Research Thematic Area 3
Community Health Systems Strengthening (CHSS) Research
We employ mixed methods to identify barriers to health service utilization. We optimize the effectiveness of strategic evidence-based interventions at scale.
Overview
The priority of Community Health Systems Strengthening Research at LVCT Health is to generate evidence for health service utilization in communities through our research-policy-practice model. We employ mixed methods to identify barriers to health service utilization. We optimize the effectiveness of strategic evidence-based interventions at scale. Thus the evidence generated from our research is used to innovate, integrate and provide comprehensive high-impact services and programs for utilization by policymakers, implementers, and service providers.
Research Partner: UNDP
Funder: Swiss Development Cooperation
Links to publications: Work in progress
RISE is a five-year research study that aims at increasing accountability for health and wellbeing among vulnerable people in urban informal settlements. The objective of the study is to understand the role of social accountability in addressing socio-economic, health and wellbeing inequities of vulnerable populations living in urban slums in Nairobi, Kenya. It is being implemented by three partners, namely, APHRC, SDI-Kenya, and LVCT Health in three informal settlements of Nairobi, namely, Korogocho, Viwandani and Mathare.
LVCT Health’s role is to conduct a photovoice study to understand experiences of vulnerability and marginalization by the three categories of persons identified as most vulnerable by the social mapping. These are children heading households, older persons and persons with disability (PWD). The photovoice study is being conducted in two informal settlements, Korogocho and Viwandani using a Community Based Participatory Research approach (CBPR).
This study employs a mixed methods approach that consists photovoice, governance diaries, in-depth interviews, key informant interviews, focus group discussions and household surveys. The results from the photovoice will be used to inform the implementation of the third phase that consists of addressing gaps identified through a co-creation process that involves the study communities in the three informal settlements.
Links to publications:
1. Egid, B.R.; Roura, M.; Aktar, B.; Amegee Quach, J.; Chumo, I.; Dias, S.; Hegel, G.; Jones, L.; Karuga, R.; Lar, L.; et al. ‘You want to deal with power while riding on power’: Global perspectives on power in participatory health research and co-production approaches. BMJ Glob Health 2021; 6, doi:10.1136/bmjgh-2021-006978.
2. Teixeira de Siqueira-Filha, N., J. Li, E. Kibuchi, Z. Quayyum, P. Phillips-Howard, A. Awal, M. I. H. Mithu, F. Manzoor, R. Karuga, S. Saidu, J. Smith, V. Sai, S. Garimella, I. Chumo, B. Mberu, R. Tolhurst, S. Mazumdar, V. Rao, N. Farnaz, W. Alam and H. Elsey (2021). “Economics of healthcare access in low-income and middle-income countries: A protocol for a scoping review of the economic impacts of seeking healthcare on slum-dwellers compared with other city residents.” BMJ Open. 2021; 11(7): e045441.
3. Aktar B, Alam W, Ali S, Awal A, Bayoh M, Chumo I, Karuga R, et al. How to prevent and address safeguarding concerns in global health research programmes: Practice, process and positionality in marginalised spaces. BMJ Global Health. 2020; 5(5): e0
Research partners: Simon Fraser University
Funder: BMGF
COVID-19 has caused a negative impact on the functioning and psychophysical health of communities, widening the gender inequity gap. Timely sharing of research findings related to disease perception, social practices that might be linked to health-seeking behaviors, barriers to care, socio-economic wellbeing and their intersectionality with gender is vital in development of gender responsive strategies.
The study sought to (a) Document and analyze gender dynamics of the outbreak response and recovery in order to understand the impact of COVID-19 on individuals and communities; (b) Document and analyze gender mainstreaming in policy making in response to COVID-19.
The study adopted an exploratory qualitative research design. Interviews were held with community health volunteers; women in the community (pregnant women/new mothers, adolescent girls, domestic workers, females in mining sector and female owners of small and medium size enterprise); and policy makers. Participants described their perceptions and experiences during COVID-19 pandemic, providing illustrative examples how they are/were affected according to their socio-economic wellbeing and access to information and services. Qualitative framework content analysis was applied to provide context specific findings. Data saturation was achieved by analyzing narrative reports of study population using the inductive thematic saturation method.
The findings showed that COVID and its preventive measures caused adverse consequences on the lives and livelihoods of women in the community. The socio-economic secondary impact was gendered – women and girls were affected more than males. Policies developed were gender neutral thus did not account for the gendered impact. The study recommended that effort by policy makers need be put in development of gender responsive plans. Implementation of these plans needs to be monitored, ensuring there is continuity of health services such as post violence services and social protection programs at community level.
Links to publications:
Papers:
1. Mueller, V., K. Grépin, A. Rabbani, B. Navia, A. S. W. Ngunjiri, and N. Wu (2022). “Food Insecurity and COVID-19 Risk in Low- and Middle-Income Countries.” Applied Economic Perspectives and Policy. 2022; 44(1), 92-109.
Technical Briefs, Reports:
1. Anne SW Ngunjiri, Lilian Otiso and Robinson Karuga (2022) COVID-19 pandemic and the health and socioemotional well-being of adolescent girls and young women in Nairobi and Migori Counties, Kenya, Gender and COVID-19 Project;
2. Alice Mũrage, Heang-Lee Tan, Lilian Otiso, Anne Ngunjiri, Kate Hawkins, Erica Rosser, and Rosemary Morgan (2022) What are the Gendered Impacts of COVID-19 in Kenya? Gender and COVID-19 Project; 3) COVID-19 Project.Rosser EN, Morgan R, Tan H, Hawkins K, Ngunjiri A, Oyekunle A, Schall B, Nacif Pimenta D, Tamaki E, Rocha M and Wenham C (2021) “How to Create a Gender-Responsive Pandemic Plan: Addressing the Secondary Effects of COVID-19.” Gender and COVID-19 Project
Abstracts (Oral and Poster Presentations):
Mueller, V., K. Grépin, A. Rabbani, A. Ngunjiri, A. Oyekunle, and C. Wenham (2022). “Domestic Burden Amid COVID-19 and Women’s Mental Health in Middle-Income Africa.” Paper presented at the Population Association of America Conference in Atlanta. April 8th 2022.
Research Partner: UNDP
Funder: Swiss Development Cooperation
Links to publications: Work in progress
Women and girls are disproportionately affected by Gender-Based Violence (GBV) owing to the increasing vulnerabilities related to gender inequality, societal norms, discrimination, and humanitarian challenges associated with the COVID-19 pandemic. Unfortunately, most GBV survivors are hesitant to reveal their experiences of violence or seek support from (in)formal service providers. They experience inadequate access to health and social care and psychological support due to a lack of information on where to seek help, fear of perpetrators, or socioeconomic barriers. Survivors who seek services receive suboptimal care as facilities and service providers do not tailor services to their needs/priorities to offer client-centered care.
Technology-enhanced healthcare delivery systems are needed to ensure continued access to sexual and reproductive health rights (SRHR), SRH and GBV information, and referral for services. In this study, we will design and pilot the technology-enhanced AGILE Chatbot that aims to accelerate access to GBV information and services for survivors of GBV. The AGILE chatbot, hosted by LVCT Health, will be piloted and implemented among adolescents, women, and LGBTQI who seek GBV and SRH information and services. After a successful iterative design and pilot process, the AGILE chatbot will be scaled up to allow access by the general public. The target population will be marginalized groups, adolescents and young people who face risk of experiencing GBV or are surivors and need post violence and support services.