'What I could borrow from their strategies?'

Lucy Kimondo has a big job, literally. As the deputy director of Population at the National Council for Population and Development, in Nairobi, Kenya, she's responsible for advocating for population and development in Kenya, at both national and county level. Kimondo, who is by training a population social scientist and has extensive experience in management of population and development programs, also recently joined the Exemplars in Global Health Senior Advisory Board. In this interview, she discusses why she thinks research into exemplars is helpful – and what she wishes she had known earlier.

Ms. Kimondo: The first time I heard about Exemplars was in June 2018 when, as part of the International Program in Public Health Leadership at the University of Washington, we visited the Bill & Melinda Gates Foundation and had a session with a team from Gates Ventures. After that, I went to the website to learn more as I wanted to learn how Peru was able to reduce stunting after it prioritized a targeted, evidence-based strategy that was a mix of new and old programs. What did they do right and what lessons could I and my colleagues learn? I looked at how they implemented their programs and I started learning what I could borrow from their strategies. From there, Exemplars became my website of choice for information. I have used the strategies of the exemplars as I prepare my advocacy strategies. If a strategy worked elsewhere, I always ask myself: how can I domesticate it for my situation?

Ms. Kimondo: My biggest surprise was that Peru was able to reduce stunting by 50 percent in eight years, giving it an average of 6.25 percent annually. Looking at their success I have been thinking what is it I can do differently to achieve progress in eliminating adolescent pregnancy in Kenya. How do I have a mix of old and new strategies for better results?

Ms. Kimondo: My work involves advocacy and public education on population and development. This is quite wide as population touches on all spheres but revolves around fertility, mortality and migration and how they relate to development. All the research in EGH have an impact on the wellbeing of the population, therefore I borrow from the findings to help develop a strategy.

Ms. Kimondo: The key activity I have now is ensuring the government is on track in achieving the ICPD25 [International Conference on Population and Development] commitments made in November 2019. Some of the implementation is directly under my docket, while others are implemented by other agencies. In the execution of this, I have gone several times to ask an expert from the Exemplars website for some solutions.

Ms. Kimondo: Before scaling up lessons learnt in one situation, it is important to scan the environment and develop a matrix to try and see what will work best and if the lessons learnt are applicable. The lessons learnt may work in one geography but not in the other. Every case has to be addressed individually. Also, timing matters. There are issues that can be scaled up in an election year - sometimes to win votes – however this is usually not sustainable. And issues implemented without being thought through fall through the cracks. What makes sharing data across country lines so challenging?

I have heard it said data will be the next goldmine, however data collection – especially in governments – is guided by laws that govern how data is collected and shared. In Kenya there is an access to information act that allows sharing of information freely, however, data sharing - especially administrative data - is still a problem. The barriers are mostly systemic and there is also a lack of analytical skills to analyze data once shared.

Ms. Kimondo: The culture of learning from each other has not taken root in most countries. This may be due to the lack of positive outliers or the belief in doing things their own way. Countries spend a lot of money duplicating practices that have failed elsewhere, instead of looking at the positive outliers, borrowing from them, and domesticating them to their situation.

Ms. Kimondo: A randomized controlled trial is an experimental form of impact evaluation in which the population receiving the program or policy intervention is chosen at random from the eligible population, and a control group is also chosen at random from the same eligible population. It tests the extent to which specific, planned impacts are being achieved, which is different from EGH which uses a mixed approach such as longitudinal data, desk reviews, qualitative and quantitative data.

EGH data is more related to further research of existing data sets with interviews to fill in the gaps. RCT is more of an impact assessment. EGH will be able to go further and find out why a certain intervention worked, while RCT will only show the outcome of the intervention without answering why the results are the way they are. RCT will show the results of not addressing a problem using the control group, which EGH does not have.

Ms. Kimondo: Countries are not homogeneous and therefore we borrow ideas and domesticate them to our situation. It is important to understand the environment we are working in as we use ideas that worked elsewhere, as different geographies may require differences in mitigation, for example in urban and rural settings.

Ms. Kimondo: In the long-term I am looking forward to the research on women’s health. My main interest is what has worked for adolescents’ health elsewhere and what I can borrow to replicate back in Kenya. It is my hope the answer is out there in one of the geographies.