Table 3 Emergent themes and illustrative quotes from discussions with three Youth Working Groups and one group of healthcare providers working at intervention facilities; Kisumu County, Kenya 2021

Facilitators of CSC

YWG: Community health volunteers were essential to the success of the CSC; some communities were eager to participate in the CSC

Providers: Willingness of the community to engage in dialogue, openness to change from the providers

“I got help from a community health volunteer (CHV)… We were walking with the CHV so that she can try and explain that this was just a participation and not giving the family planning. That this is just a participation, a collection of data… So the CHV explained and everything went well.” -YWG member

“The turn up was good. Mmmh…there are people who were responding full…. But the turn up was good. The link between us and the society was awesome, and they gave us an easy time to communicate with them.”

-YWG member

“I can say that it was an educative experience because we were able to sit with the community representatives and understand how the community views the health facility.” -Provider

Barriers to CSC

YWG: Stigma around youth use of family planning made parents reluctant to let their children go to CSC meetings; negative provider behaviors persisted after CSC implementation and discouraged participants; communities were wary due to past family planning programs that gave youth family planning without parental permission; covid-19 restrictions

Providers: Providers felt frustrated when they felt their actions were justified due to their more advanced medical knowledge; providers felt that youth may not be the right facilitators for the CSC role; providers would like better consideration of their time and more compensation for participating in the CSC

“There was a time that we were told to bring some youth also so that they can participate in this score card… gathering the youth in my community was such a problem. [When] you approach a …female youth and the parent refuses: “You want to go…you want to take her to family planning without the parents’ consent?” … So even if you try to explain that this is like collection of data the parent won’t agree because sometimes back youths were picked from the community and taken …for family planning without their parents’ consent.” -YWG member

“What didn’t go well …we were sitting with service providers. When we are seated there, they promise us what they cannot do. It’s like they were just fooling us. So, what they do is different with what they say. And that problem is still present. Like demand for informal payment. We were not able to do anything with that though we tried.” -YWG member

“You know youths if you pick them to work for a duration, like mine, I know of one who has gone to college, others have moved away, others have gone to Nairobi. So, you find out that it is difficult to work with them… I think this issue should go specifically to community health volunteers. They are always there; they meet these youths everywhere with their parents… so it is even easier managing this thing when we use community health volunteers rather than youths. It is good to use youths, but we try to identify youths who are married. Even if you are married, sometimes the marriage can dissolve, and you go and again that will be a lost asset.” -Provider

Success of the CSC

YWG: Barriers to family planning use were identified through the scorecard process; youth were proud of their role in the community; some solutions were identified and implemented

Providers: There were better relations and open dialogue between providers and community; some providers felt that misunderstandings were cleared up and that they could provide better care to their communities

“The problems were many in the facility but now when we are going to finish the program, in the last meeting that we had; I heard him saying that most youths are coming to the facility to access the service. Even the ones that were being criticized that were of young age were now coming to get the service.” -YWG member

“I think some of the things that went well is that the issues that were raised by the community, quite a few of them were implemented. Like that fear of HIV testing. We told them that there is opt out, it is not compulsory, it is optional. And so we advised the health providers that these people fear and so they should give them that opt out.” -YWG member

“And again, it helped us also to improve our services and also mmmh…helped the community to understand the facility. Like maybe there are some things they did not know about the facility and now they are getting it clearly” -Provider

Deviations from Original CSC Plan

YWG: Due to stigma around family planning use, youth leaders developed a role of “FP Educator” as they tried to convince people to come to meetings; the CSC was confused for family planning education

Providers: Some providers felt that the CSC was a way to teach the community how to be better patients instead of a way of evaluating the clinics

“My experience was… I learnt a lot of things. I have learnt a lot from the community score card and it has made me educate many about family planning.” -YWG member

“When it comes to… teaching them maybe how to use condom, the way you do it could make them laugh so much. Okay, they wanted to see it repeatedly more so we just did it because they wanted to know.” -YWG member

“And after the score card, after we had shared and came up with a way forward, we are able to see now the community come for the services. They have changed their time of coming… They view family planning as a service just like any other, mmmh… they are able to understand, they are able to be patient and wait… At each level, you are able to communicate something, they are able to understand and take it positively. Yeah So, I would say that it is becoming lighter even on our side.” -Provider