Frankel, Ariel

School of Public Health - International Health

MSPH

Kenya

Kenya-mHealth for safety and GBV risk reduction in Nairobi, Kenya

The American Cancer Society (ACS) is supporting the Johns Hopkins Center for Communication Program (CCP) and the Indian Cancer Society (ICS) to conduct research, design a communication strategy and assist in implementing the strategy in India to generate demand for cancer screening in general, create awareness about cervical cancer and increase uptake of the HPV vaccine. This will entail

PI Mentor: Michele Decker

Working and living in Nairobi, Kenya, I had the opportunity to experience and explore different sides of the cosmopolitan city known to be the hub of all sorts of political, economic and social activity in East Africa. Due to the cosmopolitan nature of the city, it was easier for me than it had been in other cities in Africa to feel more integrated and connected to the city and the people there. Of course, inevitably, I stood out in most neighborhoods, particularly in the informal settlements or slum areas that I worked in on a daily basis, but the city and the people welcomed me with open arms and were excited to talk about their country and hear about mine. The relationships I developed during my time there with both Kenyans and expats of different backgrounds and experiences, made my time there so enjoyable, educational and exciting. 

My office at the local NGO, Ujamaa Africa, was located in the informal settlement of Kariobangi North. The team there was incredibly devoted to their work and excited for me to join them and help out with some of the technical and logistical challenges we were facing in conducting the randomized control trial (RCT) for the mobile app called myPlan. The myPlan app is a decision-aid mobile app that aims to help individuals in abusive relationships strategically safety plan and identify resources for additional support. It had already been implemented successfully in several Western, higher income countries, but this was the first time it had been customized for a context in an LMIC, and in particular, to service individuals living in the most marginalized, impoverished communities in the city. 

I was very skeptical of the utility of this app before coming to Nairobi. Upon first glance, it seemed to me to be a useful intervention being forced through a technology that was not yet accessible and useful to its target population. I could see its utility at let’s say, the University of Nairobi for women who have more exposure and experience working with mobile apps on their smart phones, but in the informal settlements of Nairobi, I knew that while there was a high penetration of smart phones in these areas, the phones were limited in their smart phone capabilities, data was too expensive for their means, and many individuals would not feel comfortable or perhaps were not even literate enough to use some of the app’s services. 

However, in working with our incredible project team, which included data collectors who were community health volunteers (CHVs) from the very areas we were targeting for the RCT, I learned that the app was not only a much needed intervention, but also a useful one, though to be useful, it had to be administered in a completely different way than it had been in other contexts. This app could not be self-administered in this context, rather a CHV would walk through the app with a woman interested in using it. This turned into being one of the best parts of the app’s utility and what many of the women appreciated most, even though this made the myPlan intervention a bit more challenging to deliver than in other contexts, as it requires significant human resources for administration in these communities. Therefore, I began seeing this mobile app more as a tool for CHVs to use who are constantly confronted with IPV in their work as they service women in the informal settlements of Nairobi, rather than just a convenient mobile app for women to download and use on their own time to manage their safety. 

Despite the difference in administration of myPlan in Nairobi versus in other countries, there were huge similarities across contexts in the content itself. Obviously the content had been adjusted for this context, but despite those adjustments, many women face similar challenges across countries and economic circumstance. For example, many women often stay in their abusive relationships due to social stigma, shame, financial insecurity, and complications of child custody and safety. This I learned not only from the research, but from conversations with my team who shared their stories with me, and I with them. 

I also observed that this was not the only sexual and gender based violence (SGBV) app in Nairobi. In fact, it seemed that the ‘trendy’ and ‘innovative’ answer to most public health problems in low resource settings were mobile apps.  I noticed that Nairobi in particularseems to be oversaturated with mobile apps attempting to address a variety of public health concerns that often marginalized and/or impoverished individuals face, but the uptake is questionable and many of these ‘innovations' duplicate efforts and do not communicate with each other or with the government. This has propelled me to consider working with global health organizations that challenge the way technology is used in low resource settings. 

Overall, my experience working in Nairobi has reinforced my personal and professional interest in working with people from different countries and backgrounds to exchange ideas on ways to address public health challenges that particularly low resource settings face around the world. 

People

Noreen Hynes, MD MPH

Director, Geographic Medicine Center of the Division of Infectious Diseases

Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program

Robert Bollinger Jr., MD MPH

Director, Johns Hopkins Center for Clinical Global Health Education (CCGHE); Associate Director, Johns Hopkins Center for Global...

Joanne Katz, ScD MS,BSc

Associate Chair, Director of Academic Programs

Caitlin Kennedy, PhD MPH,BA

Co-Director, MPH concentration in Social and Behavioral Sciences in Public Health; Associate Director, Center for Qualitative...

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation
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