Hayley Stewart
Posts by Hayley Stewart:
Safeguarding in practice: anticipating, minimising and mitigating risk in teenage pregnancy research in urban informal settlements in Nairobi, Kenya
Abstract
Safeguarding challenges in global health research include sexual abuse and exploitation, physical and psychological abuse, financial exploitation and neglect. Intersecting individual identities (such as gender and age) shape vulnerability to risk. Adolescents, who are widely included in sexual and reproductive health research, may be particularly vulnerable. Sensitive topics like teenage pregnancy may lead to multiple risks. We explored potential safeguarding risks and mitigation strategies when studying teenage pregnancies in informal urban settlements in Nairobi, Kenya. Risk mapping was initiated by the research team that had prolonged engagement with adolescent girls and teen mothers. The team mapped potential safeguarding risks for both research participants and research staff due to, and unrelated to, the research activity. Mitigation measures were agreed for each risk. The draft risk map was validated by community members and coresearchers in a workshop. During implementation, safeguarding risks emerged across the risk map areas and are presented as case studies. Risks to the girls included intimate partner violence because of a phone provided by the study; male participants faced potential disclosure of their perceived criminal activity (impregnating teenage girls); and researchers faced psychological and physical risks due to the nature of the research. These cases shed further light on safeguarding as a key priority area for research ethics and implementation. Our experience illustrates the importance of mapping safeguarding risks and strengthening safeguarding measures throughout the research lifecycle. We recommend co-developing and continuously updating a safeguarding map to enhance safety, equity and trust between the participants, community and researchers.
Publication Mentorship Program for First-Time Women Authors in the Field of HPSR: An interview with Linet Okoth and Sally Theobald
We sat down to speak with Linet Okoth and Sally Theobald who are both members of the ARISE consortium, about their experience taking part in the Publication Mentorship Program for First-Time Women Authors in the Field of HPSR. The program is collaboration between Health Systems Global (HSG), the Alliance for Health Policy and Systems Research (the Alliance) and Health Policy and Planning (HPP). They invite applications from early-career women based in low- and middle-income countries (LMICs) working on HPSR issues, who are interested in publishing their HPSR research for the first time in a global peer-reviewed journal, but require guidance and support to submit a manuscript which has the potential to be published.
Linet Okoth works at LVCT Health in Kenya and was a mentee as part of the 2022/23 cohort of the Publication Mentorship Programme. She is a Senior Technical Advisor for Community Health, and is interested in health systems strengthening, specifically in community settings. Sally Theobald is a Professor in Social Science and International Health at the Liverpool School of Tropical Medicine in the UK, and was a mentor for the 2022/23 cohort of the Publication Mentorship Programme. Sally works on a number of different research projects, including ARISE.
What are the main points you think people should know about the mentorship process?
Linet: The programme is really rigorous. It requires a lot of commitment. You need to identify a policy issue to centre your manuscript around. It really helps if you have a mentor who understands your context, and who can guide you in coming up with a good topic and paper.
Sally: I’d really encourage people to apply. I think it’s a fantastic opportunity to go on a journey together with your mentor. How the scheme works is that mentors and mentees are matched based on interests and expertise and focus of the abstract in the early stages, and then you go on a journey together. In the beginning we’re agreeing key messages, making sure there’s internal coherence, and that it all hangs together. We also work with co-authors, bringing them with us.
It’s about being part of a broader family or cohort. I enjoyed building my relationship with Linet, but also having the opportunity to meet the other mentees and mentors. I think it was really positive that many of us were able to come together face to face in Bogota [at the Health Systems Research 2022 conference], to build relationships with each other, share experiences and learn new things. We had sessions that really made me think – like how do you draw people in and express the message of your paper? I think it’s great that that the program is also inspiring and teaching mentors as well.
Linet: The in-person gathering was an opportunity to meet other mentors, and the rest of the cohort, and get an idea of what they’re doing. Just having that sharing in one physical meeting was a good thing.
How did the mentorship process in help you to prepare for and publish your research?
Linet: The mentorship process has prepared me to get going with writing. The ARISE consortium is in its final year. I am part of the implementation team and a lot has happened on the ground, so you can be sure there’s so much to write. I have gained so much confidence, working with my colleagues to come up with the abstract, looking at the policy documents. I’ve done program work for quite a time, but I needed the courage to write something. This process has given me that courage, and I’m looking forward to doing even more papers with the team. Either the first draft or as a co-author on other papers, especially for ARISE. It really helps to have someone to go on that journey with you the first time.
Tell us a little more about your paper, and what motivated you to write on this topic?
Linet: The title of my paper is ‘Delivery of health services to pregnant adolescents in informal urban settlements in Kenya’ and I’m looking at perspectives of policy versus practice. In the implementation of ARISE, we’ve interacted with vulnerable populations, and one of those populations was child headed households. In the context of child headed households, you realise that many more girls are in this position than boys.
Also, I have an interest in maternal and child health, and most of the people who fall in this group are young girls who are accessing services in the health facilities. We noticed that even though we believe there are free maternal and child health services, there are challenges with young girls accessing these services because they cannot afford to, or the services are of poor quality, or they have challenges with laws and policies in the country.
So, if this girl is an adolescent and is pregnant, number one they are vulnerable because they are a child, number two they are vulnerable because they are pregnant. This made me ask ‘can I do something?’ Because we have free maternal health services in Kenya. but we still have girls not accessing services. For me it was important to find out why there was this gap? What is the issue causing them to not access the services, despite having all these things put in place for us as a country? So that’s what motivated me, and that’s what I wanted to find out. There is so much that I have gathered which speaks to the reasons why the girls are not accessing services.
How did you work together to refine this idea?
Sally: We went through different stages and phases, in terms of the focus, the messaging, the narrowing down. And what was also good for me about the process was having the journal very much on board. You have to focus the paper against the requirements and the interests of the journal.
In all of our discussions, we also talked about how youth and gender friendly services that are there in policy can evaporate in practice, if there’s not enough investment in the services and the critical health workers be able to really build gender and youth friendly services, and to build trust with people that have multiple challenges in accessing care. They may feel alienated by formal health services. Through our discussions, we looked at how we fit this within the policy literature and within the broader academic literature? How do you build on the results to tell a story, situated in the literature, as well as within the context of urban informal settlements in Nairobi, and tells a coherent narrative that resonates within Nairobi and in settlements beyond Nairobi, as well.
Linet, can you tell us a little bit about the skills that you’ve learnt through the mentorship relationship and up to this stage of the publishing process?
Linet: I think one of the skills is patience! Also, working with different co-authors, having people with different perspectives on how you want to present this information, how people think differently around your topic, and what they want to focus on. It takes patience to collate all these thoughts and opinions, bring them together into something that makes sense, and as the lead author translate this into something that is coherent.
Secondly, I really improved my literature reading skills – you need to do a lot of reading, summarising, referencing. There are lots of suggestions around papers to be read, and you need to read them all, understand them, summarise them, and be able to refer back to them. Reading for me used to be a setback, but I think now it’s a skill that I have embraced, and I’m looking forward to using in the future.
There’s a lot of information, and condensing all that information is a skill. I can write and write and write, but this was a time to think about exactly what I wanted to say, to summarise, and be succinct.
Those are key skills that I learned through the program. And I think it’s something that I am taking forward as I continue with my career in research.
Beyond the skills learned through the mentorship and publishing process, what are some of the other advantages of being part of this cohort?
Linet: Through the programme I have had exposure to people who I wouldn’t have otherwise. For me it’s about the people – technical people, who can guide me in my writing. That’s another thing that that I needed to embrace research. My background has meant working on a lot of programs and with program managers. Through this project I’ve got to know and interact with some editors, researchers and academics. That exposure for me was a very good thing. It was great to have the physical session in Bogota that brought us all together, sharing, and getting quick, in person feedback on our work.
Also, the financial support offered to allow me to travel to HSR 2022 was really important, because without it I would have had to join the session virtually which wouldn’t have been as useful. It was so good that the program facilitated our travel to Bogota, and allowed us to interact with mentors and mentees on the program in person.
Any final thoughts on the programme and the experience?
Sally: It’s really wonderful to hear Linet reflect on the courage to write, on the power of reading, on the learning, on the journey, and also feeling inspired to be able to write further papers as first author or co-author. Obviously in ARISE we’ve got less than a year left, and I would love to see all of us really pushing on the outputs of all forms, including papers!
I really want to encourage others to apply for the program. It is really hard to write those first papers, and to go though it with a mentor, but also a wider cohort and a network to support each other is a really positive process. And I learnt a lot through it as well, so this a learning and network building opportunity for mentors as well as mentees! And I think it’s a great strategic partnership between the Alliance, Health Systems Global and the journal, really coming together in that way to support authors, and helps them with that early experience.
Linet: For me the experience has been so good. It’s exposes early career researchers to writing. Once they put the call out for the next cohort, I will encourage everyone to apply. It’s just a good experience for people who want to do research, people who want to write but are struggling. Because working alongside your mentor makes the burden lighter. There were times when I struggled and panicked in the process, but someone who helps you walk this journey is so helpful.
It’s been a good experience, and good exposure. I would encourage anyone who is eligible to apply for it to go for it!
If you want to learn more about the Publication Mentorship Program you can read more on the Health Systems Global website, listen to this podcast about the experiences of some previous participants, and check out the 2020 supplement on the Alliance for Health Policy and Systems Research website.
Portraits of Strength: Women in Informal Settlements in Nepal
In this blog Anushka Thapa, Alisha Karki, Barsha Rijal, Rudra Neupane, Saugat Joshi and Jiban Karki explore stories of hope and resilience among women living in informal settlements in Nepal.
From within informal settlements, where existence can be challenging and difficult, an inspiring group of women share their stories of strength, resilience, positivity and love. Each of these stories is an example of a woman’s capacity to rise like a phoenix from the ashes, leaving an enduring mark on their family and the communities they reside in.
We present the unique stories of four remarkable women we met while working in informal settlements in Nepal, who showed courage, grace, positivity, and persistence, throughout the struggles they’ve experienced.
The ambitious young pathfinder
At just twenty years old, Aasha* is an example of hope and determination. As a full-time student, and part-time teacher, she is a fearless person who is pursuing her financial independence and balancing family responsibilities, determined to rescue her family from the clutches of poverty.
After witnessing her family’s struggle to meet their daily needs, she started offering tuition at a reasonable price in her community, ensuring it is affordable for others and allowing her to support her family. In the morning she attends college, hoping to complete her undergraduate degree, and secure a steady income for her family.
Despite many challenges Aasha has remained consistent and determined. Her story has become an inspiration, particularly for young girls and women in her community. Her determination to give her family the life she wants them to live and create a better future reflects the great potential many young women possess. Potential that can bring impactful change, inspiring entire communities.
The composed centenarian
Meet Mira Aama*, a calm and composed centenarian who radiates happiness and positivity. At the age of ninety nine, she is filled with joy and wisdom. Living with her son and daughter-in-law, she shares a strong and healthy bond with them and her grandchildren.
After losing her husband, her family insisted she continue to wear red (and whatever else she pleases) despite the cultural edict which dictates a widow/widower should not wear red-colored clothes or accessories.
Mira Aama has experienced many trials and triumphs throughout her life that have shaped her as the person she is. Despite her struggles she makes a choice every day to live her life to the fullest.
Her infectious smile and unwavering faith have been a source of strength for her family and community. As a living example of resilience, her wisdom, joy, and positivity act as a guiding stone for the younger generation. It reminds them of the importance of family, nurturing love and finding fulfillment in life’s blessings, and giving gratitude for them.
The perseverant phoenix
Anita* is another example of perseverance in the face of adversity. Even after losing her home in a recent flood and surviving an unhappy marriage, thirty nine year-old Anita remains optimistic. Anita says, “There is no use in being sad and thinking about the past, I am just positive that good days are soon to arrive”.
Her optimism to restart her life from scratch and overcome all the odds shows a great inner strength. Anita shows us the incredible power of hope.
The extraordinary housewife and her green haven
Archana* is a housewife with an extraordinary love for gardening and household work, finding purposes in all aspects of her life. Her whole life revolves around her house, family, and her blooming little garden. Her extraordinary gift for nurturing life both inside and outside her house is truly remarkable. Her small garden is a symbol of her hard work, love, and joy. Archana grows her own flowers and vegetables using bottles and jars as flowerpots, her garden reflecting her resourcefulness and care toward herself, her family, and her surroundings.
Much like her garden, Archana’s home is a reflection of her love, support, and care towards the things that give her comfort and joy. Archana’s care and creativity in her garden shows how happiness can be found in the simplest things in our life, and the creation of a beautiful, serene garden in the midst of the chaos of an informal settlement is a ray of light.
Conclusion
While life in informal settlements can be chaotic and uncertain, these women have found ways to express joy, care, optimism and creativity despite their circumstances. Aasha’s ambition to get her degree as well as support her family challenges expected norms and offers hope while Mira Aama’s joyful way of living, Anita’s perseverance despite losing her house and marriage, and Archana’s ability to create beauty through care, show that the women living within informal settlements are resourceful, courageous and resilient.
These women living in informal settlements remind us that strength isn’t just measured by grand achievements but by the everyday acts of love and resilience that enrich the lives of those around us. As we become a part of their journey, these women have been a source of inspiration and an arsenal of hope, determination, love, and compassion.
While these stories of hope and determination are incredibly inspiring, we want to acknowledge that resilience is not purely about mindset. For many people the hardships they have endured and the trauma they have experienced make it incredibly difficult to hold onto hope or to stay mentally well. And those stories are just as important and valid. They do not represent failings, but the very real experiences of people who live in situations of ongoing precarity.
* Names changed to protect individual’s privacy
Panel for DSA 2024: Call for contributions!
We are excited to announce that ARISE has a panel at the Development Studies Association Conference 2024 at SOAS in London, and we are looking for contributions!
Taking place in June this year our panel, Using community-based participatory research for developing equitable partnerships and advancing social justice: Reflecting with the ARISE consortium, will discuss how co-producing knowledge and action can increase representation of urban marginalised people. The workshop will introduce community based participatory research approaches we have used as part of the ARISE project.
Co-producing knowledge and action can increase representation, dismantle existing power hierarchies, and decolonise knowledge production. Co-production acknowledges that expertise lies not only with academics but also with directly impacted communities and can effectively advance social justice issues. Our workshop will encourage reflexivity on co-production processes in development research and action – what works well, tensions around power and equity, and how these are navigated in spaces of respect and trust to learn from vulnerable populations and shape new practices to research and action. It will introduce three approaches from the ARISE consortium from Bangladesh, India, Kenya and Sierra Leone used to strengthen capacities and representation of urban marginalised people and generate evidence and action grounded in context.
If you would like to take part in our panel then please propose your contribution by filling in the form linked on our panel page. You will need to fill out the form with the following details:
- Title (few words about the key message you would like to deliver)
- Contribution (what you would like to bring to the panel? please keep it to a few clear bullet points)
- Mode of delivery (how would you wish to present your contribution?
Please also get in touch with Neele Wiltgen-Georgi by email (neele.wiltgen-georgi@lstmed.ac.uk ) to confirm your approach will work for the panel, and discuss any other details of your submission.
We are excited to see your proposals and work together to bring an interesting and enlightening panel to DSA 2024!
ARISE at PMAC 2024
We’re excited to announce that our ARISE colleague Wafa Alam, from BRAC James P Grant School of Public Health in Bangladesh, will be attending the Prince Mahidol Award Conference (PMAC 2024) later this month. Taking place in Bangkok, Thailand, from 22 to 27 January, this international conference focuses on geopolitics, human security and health equity in an era of polycrises.
Wafa will be presenting two posters from ARISE at the international health conference in Thailand:
Co-production requires dismantling existing power hierarchies. As such, it can support decolonising knowledge generation and fostering inclusive and equitable relationships with diverse (and at times) marginalised actors participating in health governance, research and decision-making. Decolonising knowledge production recognises that expertise lies with those communities directly affected by health inequities and challenges as well as other key actors.
ARISE uses community based participatory research (CBPR) to build the capacities of urban marginalised people to generate contextually grounded evidence to incite action and strengthen relationships with governance actors. In this poster, prepared for the Prince Mahidol Award Conference we demonstrate the range of participatory methods used by ARISE. Fostering equitable research partnerships requires an openness to learn from communities, and a foundation of humility, trust and respect.
Decolonising health research requires a shift to inclusive processes, and actively engaging with communities. Community-based participatory research (CBPR) fosters collaboration among communities, researchers, and implementers to produce contextual knowledge for action. Enhancing co-production skills and competencies has been shown to improve research quality and validity, while CBPR principles have been developed, limited guidance exists on the skills needed to adhere to these. There is a need for frameworks to guide equitable and meaningful contributions from both community and external partners. This poster, prepared for the Prince Mahidol Award Conference, explores the competencies necessary to foster high quality research partnerships with community-based organisations and co-researchers.
We’re really excited about this opportunity to share our work with an international audience, and meet like minded colleagues from different contexts. See you there!
Sanitation services for the urban poor: A social capital approach to sanitation challenges in informal settlements
Abstract
Poorly managed sanitation is degrading, unhealthy and far too dominant among the urban poor. The conventional solution to poorly managed onsite sanitation and/or open defecation is for governments to provide adequate sanitation at subsidised prices. Few governments in low and middle income countries can subsidise access to sanitation facilities for people living and working in informal settlements. This leaves the urban poor in informal settlements to face challenges in accessing safely managed sanitation, with some residents and manual pit emptiers adopting social capital approaches. We sought to identify sanitation challenges along the value chain and social capital approaches to addressing the challenges. We used qualitative approaches. Our target population were manual pit emptiers and community members. We analysed data using conventional content analysis methodology. We grouped sanitation challenges into those that are outside individual households and those that are at the individual household. Challenges outside the household could not be controlled at the individual level, and included legislative, physical, and social challenges, while challenges at the individual household could be controlled at individual level, and included health, financial and technical challenges. As a result of these challenges, both the manual emptiers and community members adopted social capital approaches, which included the use of reciprocity and trust, networks and information channels and norms to counter the challenges. Sanitation challenges along the sanitation value chain should persuade policymakers and practitioners that sanitation extends beyond the four walls of a sanitation containment facility, to include emptying, transportation, treatment and disposal. Many of the challenges could be attributed to governance outside the sanitation sector. Hence long-term improvement of sanitation conditions in informal settlements ought to be supported by broader policies and strategies like social capital that begins by thinking outside “the sanitation box”.
Ivy Chumo, Blessing Mberu, Cynthia Wainaina, Wanjiru Murigi, Leunita Sumba, Caroline Kabaria (2023) Sanitation services for the urban poor: A social capital approach to sanitation challenges in informal settlements, PLOS Water 2(12): e0000086. https://doi.org/10.1371/journal.pwat.0000086
Our 2023 AGM in pictures
In November colleagues from across the consortium gathered in Freetown, Sierra Leone for the final ARISE annual general meeting. It was a wonderful week filled with sharing, learning, and reflection. Our colleague Shrutika Murthy from The George Institute collected together images from across the week, and wrote this blog. Additional images and copy from Leah Murphy and the rest of the ARISE team.
We kicked off the meeting by reflecting on the most significant changes in our work at ARISE. Doing responsive research through co-production, evidence-building and advocacy emerged as top contenders!
Some of our ARISE PhD cohort presented their progress and learnings on diverse topics including non-communicable diseases, stigma, and healthcare. The rest of the team provided insightful feedback to help them reach the finish line!
The team also visited urban informal settlements in Cockle Bay and Moyiba and were welcomed by community chiefs and co-researchers. We learnt about their histories, challenges, achievements and ARISE’s contribution.
A selection of images from Cockle Bay.
A selection of images from Moyiba.
Co-researchers presented on the consortium’s role in enhancing their capacities and enabling them to successfully advocate for their communities with governance actors. “If our votes count, our voices should too!”
ARISE country teams presented their most significant communication outputs, including impactful photo essays, photo books, briefs & documentaries.
We kept our spirits high with energising songs and dances. Music transcends all boundaries, truly!
The AGM went by in a blink! Thank you to our extraordinary Sierra Leone colleagues for welcoming and hosting us all with such warmth and love!