Sexual violence: Setting the research agenda for Kenya

This research agenda is the result of a stakeholders’ meeting held in Nairobi on June 11–12, 2008, that identified, developed, and prioritized areas for research on sexual violence in Kenya. The meeting was convened by the Population Council, Liverpool VCT, Care & Treatment, and the International Centre of Reproductive Health, Kenya. Kenya’s research agenda is premised on the need to generate the evidence required to impact policy formulation and services strengthening. Knowledge gaps that form the basis of key research areas identified include the need to: 1) Understand the nature, contexts, and prevalence of sexual violence; 2) Document and evaluate prevention initiatives from national to grassroots and spanning legislation, advocacy, and community interventions to identify replicable and scalable interventions; 3) Research innovative ways to improve access to, uptake, and deliver quality sexual violence care, treatment, and rehabilitation services for men and women in Kenya; and 4) Improve knowledge on sexual violence focusing on priority populations with higher risk and vulnerability

Standards required in maintaining the chain of evidence in the context of post rape care services: Findings of a study conducted in Kenya

Sexual violence (SV) is a serious societal problem that creates significant challenges to local communities in their attempt to create an overall plan for meeting the medical, emotional, physical safety, and legal needs of SV survivors. It is important to understand the existing links between the health sector and police as a basis for addressing the complexities surrounding SV. Appropriate management of SV survivors requires a standardized clinical evaluation, an effective interface with law enforcement for the handling of forensic evidence, and coordination of the continuum of care. From the public health perspective, the issues to be addressed revolve around accessibility of medical services and consistency in quality of care. Public health concerns are also guided by the legal procedures to be observed in the collection of medico-legal evidence by health care providers from the survivor to be used in prosecution of the sexual offenders within the criminal justice system, hence the need for countries to develop standardized mechanisms through which appropriate support will be delivered to survivors of SV from a medical and legal dimension. This report presents the findings of an operations research study conducted in Nyanza and Eastern Province, Kenya, in 2007/8

Is it feasible to integrate alcohol-related risk reduction counseling into VCT services? Findings from Kenya

In Kenya, an estimated 30 percent of men report to be alcohol users which may be fueling the HIV pandemic, due to its association with high-risk sexual behavior and reduced inhibitions. The Population Council’s Horizons program collaborated on a study to improve screening of clients for alcohol use, provision of feedback of screening results, and referrals to care and support during voluntary testing and counseling (VCT) for HIV. Overall, the results indicate that it is feasible to integrate alcohol risk reduction counseling into VCT, and that it is generally accepted by providers and clients alike. This study therefore supports the formal integration of alcohol risk reduction counseling into VCT services in Kenya

Sharing experiences and dilemmas of conducting focus group discussions on HIV and tuberculosis in resource-poor settings

Focus group discussions (FGD) are gaining in popularity in research on HIV and tuberculosis (TB) internationally as researchers seek to understand the experiences, needs and perspectives of people living with TB and/or HIV as well as their carers within the community and health sector. Conducting FGDs in resource-poor settings with vulnerable participants who are living with diseases that are frequently stigmatised poses multiple challenges. Our approach in this discussion paper is to follow the research cycle to present the practical experience of research teams using FGDs in TB and HIV in resource-poor contexts in Africa and Asia in order to contribute to effective practice. The approach highlights dilemmas and shares effective practice for negotiating initial discussions with different communities, constructing sampling frames and samples, choosing a facilitator, encouraging discussion, ethics, translation, pitfalls and dissemination. We demonstrate the techniques and adaptations needed to ensure that FGDs provide rich, high-quality and policy-relevant data on the voices and perspectives of people living with HIV and TB, community groups and health workers within the challenges of resource-poor settings. In applying theory to develop good practice in FGDs across the research cycle, a critical and reflexive approach is needed

Intersectionality and gender mainstreaming in international health: Using a feminist participatory action research process to analyse voices and debates from the global south and north

Critiques of gender mainstreaming (GM) as the officially agreed strategy to promote gender equity in health internationally have reached a critical mass. There has been a notable lack of dialogue between gender advocates in the global north and south, from policy and practice, governments and nongovernmental organisations (NGOs). This paper contributes to the debate on the shape of future action for gender equity in health, by uniquely bringing together the voices of disparate actors, first heard in a series of four seminars held during 2008 and 2009, involving almost 200 participants from 15 different country contexts. The series used (Feminist) Participatory Action Research (FPAR) methodology to create a productive dialogue on the developing theory around GM and the at times disconnected empirical experience of policy and practice. We analyse the debates and experiences shared at the seminar series using concrete, context specific examples from research, advocacy, policy and programme development perspectives, as presented by participants from southern and northern settings, including Kenya, Mozambique, India, the Democratic Republic of Congo, Canada and Australia. Focussing on key discussions around sexualities and (dis)ability and their interactions with gender, we explore issues around intersectionality across the five key themes for research and action identified by participants: 1) Addressing the disconnect between gender mainstreaming praxis and contemporary feminist theory; 2) Developing appropriate analysis methodologies; 3) Developing a coherent theory of change; 4) Seeking resolution to the dilemmas and uncertainties around the ‘place’ of men and boys in GM as a feminist project; and 5) Developing a politics of intersectionality. We conclude that there needs to be a coherent and inclusive strategic direction to improve policy and practice for promoting gender equity in health which requires the full and equal participation of practitioners and policy makers working alongside their academic partners

The practical and policy requirements for implementing post rape care services in resource limited settings

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Improving national data collection systems from voluntary counselling and testing centres in Kenya

Problem Voluntary counselling and testing (VCT) data from the registered sites in Kenya have been fraught with challenges, leading to insufficient statistics in the national office for planning purposes. An exercise was carried out to determine the barriers to the flow of data in VCT sites in Kenya. Approach A record-based survey was conducted at 332 VCT sites in Kenya. Data from on-site records were compared with those in the national office. The exercise was conducted in 2004 between 5 September and 15 October. Local setting All registered VCT sites in Kenya. Relevant changes After the exercise, various measures to enhance VCT data collection and reporting were implemented. They include the provision of a uniform clat collection and reporting tool to all the districts in the country, the strengthening of a feedback mechanism to update provinces and districts on their reporting status and increased support to the data component of the national quality assurance for VCT. Lessons learned Periodical field visits by the national officials to offer on-the-job training about data management to data collectors and to address data quality issues can dramatically improve the quality and completeness of VCT reports. The perceived relevance of the data and the data collection process to those working at the sites is the critical factor for data quality and timeliness of reporting

Improving national data collection systems from voluntary counselling and testing centres in Kenya

PROBLEM: Voluntary counselling and testing (VCT) data from the registered sites in Kenya have been fraught with challenges, leading to insufficient statistics in the national office for planning purposes. An exercise was carried out to determine the barriers to the flow of data in VCT sites in Kenya. APPROACH: A record-based survey was conducted at 332 VCT sites in Kenya. Data from on-site records were compared with those in the national office. The exercise was conducted in 2004 between 5 September and 15 October. LOCAL SETTING: All registered VCT sites in Kenya. RELEVANT CHANGES: After the exercise, various measures to enhance VCT data collection and reporting were implemented. They include the provision of a uniform data collection and reporting tool to all the districts in the country, the strengthening of a feedback mechanism to update provinces and districts on their reporting status and increased support to the data component of the national quality assurance for VCT. LESSONS LEARNED: Periodical field visits by the national officials to offer on-the-job training about data management to data collectors and to address data quality issues can dramatically improve the quality and completeness of VCT reports. The perceived relevance of the data and the data collection process to those working at the sites is the critical factor for data quality and timeliness of reporting