Stema has mobilised a network of community partners in low resource settings in five countries: Australia, Kenya, Peru, Sierra Leone, and South Africa.
These partnerships, based on respect, two-way learning, and creative problem solving, have become a lens through which we have understood how we can best contribute and the foundation from which we have built the Stema approach.
YIBEN, SIERRA LEONE
Systems beyond health systems: understanding community, culture and context to innovate access to healthcare Yiben, Sierra Leone
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:
Napo River, Amazon, Peru
Botequin Project: Systems innovation for access to medication in Amazonian Peru
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.
EAST POKOT, KENYA
Planting a seed during the drought: Uncovering local resources, identifying spaces of care, and strengthening community systems for maternal health
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.
Pretoria, South Africa
Spaces of Care: A spatial design research project investigating physical and virtual spaces of care, health and wellbeing in the city of Pretoria for adolescents with HIV
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.