Kenya

This blog by Lynda Keeru and Kate Hawkins (Pamoja Communications) reports back on the recent webinar – ‘Empowering urban adolescent mothers using digital tools’ – which was organized by the USAID Urban Health Community of Practice. The webinar on urban adolescents showcased implementation research to ensure rapid knowledge and learning from evidence. It featured speakers from theKiboresha Afya Mitaani Project and LVCT Health, both based in Kenya.

The scale of the issue

Teenage pregnancies continue to be a pervasive phenomenon in Kenya – over 50% of all maternal deaths from unsafe abortions in Nairobi are young women aged between 15 and 24 years of age. Forty-one percent of adolescent pregnancies in Kenya’s informal settlements are unintended – either mistimed or unwanted.

Dr. Lilian Otiso, Director of LVCT reiterated that teenage pregnancies are a key concern, so much so that during the recently celebrated World AIDS Day, part of Kenya’s priority areas and focus were the link between teenage pregnancies and HIV. This came from the recognition that the highest number of new HIV infections are among the population. The President of Kenya restated the need to find strategies to solve these issues together because they undermine socio-economic growth and negate the progress made to end AIDS.

Addressing mother’s needs and challenges

‘Kuboresha Afya Mitaani’, a USAID-supported implementation research project, came to life with an aim of contributing to better maternal, newborn and child health (MNCH) outcomes for 60,000 of Nairobi’s most vulnerable women and children. They focus on improving understanding of the drivers of poor health and testing innovative solutions that catalyze political interest and produce replicable models for other urban contexts.

This involves getting a better understanding of the unique and contextual needs of the individuals and communities in order to develop context-specific human-centered solutions that put at the core the voices of mothers and their support systems. The process also includes generating evidence to catalyze government interest in the adoption, implementation and scale up of the interventions. They use implementation research to establish a participatory forum of multiple stakeholders to own these interventions and ensure future sustainability.

The co-created, demand-driven data collected by the project revealed three areas of need for adolescent mothers:

• Informational: Lack of information hinders care seeking, lack of knowledge about pregnancy itself
• Emotional: Stressors on young mothers, isolation, stigma, violence and abuse and financial challenges
• Care based: Disrespect in health care settings, lack of knowledge of entitlements, poor facility settings

Dr. Sathy Rajasekharan, Co-Executive Director, Jacaranda Health, explained how the project is using digital mechanisms, such as a free text messaging service to provide pregnancy information and field questions about pregnancy, birth and the post-partum period. They receive up to 3500 messages a day from across the country and includes a million mothers. It ensures that women with clinical questions are referred to health facilities.

The picture in informal settlements

Dr. Otiso explained how adolescent pregnancies are worse in informal urban settlements than in the rest of the country. The ARISE consortium focuses on accountability within informal urban settlements and the factors that affect the health and wellbeing of people in these spaces. Policy makers often have low levels of data from these settings and so the community’s needs are often invisible in policy and programming. Lilian explained that informal settlement dwellers are commonly left out of financing options and in programs like the rollout of UHC.

Solutions need to combine different elements of programming –  community based interventions and digital technologies – to address the challenges of adolescent pregnancies and the need to care for girls in informal settlement settings and other hard to reach places. Communities must be empowered to use accountability mechanism to get redress from facilities or the state. These systems need to acknowledge that some groups within informal settlements – such as young people – are more marginalized than others.

She argued that it is sensible to combine some social accountability mechanisms like  community scorecards, participatory action research cycles, and work improvement teams at community level with data that is being generated through the digital platforms to feedback to the community as well as health workers and planners.

Future directions

It is crucial to form partnerships to implement these projects and to scale up. There is a host of diverse research on informal settlements that can be brought to bear in our mutual challenge to produce and share knowledge that is critical for policy and for scale up. It is also important to strengthen policy at national and county level to support adolescent mothers and their newborns and children.  The webinar also highlighted that embedded implementation research is demonstrating its ability to uncover critical information to affect change in hard-to-reach populations (i.e. adolescent girls living in informal settlements).  The findings have numerous potential implications for other urban areas in Kenya and across the region.

Moderator:

Dr Cudjoe Bennett, USAID

Contributors:

Dr Sathy Rajasekharan, Kiboresha Afya Mitaani Project Director, Jacaranda Health

Dr Lilian Otiso, Executive Director, LVCT Health

This blog by Lynda Keeru and Kate Hawkins (Pamoja Communications) reports back on the recent webinar – ‘Empowering urban adolescent mothers using digital tools’ – which was organized by the USAID Urban Health Community of Practice. The webinar on urban adolescents showcased implementation research to ensure rapid knowledge and learning from evidence. It featured speakers from theKiboresha Afya Mitaani Project and LVCT Health, both based in Kenya.

The scale of the issue

Teenage pregnancies continue to be a pervasive phenomenon in Kenya – over 50% of all maternal deaths from unsafe abortions in Nairobi are young women aged between 15 and 24 years of age. Forty-one percent of adolescent pregnancies in Kenya’s informal settlements are unintended – either mistimed or unwanted.

Dr. Lilian Otiso, Director of LVCT reiterated that teenage pregnancies are a key concern, so much so that during the recently celebrated World AIDS Day, part of Kenya’s priority areas and focus were the link between teenage pregnancies and HIV. This came from the recognition that the highest number of new HIV infections are among the population. The President of Kenya restated the need to find strategies to solve these issues together because they undermine socio-economic growth and negate the progress made to end AIDS.

Addressing mother’s needs and challenges

‘Kuboresha Afya Mitaani’, a USAID-supported implementation research project, came to life with an aim of contributing to better maternal, newborn and child health (MNCH) outcomes for 60,000 of Nairobi’s most vulnerable women and children. They focus on improving understanding of the drivers of poor health and testing innovative solutions that catalyze political interest and produce replicable models for other urban contexts.

This involves getting a better understanding of the unique and contextual needs of the individuals and communities in order to develop context-specific human-centered solutions that put at the core the voices of mothers and their support systems. The process also includes generating evidence to catalyze government interest in the adoption, implementation and scale up of the interventions. They use implementation research to establish a participatory forum of multiple stakeholders to own these interventions and ensure future sustainability.

The co-created, demand-driven data collected by the project revealed three areas of need for adolescent mothers:

• Informational: Lack of information hinders care seeking, lack of knowledge about pregnancy itself
• Emotional: Stressors on young mothers, isolation, stigma, violence and abuse and financial challenges
• Care based: Disrespect in health care settings, lack of knowledge of entitlements, poor facility settings

Dr. Sathy Rajasekharan, Co-Executive Director, Jacaranda Health, explained how the project is using digital mechanisms, such as a free text messaging service to provide pregnancy information and field questions about pregnancy, birth and the post-partum period. They receive up to 3500 messages a day from across the country and includes a million mothers. It ensures that women with clinical questions are referred to health facilities.

The picture in informal settlements

Dr. Otiso explained how adolescent pregnancies are worse in informal urban settlements than in the rest of the country. The ARISE consortium focuses on accountability within informal urban settlements and the factors that affect the health and wellbeing of people in these spaces. Policy makers often have low levels of data from these settings and so the community’s needs are often invisible in policy and programming. Lilian explained that informal settlement dwellers are commonly left out of financing options and in programs like the rollout of UHC.

Solutions need to combine different elements of programming –  community based interventions and digital technologies – to address the challenges of adolescent pregnancies and the need to care for girls in informal settlement settings and other hard to reach places. Communities must be empowered to use accountability mechanism to get redress from facilities or the state. These systems need to acknowledge that some groups within informal settlements – such as young people – are more marginalized than others.

She argued that it is sensible to combine some social accountability mechanisms like  community scorecards, participatory action research cycles, and work improvement teams at community level with data that is being generated through the digital platforms to feedback to the community as well as health workers and planners.

Future directions

It is crucial to form partnerships to implement these projects and to scale up. There is a host of diverse research on informal settlements that can be brought to bear in our mutual challenge to produce and share knowledge that is critical for policy and for scale up. It is also important to strengthen policy at national and county level to support adolescent mothers and their newborns and children.  The webinar also highlighted that embedded implementation research is demonstrating its ability to uncover critical information to affect change in hard-to-reach populations (i.e. adolescent girls living in informal settlements).  The findings have numerous potential implications for other urban areas in Kenya and across the region.

Moderator:

Dr Cudjoe Bennett, USAID

Contributors:

Dr Sathy Rajasekharan, Kiboresha Afya Mitaani Project Director, Jacaranda Health

Dr Lilian Otiso, Executive Director, LVCT Health

In this blog post Jacob Omondi explains issues leading to youth related crime and violence in the Mathare Valley area of Nairobi, and explores some solutions for helping youth find meaningful ways to stay away from crime and earn a living.

Mathare Valley is an informal settlement compromised of 13 villages, located approximately 9.1kms East of the Nairobi Central Business District. Within Mathare crime rates are higher on average, with Kiamutisya village in particular having a higher number of reported crimes compared to other villages in the area, owing to limited meaningful engaging opportunities leading to increased criminal activity.

Over the years, cases of violence have been continuously reported in Mlango Kubwa, associated with high rates of crime and poverty. A recent enumeration in Kiamutisya reported that 90% of the population in Mlango Kubwa Kiamutisya fall into the youth category (ages 15-24), and 70% are unemployed. With the outbreak of COVID-19, cases of youth related crime escalated. A high percentage of youth indulge in criminal activities including, snatching, mugging, robbery with violence and looting of properties, particularly during periods of protest. In one particular case, youth in Mathare barricaded Juja Road during a protest against the closure of the government youth project dubbed ‘Kazi Mtaani’, which was created to cushion youth within the pandemic period. The protests resulted to riots and mugging, with youths robbing motorists using the road.

According to Ghetto Foundation research on community-based activism, it is evident, young people (ages 15-24) are increasingly engaged in crime and violence. Reports consistently indicate increased rates of unemployment lead to increased crime. Reports indicate young people are also indulging in drug, use as a result of peer pressure and poor parenting.

Young people, especially young men, are identified as the main perpetrators of crime during peaceful protests. Such groups tend to take advantage of peaceful protests by stealing from residents and non-residents. Some young people also commit violent crimes, including stabbing residents while demanding their property. Crime and violence are among the key bottlenecks to growth, and increased cases of crime create a vicious cycle where young people struggling with the lack of economic opportunities turn to illegal activities to sustain themselves.

This poses the question: ‘Why does youthful and dynamic energy lead to crime in Mathare?

Additionally as the electioneering period approaches, politicians in Mathare are known to use young people as conduits to further fuel their interests, sparking increased cases of violence. Youths have been roundly condemned for taking part in crime in all past politically instigated electoral clashes. Youth are commonly bribed with as little as 500ksh to 1000ksh to intimidate political rivals, which leads to sprawling violence. Politicians should endeavor to create an enabling environment through the creation of job opportunities as they seek their political interests other than violence. In addition, those involved in fueling violence should not be allowed to seek any elective post.

Land is also a factor that spurs violence within Mathare. In cities and towns, access to land is a pressing concern for all residents. In the context of urban growth and inequality competition for land for development often result in conflicts, which often turn violent and affect residents. Such conflicts are common, and actors involved target youth who emerge as the main perpetrators of crime and violence during the land contestations.

Drug use emerges as another cause of crime and violence in Mlango Kubwa. A recent study by the United Nations Office on Drugs and Crime shows that “As pertains to drug and alcohol use, respondents reported that the most used substances in Mlango Kubwa are mainly alcohol, illicit brew, and marijuana. Respondents also highlighted that other drugs such as heroin, cocaine, and phenobarbital use have increased over the years. Those most vulnerable in the community are children and youth due to the normalization of drug and alcohol use the result of which is drug use from a young age”.

In order to support their drug use, young people often resort to criminal activities and violence. Finding practical ways to address the prevalence of drugs among the youth remains critical. The Government should aim to work closely with community members to identify those in the drug business and crack down on the illicit brew hubs in the area. Drug prevention programs should additionally address all forms of drug use including the underage use of illegal drugs.

Providing young people with meaningful engagement opportunities is the foundation of most efforts to tackle youth crime and violence. However, lack of proper planning and resources has resulted in a shortage of social spaces where young people can grow and nurture their skills and talent. Nurturing young people’s talent acts as a meaningful way to address social crime as this provides young people the ability to earn income independently.

Over time, there have been growing numbers of young people being gunned down through extrajudicial execution by police. The law does not allow state officers or anyone to take matters into their own hands. Article 26 of the Kenyan constitution states that, “every person has the right to life, a person shall not be deprived of life intentionally, except to the extent authorized by the constitution or other written law”. Increased cases of young people being killed by the police has been met with little or no action. Only those cases that break through into the public consciousness are given attention. There is a need for reforms in the criminal justice system, particularly in this area.

Prisons are playing a lesser role as correctional facilities. Young men and women released from correctional facilities receive minimal preparation and inadequate assistance and support, which makes their re-entry into communities challenging. The prison department must be equipped with mentors who will guide the inmates on the importance of living a good life.

The Safe and Inclusive Cities project through Muungano Wa Wanavijiji has been a great help and support to the young people of Mathare. Through the program, young people are taken through two modules, which touch on safety within the community and decent work as a means of economically empowering youth. Through the program’s safety component, youth engage collectively to devise efficient ways to address crime within their communities while the decent work component focuses beneficial and sustainable ways for young people to make a decent living for themselves.

In the final blog in this series, our ARISE co-researchers in Nairobi – John Mutinda, Lydia Akwabi, Judith Achieng, Famuel Omwaka, Daniel Obiero, and Joel Mburu – explain how they worked with participants to create and analyse governance diaries, undertaken. This blog was supported by Caroline Kabaria, Ivy Chumo and Blessing Mberu.

On our first day with the study participants we were all very eager to meet for introductions and initial group interactions. After mock interviews and de-briefing held at our offices, we agreed that we would go to the Korogocho study site first and attend the Viwandani study site the following day. Community mobilizers, who we worked with during the community profiling, social mapping and ground-truthing fieldwork exercises, were our first point of contact at the site on arrival. The community mobilizer had already contacted and organized the participants when we arrived. Participants were given face masks and safely seated observing social distancing of 1.5m, observing COVID-19 safety measures.

To begin, my colleagues and I introduced ourselves and briefly explained the objectives of why we were all there, including the nature of our study. Introductions and brief comments from the participants followed. The first to speak was a differently abled woman who introduced herself and asked about how this exercise might benefit as participants. She pointed out that many organizations have collected data from them, but without any feedback. She stated:

“Every time people from organisations come to gather data from us, then they disappear and we still see no significant changes in our community; it is as if they just use us to gather information. I want to know how I am going to benefit as a participant in this research”.

As a team we re-emphasized to the whole group that research was changing from a traditional approach to a community-based participatory approach. The participants appreciated our explanation. Participants continued with introductions, appreciations, comments, opinions, suggestions and recommendations. Even though their availability for participation was voluntary, some differently abled individuals are normally hidden from the public by their family members, some are abandoned and destitute while others personally prefer not to be exposed to the public or even to field researches because of their marginalized and vulnerable circumstances. Others are visible on the main streets of Nairobi city center as beggars. From the introductions and comments of the participants, we saw this project as a brilliant platform for the voice of community concerns. We felt good when they expressed willingness to participate in the study and they welcomed us to their homes in advance and assured us of their co-operation. By the end of our meeting, their faces lit up as they began to understand that they are people of interest who could help transform our communities – from the traditional approaches of data collection in conducting research, to the methodologies of the CBPR.

The first speaker’s comments had left us with questions. What are the realistic logistics and dynamics that must change in our country to ensure equity in representation? This was an opportunity to hear from the speaker what she thinks can be done to ensure inclusivity, in the context of the nation’s current non-disability friendly topography. As co-researchers, we noted that the way to close this marginalization gap is by seeking solutions from marginalized community members, because they “know where their shoe pinches the most”. The field data collection began soon and the respondents were very receptive, cooperative and welcoming as they had assured us they would be.

Infrastructure seems to be advancing in slow motion in Korogocho and Viwandani, looking at the roads, public hospitals and schools. But on keener observation, one notes an implosion of human energy at a deeper level, a consequence of the need generated by rural-urban migration to more cosmopolitan counties like Nairobi. We recorded that as people’s knowledge is advancing, attitudes are transforming. For instance, from the respondents we learn that there are parents’ seminars on child health and rights, adolescent girls and young women have safe spaces and there are NGOs targeting boys’ and girls’ talents. PLWDs have meetings and seminars on/with business start-ups. There are parents’ and young mothers’ seminars on small business enterprises income-generating activities. While young ladies are eager to attend seminars, young men are sometimes challenged by economic challenges and scarcity of resources that make them feel entitled to benefits for attendance and participation. There is a regular government facilitated seminar taking place at the community hall in the Chief’s camp to sensitize the community on COVID-19 safety measures, and other health matters. These basic amenities have developed because of collaboration between informal and the formal structures. For example, public toilets are built by community groups who approach NGOs with proposals and request financial contribution while the community group contributes human and material resources.

Community members often employ informal solutions first, before engaging with formal structures. Many people are not aware of whose responsibility it is officially and who is answerable formally for providing services. ARISE project has opened the community’s eyes as to who to ask for accountability. This was evident when during our data collection, there was a solid waste pile up in front of a school (St. Clair). Community members came together and went to complain to the Ward Manager, and a large green bin from Nairobi City Council was brought to the area so the people now throw their solid waste in it and it is collected bi-monthly by the city council’s lorry. What surprised one older man was that the community youths did not know that there is a Ward Manager’s office within the Chief’s camp and that such waste is part of his/her responsibility.

In the fourth blog in this series, our ARISE co-researchers (John Mutinda, Lydia Akwabi, Judith Achieng, Famuel Omwaka, Daniel Obiero, and Joel Mburu) explain how they worked with participants to create and analyse governance diaries, undertaken as part of the social and governance terrain study. Supported by researchers (Caroline Kabaria, Ivy Chumo and Blessing Mberu).

The final exercise in this process involved the creation and analysis of governance diaries. This process made us feel as though we were taking a journey with our participants, getting a sense of their lives. This exercise created bonds of trust and friendship, and presented us with an opportunity to dig deeper into governance aspects because, with subsequent visits, respondents felt more at ease around us and opened up to share more sensitive information.

Community profiling, social mapping and ground-truthing were all necessary steps in order for us to create these governance diaries. The activity involved one on one interviews/conversations with vulnerable and marginalized groups who were identified during the social mapping phase. We followed up with the four top-ranked categories identified as marginalized or part of vulnerable groups. The groups included daycare owners, child-headed households, disabled persons, and older persons.

For the purpose of representation, the study team selected participants for each category from each village. We had a total of 16 participants in each study site. We conducted the interviews in pairs of two, where one person was the moderator while the other acted as observer and note taker. Apart from taking notes, the second co-researcher also took photographs during the interview, and dealt with any issues that might interfere with the interview process.

We provided each study participant with a diary for them to note daily activities. The moderator would then go through the participant’s diary in subsequent visits before beginning the interview. This provided the chance to formulate probing questions and offered a foundation on which to build stories. During the study, we completed six visits to each participant. Each round of visits took one week, with the week after used to write reflective notes. After completing each interview we would meet as co-researchers discuss the most recent interview, and any thoughts or reflections would be incorporated into the notes in our own diaries and used to improve our approach for the next interview.

This data collection approach required patience, flexibility, trust, critical thinking, communication skills, listening skills, observation skills, qualitative skills, interpersonal and intrapersonal skills, in order to capture the thoughts and experiences of the participants on different visits. We had team meetings, debriefing sessions/clinics and reflective meetings where we learned these skills. For instance, we learned non-verbal communication skills including noting facial expressions, interpreting when the respondent is tired, and when he is not comfortable with the topic, among many other useful qualitative skills. We also learned the importance of understanding research context, content and how to interact with different people, while respecting the thoughts, feelings, culture and behaviors.

We used our diaries to record our findings and feelings after interviews, including what we observed in the interview, lessons, challenges, mitigation measures to challenges, learning/training needs and questions for the next visit. At the end of the week, we attended weekly debrief clinics and bi-weekly reflection meetings, giving us an opportunity for cross-sharing and cross-learning with other co-researchers and researchers. We got the opportunity to meet with ARISE partners during the reflection meetings, who enhanced our skills. Researchers organized a therapy session with a professional counselor to help us with our emotional and mental wellbeing. The ARISE project is among the first projects where we have had access to a counselor.

As co-researchers residing in the community, we learned that there are myriad difficulties people experience. They do not think they have the right to hold anyone accountable for a lack of access to the resources and services they need. And they often lack trust in the actors linked to these issues in the community. From our cross-learning, we realised that some participants exaggerated their vulnerabilities in the hope of gaining support of any kind. Some would ask for handouts in addition to the reimbursements we had made to them. In such cases, we explained the importance of research and re-consented. Many study participants lacked information and some had misinformation on different governance aspects. This was a major hindrance to the communities’ quest for better service delivery, as most of the structures in the community are informal.

Through field experiences, co-learning and co-sharing, we learned to adjust our language so that it would not

affect our positionality. With every group, we learned to be specific and selective with the language we used in each situation. So the language we used when engaging with older persons was different from the one we used with child-headed groups. Similarly, language for better educated and less educated differed and sometimes language for different gender groups also differed. We learned the act of community entry through the gatekeepers as we engaged them in the study at the initial phases and the importance of community solutions being suggested by the community.

Teamwork and continuous learning was the main propeller for fieldwork. Having a partner to work with and the support from the team leader as well as the researchers created an enabling environment.  Learning from our mistakes as well as from other team members was also helpful. We were the students of our own mistakes during the exercise, not allowing ourselves to repeat a mistake. Some of these lessons included failures due to poor timing and lack of a planned schedule. Here we learned that different respondents had different

preferences for interview timing. From that we scheduled our interviews based on the respondent’s availability, leading to efficiency from both ends.

We encountered a few challenges which we overcame by understanding their root cause. For instance, we managed to identify participants who were more difficult to pin down and decided prioritise them at the beginning of the week. That way, by the end of the week we would have managed to have our discussions. At the daycare we learned that lunch hours were best, as when the children were asleep the daycare owner was not occupied.

Some participants did not also understand the questions and needed you to create incidents and scenarios to understand and we did whatever suited them best. There were also too many expectations from the respondents at the initiation of the exercise, however, after clarification in the different visits, the respondents understood the project better and we had more realistic expectations. In some instances, respondents traveled out of the enumeration area and we had to be flexible and creative. Another challenge was the uptake of diaries

by the respondents. Some of them reported that they had lost their diaries whereas some complained that their siblings had misplaced their diary. Others had just forgotten to note their daily activities. To address this, we resolved to two measures; giving the respondents calls to remind them to note their daily activities in the diary and during our weekly visit we made copies of notes in order to store them safely.

Contrary to our assumption that we all face similar challenges in accessing basic services in this community, during this study we realized that we were wrong. Through the study we realised that private service providers, who have come in to bridge the gap in cases inadequate public amenities, are driven by the desire to make profits thereby making such services unaffordable to the marginalized/ vulnerable groups in the community. We are recommending the research organizations engage with the community, government and other stakeholders and come up with some sustainable programs to empower these marginalized groups and by

extension uplift the whole community.

This ARISE study has been a training and learning experience for us. It has enhanced our skills and experience in qualitative data collection, as well as enabling us to improve on such skills as writing, critical thinking, analysis, listening, interpersonal and timekeeping skills. Having been exposed to several styles of qualitative data collection, we would love to learn other qualitative data collection techniques in the future. Above all, we learnt about the different governance aspects of our communities, and we can always be consulted in the community.

In the third blog in our series, our ARISE co-researchers (John Mutinda, Lydia Akwabi, Judith Achieng, Famuel Omwaka, Daniel Obiero, and Joel Mburu) explain their ground-truthing exercise, undertaken as part of the social and governance terrain study. Supported by researchers (Caroline Kabaria, Ivy Chumo and Blessing Mberu).

Our ground truthing exercise involved confirming and validating the locations of amenities/basic services mapped in earlier exercises. We worked to confirm 30% of basic services mapped during community profiling, by collecting their coordinates, as well as locating the coordinates of any other related basic service located within approximately 20m of the amenity being validated.

We walked through villages in order to physically verify some digitized features, and confirm if this was correctly mapped and record the GPS coordinates on a tablet, then sync the data for review and analysis in real-time.

While the exercise was a success, we encountered several challenges. While we hoped to be able to use tablets to collect all this data, they proved to be slow in collecting the coordinates of these locations. We, therefore, resorted to the use of a mobile phone for data collection as they captured this information quicker. Additionally, during this exercise some residents thought we were recruiting people to receive COVID-19 relief, and so we had to explain ourselves in some places.

Lessons learned during the social mapping of gatekeepers were useful while visiting the community.

In cases where we anticipated conflict or misunderstanding, we could refer to gatekeepers who had been mentioned, including village elders, “Nyumba kumi”, the chairmen, and the Chief in order of hierarchy. Mostly the Nyumba kumi and the chairmen were the first to be consulted in the community.

As members of the community, it was easier to interpret maps and locate the identified amenities, which made the exercise enjoyable. We learned that the community members who were involved in the mapping process had a deeper understanding of the community as most of the social amenities identified were actually on the ground and in their appropriate locations. On the rare occasion of a wrongly mapped amenity, we could quickly confirm the correct location with those in the area.

In the second blog in this series, our co-researchers (John Mutinda, Lydia Akwabi, Judith Achieng, Famuel Omwaka, Daniel Obiero, and Joel Mburu) explain the social mapping exercise they embarked on as part of the social and governance terrain study. They were supported by researchers (Caroline Kabaria, Ivy Chumo and Blessing Mberu).

The social mapping exercise was the second part of the mapping social and governance terrain study we embarked on as co-researchers. Following on from the community profiling work we did, it was an equally informative activity involving participants from different social groups representing all the villages in the community. As part of the exercise, a social map/chart is prepared by the community to depict social aspects, and describes what local people believe to be relevant and of importance.

In our social mapping activity, we aimed to understand the social aspects of study communities where the ARISE project has been implemented. The activity entailed mapping/charting six themes: stakeholders, influential groups, marginalised groups, vulnerable groups, social structures, and things one would change if they had power.

In the stakeholders’ section, study participants discussed community stakeholders, and for the influential section, they discussed actors with influence in the community from the lowest influence, to the highest. They also discussed and ranked the marginalised and vulnerable groups in the community from the most marginalised/vulnerable to the least, and finally concluded by listing the things they would change if they had the power starting from the most important to the least.

Next participants took part in a focus group discussion (FGD). We subdivided the participants into two groups during the charting activity before engaging them as one group in a focus group discussion. During the charting, we would guide each of the two groups (one co-researcher in each group) on mapping.

Each group would select a moderator and a secretary and agree on ground rules. Our role was to continuously monitor and guide the groups without influencing their thoughts and ensuring every person was inv

olved in the activity.  During the FGDs, one of us would participate as a moderator and another one as a note-taker in the morning and the roles would be reversed in the afternoon. Many community participants said this exercise felt like classwork, as it involved putting thought into what they recorded as a group, but admitted that it was a thought-provoking exercise on things they usually don’t usually think about, particularly the social structures and influential groups.

As with our previous social mapping activity, we ensured that the venue adhered to COVID-19 guidelines. Study participants who arrived late to the venue were quiet and reluctant to contribute to the discussions, our mitigation was to briefly re-consent and explain to them the purpose of the study. Face masks and social distancing affected some participants’ audibility while responding to questions and we asked one to either project their voice or pull down the mask when speaking and pull it up once done talking.  A few respondents were dominant in the discussions, and we would guide them politely to allow others to speak.

We scheduled two groups each day; one for female participants and the other for male participants.

This was a community-led activity. Some participants took time debating the ranking for influential, marginalized or vulnerable groups. In many instances, they asked us not to intervene and let them decide on their own. We only gave our guidance where needed and made clarifications where possible. We noticed that some respondents were not participating in the discussion, and we encouraged them to participate and explained the value of their inputs to the final output. Outputs differed based on social group dynamics in the community. For instance, marginalized and vulnerable groups varied from group to group, but people with disability, older persons and child headed households were common. During the focus group discussion we learned that the community had solutions to many of the of the social challenges identified, they just need direction on how to begin.

Every challenge has an opportunity for learning hence we learned a lot from these activities. We learned about social structures, influence, actors, power, marginalized and vulnerable groups in the community during social mapping. Having been raised in the communities, we understood how social structures and influence impacts community profiles mapped in earlier sessions. In addition, we learned how to conduct FGDs and the importance of mastering the content to avoid asking a wrong kind of questions, receiving incorrect responses, thereby compromising the quality of the data collected. Probing was also an important quality of a moderator, allowing them to collect as much information as possible. We learned that patience was a key skill for moderators and note takers, giving participants time to express themselves fully. Being part of this study was a privilege. We are confident that we are well-positioned to understand the community better and be a change to our communities.

Our co-researchers (John Mutinda, Lydia Akwabi, Judith Achieng, Famuel Omwaka, Daniel Obiero, and Joel Mburu) talk you through their approach to community mapping and charting social and governance terrain. They were supported by researchers (Caroline Kabaria, Ivy Chumo and Blessing Mberu).

This process began with community profiling, which involved community statutory and voluntary organisations identifying community needs, particular issues, and resources. The activity allowed us to gather knowledge of our communities, allowing us to understand the basic information of the settlement, land tenure system, historical background, basic services, and livelihoods in the study sites.

This activity involved participants representing different groups from all the villages in Korogocho and Viwandani informal settlements.  We gave the study participants a printed map and asked them to identify and map basic amenities in their villages. Amenities to be mapped included; open spaces, health facilities, education facilities, water points, waste disposal sites, floodlights and other important basic services. The participants marked each of these amenities with a unique number or letter on the map and created a legend, for easier identification during analysis. After exhausting the amenities in their villages, we guided the study participants to sit in a circle while we recorded a focus group discussion (FGD). The discussions revolved around the status and governance of mapped amenities.

Our field day began with the arrangement of the hall/meeting room to ensure adherence to COVID-19 containment measures. This included adding in a sanitation station and ensuring social distance in the seating arrangement. We also displayed printed maps on spaced tables to allow for social distancing. Respondent consent was garnered upon arrival. We scheduled two groups for each day: one in the morning with female participants and another one in the afternoon with male participants.

As community members, we found this interesting because we got to learn more about our communities. We learned a lot about basic amenities, accountability, and equity of the amenities. During the focus group discussions many things emerged about the accountability of resources. Every group had different dynamics and the discussions had diverse and informative content. As co researchers we are also community members, and familiar to many respondents, which really allowed the study participants to open up and they were really  receptive throughout the study.

These activities had their challenges. For example, some participants took time to understand the map and align themselves with it. In such cases, we used our understanding of the community to explain to the map to them using known landmarks to enable them to map the amenities as accurately as possible. Some participants did not understand certain questions during FGDs, evident by their responses. In such cases, we had to rephrase the question as many times as possible until the respondents understood. Some participants also spoke in a low tone which made it hard when taking notes and we had to ask respondents to project their voice.

Some participants complained about the length of the FGD sessions, but we reminded them of the importance of this activity.

We had routine debrief sessions for co-learning and co-sharing. Researchers and the community also had trust in us as co researchers, and we were motivated and confident to give our best. We felt that the activity was of benefit to us, the community, and the researchers. Respondents had a common blanket of recommendations including improvement in public toilets, public primary and secondary schools, electricity, dumping sites, water, upgraded housing, public hospitals, security with street lighting, and improved police services.

Nicera Wanjiru (Muungano Kibera) conducts a double interview with two young people of the same age who live in Kibera informal settlement in Nairobi. How have their lives have been affected by the Covid-19 pandemic?

The announcement of the first case of Covid-19 brought Kenya to a standstill. Cessation of movement, curfews, lockdowns were never anticipated. The majority of young people lost their jobs. Young people saw their mothers and fathers break up and others were forced to change careers. To find out more I conduct a double interview with Vivian Vushele who hails from Kakamega County and resides in Kibra, and Charles Gicura. Vivian witnessed her parents separate during Covid-19 Pandemic: living with her siblings, they saw another side of their Dad that they had never seen. For Charles, he had to change careers, having trained in hospitality there was no hope for hotel industries. He says it hasn’t been easy.

Looking down at the last year, how were you affected by COVID-19 pandemic?

VIVIAN: For me, I was very much affected together with my family that is when my dad and mum separated. Their marriage became violent and my mother chose to leave. Where my Dad was working they were forced to quit their job, staying at home with no job was not easy. It wasn’t a good environment for them. It actually made my parents separate it really affected me and my younger siblings it something we never thought it would happen to our family, ever since we were young we used to see on how our family was going on and how our family was and future plan for the family was. But now when the corona thing came in. We were able to see the other side of our dad we never knew it was terrible.

GICURA: Well, last year was quite difficult, to say the least. Because with the emergence of Covid-19. A lot of our dreams were shattered, maybe because you were working and lost the job or you had a job opportunity or maybe you had something going on that is maybe school perhaps all of that was shattered because of the regulations that government put in place. You didn’t know what next, you were put in a place where you were living a day at a time.

What has resilience meant to you?

GICURA: The urge to being adaptive. You had to adapt at each day challenge that was put before you, you had to conquer it. Because there was not any other option, so you had to be adaptive of the circumstances that you were facing at that particular time. Also just encouraging my peers and family because it was a difficult time for all of them. So you had to fight not for own self but for others as well

VIVIAN: We had to pick up the pieces. This a family where we used to stay together united. We still have hope and none of us is ready to lose their dreams. We had to cope up with everything we had to pick up the broken pieces and move forward. For me that was resilience, despite all that was happening, we never lost hope.

Has your hope for the future been affected?

VIVIAN: At first they were, so it was that time I was to join a film school but due to that, everything collapsed and so we had now to start another new chapter of life. So everything was shattered.

CHARLES: Well, yes! I guess at my age having to switch careers it can be very challenging. Because you don’t know what next, you don’t have the bearing of life anymore at times you feel like giving up. But you have that spirit telling you to push on. I can say my dreams were shattered at first but by each passing time you realize then you pursue a place for yourself and then for your family too.

As a young person, have you had access to things like water, medicine, sanitizers and information in your community?

VIVIAN: I would say at first when the pandemic arrived I saw some organization which actually tried on bringing this things, water sanitizers but now due to much population they couldn’t sustain it. So we got it like for two months and everything was shattered. We had to strive to get this thing. As a family we chose food over water and sanitizers. In fact, we were struggling to get that food leave alone sanitizers.

GICURA:  Well at first there was this Government directive of providing sanitizers also free water from and also other NGOs around this place. It helped the community a lot a lot. I mean people were depending on the water they were given to wash their hands, the sanitizers to protect themselves from the virus. But as time went by this initiative came to an end, and at the process people started buying these sanitizers from their own pocket money. To an extent it became a source of families fighting because you could see the argument coming up because of one is suggesting they buy the sanitizer and water to wash their hands to protect themselves and the other party is saying we need food on the table. So they were disagreeing a lot based on the fact that these amenities were not provided to us later on.

Were these services affordable?

GICURA: Services such like water were expensive, especially in this part because the population is high we have scarcity and also a lot of people are depending on this water for a lot of things, for their businesses for their daily routine, so water became a very rare commodity. So yes we lack such items in our community for those who could not get free water they had to buy it and it was expensive.

VIVIAN: At first sanitizers were at high price and we couldn’t afford it because of the situation back at home we couldn’t afford that kind of money to go buy sanitizer and leave food so we had to choose food over sanitizer. It wasn’t fair.

Have you been involved in any projects to support your friends or community?

GICURA: Yes I did! We opened a group as young people in my community, this was after safe and inclusive cities training. From this we were able to benefit from certain projects from the chief’s office because we were doing an initiative of cleaning up our community and Kibera at large. From this we were able to benefit from things like water for the community because the chief provided some amenities to us so as we can clean our cities. So in short what am trying to say by opening the group the project just came to us.

VIVIAN: Actually there is a group that am in we went through some training from SAIC which was decent work and safety. We were able to start up a poultry farm and we kept some chickens and actually it has really impacted our lives positively.

Do you think as a country, we are able to cope with pandemics like Covid-19?

VIVIAN: For now am very sure as a country and even individuals we are. This is because the Covid-19 pandemic has taught us a lot in terms of saving the little money you have. Actually when it came it was very sudden so at least now as much as we are spending we need to know we need to save some extra amount of shillings just in case of emergency.

GICURA: Yes! I guess we have a lot of information now as a community about Covid-19 and people are really aware of what we are dealing with compared to the last few months where we didn’t know what this thing was. We also saw people face stigma when you are diagnosed with Covid-19. In fact we saw people being beaten up because they coughed in public. Nowadays people are in a better position of how they judge, of how they behave themselves and everything so I guess yeah, we are at a better place.

Any final messages?

VIVIAN: I would really love for our government to consider our youth because in slums we have so many talents, we have so many gifts. So if the government would really consider it. I think that would be the best thing. Some of us we actually need that small push up maybe us going to school and pursue our education and am very sure we would change the entire city.

CHARLES: YEAH! The whole issue of mental health, I guess it’s the main issue facing young people in this community a lot of people are said to be depressed and also they don’t have the avenues or facilities to go when they face this circumstances. So I feel if the Government can provide facilities where people can go and get counselling so as they can improve themselves and the families they live in.

Kenya’s progress towards achieving Sustainable Development Goal 6 has been slow, with only 59% and 29% water and sanitation coverage, respectively (JMP, 2019). Sewered sanitation is currently available to only about 3.9 million people in 26 counties with 61% of these being within Nairobi County. 21 counties lack any systems for waste management (WASREB, 2020), while funding for sanitation remains low. With less than ten years to go, Kenya must act fast if it is to achieve water and sanitation for all by 2030.

Women and youth are largely responsible for household water, sanitation and hygiene (WASH) management and bear a disproportionate burden when these basic services are lacking. However, they are often left out of critical discussions and decisions relating to water and sanitation. There is evidence that women and youth participation in water and sanitation decision-making and governance can lead to their social-economic and political empowerment and can enhance performance outcomes for the household and community (UN, 2019).

The ARISE team at African Population and Health Research Center (APHRC) supported the Water Services Providers Association (WASPA), Ministry of Water, Sanitation and Irrigation (MWSI), Women in Water & Sanitation Association (WIWAS) and the County Government of Nakuru to hold the inaugural Youth & Women in WASH conference (Conference website) in Naivasha, Kenya from 30June – 3 July, 2021. The theme was ‘Unlocking potentials of Youth and Women for Sustainable Water and Sanitation Services.’

The Conference was officiated by Hon. Sicily Kariuki, EGH, the Cabinet Secretary, Ministry of Water, Sanitation & Irrigation (MWSI). It brought together stakeholders from the water and sanitation sectors to share good practices, deliberate on prevailing challenges, and formulate strategies to leverage youth and women’s potential to accelerate the realization of universal access to potable water and safely managed sanitation services.

In her opening address, the Cabinet Secretary, Hon. Kariuki outlined the efforts her ministry was implementing within the Water Sector in promoting and championing women’s inclusion in decision making in order to empower them and improve services in the sector.

“When women and youth are incorporated in these sectors and in all sectors for that matter, the individual, the organization and the community is enriched,” she said.

Chief Administrative Secretary, Gender from the Ministry of Public Service, Youth and Gender Affairs, Hon. Dr. Linah Kilimo noted that access to clean water and adequate sanitation contributes to the achievement of gender equality and women’s empowerment. She noted that the violation of these requirements was a violation of women and youths’ rights.

“Inadequate access to safe hygienic and private sanitation facilities is a source of shame, physical discomfort and insecurity for millions of women across the world”, she said.  “In informal urban settlements like Mathare valley in Nairobi, women have to wait until it is dark to empty their bowels. As a result, they tend to drink less during the day resulting in all kinds of health problems,” she added.

The CAS reiterated government commitment to affirmative action funding for women and youth through the Ministry of Public Service, Youth and Gender Affairs. She urged women and youth groups at the conference to take advantage of interest-free loans such as the Women Enterprise Fund, the Youth Enterprise Development Fund and UWEZO Fund to develop and earn profits from water and sanitation projects.

The ARISE team at APHRC supported the conference preparation with Caroline Kabaria chairing the Scientific and Technical Committee. Blessing Mberu gave a keynote address on capacity development and research to optimise the untapped potential of youth and women in the WASH sector. In his address, Blessing highlighted the need for continuing demand for equity in bringing women and youth into WASH governance. Beyond the focus on existing positions however, he calls for focus on developing new and emerging frontiers in the sector where women and youth can offer leadership along the WASH value chain. Areas he identified included innovations using technology like e-payment platforms, designing, manufacture and distribution of gender sensitive sanitation products, WASH entrepreneurship and tapping into opportunities in capacity building and research leadership, where women generally have comparative advantage. He specifically called for investments in capacity building towards a critical mass of women and youth professionals for research leadership with training at Masters and PhD levels. He identified existing scholarship models for graduate training that can be amplified, and called for interrogation of the pathways of women in Science, Technology, Engineering and Mathematics (STEM) in relation to recruitment, retention and career progression towards leadership and beyond. WASH is an essential sector and the overarching question is about how to mobilize our human capital in youth and women, train and engage them. The overarching answer is about evolving an inclusive productive process of inputs and outputs in existing opportunities, in creating new ones, new frontiers, and new models by and for those well trained, ready to engage and proceed. The pathway forward includes addressing structural hindrances. The youth of today will get older and their children – the young men and women of tomorrow – will end up in the same spot and crying the same cry of yesteryears and our today.

“Every generation has their challenges and ours is with us including how to build an inclusive equitable society and sectors, Let us do it collaboratively,” he concluded.

To amplifying community voices and the interface between citizens and government to build collective capacities, ARISE mobilized and supported six youths and women from Korogocho and Viwandani informal settlements to participate in the conference and make presentations. The participants from Sidarec, Slum-Tv Kenya, U-Tena Youth Organization, Ghetto fm Mukuru, Slum child foundation, and Fuata mkwanja exhibited their activities in water and sanitation in their communities.

“We got a rare and a unique opportunity to make a brief presentation about our work in the line of Water, Sanitation and Hygiene to Ministry of Water, Sanitation and Irrigation Cabinet Secretary, Hon. Sicily Kariuki and other top delegation in our stand on the sidelines of WASPA Youth and Women Water and Sanitation conference 2021. We are happy to be working with African Population and Health Research Center, Sidarec, Slum-Tv Kenya, U-Tena Youth Organization and Ghetto fm Mukuru”, they said.

Exhibition

In addition, the community groups also discussed their work in a conference session in a joint presentation with Ivy Chumo, a Research Officer at APHRC and PhD Candidate at LSTM supported through ARISE Hub.

Innovations Award

Two community initiatives were awarded second and fourth place in the Community Category of the Conference Innovation competition dubbed Vijaana and Dada Water and Sanitation Awards. The two were feted with other competitors at a gala event officiated by the Dr. Andrew Tuimur, Chief Administrative Secretary, MWSI.

The two awardees were part of community participants in a Youth and Women Water and Sanitation Forum co-hosted by ARISE in May 2021 in Naivasha, Kenya.

Women at the helm of water and sanitation

Pre- conference (Group Photos; From left; women group and youth group)

Video links (Blessing and Florence)

In addition, APHRC partnered with the Women in Water and Sanitation Association (WIWAS) to convene a session on Strengthening the Role of Women leadership in the management of WASH at the conference. The session, moderated by Caroline Kabaria, created a forum for women leaders in the various Water Service Providers (WSPs), WASH related institutions and communities to speak candidly on the challenges faced by women and youth in accessing opportunities in the sector.

“The engrained social norms which trickle down to prejudiced hiring processes and limited training and networking opportunities has been a major contributor to the unequal employment opportunities throughout women career trajectory,” said WIWAS chair Dr. Leunita Sumba in her opening remarks at the session.

“Career progression plans in most organizations are steep and the barriers placed by the male dominance in the sector make it nearly impossible for women and youth to occupy positions of leadership. It is therefore necessary for women and youths to be proactive but also have support from those in leadership to create a level playing field,” said Margaret Maina, Managing Director Limuru Water and Sewerage Company.

During the session, Amb. Dr. Mary Khimulu presented the UNESCO World Water Assessment Program (WWAP) call to action to accelerate progress towards the achievement of gender equality in the water sector. The call is to decision makers across the board to accelerate concrete actions towards the achievement of “water access to all without discrimination; promoting women’s leadership in water management and governance; protecting women’s water rights and applying gender-equal financing, narrowing the gender gap between policy and practice, prioritizing the collection of sex-disaggregated water data and counter-fighting norms and stereotypes that disadvantage women and girls.”

WASPA CEO, Antony Ambugo, pledged to support in strengthening WIWAS through continuous collaboration as well as recruitment of members from WASPA members.  Other members of the panel were WIWAS Male Champion Eng. Simon Thuo, Beatrice Langat, a senior research Officer at Kenya Water Institute, Monica Tuli Ag. Human Resource and Administration Director at Nairobi City Water and Sewerage Company.

The women in leadership positions were also encouraged to create enabling environments for the younger generation as they work towards positions of leadership.

“Do you leave the door open behind you or do you close it?” asked Linda Gwanda, the Communication and Corporate Affairs officer of the Water Sector Trust Fund fellow panelists and the audience.

The main outcome of the session was to setup a deliberate effort by WIWAS and its members to start mentorship sessions for youth and girls at high school and college levels.

Sheillah Simiyu, Francis Onyambu, Phylis Busienei, and Ivy Nandongwa joined the ARISE team at the conference where eight abstracts and presentations were made based on various ARISE and Urbanization and Wellbeing in Africa (UWB) research at APHRC.