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STRiDE Kenya Theory of change

THE KENYAN STRiDE THEORY OF CHANGE WORKSHOP REPORT

Christine W. Musyimi1, David M. Ndetei1,2, Elizabeth M. Mutunga3, Margie Schneider4, Simon Njuguna5, Nasri Omar5, Erica Breuer4

1 Africa Mental Health Foundation, Kenya

2University of Nairobi, Kenya

3Alzheimer’s & Dementia Organization Kenya

4University of Cape Town, South Africa

5Ministry of Health, Kenya

 

 

 

 

 

 

 

 

 

 

Cite this publication as:

Musyimi CW, Ndetei DM, Kasimu MM, Schneider M, Njuguna S, Omar N, Breuer E (2018). The Kenyan STRiDE Theory of Change workshop report. Nairobi. Kenya.

SUMMARY

This report describes the Kenyan theory of Change (ToC) workshop held in Nairobi, Kenya within the Strengthening responses to dementia in developing countries (STRiDE) project, implemented in seven developing countries.  The goal of the ToC was to bring various stakeholders from the national government, researchers, clinicians, relevant NGOs, people with dementia and carers to develop impactful research and training agenda for planning Kenyan STRiDE project activities. The theme of the workshop was “STRiDE Kenya 2018-2021”. The ToC map was developed during the two-day workshop by first outlining individual, caregiver, community and health personnel, and policy level challenges within small-group discussions and through a panel discussion involving people with dementia and caregivers on the first day. The finalized ToC map included interventions required to achieve the agreed impact – “Improved dementia prevention, care, treatment and support systems so that people with dementia, carers and family have the highest possible wellbeing and functional ability,” and assumptions that needed to be considered during planning . The advisory team was also discussed among the STRiDE team members and was agreed to comprise of a representative from the Kenya Board of Mental health, gerontologist, community Health Strategy representative, clinical psychologist, neurologist and a caregiver. Final arrangements and contacting the suggested members will be made after consultation with the STRiDE management team.The key country-specificquestions which emerged from the ToC discussions included;

  1. How will STRiDE create awareness, reduce stigma on dementia, increase visibility and voice of people living with dementia?
  2. What are the STRiDE work packages that will inform operationalization of the Kenya dementia action plan
  3. How will STRiDE ensure sustained collaboration among all the stakeholders involved in the ToC?
  4. Which outcomes (outlined in the ToC map) will be achieved through the STRiDE objectives?

During the discussions, the participants felt that there was a need to train health care workers and caregivers on dementia care and create awareness on dementia to reduce stigma. The Ministry of Health’s representatives emphasized that the goal of STRiDE Kenya could help achieve some of the components of the Kenya Dementia Action plan.

1.     THE SITE AND FACILITATORS

A Theory of Change (ToC) workshop was conducted in Kenya on 7th and 8th June, 2018 at the Hillpark Hotel in Nairobi (see the map below) and was facilitated by the Early Career Researcher (ECR) for STRiDE in Kenya – Dr. Christine Musyimi, supported by the Senior Researcher from Africa Mental health Foundation (AMHF) – Prof. David Ndetei, the CEO and founder of Alzheimer’s & Dementia Organization Kenya (ADOK)–Ms Elizabeth Mutunga, the STRiDE Management Team (SMT) liaison contact for Kenya – Prof. Margie Schneider, Director of Mental Health – Dr. Simon Njuguna and a representative from the Kenya Board of Mental health – Dr. Nasri Omar. Hillpark Hotel is located conveniently located in Upperhill, Nairobi (15km from Jomo Kenyatta International Airport).  The hotel’s conference room was sound-proof and big enough with 6 spaciously arranged round tables that could comfortably accommodate six participants per table. The environment was quiet, peaceful and with 24-hour security with external back up.

Figure 1: Location of Nairobi city

Nairobi (see map ) is the capital and largest city of Kenya with a population of almost four Million and hosts people from multiple ethnic groups spread across the 47 Counties.

 

2.     AIMS

The goal of the workshop was to bring various stakeholders from national government, researchers, clinicians, relevant NGOs, people with dementia and carers to develop impactful research and training agenda for planning Kenyan STRiDE project activities. The theme of the workshop was “STRiDE Kenya 2018-2021”.The Kenyan ToC specific objectives included to;

  1. Develop a logical Kenyan STRiDE Theory of Change map including the impact, outcomes and interventions or project activities for STRiDE during and after the four-year project period.

  2. Outline the assumptions for the Kenyan STRiDE programme

KENYAN STRiDE LAUNCH

The two-day workshop began on the first day with opening remarks from the Kenyan STRiDE Senior Researcher – Prof. David Ndetei and all participants signing a consent form to allow AMHF to take photos for purposes of dissemination of findings by STRiDE partners and possible inclusion in reports and presentations. Prof. Ndetei welcomed the participants and encouraged them to think more about how to make a difference in the lives of the people with dementia and their carers. He later invited the Director of Mental health – Dr. Simon Njuguna to launch the Kenyan STRiDE project. Just before launching STRiDE Kenya, Dr. Njuguna gave a brief presentation about our (Kenyans) responsibility to address dementia through the Kenya Mental health Policy and the Ministry of Health’s draft dementia action plan (2017-2025), which highlighted the importance of giving priority to older persons in terms of prioritization of leadership on Public health agenda on Dementia, integrated dementia plan, implementation framework and promotion of universal health coverage for people living with dementia. This was followed by the official launch of STRiDE Kenya 2018-2021 (figure 2 below).

Figure 2: The official launch of STRiDE Kenya 2018-2021

   STRiDE OVERVIEW AND PANEL DISCUSSION

After the official launch of STRiDE Kenya, Prof. Margie Schneider (SMT liaison contact for Kenya) provided an overview of the STRiDE project by outlining the role of local stakeholders and the role of UK partners in understanding local knowledge and building capacity beyond the partner academic institutions in the countries. This was followed by a panel discussion (figure 3) that involved four caregivers and one person with dementia on the challenges facing caregivers (dementia context) moderated by Elizabeth Mutunga – CEO and Founder ADOK. The objective of the discussion was to provide participants across a range of professionals with the local context realities that families and caregivers go through when taking care of a person with dementia. Some of the challenges voiced out ranged from stigma on dementia due to lack of community awareness and myths and misconceptions (e.g. bewitchment) about dementia resulting into social exclusion, misdiagnosis and mismanagement of people with dementia, lack of specialists to deal with dementia, unaffordable medications resulting into relapse after stopping their treatment, financial constraints due to increased cost of unpaid care and diapers, and caregiver difficulties such as magnitude of the care and the burden of dealing with grief after losing a loved one.

One caregiver stated;

“I have felt rejected at some point in life because my mother was aggressive. I have been taking care of her since the age of 12 years and even though I do not blame anyone, I miss out on social life. I always have to be where she is so that she does not walk away”

Another caregiver mentioned that “It was a lengthy process to get diagnosis and the appropriate treatment. I have visited four different doctors and the diagnosis was only made after the fourth doctor.”  

A caregiver who had to resign to take care of her husband and still had young children similarly said;

“My husband used to be violent and aggressive and I did not understand what was happening to him until we received the appropriate information and diagnosis”

Participants suggested that it was crucial to have dementia friendly health care institutions in Kenya and to create awareness on dementia all the way from the reception desk in health care settings to community settings to reduce stigma. They also suggested the need to identify a cure for dementia, train people to deal with dementia and increase financial and emotional support for carers. They were hopeful that STRiDE will achieve some of their expectations if not all.