Funding frontline women-led organisations to redefine community impact: The case of improving women’s health outcomes in Kenya
Written by: Dinnah Nabwire, Knowledge Management Specialist, AWDF
In 2020, over 300 million African women were directly affected by Noncommunicable Diseases (NCDs) and 2.4million of these had suffered from at least one form of cancer.
Across most African countries, addressing the burden for cancers and other forms of NCDs remains undermined by low national health care budgets and intervention packages that do not intricately include the needs of most affected populations.
In our work, the African Women’s Development Fund (AWDF) has found that women-led organisations, the majority of which are situated in and across hard-to-reach, under-served and marginalised parts of communities continent-wide, are well-positioned to address the growing burden of NCDs. However, they lack adequate resources to build alliances, co-create innovative approaches built on their years of community work experience and lessons, champion advocacy and implement the service delivery needed to achieve inclusive health outcomes for women.
In 2021, AWDF extended funding to one of such powerful frontline organisations, Women4Cancer Early Detection and Treatment, a community-based women-led organisation that addresses cervical cancer across sixteen counties in Kenya. In the following sections, we present four levels of unique value addition from resourcing community-level women-led organisations using examples from our work with Women4Cancer Early Detection and Treatment.
Designing sustainable models that address underlying drivers of health inequities
In Kenya, cervical cancer kills nine women a day and is almost entirely caused by infection from the Human Papilloma Virus (HPV). While early detection and treatment is a clear path to elimination, HPV vaccines for young girls and boys can prevent infection by the virus in the first place. However, women and girls do not equitably access and utilise this opportunity due to a range of barriers.
According to Elizabeth Mbuthia, the Head of Programmes at Women 4 Cancer Early Detection and Treatment, most women targeted in the awareness sessions often lacked resources (transport and hospital fees) to access screening services at various health centres. Other critical barriers were significant numbers of women lacking information about screening opportunities, not seeing the importance of screening since they presented no signs or symptoms, while others cited lack of cervical cancer screening services at community level health centres when they visited.
With funding from AWDF, Women4Cancer Early Detection and Treatment sought to address these barriers. The team was able to provide free screening that resulted in increased numbers of women who know their status — a crucial step in maximising prevention and treatment for cervical cancer.
The organisation uses a community-driven intervention model that targets girls aged 10–14 and women. Over the past ten years, they have built reciprocal relations with the Ministry of Health, County Departments of Health, Sub- County Health Management teams, community health workers, opinion leaders, caregiver groups and schools with whom they collaboratively design and deliver interventions.
Champions who mainly consist of community health workers, particularly women, are trained and equipped with skills and tools to educate communities on the prevalence of cervical cancer, assess barriers to effective screening and popularise the opportunity for early treatment. During health camps, the project teams and volunteer nurses are attached to healthcare workers in the target health facilities to monitor the quality of services and support documentation and learning.
From the pre- and post-assessments, a significant increase in the numbers of women getting screened across health centres targeted by the project was recorded during the intervention period. At Bahati Sub-County Hospital in Nakuru North, screening rates grew from 13 in June 2021 to 241 in July 2021 following the community education activities coupled with free screening, on-site treatment and referral health camps. Similar trends were registered in the Nakuru North Sub-County Engashura, Kabatini and Dundori Health centres.
Tapping into the unique opportunity to integrate intervention lessons
At the project’s inception, the Women4Cancer Early Detection and Treatment team learnt that Nakuru County had adopted the school-based strategy for delivering the HPV vaccine for girls aged 10–14 years. Low vaccine uptake was registered when learners returned home for holidays or during short breaks and an increase in the uptake when schools resumed.
Based on these observations, the project team guided activity planning and scheduling to maximise holidays and breaks. Specific messaging was integrated to target community influencers and men as parents or guardians to support the participation of women and girls in project activities. The result was the sub-county recording a significant increase in the numbers of eligible girls taking up the HPV vaccine at the end of the intervention.
A partnership was initiated between schools and Engashura Health facility to co-host vaccination outreaches in neighbouring schools which further increased screening and HPV vaccination uptake outcomes. It also enabled the health facility to replicate similar initiatives in the sub-county. Integrating lessons during implementation ensured that the intervention model adjusts to address emerging needs, reaches excluded populations and maximises screening, testing and referrals for the navigation treatment program among women and girls manifest positive results.
Linking community needs to influence policy and programming at the county, national, and global levels.
As host of the STOP Cervical Cancer Technical Working Group secretariat, the Women4Cancer Early Detection and Treatment convenes over thirty partners, including the Ministry of Health’s National Cancer Control Programme, and nonprofits committed to addressing cervical cancer. The organisation is also an HPV vaccine technical support partner in the Advocacy, Communications and Social Mobilisation Technical Working Group (ACSM-TWG) at the National Vaccines and Immunisations Programme, Ministry of Health in Kenya.
The project team continually utilises these platforms to highlight health system challenges from the communities where they work and actively lobby government and key actors to prioritise emerging issues and barriers. During the 2019 launch of the integration of the HPV vaccination to the routine immunisation schedule, Women4Cancer Early Detection and Treatment facilitated the participation of one of the project champions to share the story of her survivorship. She also called upon policymakers who included the President of the Republic of Kenya to subsidise screening costs for more women to know their status and access navigation programs early. The project team uses their membership on these national and regional platforms to follow up these asks.
Impacting key populations and often excluded women and girls
The project team collaboratively works with the Sub-County Health Management Teams (SCHMT) in the different counties to report into the cancer registry databases like the Kenya Health Information System (KHIS). This ensures that national databases capture necessary details about women’s health and their multiple vulnerabilities crucial for health interventions that leave no one behind.
Moreover, in Kenya, it is estimated that female sex workers are almost ten times more likely to contract HIV than non-sex workers — yet, women living with HIV have a substantially increased risk for cervical cancer compared with women without HIV infection.
Before receiving funds from AWDF, Women4Cancer Early Detection and Treatment had worked with female sex workers without deliberate disaggregation. However, with the funds, they scaled up this work through deliberately targeting and training their leadership who subsequently mobilised their colleagues to participate in screening activities. The majority of the champions engaged by the project team had been trained in other health issues, particularly HIV and AIDS, which made it easy to highlight the integration between HIV and Cervical Cancer.
Like Women4Cancer Early Detection and Treatment, hundreds of African women-led community-level organisations are front lining initiatives that promote holistic outcomes for women’s health. Placing funds in the hands of community-level women-led organisations means generating community-driven strategies that reach most marginalised populations and build on resident resources to deliver sustainable high impact interventions.
This article was previously published on www.awdf.org
Does this work inspire you? Visit https://awdf.org/ to learn more about the change created by hundreds of African women-led organisations and explore opportunities to partner with us to facilitate this change.