Better Health Starts with Her: A Community-Led Women’s Health Initiative in Kibera, Kenya

*Presenting author

Nicole Tang*, Kyra Guy, Samyu Padisetti, Alyssa Ponrartana, Rose Okoyo Opiyo, Cecilia Alonyo, Emmanuel Balinda, Mike Wamaya, Heather Wipfli

INTRODUCTION

Kibera, Kenya is one of the most densely populated and largest informal settlements in Africa.
Kibera residents face sanitation and hygiene challenges, limited access to healthcare services, poor nutrition, and exposure to substance abuse, crime, sexually transmitted infections, and unintended pregnancies.
These challenges disproportionately affect women and girls, emphasizing the need for the promotion of sexual and reproductive health in these settings.
Despite the growing need for support for women and girls, there are still notable gaps in intervention efforts including legislative changes, policy reforms, and community based programs designed to improve the well-being of adolescents and the sustainable development of the country.
In order to address this gap, The Youth Public Health Ambassador (YPHA) program aims to support female youth in Kibera to develop skills to serve as peer health educators, data collectors, and drivers of positive change, while at the same time providing global health students at USC the opportunity to work in partnership with peers in Kenya and gain global health research and practice experience.

OBJECTIVES:

To assess the YPHA program and its impact on the knowledge and behaviors among youth participating in the program and the surrounding communities.
To promote investment in youth-centered health promotion programming and opportunities for youth-driven policy advocacy.

PROGRAM DESIGN & EVALUATION METHODS

YPHA Program Design:

The University of Southern California Global Research, Implementation, and Training (USC GRIT) Lab partnered with the community-driven non-profit organization serving youth in Kibera, Project Elimu, to implement a public health training program. The Youth Public Health Ambassador (YPHA) program recruited 20 female Kenyan youth aged 18-24 to serve as public health ambassadors within the Kibera community.

The program is comprised of three main phases: First, YPHAs gained a basic understanding of public health concepts including sanitation, risky behaviors, sexual and reproductive health, mental health, and gender equity. Second, YPHAs learned different types of data collection including key informant interviews, focus groups, and survey. YPHAs then identified key areas of concern in their communities and learned how to implement a youth-led, community-based health assessment developed in partnership with the USC and University of Nairobi. Upon completion of the community based survey, YPHA will then interpret their data and disseminate findings to stakeholders at the community, district, national, and international level in support of public health programs and policies. Throughout all phases of the program, YPHAs are provided with resources to assist them in educating their community about healthy behaviors.

Map of 13 participating villages in Kibera, Nairobi. From “Map Kibera Project - Maps and Statistics” by Map Kibera Project.

Community Based Health Assessment:

As a part of the YPHA program, YPHA will conduct a community based health assessment in Kibera, Kenya. Six of the thirteen geographical sub-locations or villages of Kibera (Kianda, Lindi, Soweto West, Soweto East, Kisumu Ndogo, and Laini Saba) will be purposively sampled based on presence of youth ambassadors within the site. The study's key objectives are to gather comprehensive data on the prevalence of early pregnancy, substance use, and mental health issues, identify barriers to accessing healthcare services, and evaluate the existing health infrastructure in Kibera.

Assessment of Proficiency:

YPHAs were surveyed with a comprehensive knowledge-based assessment prior to the initial workshop and following each additional workshop. Survey questions assessed accuracy and proficiency in knowledge of basic public health concepts, engagement and feedback of the programming and curriculum, and YPHA confidence in public speaking and research methods.

PROGRAM COMPONENTS

Phase 1: Public Health Training and Education

USC students developed a public health curriculum, targeting prominent issues faced by youth in Kibera.
The curriculum was delivered through an in-person training workshop facilitated by Project Elimu and USC students.
YPHAs were provided with a culturally tailored interactive workbook to follow along during workshop delivery.
Curriculum topics included: sanitation and hygiene, risky behaviors, mental health, and reproductive health.

Phase 2: Research Methods and Identification of Health Problems Within Community

YPHAs then learned about research methodology and data collection.
YPHAs led a discussion on health issues they see in their community and determined which issues they wanted to research within their community. These were identified as: early pregnancy, mental health, and substance use.
USC students and University of Nairobi students worked to design and develop a study protocol to submit to local and California IRBs. YPHAs assisted in developing the questions for the data collection tool.

Phase 3: Community Health Assessment, Data Analysis, and Dissemination

Upon IRB approval the trained YPHA will conduct the community health assessment in Kibera over a period of 2 months. Survey data will be uploaded to a database via Qualtrics by YPHAs and managed by a central USC staff member.
They will then participate in a final workshop reviewing data collection and subsequent analysis.
Following analysis, a dissemination workshop will be organized for YPHAs to share findings from the proposed study to community members, local leaders, national parliamentarians, and the Ministry of Health, as well as within local and surrounding communities.
Study investigators at USC and the University of Nairobi will work on a peer-reviewed publications and present the results at international global health conferences with ambassadors as participating authors.

PROJECT OUTCOMES AND SUSTAINABILITY

The Community Based Participatory Research (CBPR) approach utilized by the YPHA program gives young women in Kibera the opportunity to pinpoint health challenges faced by their peers and generate the data needed to support appropriate, accessible, and effective policies and programs to promote health and save lives. While the program directly trains up to 20 young Kenyan women, the community outreach that these women will carry out throughout the program and beyond has the potential of reaching hundreds of females in Kibera and in schools throughout the country. Data generated from the research component of the project will provide key information about how communities engage in female-focused health intervention. The implementation of the project will help in generating information regarding access to basic services and women’s health education, and such information may be impactful in designing and implementing successful women’s reproductive health interventions for young women in Kenya. The women-led research dissemination strategy will empower local women and girls to identify and share major risk factors leading to poor women’s health outcomes with major policymakers and stakeholders generating evidence-based intervention.

REFERENCES AND ACKNOWLEDGEMENTS

“Adolescent Pregnancy.” World Health Organization, World Health Organization, 10 Apr. 2024, www.who.int/news-room/fact-sheets/detail/adolescent-pregnancy.

Austrian, Karen, Eunice N. Muthengi, Taylor Riley, Joyce Mumah, Caroline W. Kabiru, and Benta Abuya. 2015. "Adolescent Girls Initiative-Kenya: Baseline report." Nairobi: Population Council.

Kenya National Bureau of Statistics (Ed.). (2019). 2019 Kenya population and housing census. Kenya National Bureau of Statistics.

“Maps and Statistics.” Map Kibera Project, Map Kibera Project, mapkiberaproject.yolasite.com/maps-and-statistics.php.