Chamas for Change Gender and COVID-19 Matrix
The ‘Chamas for Change: A gender-responsive and microfinance-based approach to empowering women’ is an intervention and applied research project based in Trans Nzoia County in Kenya. It is part of a community-based programme established in 2012 to support rurally-residing pregnant women and adolescent girls and mothers during the first 1000 days of their child’s life. With a goal of strengthening maternal and child health while supporting economic empowerment, the programme, led by community-health promoters, creates opportunities for group-based health education, peer support and microfinance.
Methodology
Through research, we set out to assess risks, impacts and resilience at play during the COVID-19 pandemic under the backdrop of ongoing Chama for Change intervention. The Gender and COVID-19 Matrix was utilized as a research framework which shaped data collection and analysis.
Developed by the Gender and COVID-19 Project (now, Gender and Public Health Emergencies global consortium), the Matrix supports an analysis of how gendered power dynamics shape COVID-19 pandemic experiences. It entails domains which interrogate how gender interacts with access to resources, roles in society, societal norms and beliefs, distribution of decision-making power, and institutional provisions and how this subsequently shapes differential risks and impacts of the pandemic across pre-selected COVID-19 topical domains. Our analysis was informed by data collected through 11 focus groups and 11 key informant interviews— a total of 95 research participants. Focus groups included participants and nonparticipants of the Chama for Change programme, men partners of women who had participated in the programme, as well as women and men community health promoters.
Geographical and social context
The Chama for Change program and research project are based in Trans Nzoia County. The County borders Uganda on the West and is divided into five administrative sub counties (see Figure 1) which are further subdivided into 25 administrative wards. It has two main urban centers (Kitale and Kiminini towns) and one referral hospital serving patients across the county (the Kitale County and Referral Hospital).
The population of Trans Nzoia is at 990,341, with just over 500,000 being women (Kenya Population and Housing Census, 2019). Over 77 percent are below 35 years of age and 2.4 percent of the population lives with a disability. The County reports higher rates of poverty compared to national average rates. The main source of livelihood is agriculture: The County is said to be ‘Kenya’s breadbasket’ due to its large-scale production of maize (County Government of Trans Nzoia, 2023).
Gender roles in Trans Nzoia are produced and reproduced by norms and beliefs that designate women as caregivers and men as providers and protectors. This consequently limits women’s participation in paid employment and hence access to resources. Our study indicated potential shifts in gendered power dynamics during the COVID-19 pandemic.
Access to Resources
Labour/Roles/Practices
Norms/Beliefs
Power
Institutions/Law
(government response)
What has what?
E.g. income, assets, information, knowledge (education), mobility, social networks, time
How did gendered access to resources shape the distribution of risk of COVID-19 illness and access to treatment?
What has what?
E.g., paid and unpaid labour
How did gendered labor and roles affect people’s treatment of COVID-19 infection?
How are values defined?
E.g., expectation on appropriate behaviour, attitude of influence
How do norms and beliefs affect people’s treatment of COVID-19 infection?
Who decides?
Power distribution & negotiation at household/ community level
Who made decision on treatment of COVID-19?
How is power structured?
Leadership opportunities, education, employment, ownership/inheritance rights, infrastructure
How did government institutions and law support COVID-19 treatment? Was there a balanced gender representation within related government structures?
Cost of COVID-19 treatment deterred those with limited resources from utilizing health facilities: Some used home remedies and traditional healers
Community health promoters (CHPs) were central to connecting people in isolated settings to COVID-19 testing and treatment through information sharing and referral services: Most CHPs are women
Prior to the COVID-19 pandemic, people typically sought treatment in health facilities when their conditions became critical; this health-seeking behavior was mirrored in seeking COVID-related treatment
Community health promoters (CHPs) were central to connecting people in isolated settings to COVID-19 testing and treatment through information sharing and referral services: Most CHPs are women
Quarantine centers were poorly resourced contributing to unsanitary conditions and inadequate food for COVID-19 patients; some people discharged themselves because of discomfort and hunger. The government increasingly encouraged people to quarantine in their homes due to resource constraints
Most people with COVID-like symptoms chose to quarantine at home but some homes were overcrowded and hence insufficient in preventing spread of infection within households
Women were more likely to discharge themselves from quarantine centers in health facilities to attend to care responsibilities at home
Women are perceived as more likely than men to seek treatment when ill; women were more likely to seek COVID-19 information and referral from community health promoters
Women were more likely to discharge themselves from quarantine centers in health facilities to attend to care responsibilities at home
Community health promoters (CHPs) faced restrictions and fear in responding to the COVID-19 pandemic in communities due to police enforcement of public health measures without acknowledgement of CHPs role in COVID-19 response
People dependent on daily wages for sustenance were unable to follow quarantine measures even when they had COVID-like symptoms
Fear of death upon hospitalization for COVID-19 treatment after testing positive deterred some people from going for testing when they experienced COVID-like symptoms
Random testing campaigns were undertaking within communities to bring COVID-19 services closer to the people
Individuals perceived as most affected by COVID-19 illness and death included older people, those with chronic health conditions or comorbidities, people living with disability, and pregnancy women
Fear of visiting health facilities contributed to some people seeking herbal remedies and traditional healers when they experienced COVID-like symptoms
Trans Nzoia County ran a 24-hour crisis line for COVID-19 reporting to support contact tracing work
Trans Nzoia County ran a 24-hour crisis line for COVID-19 reporting to support contact tracing work
Balanced gender representation was noted in COVID-19 decision-making bodies; this included the emergency committees and technical working groups who provided a roadmap on COVID-19 response and coordinated with the National Pandemic Response Committee
Government bureaucracy and mismanagement of COVID-19 resources was noted to delay response and undermine efficiency
At the start of the pandemic, there was only one COVID-19 treatment facility in Trans Nzoia County (at Mt. Elgon Hospital) resulting in delays in referral; services were later decentralized to increase access
Initially Trans Nzoia county did not have capacity for COVID-19 testing and had to transport samples to neighboring counties causing delays in seeking treatment
Health care facilities in Trans Nzoia County were not well equipped to respond to the COVID-19 pandemic; there was a limitation in intensive care units, oxygen cylinders, ambulances, and laboratories to facilitate COVID-19 testing
In the first wave of the pandemic, Trans Nzoia county had limited resources to respond to COVID-19 infections but increased its capacity for testing, quarantine, and treatment
Lack of an emergency fund and a pandemic response plan delayed COVID-19 response e.g., the County lacked capacity for testing, isolation, treatment, and vaccination: County resources were reprioritized to respond to the pandemic by shifting funding from other departments to the health department and from non-COVID health budget and infrastructure to COVID response. Reallocation of funding required an approval process that took at least three months.
Collaboration between the government and private healthcare facilities was slow and limited
Acknowledgements
The Chama for Change research project team includes Julia Songok (Principal Investigator), Astrid Christoffersen-Deb (Co-Principal Investigator), Sammy Masibo (Co-Principal Investigator), Violet Naanyu, Michael Scanlon, Laura Rulh, Julie Thorne, Alice Mũrage, Nadia Beyzaei, Abiola Adeniyi, Samuel Mbugua, Justus Elung’at, Anjellah Jumah, Anusu Kasaya, Sheilah Chelagat, Sally Maiyo, and John Hector.
Alice Mũrage facilitated the adaptation of the Gender and COVID-19 Matrix.
A Community Advisory Board representative of various segments of society in Trans Nzoia offered community-based expertise throughout the project and shaped our research approach.
This project is funded through the International Development Research Center’s Women RISE.
