Mandy Dube
Thank you all for the truly engaging discussion on the group. I thought that I could share a bit about what the BID Initiative is doing on the people and change management side and ask for ideas and suggestions for how we might make that aspect of the Initiative stronger stemming from the successes and lessons of other implementations. BID has the unique opportunity to adapt and modify interventions as we go along until we find a ‘successful fit’ for each context. I think that we do have a good starting ground for the people and change management side of things and this includes:
1. Identifying champions at facility, district and national level to help promote the Initiative as well as to provide feedback on the interventions as part of our User Advisory Group
2. Facilitating the growth of peer networking to share challenges and successes around immunization data collection and use
3. Conducting cross site visits where facility staff can see promising practices in action and look as ways they can adopt them in their own context
4. Using micro training videos to document and share promising practices
5. Providing platforms for viewing data in a visual way that makes it easier to see patterns in the data and make decisions based on what the data is saying
6. Improving the skill to use technology through fun and interactive activities
I am particularly keen to hear from the group on examples of how successful stakeholder engagement and buy-in were achieved as well as on successful change management interventions. What are the pitfalls that we should avoid on the people and change management side?
Puta, Chilunga
Thanks Mandy for kicking off this interesting and important discussion. No doubt change, especially behaviour change (which is what a substantial part of this will be) is indeed challenging but it can and does happen. To effect change I think first and foremost you must understand the context and the key drivers of action or non-action in the target community. This may prove difficult and demanding because this will vary from community to community, but it is a worthwhile exercise because it will help you to design appropriate strategies.
One of the biggest hurdles from past experience is just getting people to appreciate the value of data and the power that lies therein. If you can get the generators of data to value and appreciate the key role of data (and its correct interpretation and use) in making them more effective and reducing the burden of repeat actions that do not achieve what they want to achieve – that will be great gain. It is very important to demonstrate the value add of data if people are to be fully engaged, and I fully support the use of visuals that make it easier for the health worker to understand what the data is saying. I guess this is where modes of data presentation become important. It would be interesting to hear from country programs how they go about stimulating the use of data at implementation level.
Thanks
Chilunga
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Mtenga, Hassan
I agree with you Chilunga, behavioral change is quite a new and very challenging component in BID initiative particularly in Tanzania context, there are very limited strategies and interventions that addresses behavior change in Tanzania a health sector in general let alone data use and data for decision making.
There are number of challenges of which some are very specific in to particular level of health system which should be taken into account while developing these intervention. For instance why would an immunization nurse consider data quality issue while h/she doesn’t use them on day to day decision making activities or why would a district immunization and vaccine officer not interested in data quality issues while compiling monthly report. is it because they don’t have any impact on their job pay or what are the compounding factors behind such behaviors.
Also there are some behaviors that now are perceived to be normal while in actual sense they are problems and should be addressed. For example health facilities that are close to district immunization and vaccine officer office usually make frequent visits to collect vaccine to DIVO’s office when they run out of stock but when you ask them they would tell you they never had stock out problem. It might seem that they don’t experience stock out but the 15 minutes used to go and collect vaccine to DIVO’s office could have been used to perform other duties. If h/she makes four visits a month will be equivalent to an hour which is sufficient enough to compile a monthly report and submit on time and we won’t have late report problem. But they never see that as a problem and to my opinion it’s a problem and should real be addressed.
I believe we don’t have one suit fits all solutions to these problems as solutions should address particular context in particular level of health service and perhaps particular geographical location.
Regards
Hassan
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Peter Ademba
Change management is a dynamic approach that should involves a lot of mental and behaviour change that centres around health care providers as well as policy makers personnel have more knowledge on benefit of immunization to child survival and cost analysis benefit that is associated with immunization to the growing nation and its economical benefit based on individual, household, community and country level on reduction of diseases burden.
In order the change management to be effective county immunization managers should full engage political elite classes to be part of our immunization champions. In Kenya the first lady Margret Kenyatta’s promotion of beyond zero maternity initiatives has accelerates demand for mothers to bring their children for immunization to protect their children against 10 childhood preventable disease as per our country immunization schedule.
EPI team in Kenya have aligned immunization activities to ‘ beyond zero maternal health; to improve our Tetenus Toxoid uptake among pregnant women and advocated for the benefit of immunization among children below five years, while more emphasize is among children below one year, similarly we have aligned our EPI component alongside community strategy, this is part of our change management where the community health workers empowered with knowledge in identifying the children in hard to reach community and link up with level one health facilities with their catchment area, hence the use of better collection of immunization data and use at lower level has been enhanced as part of change management since the analysed data is shared by the community and local stakeholders on quarterly basis, the EPI performance shared count health management team to devolved county government to solicit for resources for accelerating the funding.
Although the initiatives is still at pipeline stage but i hope it will pick up and improves our change management in Kenya EPI health care services - below is a photo demonstrating the role of political class in enhancing immunization services
Her Excellency; First Lady, Mrs. Kenyatta vaccinating one of the children during the Rotavirus Vaccine launch at Machakos County – Kenya
The document has been authored and shared by Peter A. Ademba – monitoring and evaluation officer – ministry of health - Kenya – unit of vaccines and immunizations services – Nairobi
To view this discussion on the web visit https://groups.google.com/d/msgid/bidinitiative/56e5d18f89c7470ca0ef6ac8456250b4%40BY2PR07MB921.namprd07.prod.outlook.com.
Peter Ademba
National EPI Data Manager
Monitoring and Evaluation of Routine Immunization
Division of Vaccines and Immunization
Ministry of Public Health and Sanitation
Cellphone: (+254) 733 920 128
Esther Ouedraogo
Bonjour à tous, Nous sommes vraiment content des échanges et discussions avec le réseau BID et aimairions y contribuer mais nous confronter à la langue.Si toute fois une version française est souvent associée nous pourrons. Y participer. Merci de la compréhension. Mme Bibane YAMEOGO du Burkina Faso Envoyé depuis Yahoo Mail pour Android |
From: Peter Ademba <padem...@dfh.or.ke>;
To: Mtenga, Hassan <hmt...@path.org>;
Cc: Puta, Chilunga <cp...@path.org>; Mandy Dube <smand...@gmail.com>; bidini...@googlegroups.com <bidini...@googlegroups.com>;
Subject: Re: Change Management
Sent: Thu, Sep 11, 2014 2:02:38 PM
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Darcy, Niamh
Mandy,
I really like these approaches. Champions are really important, and it would be really great to see women play a more active role here – so that we can encourage more female champions and leaders. It might also be really interesting to add some community champions, as these are the ones who can also drive traffic to facilities. Often though, we have found that we need to have two champions say in a facility or school, to really make this sustainable as staff move or get switched. This gives some longer term sustainability. Also, having these champions who are really working well assist with identifying other champions can also help – particularly in their local area (other facilities etc).
Peer networking is great – and I think anyway to have a stronger representation from both public and private facilities would be really helpful – as often private facilities have some successes or best practices and there is not always a good forum to share – and there can often be reticence on both sides to interact, but there is often a lot that can be learned from each site. Also, related to this, I think is the idea of having localized peer networking as well as broader based peer networking – as often the localized can share more effectively. Also, these closed user groups that some mobile providers support might be an option also to allow people to send messages/call for free here.
I think on item 6, it might be good to extend to fun and interactive (maybe game?) to the data visualization also – as I think of some of these games that can be played that really show how bad data can lead to bad decisions – might even be something you could do a competition on with university students to create some mini applications as part of their practical work!
On the visual, the more that can be done with GIS the better here – as people all over I see respond much better to seeing their data on maps and also seeing how they compare with other sites – and are happier to see comparisons when done visually.
And on the community linkages – having some public forums where results can be shared and citizens can give feedback can also really help to greater sustainability when citizens hold government/private sector more accountable for health service delivery. I think this is really important for longer term sustainable change and there are plenty of CSOs invested in this kind of work already.
And finally, will add the piece about the importance of media, and media training. Having media involved either in the User Advisory Group, or some other related group, is really important – as they can really help frame the media discussions around BID to make sure this connects with citizens and government in a transparent and accountable way.
Thanks again for this interesting discussion.
Niamh
From: bidini...@googlegroups.com [mailto:bidini...@googlegroups.com]
On Behalf Of Mandy Dube
Sent: Tuesday, September 09, 2014 2:44 AM
To: bidini...@googlegroups.com
Subject: Change Management
Thank you all for the truly engaging discussion on the group. I thought that I could share a bit about what the BID Initiative is doing on the people and change management side and ask for ideas and suggestions for how we might make that aspect of the Initiative stronger stemming from the successes and lessons of other implementations. BID has the unique opportunity to adapt and modify interventions as we go along until we find a ‘successful fit’ for each context. I think that we do have a good starting ground for the people and change management side of things and this includes:
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Mwago, Baraka
Hi team,
Many thanks to Mandy who brought the discussion on board. Personal am curious of learning or getting experience on the best way to Implement Peer networking among health workers. We have identified ways and reasons of the health workers do communicate, what we have learned they do communicate mostly for restocking purpose and very few have other interaction. We have collected ideas that we think might be implemented but all have challenges of budget of sustainability and budget.
Would be grateful to hear from the team or someone give us a link where we can learn experience from other countries so that we adopt and introduce a strategy that I real worthy
Kind regards,
Baraka Mwago
Change Management Lead
BID Initiative Tanzania
Mail: PO Box 13600, Dar es Salaam, Tanzania
Street: 10th Floor, Amani Place, Ohio Street,
Mobile: (255-787) 094 824
Email: bmw...@path.org
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