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Immunization Innovation Lab: An Accelerator to Support Local Innovators in East Africa, Empowering Caregivers and Communities in Public Health

Immunization Innovation Lab: An Accelerator to Support Local Innovators in East Africa, Empowering Caregivers and Communities in Public Health

"How might we empower caregivers to seek and fully utilize immunization services in their communities?"

Through the Empowering Caregivers in Immunization Challenge, launched in 2019, IDEO, IDEO.org, and the Gates Foundation convened nearly 20,000 changemakers from over 120 countries around the world in an effort to support the adherence to immunisations within portions of East Africa that have not yet reached equity in access or distribution. The focus is on demand: "the actions of individuals and communities to seek, support and/or advocate for vaccines and vaccination services." As part of the Challenge, changemakers explored the current state of vaccine innovation in global public health, why caregivers play such an important role in the system, and which lenses might help most effectively understand and design for solutions.

Communication Strategies: 

In the context of immunisation programmes, "demand generation" means ensuring that caregivers, communities, and other key stakeholders value immunisation, find it a safe and effective practice, feel confident in the reliability of services and provision systems, and are aware and motivated enough to seek immunisation services. The Challenge focused on caregivers as a window into immunisation as part of a strategy for shifting the mindset toward "customer"-centric thinking (within a space that has largely been oriented toward suppliers and delivery approaches) and for exploring the nuances of demand through a human lens: understanding the current immunisation experience and why so many new solutions are needed.

Specifically, in the Challenge, organisers looked for solutions that: clearly articulated an answer to the challenge question (above), addressed a problem that is pressing and real by articulating the gap this idea is filling, and were new or in early stages but are related to the core competencies of an organisation. Thirty-two shortlisted concepts received feedback from the Gates Foundation and additional expert stakeholders in the vaccine innovation space. Then, US$50K in prize funds were awarded to 5 Top Ideas, with 5 additional teams receiving Honorable Mention.

Specifically, organisers focused on supporting the top of the innovation funnel, testing an experimental support model with a small set of 5 organisations, in service of understanding what it would eventually take to offer right-sized support to a larger cohort of early innovators. They recommend the following characteristics to prioritise in funnel design:

  • Deep understanding of context and contextual challenges;
  • Prioritising measurement of team and leadership capacity, rather than just the innovation;
  • Leveraging models that are accessible to low-bandwidth, low-accessibility contexts; and
  • Providing support from a programmatic team.

Thus, following the Challenge, 5 promising innovations were invited to join the IDEO Immunization Innovation Lab. Founded on the belief that people's experiences, perceptions, and preferences are critical to bringing about the behaviour change needed to bridge the immunisation gap, the 5-month accelerator programme took a human-centred approach to shift health ecosystems in the region - with an eye towards scaling support for future cohorts of public health changemakers in the East African region and beyond. Thus, in the first few months of 2020, each team was paired with one-on-one customised coaching and design support from industry leaders, meant to accelerate impact throughout the programme and after. Then, shared learning across the cohort was designed in response to the overlapping needs and growth goals identified for each organisation. Activities included working sessions and advising on best practices in health programme design, business design, and planning.

After the 5-month accelerator period, the programme supported implementation of the projects in East Africa via additional funding, mentorship coaching, and design collaboration.

Winning teams, with brief summaries of their work, include:

  1. Mama Chanjo - Masaai caregiver champion programme, Moita Kiloriti, Tanzania - Mama Chanjo set out to increase community and caregiver knowledge, attitudes, and intentions to vaccinate their babies by reinforcing social norms for immunisation and by strengthening communication between pastoralist mothers and fathers in Tanzania's Maasai communities. They did this by empowering Maasai mothers and their communities to become a part of the solution for immunisation uptake and improved maternal/baby health in their communities. The team worked with young Maasai mothers who were especially adherent to immunisation schedules to teach other mothers in the community about the importance of vaccines and maternal health. Specifically, they trained 10 MamaBaba Chanjos, each champion training 35 caregivers. In total, 140 new mothers, 120 pregnant mothers, and 90 fathers were reached, resulting in 140 children starting their immunisation journey. It is hoped that the impact will have a ripple effect in communities as others are mobilised, including grandmothers, mothers, fathers, traditional community leaders, teachers, and health workers. Throughout the process, Mama Chanjo worked to build partnerships within the Tanzania health ecosystem to begin to grow and scale their work.
  2. BIC Shanti - Empowering teen mothers, Luwero, Uganda - The Shanti Birth House, operated by Budondo Intercultural Center, is focused on improving maternal and infant health in Uganda. The project funded through this programme is specifically focused on increasing immunisation uptake for teen moms in Luwero. The team is doing this through a two-pronged approach: (i) implementing an education and awareness campaign for young mothers and their partners, and leveraging community health champions; and (ii) tackling some of the root causes they have identified for young mothers by providing holistic care and opportunities for economic empowerment in partnership with local governments. Completed design research and prototyping resulted in registering and onboarding 25 community health workers (CHWs) from 8 villages who are conducting home visits to ensure that all children get fully immunised and that teen mothers have access to accurate information on immunisation. Three teen mom groups of 30 members each were organised and provided with livelihoods support. These efforts resulted in providing information to 334 teen moms and partners, and connected 375 teen moms to CHWs. BIC Shanti formalised their relationship with district ministries and brought on a partner organisation to support economic empowerment of caregivers as an incentive.
  3. STAMP - Community-led caregiver reward system, Kiambu and Nairobi, Kenya - STAMP CLEANTECH created a royalty rewards programme in an effort to strengthen community-owned immunisation advocacy processes. The organisation reaches out to children aged 0-12 months and their caregivers by addressing barriers to immunisation uptake due to lack of accessible, trusted health information in Kiambu and Nairobi, especially during the COVID-19 pandemic. Over the course of the programme, they piloted in 4 communities, trained and onboarded 4 volunteer doctors, and reached 323 children during their initial pilot phase, in addition to on-boarding an additional 200 caregivers registered not included in the initial pilot.
  4. OGOW EMR - Electronic registry app for caregivers and clinicians, Somalia - OGOW EMR created a desktop and mobile app for medical records, inventory management, and caregiver immunisation data that provides a digital copy of child immunisation records and includes a calendar schedule for adherence, educational materials, and Q&A functionality in Somali and English. OGOW's customised portal and dashboard is designed to enable strategic and effective use of quantitative and qualitative data to monitor, learn, and communicate health surveillance metrics. The teams now partner with World Vision to help run COVID-19 awareness campaigns in Somali, endorsed by the Federal Ministry of Health. They are working alongside community champions to increase local education and uptake. In addition, they partnered with SomRep, a consortium of 7 international agencies that adopted the OGOW EMR app to reach over 45,000 pastoralists across 45 villages with COVID-19 risk communication and community engagement (RCCE) interventions.
  5. Preventive Care International (PCI) - Male champion programme, Mukono, Uganda - Piloting in 3 under-immunised communities (urban, rural, and island) in Uganda's Mukono district, the PCI team trained and activated male champions to educate community members about immunisation through the use of mobilisation trackers, board games, and family events featuring sports and games. These male champions are working to change the perception that "immunisation is a woman's issue" and are creating community ownership over child healthcare. They connected with 2,000+ caregivers and continue to strengthen their partnerships within the health systems in all 3 pilot communities. In response to COVID-19, PCI updated their education materials to sensitise champions regarding prevention methods and increased community outreach to promote social distancing.

In terms of evaluating impact within an acceleration model of this nature, organisers learned that co-creating metrics and evaluation processes with teams up front saved time and effort for everyone in the long run. This process also encouraged team buy-in and autonomy in the monitoring and evaluation process, from the start. For most of the 5 organisations, the outcomes of programme inputs will continue to evolve far past the close of organisers' engagement with them. "Foremost, in the ecosystem of demand generation - measuring impact against an immunization schedule requires patience and necessitates a longer timeline (18 months for completion of DPT-3 [Diphtheria-tetanus-pertussis], for example) as we consider caregiver and child influence based on a recently introduced innovation. A few additional aspects influencing this longtail: organiztional capacity to absorb and incorporate new ways of working, design and resource constraints within community contexts and access to consistent capital and guidance for continued implementation."

Development Issues: 

Immunisation and Vaccines.

Key Points: 

World Health Organization (WHO) data show that globally, 1 in 10 infants does not receive all their vaccines - mostly in the world's economically poorest and most historically under-invested communities. Despite many organisations focusing their efforts and resources on this issue, meeting the needs of un/under immunised children and caregivers remains a pressing challenge.

Access more information on and resources from this project:

  • Immunization Innovation Lab: East Africa - Accelerating Demand Generation [PDF, 89 pages, July 15 2020] - features more details about the projects, process, impact, learnings, experiments, and pivots. One overall insight is that building human-centred design capacity not only helped teams advance their product/service, but also increased their resiliency and capacity to pivot in the face of unexpected challenges. For example, STAMP learned to streamline systems to allow for adaptability: "Government directives on COVID-19 have greatly affected the household visits, congregating for caregivers for training on vaccines and interaction with Doctors. This affected the project since we had just started winning trust with caregivers and disrupted our initial plan. The team went back to the drawing board and started using WhatsApp and Zoom to discuss project and implement the same. CHVs [community health volunteers] had to be re-trained on virtual training and support to caregivers and Doctors hour shifted to virtual platform. The challenge has enabled a 24 /7 interaction between caregivers, doctors, and project staff."
  • See these additional resources related to the challenge.
Partner Text: 

The Bill and Melinda Gates Foundation, OpenIDEO, and IDEO.org.

Contacts (user reference): 
See video
Source: 

OpenIDEO website and Immunization Innovation Lab: East Africa - Accelerating Demand Generation" [PDF, July 15 2020] - both accessed on July 17 2020. Image credit: STAMP via IDEO

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