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School-Based Mobile Clinics

We would like to expand our school-based mobile clinics to invite parents from the surrounding area to come to the school for health information lectures and breakout sessions on reproductive health, breastfeeding, nutrition, hygiene, immunizations, among others. The parents would be invited to come to the school with their children. During or after the education, adults have the opportunity to bring their children to see our qualified nurse, at which point she will offer basic health services, check immunizations, offer medications, and conduct growth monitoring. This project would help to provide the basics for children, and provide information to parents to increase their understanding of what to expect in the first five years. [6 Jan]

Photo of Anne Riitho
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Potential User Experiences- Also, check out our User Experience Map saved as a document on this page! 

Makena became a young mother at nineteen years old. Her son Murithi is now four months old and wants to eat uji (porridge) like his older two-year-old cousin. Makena has been only breastfeeding, like her mother instructed her to do when Murithi was first born, but now that her son is getting bigger and stronger, she is thinking of giving him solid food at four months. She attends a maternal and under-5 health and education clinic after hearing about it from her neighbor who is also a mother of a young child, and she learns from a community health worker that before Murithi is six months old, his digestive system isn’t fully developed and he hasn’t gotten full immunity from her breast milk. She learns that, because of these things, giving him uji before he turns six months old may cause infections in his stomach, so she decides to continue only breastfeeding until he is older.
 
Nyawira is 30 years old and a mother to five children. Her youngest child is one year old, and she has been having one child every one to two years since she was 22 years old. She has noticed that she is having more and more difficulty caring for her growing family. Nyawira attends a maternal and under-5 health and education clinic with her one year old, and there, she learns about the importance of family planning and advantages of child spacing from a community health worker. No one had ever spoken to her about how more years between having children can decrease infant mortality. Nyawira decides to have a conversation with the nurse at the maternal and under-5 clinic to figure out what type of family planning method is best for her. After deciding what method is best from her, she acts as a champion on her community and encourages other women to access family planning methods as well. [ Updated 6 Jan]
 
Faith is the mother of three-year-old twin girls and a seven-year-old boy in primary school. She hears about a maternal and under-5 health and education clinic from her son’s primary school head teacher and attends the clinic with her twin daughters. After the health education portion of the clinic, she takes her daughters to be seen by the nurse and realizes that they both show signs of early stage ringworm. The nurse gives her deworming cream and hygiene advice for keeping ringworm-free. Faith now plans to purchase shoes for all of her children and wash their bedding weekly to keep her children healthy and happy.

Update [15 Dec.]
Murimi is the husband to Karimi and the father of four children under the age of 7 years. His wife asks him to attend a health education lecture at the children's primary school. He reluctantly attends the clinic with his wife and two youngest children. While at the lecture he learns the importance of keeping clean drinking water in the house, so as to reduce the chances his children have diarrhea. Also, he learns about the variety of family planning options available to his wife, the importance of spacing any future children for the health of his wife, and the importance of open communication with his wife on these topics. After the lecture, Murimi and Karimi have a conversation about family planning options and go to see the nurse together to make sure she has the appropriate family planning method for them. The whole family is happy to be drinking clean water and to know they can plan for their next child. 

The Plan
Our idea is to leverage our existing relationships with 72 area schools to engage parents and under-5 children, to improve the health of mothers and children. We currently conduct mobile clinics at each of these partner schools and offer free basic health care to pupils and teachers, as well as malaria education for parents insecticide-treated anti-malarial bed nets for lower primary school students. We would expand these clinics by inviting parents and under-5 children in the nearby community to come to the school on a specified day for target health and education clinics. 

Update [15 Dec.]:  Although previously we said we would invite mothers and under-5 children, we recognize the importance of involving the men and fathers as well. Therefore, in order to include the men and fathers in the community, we will invite both mothers and fathers to received educational lectures. We also recognize, that some topics and some women are more comfortable having open discussions without men, therefore some of the designated breakout sessions may be conducted targeting either men or women, and would have only one gender attending the specific session. [ Updated 6 Jan] 

Update (18 Dec): Many women and men have expressed interest in learning together with their spouses. Therefore, we will hold the educational sessions together and allow for single-sex breakout sessions after if we find it is necessary. 

These clinics will include the following six components:
  • Health education lectures specific to mothers and fathers and under-5 children on topics such as: breast feeding, early childhood nutrition, family planning, child spacing, oral rehydration therapy, danger signs of malaria, clean water in the homes, and hygiene;
  • Breakout sessions on similar topics to those listed above during the health education lectures, but incorporating hands-on activities such as making oral rehydration salts or structured play activities with children [Updated 6 Jan];
  • Clinical services for children, including growth monitoring, malnutrition screenings, immunization checks, and more, from our community health nurse, as well as volunteer partner professionals who specialize in the fields of pediatrics and female health;
  • Clinical services for mothers, including family planning modalities, HIV testing and counseling, the importance of pre-natal vitamins, and screening for iron deficiencies;
  • Mother-to-mother and father-to-father forum discussions led by our community health workers, during which parents can share experiences and learn from each other; and
  • Structured play for under-5 children who attend the clinics with their mothers led by community health workers and public health fellows, during which play activities will encourage creativity, peer communication, and critical thinking (potentially using a pre-designed curriculum, depending on connections we make with organizations that may have one).
The clinics focused on the under-5 children would have a specialized team trained in pediatric health, along with community health workers who have a focused training on the topics we will discuss. 

What will the clinics look like?  [ Updated Dec 27]
We will notify the parents of an upcoming clinic through word-of-mouth leveraging our relationships with the schools to communicate with parents.

At each clinic, we will hold a large educational session for all parents, then after the large educational session, we will have breakout sessions, allowing parents to engage in smaller discussions on various health topics. Some of the breakout sessions will be hands on to engage the parents as much as possible. An example of one of these potential sessions is making oral rehydration salts.  

During these breakout sessions, parents will be bringing their children to the nurse and clinicians for the growth monitoring and immunzation checks. 

Each school will host a clinic once per term (every three months) so parents will have the opportunity to participate in all health lectures and breakout sessions they would like throughout the year, without it being too burdensome on their schedules. 

Why this will work
We feel this idea can succeed because we already have relationships with the schools where we plan to hold the maternal and under-5 clinics.  We have been recognized by the Sub-County Ministry of Health and Sub-County Ministry of Education for our contirbution to the health and wellbeing of the children in the Maara Sub-County, and therefore feel that these new programs are a natural next step. Our pre-existing relationships with the school and the community make us uniquely qualified to take on a maternal health and under-5 health clinic.  In the past, we have seen a high turnout when we offer health education lectures to parents on topics such as malaria and hygiene. 

We have observed that mothers are keen to learn more about their own health and the health of their children. The health education lectures will be taught by our trained community health workers on topics such as nutrition, breastfeeding, weaning, immunizations, danger signs of diarrhea and malaria, importance of clean drinking water in the home, hygiene, family planning and sexual and reproductive health. 

Furthermore, in September, we piloted a very limited version of this program. We invited mothers to come to two schools to hear a health education lecture, and have their children seen by a clinician. At the time, we did not have the resources for growth monitoring or malnutrition screenings, and we had a limited curriculum for the mothers, as we were not sure what topics were most important to them, but still, we were able to achieve some impressive results. 
  • 116 children under-five were treated, or given deworming or Vitamin A doses
  • 225 Mothers attended the health education lecture
  • 17 mothers received some form of family planning from our nurse
Our existing relationship with the schools, and past successes in the community place HopeCore in a unique position to carry out this project, and have room to expand. Our 72 partner schools, where we currently implement mobile clinics, are extremely supportive of the work that we do. Additionally, we have installed clean drinking water tanks and hand washing stations in the remaining 109 schools in the Sub-County. Once started, we have the potential to expand this project to impact the entire sub-county. 

Parent Networking [ Updated based on feedback from community]
We also plan to make connections with exemplary parents, identified by our partner schools’ teachers, who will help advertise our clinics, follow-up with parents if they have questions after our clinics, and participate in education, which introduces a peers-teaching-peers component and helps make the program more sustainable. 

Targeted Health Services
For the children, our qualified nurse and visiting pediatricians will be available to treat any common illnesses affecting the children, as well as offer malnutrition screenings, growth monitoring, and immunizations. 

With the addition of requesting parents to bring their child's growth monitoring chart and immunization record, we will be offering a one-on-one opportunity to these parents to ask any questions they may have, or follow up on missed immunizations.

Structured play for children  [Updated Dec. 22]
Brief Summary
Children will also be able to participate in structured play while their parents receive health education. This structured play component will be hosted by HopeCore’s global public health fellow who has taken courses on early child development and will focus on developing an age-appropriate curriculum.
This component will focus on six main activities that have been shown to help children under-five years old develop and strengthened the motor skills, coordination, and physical and mental strength necessary for children to thrive and grow. The six main activities are: underarm ball rolls, running, jumping & hopping, side-stepping, ball skills, and following directions games. We will design and modify traditional childhood games, such as hopscotch and “Simon Says,” that focus on these activities to create games that will both transcend cultural and communication barriers so as to facilitate easy explanation to our target group of children, and be simple enough for children to replicate at home on their own. We will also explain the games that we play during each session to our parents so that parents may also participate in play with their children.
While it will be difficult to evaluate the outcomes of our structured play curriculum at the start of our program, we will be able to assess improvements in child development as soon as our second visit to any specific community. We plan to collaborate with volunteer pediatricians and pediatric nurses to develop an appropriate motor skill and development assessment checklist to use to assess individual children’s development from their first structured play session. By using this checklist, which will include “milestones” for children in each year of their life (e.g. “can balance on one foot,” “can roll a ball towards a target,” “can catch an object,” “can follow simple instructions”), community health workers and global health fellows will be able to track each child’s growth and development in a more objected and targeted way.
 
Activities
  1. Underarm Ball Rolls
    • Purpose: To help develop hand-eye coordination and whole body coordination
    • Games: bowling, “Bucket Balls”
  2.  Running
    • Purpose: To provide exercise, strengthen the cardiorespiratory system, and develop coordination between arms and legs
    • Games: “Red light, green light,” “Animal run,” weaving run
  3. Jumping & Hopping
    • Purpose: To develop leg strength, leg coordination, and balance when landing
    • Games: potato sack race, hopscotch, “Kangaroo Course”
  4. Side-Stepping
    • Purpose: To develop agility and whole body coordination
    • Games: “Ring around the rosy,” “Crab Race”
  5. Ball Skills
    • Purpose: To develop hand-eye coordination and arm strength
    • Games: “Human Basketball,” “Group Catch”
  6. Following Directions Games
    • Purpose: To develop executive control and self-regulation skills
    • Games: “Freeze Dance,” “Simon Says”

User Feedback  [Updated 18 Dec]
Throughout this week we have been seeking feedback from potential mothers and fathers who may attend the lectures. Because schools are currently on vacation, we were unable to organize parent's meetings at the schools, but through our microenterprise department, we met with loan clients who have children under the age of 5. 

We had the opportunity to ask 9 individuals (7 women and 2 men) for feedback on this program. All 9 people had at least one child under the age of five, and ages of their other children ranged from 5 years to 18 years old. The number of children each respondent had ranged from 1 to 6. 

All 9 people questioned said they would like to attend a health and education lecture, and they would attend if they were called by an area school to attend. 

First, we asked what topics they would be interested in learning about at one of these clinics. Responses were as follows, breastfeeding (4), family planning (4), nutrition (2), healthy living (2), common child illnesses (1), family life (1), and academic motivations (1). 

Next we asked, "are you interested in learning about breastfeeding, nutrition, family planning, immunizations, and/or hygiene?” and the responses were all "yes". 

Finally, to address the question of involving men and fathers, we asked how each person would feel if their spouse was in the room, and would they prefer men and women to be educated together or separately. 8 out of the 9 respondents said they would prefer to be taught together; one said "together as a family." 

The feedback from these people was very positive, and it leads us to believe we are on the right course with the program, and there would be interest in it. Similarly, the topics we had previously identified seem important to these parents, and now we have additional topics to add to our list. 

Questions for the community
  • How can we make this idea better? 
  • Do you see any potential problems we have not yet thought of? 
  • What low-cost, but effective, activities can we add to our structured play component?
  • For those who have had experience communicating with people in rural areas to advertise events, what has been the most effective means of communication? 
  • Update [15 Dec.]: Does anyone have suggestions of indicators that we could use to demonstrate the impact of this program?

Updated 6 January
 

Who will benefit from this idea and where are they located?

The beneficiaries of this program would be mothers, fathers, and under-5 children in the Maara Sub-County, Tharaka Niithi County, Kenya. In the catchment zone of our 72 partner schools, we estimate a population of approximately 60,000 individuals. After the success of this program, and the expansion to all schools in the Maara Sub-County, our catchment area would increase to approximately 100,000 individuals. [Updated 15 Dec.]

How could you test this idea in a quick and low-cost way right now?

1. When schools are on vacation (this month), our community health workers travel to homes to conduct net monitoring and ask questions on water and hygiene. We could add to these questions to determine if mothers would be interested in participating in this program. 2. Visit area churches to gauge interest in the program.

What kind of help would you need to make your idea real?

We value all advice and every suggestion given from contributors. Any other ideas to build on what is listed above, to help us test the assumptions behind our idea would be greatly appreciated. We currently have expert advice through our visiting pediatricians on health topics, but we could use more advice on the best way to offer education, e.g., would visual aids, casual conversation, or power point presentations be the most effective method of knowledge transfer?

Is this an idea that you or your organization would like to take forward?

  • Yes. I am ready and interested in testing this idea and making it real in my community.

62 comments

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Spam
Photo of Anne Marie Nzioki
Team

This is such a good idea. I only signed up with Openideo today. Is it possible that I could use your model (or work with you) to implement in Uganda?

Spam
Photo of Elizabeth Gannon
Team

I love the combination of health and education. What a wonderful use of existing opportunities and needs. I look forward to seeing the progress.

Spam
Photo of Taz Fear
Team

Hi All

This project helps to bring healthcare and education to vulnerable families and their children which is a great way engage people in a group scenario thus making it more effective for the community as a whole. I am sure that this would work really well in school's, community centres, churches and maybe even within people's place of work.

I remember a few fun low cost activities that I liked playing when I was younger and that support motor skills and learning to work as a team including:

1) 'up and under' where two groups stand in a line, each with a ball and one person passes the ball over their head, then next passes it under their legs etc. The last person gets it and runs to the front of the line and starts again;

2) 'knee and ball' where teams have to pass the ball by gripping it between their knees and without using their hands. Last person to get it runs to the front of the line and starts the passing again; and

3) for something to take home, the children could play noughts and crosses. I used to play with a stick in the dirt with friends to kill some time =)

I hope that some of this was helpful.

Keep up the great work!!

Kindest regards

Tara Fear

Spam
Photo of Natasha Abadilla
Team

Hi Tara,

Thank you for your motor skill-improving game suggestions! Games and activities like yours that can be done in rural communities with little or no extra or expensive equipment are what we are hoping to bring to our structured play component, so we really appreciate this. Please feel free to send more helpful ideas our way if you think of them.

All the best,
Natasha

Spam
Photo of Musa Innis
Team

Hi there,
Your idea is good and can help a lot if it was aimed at parents so that they (both mother and father) can know the best way in which they can benefit, so that the parents are now going into something blindfolded.

The fact you have experience is important as you will have some understanding on what needs to be achieved

How long will the lectures last for? Also if the lectures are quite regular then it will defiantly be beneficial.
I think if there is a reward system then it will be like the cherry on top.

Spam
Photo of Natasha Abadilla
Team

Thanks for your comment, Musa! We are definitely grateful that we have experience working in this community and these relationships that we're able to utilize to spread the word about our clinics.

Before each lesson, our community health workers and health educators review the lesson plan and agenda so that parents will know what they will take away from each talk. We envision lectures to last for 1-2 hours, followed by question and answer time, as well as time for discussions and forums.

In terms of a reward system, what kind do you suggest? Would this reward system be for parents who frequently attend lectures, or will it be of some other nature?

Thank you again for your input - we really appreciate it!

Spam
Photo of Dean James
Team

this is a good idea as group learning allows for discussion to take place therefore the mothers can compere what they are currently doing, one way to improve would be to offer the information prior to birth

Spam
Photo of Natasha Abadilla
Team

Thank you for your suggestion, Dean! The idea of providing mothers and fathers with information prior to birth has been suggested several times before, and we are currently brainstorming ways to do this most effectively.

Presently, we are using our already existing relationships with schools in which we conduct mobile clinics to draw mothers to our mother and under-5 program. For this reason, we are more able to reach mothers who already have children. However, I foresee us able to utilize our relationships with church and community leaders, as well as our growing relationships with parents who we have already provided health education and services to, in order to reach parents-to-be prior to birth.

Our organization also has a youth sexual health and reproduction education program through Planned Parenthood Global that provides family planning information and support to youth members of our community, which is a way we are already trying to provide pre-natal care to our target population.

Thanks again for your suggestion, and please let us know if you have any others! The comments/ideas from the OpenIDEO community have all been very helpful and are always welcome.

Spam
Photo of Rebecca Mincy
Team

Hey Anne: Very proud of the progress that your team has made in developing and prototyping your idea. HUGE CONGRATULATIONS on being selected as a Top Idea. Well done.

Spam
Photo of Natasha Abadilla
Team

Thank you so much, Rebecca! This has been an exciting learning experience for us, and we look forward to seeing the future progress we can make with it. We really appreciate your support!

Spam
Photo of Kağan Rüstem
Team

The idea of passing key information on childcare would be very beneficial to both mother and child, however there is no mention of offering this to mothers prior to child birth. Maybe it is important to get this information across to before the child is born so it can receive the best possible car before ever being born.

Spam
Photo of Natasha Abadilla
Team

Thank you for your suggestion, Kagan! During our health education lectures and discussion forums, we include pre-natal topics such as: family planning, birth spacing, taking care of your body during pregnancy, etc. Our nurse is also available to answer any questions women may come with in terms of pre-natal health.

We are currently working on how we can reach mothers-to-be so that we can provide this beneficial component to our clinics as you suggested, while remembering that we are using the schools that their already-born children attend as our leverage point. Thanks again for your comment! We welcome any more elaboration on your point.

Spam
Photo of Kağan Rüstem
Team

Its great that you have already thought about providing this info pre-birth.

I thought you could offer parents that have attended, and showed a strong understanding of the things taught in the sessions an incentive to take this knowledge back to their communities, and educate their friends and family themselves. Just what this incentive may be I'm unsure.

Spam
Photo of Chioma Ume
Team

Hello Anne! We've been having early childhood experts take a look at the ideas in Refinement and I'd love for you to share your answers to some of their questions. They've asked: Is there an evaluation plan? Can you link in the teachers in the school in the play activities with the young children? Can you integrate early development home activities that can be taught to the mothers and the fathers to extend learning at home (beyond health)? How does this utilize the preschool programs in the community?

Spam
Photo of Anne Riitho
Team

Hi Chioma,

Thank you for having the early childhood experts look at our idea, this whole process is great and we appreciate the feedback!

As for an evaluation plan, we have a number of indicators representing what we hope to see, e.g. (copied from below), "we would see an increase in the demand for family planning, an increase in the number of mothers and under-5's seen in our office-based clinic, and a reduction in basic, preventable illnesses in our nursery and baby class pupils. Additionally, over time, through growth chart monitoring, we would like to see a high percent of the under-5s tracking on target, with a reduction in malnutrition and stunted growth. Another important indicator would be monitoring the number of children who are up-to-date with their immunizations, and making sure the percentage of children up-to-date continues to grow over the course of the program." But as Natalie pointed out below, we have not established a way to monitor the knowledge retention of the parents. This is something we hope to develop and would love input from the IDEO community on how to integrate that into the program.

Linking the teachers in the school in the play activities with the young children is a great idea, one that we had not really thought of. But yes, I do think there is a possibility to do that, especially with the teachers of the younger classes in the schools.

Integrating the early development home activities beyond health would be one of our "break out sessions". We will use those smaller sessions to work with the parents and train them on games and activities they can do with their children at home. In these smaller sessions, we can do role-plays to encourage parents to interact more with their small children.

In our community, there are not defined preschool programs. The public schools admit students at age 4 and the private schools admit students at 3 years, other than through the schools, there are not preschool programs that are widely known to community members. There may be one or two, but our local staff is not aware of any widespread programs. Therefore, we are not utilizing any preschool programs, and we are hoping to help fill this gap through working with the parents and children.

Please let me know if you have any additional questions, or need any clarification on what I've said here.

Thanks!

Spam
Photo of Chioma Ume
Team

Thanks for the response Anne and Happy New Year!

Spam
Photo of Lwala Community Alliance
Team

Anne-
Love reading through this. Sounds like we should swap stories in Kenya.
Questions we had:
1. Do you connect your clients who you meet at the schools to static facilities run by the government or other service providers?
2. Do mothers have an opportunity to enroll in family planning options?
3. Are men/fathers engaged through the school programs at all?

Lwala team

Spam
Photo of Anne Riitho
Team

Hi Lwala team,

We should definitely share our experiences in Kenya, I know we have a lot of similar programs! In response to your questions,

1. We typically refer the clients to area dispensaries or larger hospitals, if necessary. We have an office-based clinic that can provide basic services, so sometimes we refer there, but for more complex cases, we are lucky enough to have Chogoria Hospital in our town. We have a relationship with a few of the doctors there and can refer more complex patients to them.
2. Mothers do have an option to enroll in family planning options! We are trying to think through ways of increasing this demand even more, and would love any ideas or suggestions you may have. We offer family planning methods through the mobile clinics, as well as, through our office-based clinic. Hopefully, through this expanded program we will have the opportunity to engage more mothers.
3. This question is so important to us, we really recognize the need for men and fathers to be engaged through the school programs. In the past, when distributing long lasting insecticide treated nets, we've invited all parents to come for the health education lectures. This is one point we may consider refining because of the suggestions to include men. We have found, many women are more comfortable asking certain questions among other women, but we could have separate sessions, on the same day, for the men and women. What do you think? Obviously, it is so important to involve the men and fathers!

Anne

Spam
Photo of Lwala Community Alliance
Team

Thanks for the greater detail:
On #2- it sounds like the trust relationships you have with the mothers and the mobile clinic model would be a good setting to utilize implants since they do not require frequent refills (like birth control pills). Have your providers been trained to insert implants? We have had a lot of luck with that method in rural Kenya.

Spam
Photo of Anne Riitho
Team

Our community health nurse has been trained in inserting implants and IUDs (though this is more likely clinic based). Additionally, we are hoping to set up a capacity building exchange where family planning experts come over at various points throughout the year to continue to build the skills of our nurse, and any new staff we bring on. This will also help us to stay up-to-date on new methods and the most recommend methods.

It would be great to have a conversation with you regarding your successes with implants and how you attracted women/youth to this method.

Spam
Photo of Natalie Lake
Team

HI Anne,

Really interesting idea. I had a few follow up questions. Does your NGO include locals who help in the educational sessions? I know that you are working with the local schools but I think that working with local health leaders is crucial to the success of your project. Training the trainers, a pyramid scheme with the best of intentions, can increase the efficacy of any project. The local health leaders will have more confidence with the local parents, will be able to do tons of follow up house visits, and would be able to work around cultural nuances.

Also I was wondering if you were doing any M&E (Monitoring and Evaluation) on your sessions aside from the outcomes of the health results and the outputs of people in attendance. Are you doing any check for learning activities at the end of sessions?

All in all a super great idea. I think combining your idea with the story stones idea for the ECD activities that could go on during your sessions would be superb. Great job!

Spam
Photo of Anne Riitho
Team

Hi Natalie,

Thank you for all of your comments and your interest in our project! I will address your questions in the order that you asked them.

First, in terms of locals who help in the educational sessions, all of our educators and community health workers are local staff and they will be leading the sessions. We think it is essential to have local staff leading the lectures to ensure that the information is clearly understood by those people attending, and that all cultural nuances are addressed. Even our nursing staff is local, except for volunteer pediatricians who are involved in an advisory capacity. Additionally, we have been able to recruit a few staff members from the local hospital to come out on our outreaches in the past and we hope to continue to do this in the future.

Training of trainers is a very important concept, I think that is where we are headed with the parents. We are hopeful that in the future, after the parents have attended a number of lectures, they will then be able to help their neighbors and community on an informal level.

As for monitoring and evaluation, we could definitely incorporate checks for learning activities at the end of the sessions. This is not something we have done in our school based mobile clinics up to this point, but we have done it in our water program in the schools. Again, it is so important so I thank you for bringing it up. Your input on how regularly the monitoring and evaluation should take place would be really helpful. Do you think it is appropriate to do a check at the end of every session, or should we do them yearly? What do you think is the most effective way to get this data without taking up too much time at each session?

And yes, I agree, story stones looks like a great project and we would love to partner with other organizations to make our idea stronger!

Thanks again!
Anne

Spam
Photo of Natalie Lake
Team

Hi Anne,

When I do educational sessions, I usually do a check for learning at the end of each session. This doesn't have to be an exam or anything but you can do different fun activities (we call them dinamicas) to check for your audiences knowledge gain.

My dinamicas usually take up 5 minutes at most and are usually very fun and interactive. I tend to do environmental dinamicas so I don't have any specific health related ones I can suggest to you right now. I will ask my health friends for some dinamica ideas that they use in their sessions though! The topics you educate on are fairly similar so I will ask around and get back to you.

Also, every few months or so I do a more formal check for learning either orally or written (depending on literacy.) People tend to forget, or mix up ideas after a few months so it is always good to re-vist/review, and retest :).

Spam
Photo of Natalie Lake
Team

Hi Anne,

I got some responses! The lovely health volunteers of Peru were kind enough to offer me three suggestions for you so here goes..

1.) Flyswatter. This is a group activity where you have the group stand in two lines. You have a bunch of photos or answers taped to a board in front of you. You read a question and they run to grab the answer, and each right answer scores their team a point.

2.) Jeopardy. Always a fan favorite. A bit harder with big groups of people

3.) Nutrition specific idea- You can create a match up chart where foods first your organize the foods into their respective categories, and then second, they work in teams to prepare healthy balanced plates for different age groups

Basically anything that is fun and interactive that involves memory. Test taking is intimidating and can hurt feelings. I personally like doing pre-tests to gage starter knowledge and it can also help you plan future talks!

Something I also do with my students (though they were highschoolers) is that I hand out a deck of cards as they walk in and then I use a second deck of cards to randomly call on people to engage my audience/get more participation and it works great for running through check for learning questions at the end of class. Adults may not like forced participation though... haha

Hope this helps! Best of luck with your project!

Spam
Photo of Natalie Lake
Team

Whoops okay I slightly mistold flyswatter wrong hahaha flyswatter is called flyswatter (matamosca for us) because you use a flyswatter to hit the right answer! You do not take the thing off the board. hahhaa sorry about that.

Spam
Photo of Anne Riitho
Team

Hi Natalie,

Thank you for all of these suggestions! They all seem like great ways to engage parents and measure knowledge gained! Please thank your health workers, I think we will definitely be incorporating some of these into our educational sessions and breakout sessions.

Anne

Spam
Photo of International Youth Empowerment Network
Team

Good job Anne! I am curious to know how long each lecture session will last? How much distance do parents have to move to get to the schools? What incentives have you prepared for the parents, teachers and health care providers to engage in this? How will you know if this initiative is having impact among these parents?

Spam
Photo of Anne Riitho
Team

Thanks for your questions! We expect the lecture to last about an hour, and then have an hour for breakout sessions. For the most part, the parents do not have to move very far to get to the schools because they typically send their children to the schools in the area. All of the children walk to school, therefore the parents are within walking distance. Also, we are not limiting it to parents of children who attend a specific school, so if there is a school closer to their homes they are welcome to attend any lectures/clinics they would like.

We have not prepared any incentives for the parents to engage in the clinics. In the past we have found the parents are happy to attend the lectures without the need for incentives. Their children get free medical care, the mothers get free family planning, and once per year the under-5 children get a malaria net. We've found these to be enough incentives, but this could change over time, it is definitely something we need to watch.

As for the health care providers, they are currently employed by Village HopeCore and therefore they are paid a salary for their services.

As for impact, we are still working through the details on how to measure the impact in relation to the parents. We have identified a number of indicators (can be found in the description or in conversations below) to track the impact on the health of the children, but we are still looking for suggesstions on tracking impact among the parents. We would love your input!

Please let me know if you have additional questions or input, we welcome it all!

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Congratulations on making it to the Zero to Five Challenge Refinement list, Anne! We like that your idea aims educate and support mothers by leveraging an existing program. It’s also great to see you collaborating on the platform by seeking feedback and engaging in conversations with other members of our community. Your descriptions of a user experience help paint a picture of what your program might look like. Consider using our tool to translate this into something more visual to share with the community: http://ideo.pn/0to5-map. Have you considered using an already-established curriculum for early childhood? Or seeking advice from other organizations who are running similar programs? If you haven’t, this is something you might want to do some research around. We think it’s great that you identify getting user feedback about your idea and we encourage you to do that and share what you learn with us. Another thing to think about is how you could test this idea in a simple way (e.g. to gauge whether people would come or determine what style of meetings are engaging for the mothers). Check out tips for Refinement http://ideo.pn/0to5-tips-refine for some tools to assist you.

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Anne, thanks for your response and Bettina – great questions, as always!!

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This is a great idea! I love the addition of adding fathers to the sessions. Do you foresee problems getting fathers to attend, and if so, what tactics are you planning to employ to motivate them to come?

Also, how will you be spreading the word about these education clinics? Is it by word-of-mouth only? Flyers at the schools?

Lastly, I"m curious how you are defining success of the program. Are there specific childhood ailments prevalent in your catchment area you will track? Family planning for mothers? What about the outcomes for the structured play for children?

Thanks!

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Team

Hi Laura,

Thanks for your comments! In response to your questions,

- We do foresee problems in getting fathers to attend, but have not yet begun to think of how to motivate them as we just added them to the idea. In the past, we've seen about 15% of the parents that show up to health education lectures are the fathers, so potentially we could use those men to motivate other men to attend. What do you think?
- As for spreading the word about the clinics, currently, we have a very close relationship with the schools, so we have been communicating through the head teacher at the school. This is usually quite successful, and often then word travels through the community by word of mouth.
- Defining success is a challenging point for us! As you can see above, we've requested the community to comment on indicators that we could potentially use. Also, we defined a few of the key points we would be looking for. Ideally, we would see an increase in the demand for family planning, an increase in the number of mothers and under-5's seen in our office-based clinic, and a reduction in basic, preventable illnesses in our nursery and baby class pupils. Additionally, over time, through growth chart monitoring, we would like to see a high percent of the under-5s tracking on target, with a reduction in malnutrition and stunted growth. Another important indicator would be monitoring the number of children who are up-to-date with their immunizations, and making sure the percentage of children up-to-date continues to grow over the course of the program.
Currently in our schools we see a high number of cases of upper respiratory infections, scabies, ringworm, and diarrheal disease. We will begin tracking these illnesses, among others, in the younger children as well.
- In defining success of the structured play aspect, I think we would have to track this on a more long term basis. Perhaps we could compare the results of the class 1 pupils at schools where we instituted structured play against the results from a school that did not have that aspect of our program to see if there are any noticeable differences. This may take a while for us to demonstrate impact. Again, if you have any suggestions, they would be greatly appreciated.

Thanks again for your comments!

Anne

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Photo of Laura Schwecherl
Team

Thanks for your answers!

Thats a great idea of seeding fathers to excite other fathers. You could come up with a quick education packet for them to share peer-to-pper, or make sure the classes don't interfere with normal work hours? (Our team at Possible finds that the large population of fathers migrating to India from Nepal for work makes it really challening to have them participate in group learning).

The ways to measure impact sound great. You should see if anyone in the IDEO community has bandwidth/connections to EMR systems (if you don't already have one in place!) to track all the measurements ... especially things like monitoring immunization records.

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Laura, thanks for your suggestions! We will definitely keep all of that in mind.

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Natasha and Anne, I really loves this idea. Based on discussions we have had in our team, one aspect that might be interesting to you surrounds the question of how to involve the fathers into this entire process? It was mentioned that for example in communities in Tanzania males make most of the decision for the family. So, although services are mainly tailored to the mother and the child, as the father might be the one making the decision of whether or not a family member will be able to take advantages of your services, thinking about involving the father from the get-go might take this idea even further.

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Hi Tino,

Thank you for your suggestion! We have also noticed that there are any ideas/concepts in this IDEO challenge that involves specifically targeting fathers to encourage their involvement in raising their children as well. However, we have chosen to target only mothers with our project because we feel that they can more openly ask questions about sensitive topics (such as sexual health and family planning) when they are in a room full of fellow mothers and no men. We will be sure to edit our idea description to reflect this reasoning. As our concept comes to life, we will consider possibly incorporating separate education and question-and-answer sessions for fathers, then a short combined follow up session with both parents, into our clinic.

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Team

Hi Natasha and Tino.
I think Tino brings up a very important point regarding the influence that a father/husband may have on decision making in families. During the research phase I spoke with a friend who works for Family Care International. FCI is a non profit doing great work in the area of maternal mortality in the developing world, including several countries in Africa. This is one of the topics we discussed. Have a look at the link below which highlights the topic that Tino brings up. I posted about their experience on one project and how finding the key influencers can make a huge difference in women accessing care. Basically what their organization did was to involve religious leaders in the education process. These leaders were invited to education workshops and they then preached to men in their congregations about the importance and value of this health care. Some of these men then gave permission to their wives to seek services - reproductive and obstetric services. This is just an example.
It might be an idea worth researching in the communities you are working in Natasha. Researching to learn if the dads are a roadblock or not.
The community health workers may have insights into the father's role in accessing health care for small children, or even whether moms will need permission to go to your health education sessions. Might the health workers who will do outreach during school holidays include that as a question for the moms? If this is deemed an issue it might be useful to approach the key influencers, the ones that the men in the community listen to, explain your program ideas to them and ask them to bring the idea to these men in the hopes that this will open the door for mothers. At this point it might not be about bringing fathers to classes, although I think that could be an amazing intervention, but more about learning whether mothers need consent to take their children, or themselves, to these classes/clinics and if so finding a way to get the fathers on board for that.

https://openideo.com/challenge/zero-to-five/research/educating-leaders-can-lead-to-support-of-new-community-initiatives

Natasha - Sorry for the late response from your post on the Football Fever Idea. Thanks for that post! It is very helpful.
I have some questions/suggestions for this project and will come back to comment later.
Great project guys!!!

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great post Bettina :)

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Thanks Tino.
As to Natasha's comment regarding having the groups be specifically for mothers I agree that that is a great idea.
Bettina

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Thank you, Tino and Bettina for your comments and suggestions. We've updated our idea to include inviting the fathers as well. What we've heard from our CHWs so far is that many men will not have interest in coming, but hopefully we can engage them! For now, we will have the groups be separate, giving both men and women the opportunity to ask questions and get the information they are seeking, while at the same time, engaging both parents equally in the responsibility of caring for their under-5 children!

Thanks again for your constructive conversation!

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Team

Hi Anne.
Great that the Health Workers are involved in gathering information and providing insights into your programming - re: men's interest in participating.

Did the Health Workers provide any insights as to whether the men in this community will allow their wives to come to the educational sessions? particularly the ones involving family planning?

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Photo of Anne Riitho
Team

Hi Bettina,

This question has come up a few times regarding if men allow their wives to come. We have not seen men as a barrier to women's attendance at similar events in the past. our CHW's have reported that men would not stop their wives from coming, especially because there is so much information being transferred outside of only family planning.
We plan to do some informal interviews this week with both men and women in our area to help answer this question. Keep an eye out for updates!

Thanks!
Anne

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Team

Hi again Bettina and Tino,

I wanted to direct you to the feedback we received from a few men and women in the community. Both expressed interest in learning with both men and women in the room. We will still have single-sex breakout sessions if there are any sensitive topics, but for issues related in the family we hope to educate both men and women together.

Thanks again for all of your constructive comments and discussions!
Anne

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Photo of Bettina Fliegel
Team

Great feedback Anne! Thanks for sharing. I love that topics came up that were not on your list. It will be interesting to learn more about the community's interests and needs as you move forward with the project. The group that you surveyed will likely spread the news that this project is in development!

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Team

Hi Natasha and Anne!
Great project. I like that it builds off of an existing service and services.
I have some questions/ideas?

In terms of getting the word out about this new service have you considered a community vaccine drive to roll out your idea?

Where are the schools in relation to other health services for small children? vaccine clinics? Will your proposed mobile clinics have any interplay with these other health services?

What are your ideas for the groups themselves? If you are going to have a discussion on nutrition it might be beneficial to have this for mothers of a certain age group rather than 0 - 5 all together. The same would pertain to discussions/classes on child development. One idea is to have a set group of moms, with children of a similar age, and have them meet weekly and vary the topics. I have seen this model in the US and it builds community for the moms overtime.

I might also investigate further from the mothers what topics they are specifically interested in. You might be able to build sessions around these topics. Also it can be helpful to review what local practices are regarding health. In this way myths can be debunked and important signs and symptoms for illness reviewed so parents understand when it is vital to go for care quickly, even if they also use a home remedy.

Playgroups for young children while moms attend the workshops is a great addition! As 0 - 5 is a wide age range the children will have varied abilities and attention spans. It may be helpful to have more than one adult supervisor.

As to format of the meetings - Sitting in a circle and having interactive communication is a great format. Visuals can be very useful as can be interactive demonstrations. (Demonstrating how to dispense meds, showing moms the different forms of contraception, cooking demos re: nutrition...) When it comes to development I think visuals - pictures or videos - will be helpful for all parents regardless of language or literacy. It just helps to see what is normal and to see what to expect over time. (I am a pediatrician working in low income communities in NYC. In my experience demonstrating and reviewing instructions, asking moms to review back with me or the nurse has been helpful.)
Good luck moving forward! Great project Anne and Natasha!

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Team

Hi Bettina,

Thank you for all of your comments! We will definitely be incorporating some of your suggestions into the programming. Finding out from mothers what topics they are specifically interested in is a high priority for us, and including discussions arounds myths is always important because they are so prevalent. And yes, we agree, depending on the number of children attending, we will need to adjust the number of adult supervisors present.

Its great to hear that you are a pediatrician, and we would love to keep in touch as we move forward to continue to get feedback from you.

Thank you for your comments and support!

Anne

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Team

Hi Anne and Natasha.
Nice to read the comments here and see the builds on your project!
I see from the comment to Lwala above, and to myself and Tino below, that you are planning to incorporate educational programming for men/fathers. That makes me wonder - as you are planning to have a children's program while the moms are at their educational session might it be an idea to have back to back parent's programs - during which time moms or dads are with their children in the children's program? In this way parents can also interact with their children at play and learn about appropriate play for their child's age? This would also bring more adult supervision into the room.
The World Wide Orphans Foundation has a very interesting model using Toy Libraries to engage guardians and children in play. They have developed cards that have guidance on how the toy can be used to enhance development at a certain age. (have not seen them myself but it sounds like an amazing tool) Perhaps something to learn from?
https://openideo.com/challenge/zero-to-five/research/ensuring-that-orphans-worldwide-thrive-the-world-wide-orphan-foundation
https://openideo.com/challenge/zero-to-five/ideas/element-of-play-supporting-vulnerable-children-to-develop-and-thrive-through-play

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Team

Bettina,

Thank you so much for the suggestion! We will definitely look into that model and determine if it fits in our setting and within our time constraints. Thank you for the links to the other projects and for your engagement with our idea.

Anne

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Anne,
Interesting program idea! It's a big step forward to have a strong relationship with the schools, and I like the idea of structured play for the children during the group sessions.

I'm wondering what you expect your main outcomes to be, and how you'll measure them? Do you currently collect measures that you would expect to improve?

A little off topic, but we initially had difficulty obtaining accurate data. We developed a training curriculum specific to our needs for anyone who works with us in program monitoring and evaluation. It includes topics like voluntary participation, confidentiality and asking questions without bias. It sounds like our contexts may be similar in some ways- we'd be happy to share it if it would be useful.

Please also let us know if you have any thoughts or suggestions on our idea: https://openideo.com/challenge/zero-to-five/ideas/mother-mentors-for-child-development.

GHEI team

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Hello GHEI team,

Thank you for your comments and questions. We would love to see your training curriculum for program monitoring and evaluation. We are still in the early stages of building out our monitoring and evaluation systems.

We hope that our main outcomes would be a healthier maternal and under-5 population. Ideally, we would see an increase in the demand for family planning, an increase in the number of mothers and under-5's seen in our office-based clinic, and a reduction in basic, preventable illnesses in our nursery and baby class pupils. Additionally, over time, through growth chart monitoring, we would like to see a high percent of the under-5s tracking on target, with a reduction in malnutrition and stunted growth. Another important indicator would be monitoring the number of children who are up-to-date with their immunizations.

We would love suggestions from you and others on different indicators you see as significant!

I will definitely be checking out your idea as well, thanks again for your input!

Anne

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Hi Anne this is brilliant, I am more than willing to be part of this, we can all should aspire to be social change agents. Very feasible, your idea is, good work.All the best.

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I think that this is a really great idea! I was just wondering if you hold these sessions while the students are in school or on the holidays and weekends? Does this disrupt the students learning?

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Thanks for that question, Ellen! We were very concerned about disrupting students' learning as well, but from our two pilot projects, we've seen that schools were able to provide rooms ad spaces far enough away from regularly-used classroom so as not to distract students at all.

The issues we will most likely run into if we try to host these clinics when schools are on holidays (~3 months per year in this school system) is that we we won't be able to most effectively leverage our relationships with schools and their teachers to communicate about these clinics or host these clinics, as teachers will also be on vacation then. Concerning weekends, many schools within our catchment area also have class on Saturdays, and most families use Sundays as time they reserve for each other and for church services.

Thank you again for your comment! Please do let us know if you have any feedback - we'd really appreciate it!

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Great Idea, I like how you describe .

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Hi Anne,

Exciting to read about this idea! Am very interested to read about your initial interviews with parents about this idea and your answers to Meena's questions. Knowledge transfer has been a really popular theme in the challenge so far, and I wanted to draw your attention to a few things that immediately came to mind that you might find inspiring as your idea takes shape. First, a creative way of introducing hygiene products in India: https://openideo.com/challenge/zero-to-five/research/masti-clean Second, an idea about community pediatric care in Nepal: https://openideo.com/challenge/zero-to-five/ideas/we-need-to-deliver-group-pediatric-care

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Hi Chioma,

My name is Natasha, and I currently work for the same NGO as Anne, through which we have made connections with the 72 schools mentioned in our idea description. Thank you for sharing the two ideas - looking through them, it seems that we could learn much from the first about introducing another hygiene-related component to our idea, and that we could potentially collaborate and learn from the second since our ideas are very similar.

Anne will soon make edits to our idea submission, as we have brainstormed responses to Meena's questions, so be sure to look out for those soon! Also, please feel free to shoot us any other ideas or suggestions you may have and share our idea with others so that we can continue to learn from other contributors as well! Thank you!

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Anne and Natasha, love the idea! Natasha provided me a link to your concept and I think there are synergies between our ideas. We came up with the "Hour to Thrive" where the first 30 mins is for cooking+eating and the last 30 mins is focused on fun education. Providing "free basic health care to mothers+kids" is one of the last 30 min options.

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Thanks for the compliment, Hao. If you have any ideas about ways we can make our concept better, please feel free to let us know!

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Hello Anne and Natasha,

I like your approach. I think it embodies community mobilization at the core.

I think you can have databases for different village and cities which include mothers' contact mobile numbers in order to invite them via SMS to events to ensure a fuller involvement by the community and reduce absences via SMS reminders.

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Hi Eleftheria,

Thanks so much! I think your suggestion is innovative and something we'd want to definitely try out. Anne and I were just talking today about the large amount of cell phone use, even in very rural areas, and this is a great way to make sure mothers always hear about our clinics near them. Thank you again for this idea!

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Anne, your idea is nice. Have you considered integrating the talks to open days if they exist in the schools that you are currently working in? Do you by any chance have Champion parents who can take the lead in mobilizing and talking to their peers?

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Hi, my name is Natasha and I am also on the team for this idea. Thank you for those suggestions! I am not sure if "open days" currently exist in our partner schools, as I have not heard of them but have only been working with our organization for four months. Having parents take the lead in mobilizing and talking to their peers is an excellent idea that we had not considered yet - this would also make the program more sustainable and increase parental involvement. Thanks so much for those points - please continue to post if you have additional ideas!