Thousands of Kenyan adolescent girls and young women have remained HIV-free through the US government-funded Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) program—but what happens after they graduate from the program?
Multi-sectoral collaborative relationships
Adolescents and youth
Gender equity in programming
Through a learning exercise at the end of the project, participants spoke of their financial stability, self-reliance, expanded roles in the community, and improvements in their relationships. Photo: PATH/Oluoch-Madiang’ Daniel.
Globally, there has been a slow but steady decline in the number of new HIV infections. However, for some groups of people, HIV infection is on the rise. Adolescent girls and young women (AGYW) are disproportionately affected by and account for up to 67% of new HIV infections in sub-Saharan Africa, where each week there are about 7,000 new HIV infections among AGYW aged 15 to 24. Young women are also twice as likely to be HIV-positive compared to men.
Since 2016, PATH and partners have been implementing DREAMS to keep AGYW HIV-free. DREAMS provides AGYW ages 9 to 24 years old with critical services aimed to prevent HIV acquisition. After DREAMS enrollees receive all their age-specific services, they graduate and exit the program. Despite having participated in financial capability and entrepreneurship trainings, many young women still lack the networks, opportunities, and capital to earn a living and become financially stable.
PATH conceived and implemented the 30-month Chak a Chaka project (2020–2023) to provide 1,225 DREAMS graduates with critical transitional support to build sustained economic security to protect their health and wellbeing, and the health and wellbeing of their children and families.
The vision was to pilot a project model for adoption by other stakeholders and organizations in Kenya, and in similar settings where young women’s access to resources and knowledge are limited by structural gender-related barriers. At the end of the project, PATH undertook a learning exercise to generate insights into program successes, challenges, impact, and areas for improvement through focus group discussions (FGDs) with young women who participated in the program.
PATH led the Chak a Chaka project implementation with participation from regional stakeholders from the Ministry of Labor and Social Services; Ministry of Public Service, Youth, and Gender Affairs; the Kenya National Chamber of Commerce and Industry; community-based organizations; and local technical and vocational training centers.
Chak a chaka is a popular Luo phrase encouraging people to start whatever endeavor they are thinking of doing despite limited resources. PATH conceived and implemented the Chak a Chaka project in two phases. During the 18-month pilot phase (2020–2021) the project provided 1,255 DREAMS-graduated young women 20 to 24 years old with the means to financial independence, by facilitating access to entrepreneurship, training opportunities, and seed funding for business activities. This included the development of savings culture amongst low-income women through an innovative matching funds approach for a duration of time; supporting young women to access the National Hospital Insurance Fund (NHIF) to alleviate health care costs and enable saving; organizing young women into registered and trained savings groups equipped with appropriate group structure, tools, and training; and providing group grants as seed capital for business engagement.
Through this model, Chak a Chaka expanded the pathways of women’s access to financial stability through individual savings, establishing and running individual microenterprises, and participating in group business for profit.
Concurrent to these initiatives was constant access and uptake of requisite HIV prevention biomedical services and commodities, pre-exposure prophylaxis, HIV testing services, family planning, condoms, and antenatal and post-natal care services.
Why was PATH chosen to do this work?
At PATH, we understand the complex social, behavioral, and economic dimensions of HIV prevention and sexual and reproductive health throughout the lifecycle—and their importance to building a people-centered primary health care system that addresses the needs of women and girls. We have provided technical support and leadership in more than 35 countries to develop, scale, and mainstream evidence-driven innovations, including those responsive to diverse adolescent and youth populations. PATH brings a critical, gender lens to developing and implementing health solutions. We develop and promote health innovations that address the needs of women, men, and individuals of all gender identities and expressions. PATH has been partnering with communities, civil society organizations, and government stakeholders in Kenya for over three decades, including a variety of projects that have used gender-responsive and gender-transformative HIV programming.
“Economic empowerment, gender norms transformation, and consistent access to quality health services—it’s through this nexus that young women can continue to be HIV-free.”— Oluoch-Madiang’ Daniel, PATH, Senior Technical Advisor – AGYW
The learning exercise
To inform future integrated economic-HIV prevention interventions for DREAMS-graduated and other young women in Kenya, we undertook a learning exercise in May 2023 to capture feedback and perspectives from a randomly sampled subset of Chak a Chaka project participants. PATH staff facilitated a total of five FGDs with a total of 60 young women in Homa Bay, Kisumu, and Migori Counties to collect information about program successes, challenges, impact, and areas for improvement. We used FGD guides designed to help us gain insights into the following questions:
- What did participants know about Chak a Chaka before they enrolled? What have they found most and least useful, and would they continue to participate in savings groups after the project formally ends?
- Did participants experience changes in knowledge and self-efficacy in the areas of finance, saving, business development, and did participants experience changes in self-efficacy or decision-making power within their family or home?
- Did participation in the Chak a Chaka program affect participant’s health and relationships, particularly how they related to their male partners, and their knowledge and access to health services?
- Did participation in the Chak a Chaka program affect the way participants perceive their roles in their community, and their networks and knowledge of other organizations and partners?
We used FGD notes highlighting key messages, reactions, and discussion points raised by participants in response to various questions. The data review and synthesis process relied on the identification of key concepts to characterize emerging themes (i.e., theming the data). In this case study document, we present key findings organized around some of the themes that emerged.
INCREASED UNDERSTANDING OF MONEY MATTERS AND INSURANCE PROTECTION
All FGD participants described financial management skills as their most useful and important learning from the Chak a Chaka program. Business management skills were key takeaways for many participants: they learned how even a small amount (for example, Kshs. 100, or USD .75) could be used to buy produce wholesale and sell for a profit or engage in other small money-making activities.
One of the young women likened money to a temporary visitor, but noted that even small amount can be used for planning:
“Money is like a visitor; it comes and goes. In Chak a Chaka I learnt how to save and plan with the little I have.”
Participants also reported learning how to use more substantial funds to launch, formalize, and grow a variety of different businesses; interact with customers; take lessons from other businesses; implement effective record keeping and bookkeeping; create business plans; and pivot their businesses when one enterprise didn’t work out.
Many participants shared that they had not been familiar with Kenya's NHIF prior to enrollment in the Chak a Chaka program, or thought it was unnecessary. They said that the sessions that Chak a Chaka organized with NHIF representatives to explain NHIF and assist with registration, as well as the Chak a Chaka program’s coverage of dues for the first six months of the program, were helpful. Many continued to pay their own monthly dues when Chak a Chaka stopped covering costs and explained how this health insurance coverage had been crucial during health emergencies for themselves and their families.
TAKING ON NEW ROLES AS ENTREPRENEURS, LEADERS, AND MENTORS FOR ECONOMIC EMPOWERMENT AND FAMILY PROVIDERS
Some of the young women shared that involvement in Chak a Chaka changed their understanding of who can start a business—before, they had thought that only men or people with more money could start businesses, or that there were only certain types of businesses that women could run (e.g., hair salons, clothing retail). The shift in thinking about their roles as young women entrepreneurs with financial rights and access also extended to the use of banking services. As one FGD participant shared:
“We used to have a mentality that people with jobs are the ones to use the banks.”
Many FGD participants described an expanded and more active role in their communities after beginning the Chak a Chaka program, which extended beyond direct program activities (i.e., group meetings, individual and group businesses, trainings, health sessions). Additional activities they took on included mentorship to girls and other women on financial literacy and business (facilitated through churches and other community organizations), increased participation in church events and fundraising, and community service work like tree planting. A few shared that they were increasingly asked to speak in community forums.
For some participants, leadership was a key learning from the project. As young women took more ownership over their individual and group businesses, they developed the associated skills to lead, manage, and seek additional opportunities.
“I was elected a [Chak a Chaka group] leader and through my position I was able to interact with different people. It made me move from where I was into someone. I can speak with partners from NGOs or other stakeholders in different forums.”
Another explained that through her work with Chak a Chaka, she is now viewed as a role model in her community:
“I have seen changes, I used to live differently before Chak a Chaka. People now copy me and some even seek advice from me. I am busy doing my business, I am a mentor.”
Both for those who lived with their parents and those who lived elsewhere, many young women shared that prior to the Chak a Chaka program, they had depended on their parents for support, and through their own economic empowerment they were now able to support their parents, a reversal that they felt was positive.
The ability to pay for school fees and other needs of both their siblings and their own children, and to respond to financial requests from their parents and other family members, were positive impacts that Chak a Chaka participants frequently mentioned and took pride in.
FGD participants shared that after their engagement in Chak a Chaka, they felt an increasing sense of dignity, independence, and self-reliance:
“I can depend on myself. I used to rely on people. I don’t beg anymore through Chak a Chaka.”
“It has helped me: I have my own business. I can pay my own bills and don’t call friends to help.”
“I am economically empowered apart from the [vocational training] course; I can do several things. I don’t depend on one thing.”
GREATER SHARED DECISION-MAKING WITHIN COUPLES
Mutual decision-making and planning emerged as a major theme when participants were asked to talk about changes in their relationships to husbands, boyfriends, or other male partners. Prior to the Chak a Chaka program, many women said that they were shut out of household decision-making processes entirely. As their own financial power grew, women’s dynamics with their partners changed, and most said that they now sit down with their partners to make financial and other household decisions together, plan for expenses, and openly share their finances.
Many participants shared that their increased financial independence had increased peace and respect in their homes. Some used the term “parasite” to describe how they viewed themselves or were viewed by partners prior to Chak a Chaka and shared that now that they didn’t have to ask male partners for money or other household items, the frequency of quarrels in their homes had decreased. One young woman explained:
“I used to rely on my husband and there was always conflict with regards to money. Once I started the business, we shared costs in the house and now we are peaceful. When my husband sees that I am also contributing at home there is a lot of peace.”
Single women, or women with multiple partners, also noted changes following the Chak a Chaka program. One participant noted a decreased dependence on men generally as she has increased her own financial self-reliance. Another noted that previously, she had taken lines of credit from male partners, a practice which required several partners to obtain sufficient funds. After her Chak a Chaka activities, she no longer needed to engage multiple partners.
RELATIONSHIPS WITH MALE PARTNERS
Beyond general relationship dynamics with male partners, FGD participants were also asked if they had perceived any changes in the way they or other group members talked about gender-based violence (GBV), or to share experiences (from personal experience or observation among others). Several women shared that they had observed instances of GBV (both verbal and physical) decrease among Chak a Chaka participants during the program. Health sessions and mentorship offered through the Chak a Chaka program also gave them more resources to address GBV and help others. These resources included both violence mitigation approaches they could employ themselves, and external resources such as referral networks, DREAMS offices and staff, and Justice Centres. They also felt they could talk more openly about GBV, with less secrecy or stigma, which helped to shed light on the high prevalence of GBV among participants and in their community. One woman said, “We get involved in various problems. Through our trainings we help even the community other than Chak a Chaka members. We guide them as well.”
Four takeaways about Chak a Chaka
- The Chak a Chaka program led to increased gender equity through economic empowerment and within interpersonal relationships.
- The impacts of economic empowerment extended beyond financial stability, and included increased self-reliance and confidence, expanded roles in the community, and improvements in relationships with male partners and family members.
- Chak a Chaka participants felt prepared and motivated to continue their businesses and groups after the project ended, and that the knowledge they gained through Chak a Chaka was adequate to sustain their enterprises going forward.
- Participants have also increased their community connections and networks, and now have financial resources that extend beyond their Chak a Chaka groups.
Funding for the Chak a Chaka project was generously provided by an anonymous donor.
The Maseno University Ethics Review Committee approved the protocol for this activity. PATH also obtained a research license for this work from Kenya’s National Commission for Science, Technology and Innovation, and communicated with the County Commissioners of Homa Bay, Kisumu, and Migori counties prior to data collection.
The full learning exercise report may be found here.
You can learn more about PATH’s HIV prevention work with adolescent girls and young women, our commitment and programs related to gender equity in health, and our Kenya program portfolio at www.path.org.