Improving Public Health: Rural/Urban Challenges

As Rain Barrel Communications strengthens its capacity to support clients in integrating behavioral science insights to their public health initiatives, we are bringing specialists and researchers on board to bolster our country teams. Kelvin Kihindras, a Kenyan researcher who joined our roster of Associates earlier in 2022, brings his passion for social and behavior change communications to Rain Barrel as our work in Africa and other regions expands. Paul Hoeffel, a co-founder of Rain Barrel, recently spoke to Kelvin, who lives in Nairobi, about the challenges he sees.

Paul Hoeffel:  I am pleased to welcome you to Rain Barrel. I think you are the first Associate to come to us through the Linkedin network. Tomas Jensen, our Managing Director, reached out to you in the course of his online research and the connection clicked. We were impressed by your experience, but what attracted you to Rain Barrel’s work?

Kelvin Kihindras: Yes, Tomas and I connected virtually and I felt the energy and clarity of purpose of Rain Barrel from the outset. As I checked my email, I saw that I had flagged Rain Barrel back in 2018 as a possible match. I was impressed by how international your Associates are and the diversity of projects in the Global South and ties with the United Nations. I have worked mostly in Kenya but feel your model and my expertise – in behavioral science and research ethics particularly – can work anywhere if tied into a dynamic team of colleagues with local roots.

Paul: Yes, our weekly management meetings require a call with our staff in Argentina, Australia, Kenya and the U.S. Our project team meetings can be even more diverse.

I understand that you have been studying and working in Nairobi, for the past ten years but that your roots are in rural Kenya, a village in Lusengeli Village in Vihiga County.  Your rural upbringing gives your professional training a special depth.

Kelvin (left) interviews male respondents on a public health research study in Mwihoko, Kiambu County, Kenya.

Kelvin: My work in social and behavior change communications is primarily urban-based but I feel I have a special advantage with small village roots in Lusengeli in Vihiga county. When I was growing up we didn’t even have television. Even now, though it is changing rapidly, the use of cell phones and social media is limited – no Internet cafes to gather around like in the cities and towns. And unlike urban areas, the population in the countryside is less likely to be literate. These are realties that make SBC outreach far more challenging. You really have to know how people communicate, who they listen to, who they trust and even the forces that misinform them.

Paul: You worked with the Busara Center for Behavioral Economics focused on rural areas. Can you describe a project?

Kelvin: One involved an outbreak of cholera in Kajiado and Narok Counties. The Ministry of Health and UNICEF needed to determine how deep it was and what to do about it. Various government agencies joined forces to do qualitative and quantitative research in three counties most affected. We mapped several villages and figured out the best ways to reach households and the general public. My job was to communicate with local authorities, getting permission from village elders and hire locals to do our research in the communities. We had to determine how households obtained their water – what the sanitary habits and facilities were. This qualitative research enabled us to emphasize certain practices – distinguishing different sources and quality of water ­­– using flyers and radio spots to scale up the public awareness from boiling water for certain uses, handwashing to other sanitary habits.

Paul: And you have worked with younger people, no?

Kelvin: In 2019, the Kenyan government, through Minstry of Health included HPV vaccine in the national immunization package. The vaccine was made available for 10-year-old girls, free of charge at schools and health facilities. (The Human Papillomavirus – HPV - vaccine is a cost-effective approach to the prevention of cervical cancer.) Still, we had barriers for low complete vaccine uptake, including stigma, lack of knowledge, and misperceptions about side effects. The campaign was met with widespread resistance involving conspiracy theories – that the vaccine would cause sterility, for example - and opposition from groups like the Catholic church. While at Busara Center, I was part of the team that conducted a study to investigate  how doctors’ endorsement of the HPV vaccine communicated through a public health poster affects parents’ decisions to vaccinate their daughters in Kenya. Participants saw a poster from a national campaign about HPV vaccination and either nothing further (Control) or an additional poster containing an HPV vaccine recommendation from a female (FDR) or male doctor (MDR). Primary outcomes are intentions to vaccinate and perceived safety of the HPV vaccine. Both recommendation arms increased the likelihood that participants reported the highest levels of vaccine intentions compared to control. Public health campaigns are frequently multi-media, utilizing social, visual, video, and radio media. Our results speak only to the efficacy of a doctor’s recommendation within a printed or online poster.

Kelvin interviews female participant who is guardian to a minor on a social behaviour change study in Muhudu, Vihiga County, Kenya.

Paul: In addition to your SBC work you have brought ethical concerns to the research that organizations undertake, not only in Kenya but other countries in the Global South. Establishing trust and credibility is essential when so many people have become skeptical about the work of NGOs and governments. It’s certainly a major concern in our work at Rain Barrel. What is your experience?

Kelvin: At Busara Center, I was also acting as Ethics Officer and building trust with the community, stakeholders and everyone involved was central to our work. It is essential that the research necessary for most organizations has clear ethical guidelines that ensure confidentiality, privacy and data protection. We need to control who has access to data, how it is collected and how it is shared. Ethical compliance to strict protections is simply a demonstration of respect for the people you want to work with, the people you want to help.

Paul: Why are you attracted to Rain Barrel, given the number of consultancies that are working in your field? 

Kelvin: I tend to be a loner but I recognize the value of the free exchange of ideas and dynamic relationships that makes for a rich professional experience. Rain Barrel is doing something unusual in assembling multi-faceted teams that communicate across borders and regions. Your model of collaboration is wonderful and rare, especially around the limits imposed by the pandemic. I look forward to creative interaction with these colleagues around the world.