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PErsonalised Reminder Calendar sYstem (PERCY): Empowering caregivers to immunize their children

Providing caregivers with personalised calendars and support to ensure their children are fully immunized.

Photo of Mikey Rosato
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Describe what you intend to do and how you'll do it in one sentence (required 250 Characters)

We will provide caregivers with personalised calendars and support to ensure their children are fully immunized. We will collaborate with Ministries of Health to get the calendars and support to those who need them most.

Explain the idea (less than 2,000 characters)

Immunization coverage is far from universal, particularly in Low and Middle-Income Countries (LMICs). Standard development practice to fill the coverage gap includes a wide range of behaviour change interventions. More recently, reminder/recall interventions leveraging mobile technologies such as SMS have shown the potential to bridge the coverage gap, including in relation to immunization. However, over 1.7 billion women in LMICs do not own a mobile phone, particularly in rural areas. As a result, there is urgent need for alternative analog reminder/recall solutions, that can empower caregivers to support increases in timely and complete uptake of immunizations, but with broader reach particularly in poor rural communities. Evidence suggests that these solutions are likely to be most successful when they are personalised, locally designed and combined with home visits. We have developed a simple innovation – PErsonalised Reminder Calendar sYstem. Community Health Workers or Community Health Volunteers are trained to identify pregnant women and visit them before they give birth to: a. Identify expected date of delivery. b. Dial the date into a simple paper ‘calendar wheel’, which automatically computes recommended dates for immunizations in first two years of life. c. Use the recommended dates to: i) Personalise simple wall calendars for each child, that caregivers can keep, which also include visual child health messages; and ii) Update a register that they use to plan follow-ups at key points in the child’s immunization journey to support adherence. d. Provide advice using a set of picture cards and refer the caregiver to local self-help groups to help overcome any socio-economic barriers to adherence. The innovation could scale to all countries with low immunization coverage, particularly to areas with low mobile phone usage through: 1. Integration into existing home-based record systems; 2. Financing by paid for advertising printed on the calendars.

Which part(s) of the world does this idea target?

  • Eastern Africa
  • Middle Africa
  • Southern Africa
  • Western Africa
  • South-eastern Asia
  • Southern Asia

Geographic Focus (less than 250 Characters)

The innovation targets caregivers in all countries with low immunization coverage, particularly areas in these countries with low mobile phone usage. These are likely to be predominantly rural areas in countries in Africa and South Asia.

Who are your end users and how well do you know them? (750 characters)

The end users of PERCY are caregivers in countries with low immunization coverage, particularly those living in areas with low mobile phone usage. Women and Children First has over 15 years experience collaborating with these caregivers, including in Bangladesh, Ethiopia, India, Malawi, Nepal, Sierra Leone and Uganda. These experiences have always confirmed caregivers can lead in solving the global health problems facing women, children and young people. We are planning to start prototyping and piloting PERCY in Salima District, Malawi, where we have been collaborating with MaiKhanda Trust, a Malawian NGO, and the Malawi Ministry of Health since 2006. Through these partners we have very strong relationships with local communities.

How is the idea unique? (750 Characters)

Personalised calendars have been successfully used in high-income-countries to increase child immunization rates. However, in these systems women were required to interact with facility health workers, who use computer software and hardware to tailor and print the calendars. This model is not feasible in rural settings in LMICs, as many caregivers do not seek care at a facility, further support is required to overcome other barriers to access, and it is relatively high cost. In our innovation, pre-printed calendars will be personalised by CHWs/CHVs in caregiver’s homes, using a paper ‘calendar wheel’ to accurately compute dates and provide support to overcome access barriers. The system can also be financed by advertising revenue.

Idea Proposal Stage (Select 1)

  • Blueprint: We are exploring the idea and gathering the inspiration and information we need to test it with real users.

How many months are required for the project idea? (140 characters)

24 months to prototype and pilot the innovation in Malawi, preparing for an evaluation of its potential for adoption and scale-up.

Organization Name (less than 140 characters)

Women and Children First

Type of Submitter

  • We are a registered NGO or Non-Profit Organization

Organizational Characteristics

  • Women’s health/rights focused
  • International/global organization (implementing in multiple countries)

Organization Location (less than 140 Characters)

London, United Kingdom

What is the current scale of your organization’s work?

  • Community (working within one or a few local communities within a region)

Website URL

www.womenandchildrenfirst.org.uk

Tell us more about your organization/company (1-2 sentences)

Women and Children First develops community-based innovations for the global health problems facing women, children and young people in the world’s poorest communities. We took our flagship innovation – the Participatory Learning and Action (PLA) group approach – from conception through rigorous evaluation to a WHO global recommendation. At scale PLA groups could save the lives of 350,000 mothers and newborns per year. We believe PERCY has the potential to be our next flagship innovation.

Who will work alongside your organization in the project idea? (750 characters)

We are planning to collaborate in prototyping and piloting the innovation with communities in Salima District, a Malawian NGO called ‘MaiKhanda Trust’ and the Malawi Ministry of Health. We have collaborated with all these partners on several mother and child health projects over the last 12 years. Each brings their own expertise to ensure the innovation is as effective and scalable as possible. They will advise on the feasibility, acceptability and accessibility of the innovation. They will also help to ensure evidence is used to inform policy and practice.

How many people are on your team?

3

Tell us more about you and your team

Since we were founded in 2001 we have successfully delivered over 40 international mother and child health projects, reaching 12 million people in 13 countries. We believe PERCY has the potential to be our next flagship innovation and we have a strong team, stellar board and ambitious new strategy to take it forwards. Our team includes experts in the design, implementation and evaluation of community-based approaches to improve mother and child health in developing countries, including Malawi: a) Mikey Rosato - PhD in Global Health and Development. 20 years experience designing, implementing and evaluating community-based maternal and child survival programmes. b) Joanna Drazdzewska – Grants Manager. MA in Development Studies. Significant experience implementing reproductive, maternal and child health programmes. c) Annie Sondaal - Technical Officer. MA in Global Health and Development. Significant experience in implementation and evaluation of community-based approaches.

Overview of How Your Concept Has Evolved (5-6 sentences):

Beneficiary feedback and User Experience Map - a) plan to add national, religious and other events to wall calendars as milestones against which caregivers can track immunization dates; b) plan to add a checklist of recommended immunizations to calendars so caregivers can track those received/outstanding; and c) plan to use regular support visits from community health volunteer to 'edit' the calendars, if needed, to account for any local changes - for example, if an immunization campaign is planned or if a facility changes clinic dates/times. Business model canvas - confirmed that the Malawi Ministry of Health community health volunteer platform is key - the most efficient mechanism through which to efficiently and effectively scale PERCY.

Viability (3-4 sentences and activity upload):

https://canvanizer.com/canvas/wdAyUr4pOSGPq Insights: Collaboration with the Ministry of Health is key. Their support will provide access to the community health volunteer platform, through which the innovation can be most efficiently and effectively scaled, and potentially funds. We are well aligned: a) long relationship; b) use of community health volunteers to drive demand for services is national policy; c) Malawi has an existing 'Home-based records package'; and c) we have been invited to present the concept at the next community health taskforce meeting in May, to gain approval and support. Steps: 1. Gain full Ministry support. 2. Final round of prototyping and refinement. 3. Start rigorous pilot testing on a small scale.

Feasibility (3-4 sentences):

Caregivers face two critical challenges: a) knowledge of when to immunize; and b) barriers to acting on this knowledge. Prototyping shows that our innovation can overcome both. Prototyping during refinement has shown that the calendar wheel can accurately personalise wall calendars to remind caregivers of when to immunize. Prior experience with community health volunteers in Malawi has shown they can provide a source of support for caregivers to overcome barriers to immunization - for example, by linking caregivers to self-help groups and providing advice and emotional support for adherence.

Desirability (3-4 sentences and activity upload):

1. Confirmed that PERCY is primarily for caregivers in rural areas with little/no access to tech reminder systems. 2. Cultural norms prevent early disclosure of pregnancy. Caregivers will likely enter the PERCY system in the second/third trimesters. This is good - ensures minimal lapse between receiving a calendar and the first immunization. It will also help to ensure the expected due date is more accurate as there may be triangulating information available from any antenatal sessions attended. 3. Tracking dates will be most accurate if the calendar is also populated with relevant national, religious and other event dates. These are widely known and will provide milestones against which caregivers can locate immunization dates.

Community Focus (2-3 sentences):

Child mortality in Malawi remains high - six in every 100 children die before the age of five. Over one-third of these deaths could be avoided through increased immunization coverage. Our idea empowers three key community assets to act on this shared concern: 1) caregivers with the knowledge and support to act to reduce the number of deaths by ensuring their children are immunized; 2) community health volunteers with tools that are simple and effective at reducing mortality; and 3) it leverages existing self-help groups to support caregivers to take action on the information from volunteers.

Community Impact (2-3 sentences):

Currently, only 76% of children in Malawi are fully immunized. The Malawi Ministry of Health is targetting a full immunziation coverage rate of 90%. Our idea will help to achieve this target - more children will be fully immunized because caregivers will have the information and support they need to ensure this happens. The idea is low-cost and leverages existing community health volunteer systems, so is potentially scalable across Malawi and to other similar contexts. It will be sustained beyond the end of Gates support through public/private partnerships between governments and advertisers.
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Attachments (2)

WCF_PeRCY_09032019.pdf

PERCY - Detailed concept note.

WCF_CalendarWheel_09032019.png

PERCY - Prototype paper 'calendar wheel' used by Community Health Workers / Community Health Volunteers to calculate recommended dates for immunization and personalise immunization calendars.

6 comments

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Photo of Ashley Tillman
Team

Hi Mikey Rosato great to have you in the Challenge. I know you are still in the blueprint phase, but I'm curious to learn a bit more how you collected feedback from users, and the logistics of how the clock will work?

Looking forward to learning more!

Photo of Mikey Rosato
Team

Hi Ashley, thank you!

Happy to tell you a little more about how we collected feedback from users. In our innovation we have two sets of users: a) Community Health Volunteers (CHVs) who will use the calendar wheels to personalise immunization wall calendars for caregivers and provide support and advice; and b) caregivers, who use immunization wall calendars to adhere to their child's immunization schedule.

In relation to CHVs, we have existing programming in Malawi, in collaboration with our partner - the MaiKhanda Trust - and have been working with CHVs for many years. Through these experiences we have trained CHVs to support caregivers, particularly women, to overcome barriers to uptake of antenatal, delivery, postnatal and immunization services. For example, they have been successfully trained to identify and track pregnant women, provide reminders on key health service contacts, bring them together in self-help groups and provide emotional, tangible and informational support. These are very similar tasks to those required to support the delivery of the PERCY system, with the key difference being the addition of the calendar wheel tool to help them more accurately provide reminders. These historic programmes have been rigorously evaluated, including through interviews and focus groups with CHVs, and the findings have shown that they are motivated and capable of providing tailored support to pregnant women and mothers. More recently, through an ongoing programme in Salima District, we have conducted small scale group discussions with caregivers to explain the PERCY system in detail, share the calendar wheels and gather specific feedback on this tool. Both historic and recent feedback has been used to refine the concept further.

In relation to caregivers, we have not been able to directly gather feedback to date, but this is planned now that we have secured the essential buy-in from the Ministry of Health (confirmed last week) and have raised the required funds to complete pilot test PERCY on a small scale. In the meantime, we have gathered feedback from 'proxy' users - Malawian technical experts in maternal and child health. We presented the PERCY system in a workshop setting, asked them to imagine they were Mary Banda (our 'ideal user') and walked them through the system. At each step we stopped to answer questions and gather their feedback. This feedback has helped to refine PERCY, but feedback from actual users will still be gathered to triangulate and refine further.

Thank you also for your second query in relation to logistics of how the clock will work. I think you may have confused PERCY with 1-Clock, another innovation that has been submitted to this challenge by Conrad Tankou. I am sure he will be able to provide more detail on this.

Thanks again for your questions.
Best wishes,
mikey

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