Chaguo Letu (Our Choice) Project Introduction – The Problem The need to make better decisions is now more important than ever. However, there is limited evidence demonstrating that leaders in the health sector are sufficiently prepared to make informed, consequential, strategic decisions. The aim of this qualitative study is to explore the relevance of scenario based planning to strategic health decision making for the implementation of a cervical cancer sample self collection program in Kenya. Cervical cancer is considered to be preventable when precursor lesions are detected and treated before they develop into cancer. Unfortunately, In Kenya, it is estimated that less than 3.2% of women have been screened for cervical cancer. The WHO/ICO 2010 Summary Report for Human Papillomavirus and Related Cancers indicates that every year 2,454 women in Kenya are diagnosed with cervical cancer and 1,676 die from the disease. In addition, it is predicted that the annual mortality rates will grow to over 3,000 by 2025 if cervical screening programs are not expanded. Recent studies have shown that sample self collection could be a useful component for cervical cancer screening programs, especially in those settings where women do not have easy access to screening services or are reluctant to undergo screening by medical personnel due to cultural beliefs. In 2012, Rositch et al. published the results of a study that involved 409 adult Kenyan women. The results showed that 82% of women reported that they would feel comfortable using a self sampling device. These findings demonstrate that self-sampling could be an acceptable modality for cervical cancer prevention and screening. The magnitude of the cervical cancer problem, coupled with the potential for prevention with recent technological advances, have made it imperative to step back and reassess strategic options for dealing with cervical cancer screening in Kenya. There is a great need to identify cervical cancer prevention strategies and solutions that are logistically feasible, affordable and socially acceptable in Kenyan communities.
Project Management Team This project is a collaborative effort between Action Africa Help International and Irene Podolak, a PhD Candidate from Brock University, Canada. The specific members of the Project Management Team include the following:
Dr. Githaiga Kamau (Principle Investigator) Country Program Manager, Action Africa Help – Kenya.
Irene Podolak (Principle Student Investigator, Project Mentor) PhD Candidate, Brock University.
Dr. Caroline Kisia (Project Supervisor) Executive Director, Action Africa Help International.
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Dr. Jarold Cosby (Research Supervisor, Project Mentor) Associate Professor, Brock University.
Robert Alela (Senior Project Officer) Action Africa Help Kenya.
Fridah Musya (Project Support) Consultant, Deloitte Consulting Kenya.
Ann Thuo (Project Communications) Communications Manager, Action Africa Help International.
Wilf Podolak (Project Support) Scientist/Educator.
Winnie Luong, (GCC Project Coordinator) Grand Challenges Canada.
Study Participants This study encompasses urban and rural settings in Nairobi and Kiambu counties within Kenya. The Local Decision Influencing Participants (LDIP’s) for this study include representation from the: Kenya National Ministry of Health, County level reproductive health departments, National Public Health Laboratory, University of Nairobi, Kenya Medical Women’s Association, United Nations Population Fund, plus the MOH Deputy Chief of Pharmacy, CEO of a private laboratory and a private gynecologist. In addition, through a number of focus groups, local village women and community health workers are also providing input into the study.
Source of Funding
Irene Podolak has been awarded the Frederick Banting & Charles Best Graduate Scholarship from The Canadian Institutes for Health Research to conduct this study.
Action Africa Help International has been awarded the Grand Challenges Canada Stars in Global Health grant to conduct this study.
Project Goals and Objectives The fundamental goals for this project include the following: 1. To show the extent to which the Participatory Action Research (PAR) methodology and the Scenario Based Planning (SBP) method, with the application of advanced analytics, could enable strategic, consequential, informed decision making. 2. To determine how decision makers could apply SBP with analytic tools and techniques to make strategic, consequential decisions (in rural/urban settings in Nairobi and Kiambu Counties) on how to implement a cervical cancer sample self collection program. The specific objectives of this research study include the following: 1. To identify exemplary practices and enablers of predictive/prescriptive decision making and the measurement of impact. 2. To implement the PAR methodology with the SBP method and analytic tools and techniques to help local decision makers make strategic, prospective, prescriptive decisions. 3. To develop and recommend robust, flexible and innovative strategies that have the potential to enable a health district in Nairobi and Kiambu County to implement a cervical cancer sample self-collection program; one that has the greatest potential to be logistically and financially feasible, plus socially acceptable. 2
4. To contribute to other health organizations being able to improve their strategic decision making processes from the resulting learning and outputs of this study.
Study Design The key study design components for this research study include the following:
Application of the key principles of the Participatory Action Research methodology: collaborative participatory action to solve problems; linking scientific understanding to social action, and co-construction of knowledge through research to influence social improvement.
Application of the key steps involved with the Scenario Based Planning method: 1) definition of scope, 2) perception analysis, 3) trend and uncertainty analysis, 4) scenario building, and 5) strategy definition.
Application of the Data to Decision Model to support informed decision making with the use of analytic tools to conduct an impact analysis of the implementation options for a cervical sample self collection program.
Phase 1 – Project Initiation (October 2013 to April 2014) During Phase I of the project, the PMT was actively involved in the following activities:
Identifying Project Management Team (PMT) participants and Local Decision Influencing Participants.
Assembling PMT and conducting PMT meetings.
Obtaining consent from participants.
Initiating project logistics.
Training study participants on the methodology, method and tools.
Conducting Workshop #1.
Phase 2 – Diagnosing and Planning (May 2014 to June 2014) The key activities conducted during Phase II of the project include the following:
Conducting a review of the literature pertaining to cervical cancer prevention and screening in Kenya.
Conducting interviews to collect participants' perceptions of those factors that need to be addressed when designing implementation scenarios for a cervical sample self collection program.
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Conducting a focus group with the women off Tala Village to get their perceptions on the social acceptability of conducting cervical sample self collection.
Identifying potential implementation scenarios for a cervical sample self collection program.
Conducting Workshop #2
Next steps Going forward, the next steps of the Chaguo Letu Project include the following:
Conducting further focus groups and interviews to collect additional data pertaining to the implementation scenarios for the cervical sample self collection program.
Conducting a detailed analysis of all of the data collected to date on the project.
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Development of recommended implementation strategies for the cervical sample self collection program
Authors: 1. Irene Podolak, PhD Candidate, Brock University, Ontario, Canada 2. Wilfred Podolak, Vice President, Podolak & Associates, Ontario, Canada
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