My experience with government officials in Kenya
Stakeholder communication as we know it is going through an era of transition. We are moving from the traditional ‘informing’ and ‘consulting’ others on what we have already prescribed, to more ambiguous communication relationships that are about ‘co-designing’ and ‘co-producing’ our collective project narratives and mechanics. People no longer want to be on the receiving end of one-way information and messages, they want to be co-authors and co-shapers of their own experiences of the world around them. This need for consultation is particularly relevant when working with people we don’t know, in contexts we are unfamiliar with, and with subject matter we may know little to nothing about.
While living in Kenya, I had the opportunity to work with the Kenyan government’s NHIF and the World Bank Group on redesigning the national social health insurance program for the informal sector – which makes up about 80% of the population. Without health insurance, households suffer from significantly high out of pocket health costs which often means delays in seeking care and considerable knock-on effects for families and the health system overall.
As part of their Vision 2030 initiatives, the government is looking for ways to increase health insurance coverage from 4.6 million to 25 million people nationally by targeting the informally employed. The informally employed are an amorphous group with irregular and undeclared incomes making it difficult to collect premiums and set fair rates according to ability to pay. The aim of this project was to conduct qualitative, human-centred research and co-design a more citizen-centred government health insurance offering that will attract and retain more informal sector members.
I recall in my first meeting with the stakeholder group, a senior leader at General Management level within the government hierarchy pulled me aside and said:
"Whatever you need to make this project a success, you just let me know... I appreciate that you didn't come here with a polished presentation about what you are going to do, but instead, you gave us paper and pens to tell you what we know, what we don't know, and what we need from you."
She reflected on how others before me never cared to ask, which suggested to her that they were either not curious enough to wonder or didn't value her and her team’s views on the matter at hand. Kicking off the dialogue with key project sponsors and stakeholders in this context meant starting with saying "I don't know.... but you know!" Exposing my own uncertainty, my doubts, my questions, basically putting my vulnerability front and centre in our first meeting didn't discredit me -- it gained me their respect. It also shifted the power dynamics between us. I was the one at the front of the room, I was the one with the whiteboard marker in hand, I was the one who had been granted ownership and control of that time during the meeting, all eyes were on me, and as all these factors allowed me to command this space I opted to give it all back to the 20-odd people in the room and ask them:
What do YOU believe are the reasons for this project?
Who are the people who will be effected by YOUR decisions relating to this project?
What do YOU think are their views and experiences of the service you are offering them?
What are the changes YOU anticipate are needed for this project to succeed?
How will YOU know if this project was a success or not?
What are the questions YOU think are still unanswered in your mind – where should we start?
Every single person in the room was armed with paper and markers, quiet time to think and write, followed by an honest and vulnerable space to explore their answers together. A rich conversation surfaced where key clues and real issues emerged. All documented in their words, clustered in themes they labelled. I didn't realise it at the time, but running a project with the aim of reducing out-of-pocket expenses for 80% of Kenya's population was as much a project of power and trust, as it was a project of health service redesign.
This co-designed and facilitated approach to stakeholder communication contributed to why people walked away feeling heard, understood and appreciated. Furthermore, it provided an enabling environment for the project to be prioritised, with some stakeholders going above and beyond their usual remit to see it got the resources and attention of others in the organisation it required.