experiences from the Get Up, Speak Out for Youth Rights! (GUSO) programme in Kisumu and Siaya Counties, Kenya

Recruitment

Two types of peer educators were recruited to the GUSO programme: those who were based in their communities, including schools, whose primary role was to provide SRH information and education to other young people; and youth peer providers⁷ who were based in participating health facilities and supported young people’s access to health services.

Recruitment methods varied, with some peer educators being recruited through community leaders, such as chiefs, friends, family or community health workers because they showed one or more desired qualities, including friendliness, leadership skills and/or specific technological abilities. Other peer educators said they thought that they were recruited because they were struggling with issues pertinent to the programme, such as teenage pregnancy or drug use, whilst yet others responded to advertisements. Some participated in an interview process while others did not.

Gender was only taken into consideration insofar as an equal number of girls and boys were recruited as peer educators. Recruitment could therefore be described as gender aware, based on the premise that gender would be important in influencing young people’s receptivity to information and outreach: ‘They were looking for gender equality so that females could talk to females and males to males.’ (Peer educator, Siaya)

Training and support

The amount and content of training and support provided to peer educators varied widely. Twenty-two of the 24 peer educators reported receiving training to some degree; most of the training was geared towards preparing them to provide SRH information, education and/or services to other young people. However, peer educators reported varying training duration, from three days to five weeks. All peer educators reported receiving support in terms of supervision and technical updates during their work.

The topics covered in training also varied widely, with contraception and HIV prevention being the most commonly cited; menstrual hygiene, gender-based violence, and substance abuse and other topics were mentioned by a few peer educators. Many described being trained in how to conduct outreach work, speak to other young people effectively, and provide referrals to SRH services. All the peer providers and some community-based peer educators also received training in service provision – primarily counselling on issues such as contraception and pregnancy, HIV testing and counselling, and mental health.

Just over half of all the peer educators mentioned receiving refresher training or content related ‘updates’ throughout the time with the programme. Most peer educators described receiving a significant amount of supervision and support from the organisation with which they worked, including monthly meetings with supervisors in some cases. Those working in health facilities were most likely to mention supportive supervision.

Compensation

Compensation of peer educators varied widely. Some reported receiving only travel cost reimbursement, while others received monthly stipends. Some peer educators reported that they received incentives such as t-shirts, caps, notepads and/or pens. In the case of one programme partner, peer educators had been recruited through a separate programme that paid their school fees, and this caused a degree of confusion as to whether their peer education activities were a required activity to continue receiving that benefit. Finally, several stakeholders recognised the importance of compensation of some kind for peer educators to continue to motivate them and ensure their participation:

Access to information and education

Monitoring data reveals that over 7,600 people were trained to provide SRHR education and information to young people in Kenya; however, it is not known how many of these were peer educators (GUSO Kenya Citation2021). Peer educators were trained to provide information and education through a variety of channels, including one-to-one, informal interactions and more formal group sessions in school and at community events.

Every peer educator interviewed stressed the importance of sharing information with other young people, with many seeing this as the most important part of their role. Importantly, peer educators expanded on the reach and content of what they provided, going above and beyond their prescribed roles and responsibilities. For example, many described taking on personal responsibilities for the well-being of young people in their communities. Being seen as a role model and mentor in the community was a badge of honour. Other young people as well as parents and community leaders asked them for advice outside of their ‘working hours’ (FGD4) – tasks that likely went undocumented through the formal reporting channels. Programme participants described being given ‘guidance’ by peer educators to help make informed decisions about life matters (FGD4).

The content of the information provided by peer educators went beyond the SRHR topics included in their training. Much of it could be described as general life coaching or counselling on relationships with parents; teenage behaviour; peer pressure; drug use; friendships; life goals; education and more. One peer educator shared:

Informing young people about available SRH services was another part of peer educators’ role. Many said that making referrals and/or escorting young people to health facilities was of crucial importance to ensuring that they are able to act on the SRH information received. One peer educator described the linking role that she played between information, services and enabling environment as follows:

Monitoring data indicated that over 615,000 young people were reached with information or education during the five years of the programme, although data on the percentage of these reached by peer educators is not available.

SRH service utilisation and quality assurance

Peer educators helped increasing the utilisation of youth-friendly SRH services⁸ through community outreach, awareness raising and referrals for young people as well as by directly providing services to young people. They also monitored service quality and participated in formal and informal quality assurance processes.

During community outreach, peer educators’ efforts were focused heavily on raising awareness of the availability of SRH services for young people as well as how youth-friendly the services were. This was needed in order to overcome preconceived ideas amongst young people about the SRH services: ‘The youth used to have a mentality that some nurses were bad … We connect the youth to the health providers who have changed their attitudes towards youth and become more supportive. Youth now feel free to come and get health services at the facility.’ (Peer educator, Siaya)

Some peer educators, such as those working with KMET, were trained as peer providers and were able to provide contraceptive and counselling services to young people themselves. Others simply referred young people to the youth-friendly services in their area. Yet others personally escorted young people to the services, ensuring they knew where to go. Furthermore, many peer educators participated in HIV testing and cervical cancer screening drives in their communities, ensuring the inclusion and participation of young people.

With respect to quality assurance, peer educators provided feedback from young people to service providers that allowed improvements and adjustments to be made . At the health facility level, peer educators were the ‘eyes and ears’ of young people, with many indicating that they made ‘regular visits’ to check on the quality of services provided to young people: ‘We ask about services which are not being provided to the youth and communicate the same to TICH which comes to help and improve the quality and range of services offered’ (Peer educator, Siaya). Another peer educator in Siaya described how he regularly asked health facilities’ staff members how they were providing services to young people, ensuring that they were making use of the dedicated youth room. Two other peer educators mentioned encouraging health providers to be friendly, maintain confidentiality and use polite language when speaking to young people (Siaya). Yet others helped clinics become more ‘attractive’ to youth by planting trees and designating corners or rooms specifically for young people, to make them feel comfortable.

Monitoring data for the GUSO programme reveal that over 3 million direct and indirect SRH services were provided to young people during the five year implementation period across Kenya (GUSO Kenya Citation2021). As with information and education, figures that isolate peer educators’ contributions are not available. The endline evaluation of the GUSO programme in Kenya showed increases in young people’s utilisation of the following services in the implementation areas: male circumcision, child protection, STI testing, counselling for sexual violence, and voluntary counselling and testing for HIV (Kok et al. Citation2021).

Community support

One of the five GUSO outcome areas was ‘improved socio-cultural, political and legal environment’ (for SRHR). The programme did not measure peer educators’ contributions in relation to this outcome. However, this study found that peer educators worked to increase the support and involvement of important stakeholder groups and, as a result, were able to share their ideas more freely.

In particular, peer education increased community support for youth SRHR and support for the provision of SRH information, education and services for young people, as well as collaboration between different community actors, such as parents, churches, teachers, police officers, paralegal workers, school administrators, health management committees, local provincial administration and parents. Whilst some actors were resistant to the GUSO programme at first, they eventually changed their minds:

As a result of greater acceptance from their communities, peer educators gained access to platforms through which they could highlight issues of importance to them, including adolescent sexuality; teenage pregnancy; unsafe abortion; return to schools for pregnant girls and young mothers; drug use; justice for survivors of sexual violence; and reduction in child marriage. New spaces opened up for young people to voice their concerns, including policy-making forums and new decision-making opportunities within the GUSO implementing partners (Peer educator, Siaya).

Peer educators tackled sensitive issues, increasing openness to discussion amongst stakeholders in the community and gaining support for engaging with such concerns. One adult stakeholder shared the following: ‘Unlike in the past, peer educators are able to address sensitive topics in the community such as teenage pregnancy and unsafe abortion’ (Local government representative, Siaya).

Organisational and programmatic strengthening

Strengthening the Kenya SRHR Alliance was the first outcome area of the GUSO programme in Kenya. However, peer educators’ contribution to this element of work was not measured. Our study findings highlight how peer educators not only brought enhanced visibility to implementing organisations but, also, taught them what being accountable to young people meant in practice.

Adult stakeholders interviewed credited peer educators with bringing greater visibility to the work of their organisations, making them more credible and known about for their ability to reach youth. Programme participants agreed, with one group saying that there were ‘more partnerships with the community’ as a result of peer educators’ innovative activities [FGD3]. Several peer educators noticed a shift in how supportive organisations were for youth, with one commenting: ‘[The partner organisation] has become more supportive of youth’ (Peer educator, Kisumu). According to one peer educator, implementing GUSO partners saw ‘an increase in youth participation in [their] programme activities and in the community’ (Peer educator, Siaya).

Apart from strengthening organisations, peer educators were recognised as strengthening the GUSO programme as a whole. Peer educators were seen, and saw themselves, as links between various components of the programme, including services, information/outreach, advocacy, youth participation, advocacy and monitoring and evaluation. At the county level, a government stakeholder noted the importance of linkages created with peer educators:

Another stakeholder observed that peer education not only expanded the reach of the programme within communities but, also, provided a way to sustain efforts beyond the life of the programme:

Gender norm transformation

Study participants reported many examples of changes in gender norms brought about by peer education. These included greater value being placed on girls’ education, including for pregnant girls and young mothers; greater acceptance of girls desiring relationships; positive views of girls who do not follow traditional gender roles; encouragement for the sharing of responsibilities between boys and girls; and community mobilisation to encourage reporting and prosecution in cases of sexual violence.

Study participants mentioned change in relation to the reporting of sexual violence in their communities. One peer educator explained: ‘I think it is a bit easier now to get community support for arrests of defilements perpetrators especially among relatives.’ [PE10] Young programme participants also mentioned how peer educators were working with chiefs and village headmen to ensure that sexual violence cases were reported to the police; the latter spoke of knowing the steps to follow in the case of rape and how to speak out as a result of interacting with GUSO peer educators (FGD1). One peer educator also mentioned working with county level officials to develop a new sexual and gender-based violence policy (Peer educator, Kisumu).

Youth economic empowerment

By working together, peer educators found unity of purpose, leveraging the network created as an opportunity to create economic opportunities for themselves and other young people. Peer educators in Siaya and Kisumu Countiesd formed small groups called chamas that evolved into community welfare services, saving schemes and business groups. Some chamas initiated enterprises that made and sold baked food, sanitary towels and jewellery, whilst others started grocery and tree seedling planting businesses. Two peer educators explained how they had been able to establish their businesses using the allowances they received as peer educators. To ensure viability, one stakeholder described how ‘peer educators [had] engaged local politicians and secured sponsorship for income generating activities such as setting up a small gasoline station’ (GUSO staff member, Siaya).

The ripple effects of this entrepreneurship were evident at various levels of the community. Peer educators engaged other young people in these economic endeavours, thus expanding their collective economic power. During one focus group discussion, a participant commented how by ‘making necklaces, sanitary towels and small grocery business, youth are becoming more independent and charting their own future’ [FGD1]. Peer educators also reported an increased ability to support their families, including paying for their own or siblings’ school fees, accumulating savings, enhancing their social status, and gaining recognition for being role models.

Confidence, life goals and employability

Study findings suggest increased self-confidence amongst both programme participants and peer educators as a result of their participation in the GUSO programme. This in turn contributed to changes in life goals and aspirations as well as job opportunities.

For programme participants, changes were shaped by participation in activities such as sport and drama, which enhanced their self-esteem, as well as enhanced awareness of their own health and rights (FGD1). One group of participants observed that after engaging with peer educators, they were better equipped to deal with peer pressure (FGD1).

Many peer educators also experienced increases in confidence. Factors that contributed to this included training, volunteer experience, being seen as role models, and public speaking engagements.

Changes were also witnessed in peer educators’ employability beyond their own communities. One stakeholder described how some GUSO peer educators transitioned to take up more responsibilities including jobs elsewhere in Kenya: