Can Simple Psychological Interventions Increase Preventive Health Investment?

Behavioral constraints may explain part of low demand for preventive health products. We test the effects of two light-touch psychological interventions on water chlorination and related health and economic outcomes using a randomized controlled trial among 3750 women in rural Kenya. One intervention encourages participants to visualize alternative realizations of the future; one builds participants’ ability to make concrete plans. After 12 weeks, visualization increases objectively measured chlorination, reduces diarrhea episodes among children, and increases savings. Effects on chlorination and savings persist after almost three years. Effects of the planning intervention are weaker and largely insignificant. Analysis of mechanisms suggests both interventions increase self-efficacy – beliefs about one’s ability to achieve desired outcomes. Visualization also increases participants’ skill in forecasting their future utility (Gabaix and Laibson 2017). The interventions do not differentially affect beliefs and knowledge about chlorination. Results suggest simple psychological interventions can increase future-oriented behaviors, including use of preventive health technologies.

Embracing risky refuge: women, land laws and livelihood vulnerabilities in rural Kenya

There has been a growing interest in laws governing resources particularly land in reference to gender in Africa. Law reforms in relation to land have produced potentially useful regulations and espoused egalitarian land rights. However, the backdrop to these reforms contains a scene of land disputes, resistance to laws, violence against women and poor enforcement leading to injustices to women with a pervasive effect on families in vulnerable communities. Using focused ethnographic research methods, the writer investigated women's land rights between November 2015 and August 2016. In-depth interviews, focus group discussions, review of archival records and observations were utilised. The study found that in contexts of prolonged livelihood vulnerabilities, as in the case of the Luo people of south-western Kenya, women seeking refuge from livelihood difficulties employ two strategies to anchor their security. They migrate from marital homes to fishing villages and also lay claim to marital land, which is held by men according to customary laws. These strategies produce social dilemmas and risky manoeuvering. Statutory land laws that are enacted to mitigate land related conflicts undermine the existing customary land laws that advantage men. Therefore, women's land claims, and statutory land laws that espouse equality in land ownership, destabilise men's sense of masculinity. By drawing on the experiences of women, I show the intersection between land laws, enduring injustices and gender relations in a context of strained livelihoods.

Electric Two-Wheeler Vehicle Integration into Rural Off-Grid Photovoltaic System in Kenya

In both rural and urban areas, two-wheeler vehicles are the most common means of transportation, contributing to local air pollution and greenhouse gas emissions (GHG). Transitioning to electric two-wheeler vehicles can help reduce GHG emissions while also increasing the socioeconomic status of people in rural Kenya. Renewable energy systems can play a significant role in charging electric two-wheeled vehicles, resulting in lower carbon emissions and increased renewable energy penetration in rural Kenya. As a result, using the Conventional and Renewable Energy Optimization (CARNOT) Toolbox in the MATLAB/Simulink environment, this paper focuses on integrating and modeling electric two-wheeled vehicles (e-bikes) into an off-grid photovoltaic Water-Energy Hub located in the Lake Victoria Region of Western Kenya. Electricity demand data obtained from the Water-Energy Hub was investigated and analyzed. Potential solar energy surplus was identified and the surplus was used to incorporate the electric two-wheeler vehicles. The energy consumption of the electric two-wheeler vehicles was also measured in the field based on the rider’s driving behavior. The modeling results revealed an annual power consumption of 27,267 kWh, a photovoltaic (PV) electricity production of 37,785 kWh, and an electricity deficit of 370 kWh. The annual results show that PV generation exceeds power consumption, implying that there should be no electricity deficit. The results, however, do not represent the results in hourly resolution, ignoring the impact of weather fluctuation on PV production. As a result, in order to comprehend the electricity deficit, hourly resolution results are shown. A load optimization method was designed to efficiently integrate the electric 2-wheeler vehicle into the Water-Energy Hub in order to alleviate the electricity deficit. The yearly electricity deficit was decreased to 1 kWh and the annual electricity consumption was raised by 11% (i.e., 30,767 kWh), which is enough to charge four more electric two-wheeler batteries daily using the load optimization technique.

Implementing a Comprehensive Value-based Healthcare System to Improve Pregnancy and Childbirth Outcomes in Urban and Rural Kenya.

Background: Maternal and neonatal mortality rates in many low- and middle-income countries (LMICs) are still far above the targets of Sustainable Development Goal (SDG) 3. Value-based healthcare (VBHC) could potentially surpass traditional input-oriented approaches to create a high-quality health system and to improve maternal, newborn and child health (MNCH) outcomes. This paper describes the implementation of VBHC in urban and rural Kenya with the aim to significantly improve MNCH outcomes.Methods: We developed a theory of change (ToC) and used an incremental cohort-based implementation approach to create short and long learning cycles along which different components of the VBHC framework were introduced and evaluated. We sought to leverage local resources and used a mobile phone-based platform to support pregnant women and MNCH providers throughout the patient journey, using the system for communication, payment and data collection. We created dashboards and used interviews and focus group discussions to gather feedback and to collect the data to describe the implementation process in this paper.Results: We implemented all elements of VBHC, starting small and expanding cohort by cohort. Short and long learning cycles between cohorts enabled implementation of the framework in a relatively short time frame. Data on outputs and outcomes show that the VBHC framework had impact on three levels: Mothers’ improved adherence to maternal healthcare, incentivizing providers to improve quality of care, and transparency of outcomes and costs. This paper describes the implementation process and while the evaluation of health outcomes is ongoing, first results show improved adherence to evidence-based care pathways at a low cost per enrolled person.Conclusion: This study has shown that implementation of the VBHC framework in an LMIC setting is possible with some adaptations to the local context. The incremental, cohort-based approach enabled an iterative learning process, which could support the restructuring of health systems in low resource settings going from a supply-driven model to a value-driven model.Trial registration: Not applicable

Characterizing multidimensional poverty in Migori County, Kenya and its association with depression

Introduction Narrow, unidimensional measures of poverty often fail to measure true poverty and inadequately capture its drivers. Multidimensional indices of poverty more accurately capture the diversity of poverty. There is little research regarding the association between multidimensional poverty and depression. Methods A cross-sectional survey was administered in five sub-locations in Migori County, Kenya. A total of 4,765 heads of household were surveyed. Multidimensional poverty indices were used to determine the association of poverty with depression using the Patient Health Questionnaire (PHQ-8) depression screening tool. Results Across the geographic areas surveyed, the overall prevalence of household poverty (deprivation headcount) was 19.4%, ranging from a low of 13.6% in Central Kamagambo to a high of 24.6% in North Kamagambo. Overall multidimensional poverty index varied from 0.053 in Central Kamagambo to 0.098 in North Kamagambo. Of the 3,939 participants with depression data available, 481 (12.2%) met the criteria for depression based on a PHQ-8 depression score ≥10. Poverty showed a dose-response association with depression. Conclusions Multidimensional poverty indices can be used to accurately capture poverty in rural Kenya and to characterize differences in poverty across areas. There is a clear association between multidimensional poverty and depressive symptoms, including a dose effect with increasing poverty intensity. This supports the importance of multifaceted poverty policies and interventions to improve wellbeing and reduce depression.