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 is one of the largest and oldest informal settlements in Africa. It serves as a residential area for many Kenyans, especially those migrating from Western Kenya in search of employment opportunities in Nairobi. However, the inhabitants of Kibera face numerous challenges including inadequate access to clean water, poor sanitation, limited healthcare services, and poor nutrition, which contribute to the overall poor living conditions. Adolescents in Kibera encounter a range of health issues, exacerbated by limited access to quality education and health services, alongside exposure to substance abuse, crime, sexually transmitted infections, and unintended pregnancies (Austrian et al., 2015). These health challenges disproportionately affect women and girls, who navigate restrictive gender norms and roles within their communities. Cultural perceptions of gender significantly influence adolescent health outcomes, impacting community practices and policies, particularly in informal settings where access to necessary care is already constrained. Promoting sexual and reproductive health in these settings is essential for the well-being of adolescents and the sustainable development of the country. Globally, early and unintended pregnancies remain pressing issues, with 21 million adolescent girls aged 15 to 19 and 2.5 million girls under 16 giving birth each year (WHO, 2024).

To effectively address these issues, targeted interventions including legislative changes, policy reforms, and empowerment programs are essential to raise awareness and sensitize communities. Empowering young girls is crucial for fostering economic growth and contributing to national development. By equipping them with the skills necessary for a healthy reproductive future, as well as educational and employment opportunities, we can help break the cycle of health disparities. Multidimensional approaches have the potential to empower adolescent girls significantly and contribute to achieving the UN’s Sustainable Development Goal 5, which aims to promote gender equality and empower all women and girls. Developing interventions that specifically address the challenges faced by adolescent girls in Kibera and similar informal settlements is vital for advancing the global discourse on gender equality and women’s empowerment. Recognizing this need, the University of Southern California’s Global Research, Implementation, and Training (USC GRIT) Lab is collaborating with Project Elimu, a community-driven non-profit organization focused on youth, to establish a public health training initiative. The Youth Public Health Ambassador (YPHA) program stands at the forefront of this initiative, aiming to cultivate a new generation of leaders in Kibera who can drive community change, promote health education, and advocate for the rights and well-being of adolescents. The YPHA program aims to support youth in Kibera to develop skills to serve as peer 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:

Strengthen public health/reproductive health knowledge for women
Increase research capacity in a research dense area, leadership training, and global educational partnership.
To promote investment in youth-centered health promotion programming and opportunities for youth-driven policy advocacy.

PROGRAM DESIGN & EVALUATION METHODS

YPHA Program Design:

To build capacity to further understand and address persistent health challenges in Kibera, the University of Southern California Global Research, Implementation, and Training (USC GRIT) Lab is partnering with the community-driven non-profit organization serving youth in Kibera, Project Elimu, on a public health training program. The Youth Public Health Ambassador (YPHA) program aims to support youth in Kibera to develop skills to serve as peer 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. Project partners will recruit 20 Kenyan youth aged 16-20 and 10 USC global health students to participate in a three-phase capacity building and training program.

The program is comprised of three main phases: First, USC students will assist in training YPHAs in basic public health concepts including sanitation, risky behaviors, sexual and reproductive health, mental health, and gender equity. The YPHAs will also learn different types of data collection including key informant interviews, focus groups, and survey. Second, YPHAs will identify key areas of concern in their communities and learn how to implement a youth-led, community-based health assessment developed in partnership with the USC and University of Nairobi students. YPHA will then interpret the data they collected through this CBPR study. Throughout all phases of the program, YPHAs were provided with resources to assist them in educating their community about healthy behaviors. The program will culminate in a final data analysis workshop focused on interpreting data collected and disseminating results to stakeholders at the community, district, national, and international level in support of public health programs and policies.

This study will be conducted in Kibera informal settlement in Kibera Sub-county, Nairobi County. Kibera covers an area of about 12.1 square Kilometers, and host approximately 185,777 individuals from multiple ethnic and religious groups (KNBS, 2019). Kibera, the densest slum in Africa and the second largest slum in the world is located approximately 5 km southwest of Nairobi city and stretches approximately 2.5 square kilometers. Six of the thirteen geographical sub-locations or villages of Kibera will be purposively sampled based on presence of youth ambassadors within the site. These include Kianda, Lindi, Soweto West, Soweto East, Kisumu Ndogo, and Laini Saba. The sample size will then be proportionally distributed in these six sampled villages based on the population size. We aim to include 3-5 health care facilities per study village, which will be identified by YPHAs who live in those villages.

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

RESULTS

Phase 1: Public health education workshops

Project Elimu volunteers identified 20 youth ambassadors ages 16-20 in Kibera, an informal settlement in Nairobi. Participating youth met requirements including appropriate age, availability, ability to read and write in English and Swahili, and willingness to volunteer. USC global health students were selected through the Global Research, Implementation, and Training (GRIT) Lab. USC students developed a public health curriculum, including an interactive workbook, targeting issues identified by the YPHAs. The curriculum was delivered through an in-person training workshop facilitated by Project Elimu and USC students. Following the workshop, YPHAs were provided with basic resources to assist them in providing educational outreach to peers.

Phase 2: Identify health problems in the community

YPHAs led a discussion on health issues they see in their community and determined which issue they wanted to implement a CBPR study on. They identified early pregnancy and women's health as a topic that more research, knowledge, and data would be beneficial. USC students and University of Nairobi students worked to design and develop a study to submit to IRB. YPHAs assisted in developing the questions for the data collection tool.

Phase 3: Community health assessment & data analysis and dissemination

The YPHA will initiate and administer the questionnaire with the study participant or a consenting adult. The assessment will generally cover the following components: demographics, knowledge attitudes, and beliefs about early pregnancy and related mental health and substance use information, as well as access to care services and community resources. The questionnaire will be translated into Swahili, the local language, by a qualified translator hired by Project Elimu (Kenya). They will ask the questions and enter the answers using handheld tablets preloaded with the survey instrument.

Project Elimu staff will contact health clinics identified by the Ambassadors as present in their villages and ask the clinic supervisor to participate in the study. By consenting to participate, the clinic supervisor agrees to allow the study team to conduct the clinic survey. Small incentives will be provided to participating clinics, including basic supplies such as soap, gloves, and masks.

There will be a final workshop will regard data collection and subsequent analysis. Data will be collected through Qualtrics on digital tablets during interviews/assessments. Once a week, ambassadors will be visited by Project Elimu volunteers, who will upload the data collected to the cloud. The database will be managed by a central USC staff member and checked for problems. Project Elimu volunteers will follow up on any incomplete or inaccurate data directly with the relevant YPHA.

Frequencies, percentages, means, medians, interquartile ranges, and other descriptive and graphical statistics will be computed to understand knowledge, attitudes, and beliefs relating to women’s health issues as well as barriers to health-promoting behaviors.

A dissemination workshop will be organized to share findings from the proposed study to community members, local leaders, national parliamentarians, and the Ministry of Health, as well as within national and international public health and development communities. Proposed dissemination activities will include local community meetings to share results with community members, meetings with local and regional leaders, meetings with national policymakers at the Ministry of Health and National Parliament, and the release of information via radio shows, Television shows, and local and national press. Study investigators at USC and the University of Nairobi will work on a peer-reviewed publication with the study design and results and present the results at international global health conferences.

PROJECT OUTCOMES AND SUSTAINABILITY

The goal of the protocol is to strengthen public health/reproductive health knowledge for women as well as increase research capacity in a research dense area, leadership training, and global educational partnership. Increasing evidence highlights the effectiveness of investing in youth-led community-based research to boost adolescent engagement and empowerment. The CBPR approach used by the YPHA program enables youth in Kibera to identify health challenges faced by their peers and gather the necessary data to support effective, accessible health policies and programs. The methods employed by the program and study creates active collaboration between researchers and community members to provide a culturally and contextually tailored understanding of health in Kibera. Additionally, the program provides USC global health students with the chance to participate in sustainable, community-driven initiatives, equipping them with valuable experience for building ethical global health partnerships in the future. While the program directly trains 20 Kenyan and 10 US youth, the outreach efforts they undertake have the potential to impact hundreds of other young people in Kibera and across boarding schools in the country.

ACKNOWLEDGEMENTS