Health kiosks in community markets: readiness for primary care–market collaboration in Kenya

Abstract

Abstract The third contribution presents the HEKIMA studies in Kenya, which co-develop community market–primary care partnerships to address inequalities in cardiovascular disease prevention and control among rural and urban populations including nomadic pastoralist Maasai communities. The studies examine health kiosks in community and livestock markets as an innovative interface linking primary care with local social and economic spaces. Using a mixed-methods approach, HEKIMA combines participatory, art-based concept mapping with system readiness assessments across health centres and markets. Stakeholders from health and non-health sectors collaboratively identified and prioritised actions across domains, including service delivery, communication, partnerships, workforce, infrastructure and culturally appropriate health promotion, with attention to gendered roles and access within pastoralist livelihoods. Beyond priority-setting, HEKIMA interrogates the relational dynamics through which knowledge is produced in nomadic pastoralist contexts, highlighting how participatory processes can reshape power imbalances between health systems and pastoralist communities. The co-development process created space for Maasai perspectives, values and lived experiences to inform what constitutes acceptable, accessible and meaningful care, while also revealing tensions around authority, representation and decision-making. It emphasises how climate variability and mobility shape health access, underscoring the need for flexible, resilient service models. Concurrent readiness assessments across health centres and markets identified enabling conditions, such as governance structures and strong community networks, alongside critical gaps in medicines, data systems, equipment, space and health–market linkages. These findings highlight how participatory, co-developed approaches can support equitable, climate-responsive and gender-sensitive primary care models in underserved pastoralist settings.