more unified approach to adolescent mental health care. By working together, these groups can develop stronger and more responsive policies and guidelines, build stronger referral networks, and avail the necessary resources to ensure that every adolescent in need receives timely and practical support. These collective actions address existing challenges and lay the groundwork for a more inclusive and supportive mental health system for adolescents. A more supportive future The future of adolescent mental health depends on collective action. By empowering community stakeholders and fostering collaboration, we can build a support network that effectively addresses the mental health needs of young people. The findings of the RAMH Project highlight the importance of a well-informed, collaborative, and resource-rich approach to mental health care. These findings highlight the need for strengthened referral systems, increased community involvement, and better resource allocation to ensure adolescents receive timely and adequate mental health support. Let us unite to create a community where stigma no longer silences those in need and where adolescents receive the support they deserve. Together, we can have a meaningful impact by ensuring that the health system and the community prioritize every adolescent’s well-being. Simeon Kintu Paul is a Research Officer at the African Population and Health Research Center. A trained psychologist, his work focuses primarily on mental health research.

Balancing AI and Human Agency in Education

As we mark the International Day of Education 2025, the convergence of artificial intelligence (AI) and human learning presents an unparalleled opportunity and a profound challenge. This year’s theme, “AI and education: Preserving human agency in a world of automation,” invites us to critically assess how this transformative technology reshapes education while safeguarding the core values of human development and agency.  Over the past decade, we have witnessed significant changes in the education sector. Classrooms have been dramatically transformed with the adoption of AI tools for everyday learning, ranging from personalized learning algorithms to automated grading systems. These tools have brought unprecedented efficiency and scalability to education, allowing teachers to focus more on individual student needs and creative teaching. However, this technological revolution has raised important questions about the role of human agency in education. As we automate more aspects of learning and teaching, how do we ensure that students and educators maintain control over the educational process? First, we should understand that AI should improve, not replace, human capabilities in education. The key to preserving human agency in education lies in striking the right balance between technological efficiency and human involvement. While AI can excel at tasks like providing instant feedback on multiple-choice assessments or generating practice problems, it cannot replace the nuanced understanding of human teachers who recognize the emotional and social aspects of learning. In Africa, where education systems face unique structural and resource constraints, AI offers the potential to leapfrog traditional barriers. Personalized learning algorithms can address disparities in access to quality education, and automated systems can bridge gaps in teacher-to-student ratios. Yet, as we embrace these innovations, we must ask ourselves: are we creating systems that empower learners and educators, or are we unknowingly relinquishing control to technologies that prioritize efficiency over human connection? Nonetheless, AI’s impact cannot be overstated, and we have done well as a continent in embracing it. However, we must improve and strengthen our data systems to fully maximize their potential in our education sector. These systems play an integral role in the AI ecosystem, providing the infrastructure and processes necessary for managing, storing, and processing the data that powers AI applications. As we grow, the balance between technological advancement and human agency is particularly important for Africa. While AI can support the rapid scaling of educational solutions, the essence of education—critical thinking, empathy, and emotional intelligence—remains deeply human in their nature. It is imperative to build educational systems where technology complements rather than overrides the social and cultural dimensions of learning. This is especially relevant as the continent invests in strengthening education data systems to power AI-driven decision-making. Projects such as the Knowledge Innovation Exchange Strengthening and Enhancing Education Data Systems (KIX-SEEDS) led by the African Population and Health Research Center (APHRC), implemented in Uganda, Burkina Faso, and Senegal highlights the strategic importance of efficient data infrastructure leveraging on technological developments. Improving how education data is collected, managed, and analyzed ensures that AI applications serve context-specific needs while enhancing transparency and accountability. Recently, concerns have been raised about how AI slowly takes away students’ critical thinking ability, sparking calls to shun technology, especially in the classroom. Valid as these concerns may be, AI will not soon leave our classrooms. Therefore, the focus must shift to helping students understand how to evaluate AI-generated content and develop independent thinking skills. This includes teaching them when to use AI tools responsibly and when to rely on their cognitive abilities. Another important aspect of education that AI cannot fully address is nurturing emotional intelligence, empathy, and social skills among learners—critical aspects of education that only human teachers can provide. Ultimately, students should be taught to use AI as an enhancer for whatever aspect of their education they seek to improve, empowering them to be active participants rather than passive consumers of technology. On the other hand, we must also invest in empowering educators to integrate AI tools into their teaching methods effectively and responsibly. This means ongoing training to understand AI capabilities, limitations, and biases, enabling them to make informed decisions about when and how to use these tools. In the long term, it will also be helpful for educational institutions to develop curricula incorporating AI while focusing on human-centric skills like critical thinking, creativity, and emotional intelligence. As AI increasingly permeates classrooms, the debate around its implications for critical thinking intensifies. Concerns about AI undermining students’ ability to think independently are valid, but the answer does not lie in rejecting technology. Instead, the focus must shift to equipping learners with the cognitive tools to evaluate AI-generated content critically and responsibly use them to their benefit. In doing so, we cultivate a generation that is not only technologically literate but also capable of harnessing AI as a tool for innovation and problem-solving. Equally important is the role of educators. Empowering teachers through ongoing training in AI integration is essential to maintaining their leadership in the learning process. As we move into 2025 and beyond, the relationship between AI and education will continue to evolve. The key is not to fight against automation but to skillfully integrate it while safeguarding the irreplaceable human dimensions of education. Success in this endeavor requires ongoing dialogue between educators, students, parents, and technology developers. With the penetration of AI into our everyday lives, the future of education lies in creating a symbiotic relationship where technology enhances rather than diminishes human capabilities. By focusing on critical thinking, creativity, and emotional intelligence while leveraging AI’s capabilities for personalization and efficiency, we can create an educational system that prepares students for a future where human agency and technological advancement coexist harmoniously. Ultimately, the African continent has an unprecedented opportunity to lead in reimagining education systems where AI and human agency coexist harmoniously. By investing in both technological infrastructure and human-centered pedagogies, we can prepare a generation of learners equipped to navigate a future defined by collaboration between human creativity and machine intelligence. In this endeavor, Africa’s diversity and resilience could be a powerful blueprint for the world.

Closing the Gap: The future is technology.

Artificial Intelligence (AI), machine learning and other technological advancements continue to permeate most sectors globally. While most African schools continue to struggle with basic infrastructural gaps, global technological advancements are accelerating at an unprecedented magnitude. A report by the World Economic Forum stated that 65% of children starting elementary school today will work in jobs that are not in existence currently—highlighting the undeniable role of technology in shaping the future.  What does this mean for the future of Africa? It means, the technological and economic divide between Africa and other parts of the world will continue to widen, making the vision of  African-led solutions to address the continent’s  developmental challenges increasingly difficult to achieve. It also means if Africa does not invest in technology and discovery  research, the continent will remain unprepared for future pandemics. These investments will help in advancing detection and prediction mechanisms as well as improve the capacity to develop vaccines and other diagnostic tools. However, with 70% of the African population below 30 years, the continent can tap into the potential of its youthful population by investing and creating an enabling environment for them to innovate. What must we do and do it urgently?  The proposed solutions are therefore three-fold: Investing in digital infrastructure, capacity building, and policy-level interventions to support data privacy and adoption of proposed intervention. We must rethink the current education system. Education systems should consider programs to equip youth with skills such as digital innovations, coding, data analytics, critical thinking and problem-solving. These skills will enable them to catch up with the demands AI has on almost everything.We must have kids introduced to the digital space from an early age. Introduce digital innovations, coding, data analytics, and activities that involve creativity, problem-solving and critical thinking. Rethink the teacher training, and remodel how parents view the success of their children from subject grading to other abilities that align with the future their kids will live in. We must have governments invest in the required infrastructure such as computers, internet connectivity, electricity, and other digital learning tools. We must encourage private partnerships that will offer mentorships to children at an early age, modeling real-life experiences. It is this kind of exposure that will stimulate students to think about their role in the African future.  African Population and Health Research Center (APHRC) through its Knowledge Innovation Exchange- Strengthening and Enhancing Education Data Systems (KIX-SEEDS) project on scaling up sub-national education data value chains in sub-Saharan Africa seeks to understand and bridge the existing capacity gaps on data systems and data analytics within African education ecosystem. The project will leverage AI to demonstrate how the continent can address its developmental challenges with a focus on education. This project, implemented in Burkina Faso, Senegal and Uganda, seeks to implement education data systems that respond to local community needs. The enhanced data systems will have the capacity to analyze large data and provide summarized results consisting of various aspects of the school ranging from the school infrastructure to the child-level information. The Data systems will have the capacity to incorporate machine learning algorithms that highlight disparities in access and outcomes of learners across gender and socioeconomic spectrum to address Gender Equity and Social inclusion (GESI). Apart from the project lobbying for enhancement of the digital infrastructure, stakeholders in the education sector will be trained in various aspects such as data analysis, data management, visualization and data for decision-making.  The future waits for no one. As AI continues to revolutionize the world, African nations must act swiftly to prepare their youth for the opportunities and challenges ahead. By aligning education systems with technological trends, the continent can unlock its immense potential, ensuring that the next generation is not just ready for the future but capable of leading it. The time to act is now. For every child inspired to learn coding, for every teacher trained in AI concepts, and for every school equipped with digital tools, Africa takes a step closer to bridging the gap between education and the technology-driven future.

Insights from the Field: Challenging the Politics of Social Exclusion in West Africa

As we reflect upon the year 2024,  CPSE’s West Africa engagements in Sierra Leone, Liberia, and Burkina Faso have offered a unique lens into understanding the lived experiences of adolescents, young people, and women who often face considerable barriers to accessing and securing sexual and reproductive health and rights (SRHR) across the continent. These are the lessons, observations, and stories that resonated most deeply. For too many, starting a family becomes a journey fraught with uncertainty. Unplanned pregnancies often leave women vulnerable—facing spousal neglect or intimate partner violence, societal stigma and marginalization, and insufficient healthcare access that could lead to increased maternal health risks due to delayed or missing prenatal care or unsafe abortions.   Teenage pregnancies amplify this vulnerability, pushing young girls into education disruptions,  a cycle of stigma, exclusion, and hopelessness, including mental health challenges and sometimes poor child outcomes. Abortion, a deeply polarizing issue, becomes the only recourse for some—whether clandestinely performed by unqualified individuals or self-induced out of sheer desperation. The outcomes of unsafe abortion range from severe complications and lifelong consequences to death.  These grim realities underscore the urgent need for open, judgment-free conversations about reproductive health in Africa, a topic still shrouded in taboo.  A recurring theme emerged across the three West African countries: the absence or sluggish progression of robust policy and legal frameworks to address these pressing issues. In Burkina Faso, stakeholders raised concerns about the cultural sensitivity of sexual and reproductive health (SRH) advocacy. With various policy frameworks in place, though critical, they are ineffective for the sourcing and uptake of reproductive health services in the country. In Liberia, the transition to a more progressive Public Health Bill that addresses these critical SRH needs remains sluggish, hindered by resource constraints and social, religious, and cultural barriers, including competing priorities by the government of the day. According to the Clinton Health Access Initiative (CHAI), the joint study on the incidence of abortion, magnitude of complications, and health system costs of unsafe abortions was cutting edge and timely. The first nationwide study on a taboo issue has influenced discussions and debates on the Public Health bill. It provided a “why and how” to those questioning and resisting these conversations, often due to ignorance rooted in culture and tradition.  Sierra Leone, grappling with its unique challenges, still tries to put up as a beacon of resilience, with community-driven innovations offering hope, coupled with the government’s commitment to advancing reproductive health rights through the Safe Motherhood and Reproductive Health Bill with tangible progress expected after a long time. Local organizations like Marie Stopes have been steadfast advocates of the bill, aligning with the Ministry of Health and Sanitation and joining various NGOs and civil society coalitions, notably the People Alliance for Reproductive Health Advocacy (PARHA). According to the Director of Reproductive Maternal, newborn, child and adolescent health (RMNCAH), Dr. Tom Sessay, the study on the incidence of abortion, magnitude of complications, and health system costs of unsafe abortions was used to create awareness on the bill and the source was often quoted to ensure the findings are accepted and credible.  When policies are absent or poorly enforced, it is the most vulnerable—children, women, and girls—who pay the price. Their needs are deprioritized, excluding them from the prosperity others enjoy. Some norms often amplify exclusion. For instance, menstruation—an everyday reality for half the population—is cloaked in secrecy, leaving women to manage with inadequate resources and support. Conversations around reproductive health are similarly hushed, often relegated to whispers in the dark. Women still struggle to access basic menstrual health products coupled with poverty, even as they shoulder societal expectations. This silence perpetuates stigma, leaving issues unaddressed and unresolved. Amid the challenges, there are pockets of hope. Some communities are harnessing indigenous knowledge to address health deficits. Sierra Leone is exploring innovative ways to improve SRH outcomes through cross-sector partnerships, youth involvement, and social media campaigns. Liberia is building alliances to amplify advocacy for health reforms. For instance, an inter-sector working group on SRHR is working with policymakers at the Liberian Senate to provide technical guidance on the draft Public Health Bill. Additionally, civil society organizations are working with public health providers, midwives, and nurses to advocate for accurate abortion-related services devoid of stigma. These examples reaffirm that solutions exist when communities come together with a shared purpose. Synergistic engagements—where governments, civil society, and local actors work hand-in-hand—are crucial to overcoming exclusion and lifting those left behind. The stakeholder engagements in West Africa have highlighted that social exclusion is not a destiny but a consequence of choices, priorities, and actions. As Africans, we must ask ourselves: What kind of future do we want to build? How do we develop sustainable local solutions?  How do we ensure that no one is left behind?  The year 2024 has shown the depth of our challenges and the immense potential we hold as a continent. We need to turn insights into action, dismantling the structures of exclusion and building a more equitable Africa for all. This is our story to tell and our time to act. 

#BehindClosedDoors: Recognizing the Silent Struggles of Mental Health

Despite increasing awareness, mental health remains stigmatized, leading to discrimination, misunderstanding, and inadequate support. One of the greatest challenges in recent years has been gaining widespread recognition of mental health as a critical health issue. This global health crisis affects people of all ages, backgrounds, and socioeconomic statuses but often goes undiagnosed and untreated in many parts of the world. This has left many people suffering in silence, battling invisible wounds that have a significant impact on their lives. A few years ago, I had a deeply personal experience with mental health issues through a close friend who meant a great deal to me. During the COVID-19 pandemic and related lockdowns, we spent a good amount of time together, and our friendship grew even stronger. We had a great bond that others admired, filled with laughter, cookouts, shopping, and simply enjoying life. Everything felt normal for a while, but then small changes began to happen. He stopped coming to our morning workouts, which he enjoyed and had proposed we do together. At first, I didn’t think much of it since we still spent time on other routines. But as time passed, I began to notice significant changes that hinted something was not quite right. Being outspoken, I decided to talk to him about it and ask whether everything was all right. I even proposed taking a short vacation to get a change of scenery now that the lockdown had ended and traveling was easier. But every time I tried to ask how he was doing or what was the matter, he quickly shut me down and changed the subject. He became more sensitive, reacting strongly to situations that seemed minor to me. I remember he got extremely upset because I didn’t stand beside him while he cooked our special meal. He started shouting, asking why I couldn’t just stay by his side, which felt completely out of proportion to me. Small disagreements that we used to laugh off began turning into serious arguments, sometimes escalating far beyond what seemed necessary. I’ll never forget how angry he would get whenever his favorite football team lost, often directing his frustration at me as if I were somehow to blame. I was confused by his behavior but brushed it off as mood swings, convincing myself it was just a phase that would eventually pass. As time went by, my friend seemed to struggle even more. He withdrew more and more from the activities he once loved. He had previously committed to therapy, something he told me he started in his early 20s to deal with challenges from his childhood. But as his motivation went down, he began skipping sessions, and soon, he stopped going altogether. I even offered to accompany him to therapy, hoping it might encourage him, but he quickly dismissed the idea. His behavior became increasingly concerning. His eating habits also became erratic; some days he would overeat, while on others, he’d go a day or two without food. There were times he would lock himself in his room, surrounded by silence, skipping showers and daily routines. This was someone who had always taken pride in how he looked and smelled. Slowly, the best friend I knew seemed to be slipping away, buried under emotions he could no longer express. The breaking point came when he attempted suicide. He had secretly purchased a rope, hiding his intentions well. We had just spent a weekend together with a few of our friends, and he seemed to be doing exceptionally well. He was his old self, even hugging me goodbye while cracking a joke as we left his house with one of his neighbors. However, as soon as we were gone, he took the opportunity to try and end his life. Fortunately, the neighbor had left his laptop charger at my friend’s house, and attempts to reach him through the phone (friend) were futile). He got so worried, decided to rush back and when he arrived, the front door was locked. After ringing the bell with no response, he went around to the back and found him hanging, from a rope, unconscious. He quickly took control of the situation, and my friend was rushed to the hospital. This occurrence greatly shocked and worried me. The weekend had been a time well spent, and he seemed to be in high spirits. Later on, I came to learn that his struggles were rooted in traumas that stretched back to childhood; layered pains that had accumulated and finally became unbearable, leading him to severe depression. This incident taught me that mental health issues aren’t always visible, but there are signs we can learn to recognize. Beyond my personal experience, working at the African Population and Health Research Center (APHRC) has allowed me to engage with significant professionals who are dedicated to addressing mental health issues. Initiatives such as the Mental Health Data Prize Africa (MHDPA) are seeking to bridge critical gaps in the understanding of anxiety, depression, and psychosis across Africa and beyond. With at least 116 million people globally living with mental health issues, including depression, the Mental Health Data Prize Africa (MHDPA) initiative has created a vital platform for innovators, researchers, startups, and people with lived experience to propose solutions to these pressing challenges. Supporting someone facing mental health challenges requires patience, understanding, and compassion, often from their loved ones. Recognizing the signs and encouraging them to seek help can make all the difference. It’s essential to educate ourselves on the symptoms of mental health disorders and learn to recognize the signs that our loved ones may need help. A simple gesture, a conversation, a shared meal, a listening ear, or a paid therapy session gift can serve as the lifeline that someone desperately needs.

HIV Prevention Campaigns: Are Boys Being Left Behind?

In the global fight against HIV, numerous interventions have been directed towards supporting adolescent girls and young women (AGYW), who are more than twice as likely to acquire HIV as their male peers. This is due to a variety of factors, including  gender inequality and unequal power dynamics,which undermine their ability to make decisions about their sexual and reproductive health. Consequently, reducing the risk of HIV infection among AGYW has been a global priority.  Programs such as the Determined, Resilient, Empowered, AIDS-free, Mentored and Safe lives (DREAMS), backed by PEPFAR, aim to do this among AGYW in Sub-Saharan Africa by addressing structural and behavioural factors that increase their vulnerability. The African Population and Health Research Center (APHRC) conducted an impact evaluation of the DREAMS program in Korogocho and Viwandani from 2017 to 2022. The evaluation assessed the impact of DREAMS interventions in reducing HIV infections among AGYW by examining various outcomes, such as changes in HIV incidence, improvements in Sexual and Reproductive Health (SRH) knowledge, and the overall empowerment of young women while also looking at the program’s scalability. The DREAMS program comprises a layered multi-component package of evidence-based interventions. These interventions address the biomedical, structural, and social risks of HIV acquisition by empowering AGYW and reducing their risk of infection. It also provides an opportunity to strengthen their families with social protection through programs like parent/caregiver programs, mobilize communities for change and reduce the risk of HIV among men who are likely to be sexual partners to AGYW. The interventions include: sexual and reproductive health (SRH) education, HIV prevention services, education support, social protection and economic empowerment activities like vocational training and business start-ups among others. While the focus of DREAMS is primarily on AGYW, some interventions do target young men. These include HIV testing, condom distribution, PrEP education and participation in health promotion sessions. However, the level of engagement and tangible benefits for adolescent boys and young men (ABYM) remains limited in comparison to those available to girls. The DREAMS program reached many AGYW identified as vulnerable, offering them substantial educational support, vocational training, and resources for business start-ups. However, boys received fewer tangible interventions in comparison.. Some adolescent boys and young men (ABYM) were engaged in biomedical and behavioral interventions. However, due to the nature of the interventions they received they would only be engaged for a short period of time and their participation often waned with time. Despite the understanding that the DREAMS program was a girl-centered initiative, ABYM expressed concerns about being left out of the program. The issue raised was DREAMS being seen largely as a girls-only initiative which limited their involvement in the program. While ABYM appreciated the benefits they received from the program, they felt these services were either inadequate or fell short of addressing their broader needs. These programs have made great progress in reducing the rate of HIV incidence among AGYW but, the question that arises is: Are we leaving adolescent boys and young men behind? It is understandable why AGYW have been the focus of most HIV interventions, yet we cannot ignore that ABYM are also vulnerable to HIV infection. There are some interventions available for ABYM such as MenEngage which engages men and encourages testing for HIV, enrollment on treatment for those who are HIV positive and adherence to treatment. Additionally, Voluntary Medical Male Circumcision (VMMC) which has proven to reduce risk of HIV acquisition in men by 60% and has been promoted widely as a core HIV prevention strategy. Interventions like this are, however, minimal compared to those for AGYW. As a result, many ABYM lack access to sexual and reproductive health education and services, creating a knowledge gap that often contributes to risky behaviors like unprotected sex, multiple sexual partners, and low condom use. This is evident in the Kenya Population-Based HIV Impact Assessment report (KENPHA 2018), which found that HIV testing services are predominantly accessed by young women, leaving many young men untested and uninformed.The consequences of this could be girls being more economically stable compared to their peers, increased HIV incidences among ABYM, resentment towards future HIV programs which will further limit ABYM’s access to prevention services and contribute to power imbalances with AGYW’s, potentially leading to relationship issues like gender-based violence, separation, divorce, and restricted access for girls to HIV prevention services. We must realize that boys and young men without proper education and resources can be both vulnerable to infection and vectors of transmission. An example of a key challenge of HIV prevention in adolescents and young men is the resistance to or lack of understanding of VMMC. In cultures where circumcision is not traditionally practiced, it may be viewed as unnecessary or even harmful, dismissing its proven benefits in reducing HIV risk. This resistance, in addition to misinformation, leaves boys and men at a greater risk of  infection. To overcome these barriers, it is essential to engage these communities with culturally sensitive education that highlights the role of VMMC in comprehensive HIV prevention strategies. Additionally, gender stereotypes that portray ABYM as less vulnerable to HIV or sexually transmitted infections (STIs) also contribute to their low uptake of services. Harmful gender norms such as initiating sexual activity early in life, having multiple sexual partners and representing themselves as knowledgeable about sexual matters and disease prevention even when they are not, discourages ABYM from accessing the information and services they need. For HIV prevention campaigns to be fully effective, they must actively address these societal barriers and create an environment where ABYM feel empowered to seek help. Without targeted interventions there is a risk that the new generation of young men will be under informed and unprepared to protect themselves and their partners from HIV.  To effectively fight against HIV, a holistic approach should be implemented that addresses the unique needs of both ABYM and AGYW. This has been proven to be possible by evidence from the DREAMS initiative which showcased the importance of education and empowerment in reducing HIV risk. Similar efforts can be made to reach ABYM which will make them more likely to make safer sexual choices reducing both their chances of contracting HIV and the likelihood of spreading the virus.  A few examples include: Sports-Based Programs: Initiatives that combine football tournaments with health education sessions have shown promise in reaching young men effectively. A notable example of this is Grassroot Soccer (GRS) founded in Zambia. GRS leverages soccer’s universal appeal to engage ABYM aged 12-19. The program combines evidence-based health curricula, mentorship from trained coaches, and an inclusive, fun culture to educate participants about HIV prevention and encourage behavioral change. For instance, activities like “Risk Field” use soccer drills to illustrate the consequences of risky behaviors, providing a relatable context for understanding how individual actions impact communities. Data from Zambia showed that nearly 60% of GRS participants sought HIV testing compared to 13% of the general population. School-Based Education: Expanding comprehensive sexual and reproductive health education in schools is crucial. Tailored curricula should emphasize the importance of HIV testing, condom use, and the role of boys in reducing HIV transmission. Peer-led initiatives in schools can create relatable and impactful messaging for ABYM, helping to normalize HIV prevention behaviors. Digital Outreach and Media Campaigns: Leveraging social media, gaming platforms, and apps can provide targeted and engaging content about HIV prevention. Interactive and gamified platforms are particularly more appealing to younger male audiences making learning about HIV prevention more engaging.  The progress made in protecting adolescent girls and young women from HIV is worth celebrating but it is important to recognise that ABYM are a big part of the solution. As the global community continues to fight against HIV, it is time to ensure that no one is left behind!

Politics of Policy Making in Kenya

In Kenya, a complex interplay of socioeconomic and political factors has shaped policymaking processes over the years. While research is vital in driving national development, translating it into evidence-informed decision-making (EIDM) has historically been slow, particularly in sub-Saharan Africa. It is often entangled in intricate political cycles. Research by Zoë Slote Morris,1 Steven Wooding,2 and Jonathan Grant2  has shown that historically, research can take an average of 17 years to influence change and practice. At the African Population and Health Research Center (APHRC), we believe this timeline can be dramatically reduced from 17 years to just 4. By collaborating with governments and key stakeholders, we are working to cut this period by harnessing the power of EIDM to improve the quality of decision-making and enhance policy design. EIDM ensures that the best available evidence is used to inform decisions that are not only data-driven but also context-specific and impactful. Despite the wealth of high-quality research, its integration into policymaking remains subpar. Why are researchers and subject matter experts continuously overlooked and uninvolved in the process? To answer this question, examining the context of policymaking in Kenya and understanding what informs the policy process and the factors at play is essential. In Kenya, policymaking is a cyclical process tied mainly to the five-year election cycle. Politicians often make grandiose promises to the electorate based on prevailing issues of public interest to woo support. Politicians seeking to garner support make ambitious promises to the voters based on prevailing public interest problems. Typically captured in election manifestos, these promises set the tone for the incoming government’s priorities. As these promises are based on populist opinion, they tend to change a lot once a new team is in power. They, however, shape resource allocation for the next five years as the government of the day strives to maintain popular support in preparation for the next election cycle. Decision-making is, therefore, political and always fluid. Decisions and or policies of past regimes and elected leaders at all levels are often set aside, creating gaps in their implementation and losing public resources already invested. It is, therefore, hard to determine the long-term impacts of ‘good’ policies; in our case, assessing the change in practice is hard. Ultimately, this cyclical nature of policy-making hampers sustainable community development as every five-year cycle repeats itself, often resetting progress. Resource allocation plays a crucial role in the decision-making process. Like any other developing nation, Kenya has a scarcity of resources, which means competition for priorities and needs. The two levels of government prioritize what may be essential and visible to capture political expediency and regime interests that sometimes reflect political manifestos. Many times, this is always in a ‘survival mode.’ This leaves it susceptible to influence by external organizations willing to provide commercial loans or grants tied to foreign interests. Usually, ‘’s/he who pays the piper calls the tune’. The funder has priorities that do not necessarily align with community needs. At the individual level, policymakers tend to prioritize policies that have funding. They engage in policy-making activities that assure them of access to compensation and resources as individuals and their constituents. This financial motivation can be a significant determinant and even lead to rushed decisions and policies that lack thorough research and long-term viability. The majority of decision-makers in Kenya occupy both elective and appointive positions. Every new regime at both levels of government brings in its people. Unfortunately,  the election process often generates bitterness, leading to inadequate handovers between administrations. These appointees serve at the discretion of the appointing authority. At the same time, elected leaders are also subject to party positions. They can be whipped to vote in a particular manner on a policy out of fear of being de-whipped from parliamentary committees or losing the party’s support and thus the chance for re-election. This constant threat of de-whipping causes the elected decision-makers to operate in an environment of worry that stifles independent thinking. As a result, some leaders who could otherwise contribute significantly to policy-making are often reduced to  “gallery players” merely endorsing decisions driven by populist opinions, vested business interests, or pre-approved agendas from influential figures. In such an environment, the public’s immediate wants often outweigh rational,  scientific, or evidence-based decision-making. So, how does a research institution seeking to transform lives navigate these complex challenges and move the needle from 17 years to 4 years? Can adoption and adaptation of an EIDM approach make a difference? The simple answer is Yes. Long-term plans such as Kenya’s Vision 2030 and regional declarations have been used to identify and prioritize areas of research and funding. They inform organizational plans and, in some cases, as the yardsticks for understanding the government agenda. No funding can be committed if a research institution’s policy and goals are outside these development plans. In the spirit of co-creation, APHRC must carve out a sphere of influence and lead in providing evidence while creating development plans to align goals and coordinate interventions, making it easier to transform lives. To address and mitigate against changes occasioned by leadership shifts, APHRC needs to support the development of capacities for middle to senior-level technocrats. Through its initiative to develop young researchers, young technocrats can be equipped with similar skills to better inform the decision-making process in government. This will have a lasting impact as senior-level policymakers heavily rely on technocrats in the decision-making process and development planning. It will also help build a network that APHRC can call upon in its work and help achieve the goal of sustained policy engagement. By employing these two strategies—co-creation of development plans and capacity building—APHRC will leverage over 20 years of research and evidence to apply EIDM as a pathway to impact. This will bring the institution closer to transforming lives in Africa and shorten the timeline for Evidence-Informed decision-making.

Which COVID-19 vaccines are available?

The list below is for COVID-19 vaccines that have been given emergency licensure for use.  Pfizer/BioNTech Comirnaty,Moderna COVID-19 vaccine (mRNA 1273),Janssen/Ad26.COV 2.S SII/COVISHIELD and AstraZeneca/AZD1222 vaccines, Sinopharm COVID-19 vaccine,Sinovac-CoronaVac,Bharat Biotech BBV152 COVAXIN vaccine, Other vaccines being used in other but not authorized by WHO: Sputnik V Read more :COVID-19 vaccines (who.int)

Are COVID-19 vaccines safe?

Vaccination is safe and side effects from a vaccine are usually minor and temporary, such as a sore arm or mild fever, depending on the type of vaccine. More serious side effects are possible, but extremely rare. Any licensed vaccine is rigorously tested across multiple phases of trials before it is approved for use, and regularly reassessed once it is introduced. Scientists are also constantly monitoring information from several sources for any sign that a vaccine may cause health risks. (WHO) Read more :Regulation and quality control of vaccines (who.int)

Which vaccines are given to children?

Commonly recommended childhood vaccines include: Oral polio vaccine; BCG; Diphtheria-Tetanus-Pertussis , Measles-Mumps-Rubella vaccine, hepatitis B, Haemophilus influenzae type b; and Pneumococcal conjugate.

 Is it safe to have multiple vaccines at once?

Yes it is safe. It is possible to get multiple vaccines at once. Indeed in the childhood vaccination schedule, certain vaccines are combined in a single shot as is the case with diphtheria-tetanus and pertussis (DTP) vaccines. Also, DTP can be given at the same time as the oral polio vaccine (OPV).

 What does the vaccination schedule look like?

A vaccine schedule is the recommended organization on how, who, and when vaccines are delivered to recipients taking into account the age, risk of exposure, level and duration of initial immune response,  and the prevailing service delivery mechanisms. An example of a schedule is the WHO recommended childhood schedule for most developing countries: BCG and OPV at birth; OPV1, DTP1 at six weeks; OPV2 & DTP2 at 10 weeks; OPV3 & DTP3 at 14 weeks and measles at 9 months. 

What are the types of vaccines available?

There are several different types of vaccines. Each type is designed to teach your immune system how to fight off certain kinds of germs—and the serious diseases they cause, the available technology, desired strength of immune response and characteristics of the disease causing germ. Based on a number of these factors, scientists decide which type of vaccine they will make. There are several types of vaccines, including: Inactivated vaccines: These are vaccines derived from the germ that cause disease that has been destroyed/killed and unable to cause disease, reproduce or grow. Live-attenuated vaccines: These are vaccines derived from the disease causing germ that has been partially destroyed to limit their ability to cause disease, grow or reproduce.  Subunit, recombinant, polysaccharide, and conjugate vaccines: These vaccines use specific pieces of the germ such as its proteins, sugar, or casing as signature that would trigger an immune response when introduced into a human body Toxoid vaccines: These vaccines use a harmful product (toxin) naturally produced by the disease causing organism. Examples include tetanus toxoid vaccine. Viral vector vaccines: These vaccines are made through use of a different virus, such as the adenovirus, that has been modified for the purpose of delivering genetic material for a desired viral antigen, such as the spike protein for SAR-CoV-2 virus,  into the human cells. As a result the virus infected human cell receives the instructions and starts making the antigens against which the body mounts an immune response.  Nucleic acid (Messenger RNA (mRNA)): These vaccines use a component of the virus (mRNA) which the virus uses to manufacture other molecules needed for its own propagation. When introduced into a human body through a vaccine, the viral mRNA instructs the human cells to make a protein that triggers an immune response just like a natural infection would. This approach is a new technology and has been used in some of the COVID-19 vaccines.

How do vaccines work?

Vaccines generally work through provoking the body into developing and mounting an immune response by imitating an infection. As a result the body produces specialized immune cells and antibodies against the target organisms. The initial exposure (vaccination) also makes the body “remember”” past exposures and thus mount a quicker response in future exposures to the same disease causing agent.

What are vaccines?

A preparation that is used to stimulate the body’s immune response against diseases. Vaccines are usually administered through needle injections, but some can be administered by mouth or sprayed into the nose. (Understanding How Vaccines Work | CDC)