Systems Thinking and Water, Sanitation and Hygiene: Examples from Kenya’s <i>Afya Jijini</i>Program

The Afya Jijini program targeted improved access to and quality of health services in Nairobi City County through the strengthening of local health systems. The program took a systems thinking approach recognizing that strong, coordinated commitments and contributions from various levels of multiple sectors such as health, public works, and education would be essential to the program’s success. Consistent with the World Health Organization’s proclamation that the provision of safe water, sanitation, and hygiene (WASH) are prerequisites for all public health endeavors, WASH-related efforts were woven into nearly all facets of the Afya Jijini program. IRC is a nonprofit located in the Netherlands focused on systems thinking approaches for sustainable WASH improvements. IRC’s 9 building blocks are tools to assist in breaking down the complexities of systems, identifying key actors and factors that contribute to sustainable improvements, and setting clear program indicators and targets for success. This conceptual manuscript seeks to explore the Afya Jijini program through the lens of the IRC’s building block approach to systems thinking. Examples of Afya Jijini programming aligned with each building block are presented to assist program planners and guide future interventions. Afya Jijini could have benefited from increased attention to several key building blocks, including institutions, finance, and learning and adaptation.