Our approach is informed by extensive fieldwork in low-resource settings around the world.
Stema has mobilised a network of community partnerships in low resource settings, based on respect, two-way learning, and creative problem solving.
This field work is the lens through which we have understood the most effective ways to contribute, and has formed the foundation of the Stema approach.
Use the map to explore our field locations. You can read more about each project featured on the map below.
In all areas of the world, civil society organisations (CSOs) work to mitigate the detrimental impacts of multiple challenges including climate change, social inequity, regional geopolitics, and extractive economic systems. While such challenges exacerbate localised experiences of health, social and environmental inequity - CSOs utilise local knowledge and resources to respond and address such challenges simulataneously. Translocal Health explores the responses of five partnership CSOs in terms of building livelihoods, well-being, environmental protection, and health to address the current and future global planetary health crises. Through using a trans-local approach, we hope to demonstrate and harness the power of acting at a local level in the midst of larger system challenges.
We proposed to use the Stema HPS approach (Human-centred design, Participatory research, and Systems-thinking) to work with Sunrise Health Services and its communities to identify local community resources (discover), plan how these might come together into locally-driven interventions (define), encourage participation at all levels in the initiatives (deliver), and report on how these initiatives have changed community health and wellbeing (evaluate).
The Khuluma model is a digital psychosocial support intervention that has been successful in South Africa. It is a closed peer-to-peer messaging service for adolescents with HIV in Pretoria and Cape Town.
Stema is keen to explore how digital spaces of care complement the physical spaces that adolescents have to encounter to look after their health. This includes thinking about networks of care and support for complex health conditions such as HIV, where mental health and issues of stigma are significant barriers to good care.
We employ design research tools such as participatory mapping, user journeys, day in the life stories and photo diaries to capture health holistically in adolescents. This allows us to understand the complexities and specificities of the adolescent experience.
The research is an intervention in education and empowerment, and the aim is to also stage an intervention realising and enacting what a space of care is for the group. Spaces of care may be physical or virtual. This concept of 'spaces of care' for HIV was explored through a series of maps describing patient journeys within the city. This project explores resourcefulness through studying the interaction between technology, design and systems in this community.
Orus is a farming community in the East Pokot region of rural Western Kenya. It is located approximately 45km North of Tanglebei, a small market town with a basic health centre, accessible by a rough dirt road.
The community of Orus covers a vast spread of land and is comprised of around 20 homesteads. Each homestead is comprised of a polygamous family group: men may have multiple wives, who live in separate huts around a central area. The homesteads are comprised of a number of manyattas (wood structure/scaffolding, mud walls and thatched roofs), a central communal area, storage huts, and fenced areas for livestock. The community also has a central water tower (which charges 10 shillings - 1 cent - per billycan of bore water), a primary school (two buildings, one unused and decrepit but with functional solar panels), and an unused hospital building.
A mixed methods, exploratory and participatory approach was undertaken in Orus to uncover resourcefulness within this community to improve health and wellbeing.
In the remote region of Yiben in Northern Sierra Leone, most people never considered going to a health facility, and instead used local medicine. This was due to long distances, lack of access to transport, poverty, opportunity and costs. Multiple informal systems of healthcare existed in the community, mainly involving the use of herbs and leaves from the surrounding jungle. Knowledge about the traditional medicine has been passed down through families and practiced by local healers (soothsayers) and traditional birth attendants. In a bid for access to modern healthcare, the community instigated and built a health clinic in 2016. It is now serviced as a Maternal and Child Health Post under the government health system. Overall, there is still a very low level of health knowledge but an openness to learning and a high rate of interaction with the health facility.
In 2018, we partnered with the Yiben Community leadership, Set4Life Australia, and the local government to investigate community and health system development in three key areas:
In the Napo River of Peru, poverty and geographic remoteness collide to pose a significant and often insurmountable barrier to healthcare. There are very few health facilities within reach of many river communities. River transport to health facilities is expensive and unaffordable for many. Access to basic medicines is near impossible. Where there are no formal models of healthcare delivery, local community health volunteers (known as agentes communitarios de salud, or promotores) fill this gap. Promotores are voluntary, elected health leaders in Napo River communities, who act to support health and wellbeing for those who can't access the healthcare system.
Promotores and community members have identified access to medicine as a key health issue in the Napo River and have expressed interest in and dedication to the idea of community-based pharmacies (known locally as botequins) to bring medicine and medical treatment closer to the community.
Stema has partnered with DB Peru and Altro Foundation to develop a decentralised, community-led medication procurement, storage, and delivery system. The project is placing small botequins in five rural communities which will be stocked and managed according to community needs, financed by the community, and delivered by trained promotores.