Rustam Nabiev
How can we make people stronger?
Note: For more user-friendly version with pictures and videos, please visit a link: https://shifoorg.exposure.co/making-communities-stronger
We want to strengthen preventive health services and make them available for all children, no matter where they live. Preventive health services such as giving vaccines, vitamins and deworming pills save children's lives and make communities stronger.
When we consider preventive health services for children (vaccines being important component) the following stakeholders/end-users are directly involved in receiving, delivering, planning, and financing of these services:
- Families and Communities
- Community Health Workers
- Nurses
- Health In Charges
- District Health Officers (DHO) and DHO Team
- National policy and decision-makers (different departments at Ministry of Health)
- Local and National Drug Supply Chains
- Global organisations (UNICEF, GAVI, WHO, Gates Foundation, etc.)
If we want to strengthen preventive health services in a district, region or nationally, using information and communication technology (ICT), the ideal project should consider the needs of each of these end-users. However, practice shows that it is hard to even satisfy the real needs of one of these end-users. You will know that you satisfied the needs, when people feel stronger, when your solutions become part of their life. When people forget how it was before your solution - and never want to go back!
A great example at hand is introduction of smartphones and the Internet. How many of us would want to go back to before the smartphone or before Internet era?
Many eHealth projects that are initiated globally have great intentions, but are still focusing on perceived values, rather than the real values of the end-users. I have done that mistake as well, many times.
After working for more than a decade in Sweden, Europe, and since 2008 in Uganda, our team at Shifo have understood that the most important end-user who should feel stronger is the nurse. The nurse is without a doubt the one who is doing the toughest part of providing preventive health services, oftentimes in difficult conditions:
- She provides health services to children
- She educates families on importance of following up on vaccines and other services
- She coordinates care with Community Health Workers
- She goes and takes necessary vaccines, vitamins and other supplies from drug warehouses
- She reports on progress to Health In-Charges and District Health Officers
- And so much more.
At Shifo, we are concentrating all efforts to make the nurses feel stronger. In pursuit of this aim, we gradually introduced a tool called MyChild System in Mukono District, Uganda, where all 16 public health centres (on level 3 and 4) are using this tool since May 2014.
MyChild System was developed based on research done at Karolinska Institutet, and funded by Gates Foundation.
Today, nurses in Mukono District only use MyChild System for registration and service delivery. Paperwork has been eliminated.
What makes nurses using MyChild system feel stronger?
1) Using advanced information technologies and tools to do her job efficiently and accurately brings job satisfaction.
2) Knowing health progress of every child in the catchment area gives her recognition in the community and among families who visit her clinic
3) As administrative tasks are reduced/eliminated she can concentrate on the priority task of providing health services.
4) Knowledge of children who are due for vaccination/ have missed vaccination improves collaboration with Community Health Workers (CHW) for effective follow-up of every child
5) Increased sense of being a change leader, because the nurse knows the health status of her community and can suggest ways to improve on the situation
6) The opportunity to participate in local and national workshops to present her success stories of using modern technology to advance her work is empowering
7) Continuous learning on the job by own progress and others - learning something new makes anyone feel stronger.
Confident that nurses are happy by using MyChild System, we started working very closely with health centre in-charges and district health officers, to understand what makes them feel stronger. It is very rare that the data alone will allow decision-makers to make a better decision. When we align good judgment, humane feelings, a sense of caring and commitment with much richer data from many more sources that is systematically available from MyChild System, then we believe it will lead to a better decision.
Currently we are evaluating 2 ideas:
1) Sending monthly and quarterly performance indicators to all health in-charges and DHO teams. These are individually written emails where we include different types of key performance indicators to see which one would make them feel stronger
2) Organising local workshops where DHO, health in-charges and nurses present current situation, discuss gaps, and decide on necessary actions to close the gaps. These discussions are informed by key performance indicators generated by MyChild System.
Thereby creating a virtuous circle of development, informed by real-time and reliable data from the field.
What is mentioned above is not unique or new. We simply build on what is already common practice during implementation, scale and sustainability of eHealth systems in Scandinavia.
I want to encourage us all to shift focus from our own beliefs, needs and demands and focus on real needs and values of end-users.
That way we can bring solutions that make end-users feel stronger.