Health system readiness for prevention and response to female genital mutilation in West Pokot County of Kenya

Abstract

Abstract Background Health system-led end female genital mutilation (FGM) interventions should leverage on prevention and curative functionalities of the sector for which integration of human rights, social justice and care services can be realized. Objective We, assessed health system readiness for FGM-related prevention and response in West Pokot county of Kenya. Methods Qualitative and quantitative data collection approaches to capture responses across stakeholders and beneficiaries were used. Interviews were conducted with 34 policy actors at national and county levels; four focus group discussions conducted with service providers and women with FGM; 23 in-depth interviews involved service providers and 30 facility assessments were conducted. Quantitatively data were analyzed and presented in proportions and frequency tables while qualitative data were analyzed into themes and presented in narratives. Triangulation of quantitative and qualitative findings provided the discourse herein. Results The findings showed that: national as well as health-sector specific laws/policies addressing FGM were identified albeit limited knowledge on their contents; health facilities offered essential reproductive services namely antenatal, delivery and postnatal care, family planning and gynecological but only (23%) end FGM-related interventions. This was coupled with lack of guidelines and protocols to support FGM prevention and care services. Women with FGM presented with physical, birth, gynecologic, psychological and sexual complications but mitigation measures for these impacts were generic characterized by high proportions of referrals and explicit neglect of FGM-related sexual and psychological complications. The challenges identified to affect response to FGM included: lack of data capture and resources (IEC materials) for promoting awareness, inadequate FGM-preventive interventions, and limited capacity for health care workers (HCWs) to offer FGM care services. Conclusion A favorable legal-policy environment, vast infrastructure network and resilient human resource were hallmark of West Pokot health system that ought to have supported FGM response. This calls for health system strengthening with consideration for dissemination and sensitization about existing policies, development of skills supports tools, training of HCWs in high FGM prevalent settings, anchoring FGM in the HMIS, documentation, development of IEC materials to support FGM messaging as well as addressing financing, resources and adopting integration of end FGM intervention into health programs.