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Creating Comprehensive Care Groups Using Front Line Teams [Updated Jan 5]

Nyaka AIDS Orphans Project's idea is a community campaign that tackles the problems of children's interaction with the environment, lack of green vegetables in diet and life skills for both parent and child, by organizing pregnant women in rural southwestern Uganda into comprehensive care groups where health education, life skills, developmentally appropriate games and parenting techniques are taught by front line health workers [Updated 15/12/2014] . The women will be enrolled during pregnancy until their child reaches age five. They will be given incentives to attend ante natal, post natal, and group meetings. The tools given to these women will allow not only the baby enrolled to thrive but also all future children and their families.

Photo of Ellen Taetzsch
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Current Situation:

The importance of early childhood development is not common knowledge in Kambuga sub-county in southwestern Uganda. Young children spend most of their time on the backs of the mothers. Often times the highly nutritious foods are reserved for the fathers and older children in the family. Currently, pregnant women in this area have only one place where they can deliver and go for ante natal and post natal care, the local area hospital. This means that many women must travel a long distance to get the care that they need. It is our hope that in the next 5 years the clinic that Nyaka AIDS Orphans Project currently runs will have a maternity ward to aid in the difficulty pregnant women currently face.

Nyaka AIDS Orphans Project has been working in this area for over 10 years. It is a local NGO that employees individuals from the area to assist the community. Currently it runs 2 primary schools where orphans attend free of charge and are given uniforms, school supplies and two meals a day. It will also be opening a secondary school in February 2015. In addition to education, Nyaka works with grandmothers who care for orphaned children. We provide micro finance loans and education opportunities for these grannies. Nyaka also runs a clinic that provides basic services for free to Nyaka students and grannies. We plan on expanding these services in the next five years to provide more comprehensive care. The organization strives to provide a holistic approach to development and has realized that we are lacking in early childhood development. This is why this challenge was accepted. Nyaka has the knowledge and trust from the community to have an effective program.

Devising the Program:

We wanted to use the organizations already existing resources, relationships and partnerships to better inform us in how we could tackle this question. We talked with mothers with young children, pregnant women, traditional birth attendants, health facility staff, medical professionals at the local hospital and clinic, community leaders as well as motorcycle drivers. What we determined is that over half of the women do deliver at health facilities. Ideally we want to make the number higher. Many women, however, do not attend all ante natal visits and especially do not attend post natal care. Also, many women are unaware of the importance of early childhood development and of best ways to care for the young children.

We discussed the biggest challenges that these women face in attending ante natal, post natal and deliveries at the hospital. They said that transport was the most difficult. We made sure to address this in our intervention. We also asked what they thought would be the biggest challenges in raising children. All of these answers were taken into consideration when designing the program.

The organization also runs grandmother groups that have been successful within these communities. We have also noticed that many other groups, such as savings groups, are effective. We discussed with the women with small children if they thought a group format would be well received. They said yes. This is why we decided to uses this format in our intervention.

Front Line Health Care Workers:

Front line health care workers will be trained and employed to visit all houses in a pre-determined catchment area. Currently, in this area there are a form of voluntary front line health workers (VHT) trained by the Ministry of Health. Their role is to be the eyes and ears for the Ministry of Health within the community as well as to provide health education and referrals to health facilities. This has had varying effects depending on the commitment of the VHT to the area they serve. The front line workers in this program will build off of active existing VHTs as well as create new front line workers. These workers will be given a salary for their work increasing their motivation and accountability. The front line workers will manage chronic illness by dispense medicines that need to be taken regularly, distribute family planning and triage health concerns for the local health facilities.  After discussing this with the community members we have decided  that only bringing prescribed long term medicine such as family planning but nothing more.  The community members feel more comfortable recieving care from doctors and nurses[updated jan 5]

The front line workers will also be responsible for identifying pregnant women and enrolling them in a comprehensive care group. They will keep records of these pregnant women's phone numbers and will be able to text the women reminding them when group meetings are and when they are due for ante natal and post natal care. These phone numbers may also be used to alert community members of upcoming health events such as immunization campaigns or visiting doctors. Appropriate health education, based on prominent health challenges at that time, will also be disseminated via text to community member.

Comprehensive Care Groups:

The comprehensive care group will be established for pregnant women and women with young children. The composition of the groups will depend on the area that these women live in and the number of pregnant women. Ideally, women with similar due dates will be enrolled in a group. The women will be expected to attend ante natal care at the clinic or hospital and health education sessions, run by the front line health worker, while pregnant to prepare them for the birthing process and caring for a new born.

The women enrolled in the comprehensive care groups will continue attending meetings until the child is five years old. At least one meeting a month will be run by the front line health worker. The mothers will be taught about exclusive breast feeding, proper nutrition for both mothers and baby, developmentally appropriate games to play with the children, family planing, the importance of saving as well as other topics that are appropriate. The front line worker will also be able to asses children at these meetings to make sure that they are meeting their developmental milestones and are gaining the proper amount of weight. They will also bring immunizations for the children to ensure that the children are fully immunized.

Incentives:

Currently in this part of Uganda women often do not attend all of their antenatal visits and many still decide to have home births. In order to encourage women to go to the health facilities for these visits we've decided to incentivize the visits. Women who attend 1 health education session will be given a piece of kitenge material. The reason for the kitenge material is that each women is required to bring kitenge material to each ante natal visit and during delivery in order to cover the examination bed. The kitenge given will remain at the clinic with their name and be used during all ante natal visits. After delivery the women will go home with the kitenge material. This will encourage women to deliver at a health facility. The reason that this incentive was deemed appropriate is currently a women is given a “delivery kit” at the hospital when she comes in for labor. When speaking with 2 nurses 1 doctor and many mothers of young children it was determined that a kitenge would be a good incentive to encourage women to continue attending ante natal and attend the clinic for delivery.

We will also offer pregnant women who attend 4 comprehensive care group meetings a voucher to give to the motorcycle taxi drivers when they go into labor. The drivers will pick them up and when they arrive at the hospital present the voucher to be paid for the service.

Once a women delivers she will be expected to attend post natal care at a health facility. Few women attend post natal care in this area because they feel that their baby is alive and healthy so there is no reason to travel to the health facility. This is why women who attend all post natal visits will be given a cloth diaper for the baby. This again was determined after speaking with women who have young children and consulting with nurses and doctors.

Women who attend 4 comprehensive care group meetings after delivery will receive a receive a sachet of seeds for kale or other green leafy vegetables high in nutrients. In the target area many children and families rarely eat green vegetables due to difficulty in obtaining these foods. The women will be able to grown their own green leafy vegetables to eat and sell, enabling them to better the health of their family.

Again, women who attend an additional 4 comprehensive care group meetings will receive a Moringa tree. The front line worker will teach women how to plant and care for there tree. In addition they will be taught the benefits the different part of the tree possess, such as the seeds with water purification and the leaves with the great nutritional benefits, and how to prepare food using the leaves from the tree. This will allow for nutritional benefits for the family for years to come.

In addition to Moringa trees and green vegetables, women who attend a 12 comprehensive care group meetings after delivery will be qualified to receive a micro finance loan. The group will have to decide among the group members who is most deserving of these loans. These loans will be approximately $60 and will allow women to being small business such as goat rearing or selling vegetables. This will allow the families to gain a more secure financial footing and allow for the families to be able to buy nutritious foods and begin saving for school fees. Currently, this organization provides micro finance loans to granny groups in the area. After researching and evaluating the loans program we determined that the loan amount that had the greatest impact on a grandmother’s life was $60. Since grandmothers in this area are often caring for large families due to the HIV epidemic creating orphans, we've determined that mothers and grandmothers are in similar situations and the same loan amount should be awarded to members of the comprehensive care groups.



Conclusion:

Nyaka AIDS Orphans Project has a relationship with this community already. This prior relationship will be invaluable in the success of the comprehensive care group program. It also aligns well with Nyaka's future goals and current partnerships. We will be able to use our partnership with the government run hospital in the area and the grandmothers in the area to enable us to identify women and deliver babies in hospital settings. We already have a clinic where patients attend and successful programs are run. Nyaka will be building off of what it already has in place to better address the needs of children under five.

These groups will provide a place for health education by the front line worker and a gathering of people for health facilities staff to easily access. It also provides a place for children to interact with other children engaged in developmentally appropriate games helping the child develop fine motor skills and social skills. The incentives encourage women to initially attend group meetings and once this occurs the women will become more invested in the program itself and begin to see the benefits of attending meetings. The women within the group create a support network with other women in their own community. These women will be able to rely on one another to assist with problems they are facing and get advice from others who have gone through similar difficulties. This support network will continue even after their child has reached the age of 5.

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

This program itself identifies pregnant women to enroll in comprehensive care groups. Women will remain enrolled in groups until their child reaches the age of five. Not only will women and children enrolled in the comprehensive care groups benefit from this program but also the other family members. The family will benefit from the health education and life skills that the mothers have gained and the changes towards more healthy behavior as well as the profits from the business started through the micro finance loans. It will also benefit the entire community. The front line worker is responsible for visiting all houses in a catchment area. They are responsible for treating, triaging and referring all community members. The area that this program is targeting is a rural village in south western Uganda. People in this area are subsistence farmers and many survive on less than $2 a day. The main crops that are grown are bananas, beans, millet, and maize. People in this area raise cattle, goats, sheep, chickens and pigs. Malnutrition is a problem, especially with individuals lacking the ability to eat vegetables. Health facilities are often a far distance from families making health care difficult to access. Women tend to have many children in the understanding that not all of their children will make it past their fifth birthday.

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

The first way we would test the idea would be to test giving kitenges to ante natal clients. They would be given a kitenge at their first visit and it will remain at the hospital until the time of the delivery. This will help us to determine if that is motivation for the women to continue attending all of the ante natal visits and delivery. We would measure the number of patients that returned for their following ante natal visits and who delivered at a health facility. We could also measure the number of women who were referred to the clinic for ante natal by those who received kitenges. We could hold a test session of the comprehensive care group to determine how best to engage mothers and children and determine the best incentives to keep women coming to group meetings. We could also hold these sessions with the same group of women to determine if receiving a packet of seeds after attending a pre determined number of sessions keeps the same mothers coming and if new mothers attend wanting to know more about the program.

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

We would need expert advise to ensure the program be successful. We would like advise on best practices in engaging mothers in learning about early childhood development and pregnancy and delivery. We would also need an expert in early childhood development to assist in developing games for mothers to play with their children or facilitate between children using locally available resources. We also need monetary assistance in order to begin the funding for the micro finance loans, incentives, assisting with the salary for the front line health care workers and other incidental costs. We also would like partner organizations that could compliment the program well. An example would be Text for Change. They could assist in the dissemination of health messages through mobile phones and reminders for ante natal and post natal appointments. Another example would be health facilities that have a maternity ward.

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.

42 comments

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Comment
Spam
Photo of Irene Blas
Team

Nicely based on the area your going to be working! Is key to make mothers get involved sonce tehy get pregnant because is in that moment when they need to make their children thrive. Great idea!!

Spam
Photo of Musa Innis
Team

I think your idea is really nice and a great contribution that could be implemented in the Ugandan lifestyle.

Although I do question some things: How far would the pregnant women have to travel? Because I'm sure a long distance journey would become demotivating. 

Whilst the parents are taking part in the meeting where will existing children be?

Also I feel that fathers should have to get involved as well

I think the growing crops is an amazing idea to keep their minds off the pregnancy

But overall an amazing idea with nice diagrams and video and I wish you all the best!!

Spam
Photo of Ayman Hanafi
Team

Great work Ellen. Providing this system of care for pregnant women would be such a bonus to achieve. These women have suffered for years so you can imagine the relief for them when they realize that this help is available. Good luck with your good work.

Spam
Photo of Chioma Ume
Team

Hello Ellen! We've been having early childhood experts take a look at the ideas in Refinement and want to share some of their feedback with you: This program provides additional capacity to the existing government VHWs and has potential to implement an effective pre and post natal healthcare and child development package to families. It could be useful for Nyaka to design from the outset to work with district education and health officials and potentially offer a program which can be replicated in other districts. From experience, similar programs in Kenya have faced challenges embracing young parents into the program. Teenage mothers may form a large population of the community and may be the most reserved and resistant; an approach targeting and supporting these mothers in particular may be useful to consider to ensure they are willing to participate in this program.

Spam
Photo of Chioma Ume
Team

Thanks Ellen!

Spam
Photo of Bettina Fliegel
Team

Hi Ellen. Can you describe the current care options that exist for pregnant mothers in the village you are working in? Why would you need to employ a new line of workers if there are already health workers? It seems that you are proposing a parallel program. Would be great to get more of a sense of the need and how you came to develop your specific proposal. Did you have input from local women? Are there any locals on the team you will be working with?

Kale seeds as an incentive is interesting to me! If these seeds are available why aren't families routinely growing kale? Is kale something that local families will eat? Is it difficult to grow in that area?

Excited to hear more about your proposal!

Spam
Photo of Bettina Fliegel
Team

Awesome info Ellen! Very clarifying.
One further question - How do you define "at risk" pregnant women?
Bettina

Spam
Photo of Bettina Fliegel
Team

Ellen,
Hi. Sorry for the late response. Your comment/answers to my questions are extremely helpful. As a suggestion, can you incorporate this information into your post above? Maybe an outline of what you propose, what the current situation is in regards to prenatal and postnatal care including the difficulty women have accessing care since it is far away etc, and the research that was done to come up with the proposed changes/new programmatic ideas? Does that make sense? It would be helpful to describe the research that was conducted within the community and with the various stakeholders as you describe above in your comment - mothers, traditional healers, physicians, community workers, grandmothers and perhaps even the taxi/motorcycle drivers as you mention using vouchers for their services. All the learnings that the team had from this process would be great to hear about.
One question I have about the kale is whether women currently prepare greens at all in the home? As it will be a new food for many of the families have you considered doing cooking demos and taste tests with the women? Might this incentivize the incentive if they see how versatile, easy to prepare and tasty the food can be?
Good luck Ellen. Looking forward to reading updates as this project develops!

Spam
Photo of Ellen Taetzsch
Team

This is really helpful! Thank you! Women do cook greens in the village they just aren't readily available. That is the struggle. By providing seeds then the women will be able to get them from the garden. We are also hoping to shift them from a less nutritious green to kale full of nutrients.

Your suggestions are so great. I am going to update this again. Thank you again!

Spam
Photo of Bettina Fliegel
Team

Thanks Ellen. Very happy to have this conversation! For me the post is much clearer now and I understand how the project has taken shape and who is sponsoring it. I have a few further questions that will clarify further for me. Hope that is ok.

The kitenge kit - it seems to be very important. What exactly is it? If women receive a "delivery kit" when they go to the hospital what is in that kit and how does the kitenge differ?

I am curious about your conversations with the traditional birth attendants. They attend home deliveries, correct? How do they feel about this initiative?

You also mention that moms currently serve their husbands and older children the best food. Regarding the dads - are they onboard for this project? Will they permit their wives to go to maternity care, and to deliver out of the house? participate in health education classes? The reason I ask is during the research phase we learned that husbands do not always allow their wives to do these things and that it is sometimes important to enlist key community influencers to help change thinking on these issues.

I love the transport voucher incentive. Fantastic initiative. This might help get dads on board as well as they will not have the financial burden of transport. I learned in the earlier Women's Safety Challenge that this in itself might deter families from going to a hospital for a birth. Were the motorcycle drivers excited by this new business source? Are they available 24/7?

Where do you plan to hold the monthly meetings for the Care Groups? Have you considered how that will be structured in terms of moms bringing children with them to the groups. There is a post on this site, Maternal and Under Five Educational Groups - they are working in Kenya, and they are planning to have a parallel childcare group when moms meet so that the children can be engaged as well as the moms.
https://openideo.com/challenge/zero-to-five/ideas/maternal-and-under-5-health-and-education-clinics
Excited to understand and learn about this organization and this project Ellen!

Spam
Photo of Bettina Fliegel
Team

Great news Ellen. Congrats to you and the Nyaka Aids Orphans Project on moving on to Refinement!

Spam
Photo of Ellen Taetzsch
Team

Thank you! This is all very exciting! I feel honored.

Spam
Photo of Twesigye Jackson Kaguri
Team

Great conversation here. Ellen great responses. Nyaka was and continue to rely on local people. I started Nyaka in a village where I grew up and we pride ourselves in being the org that relies on local experts. We have several programs because of the need and this idea is one of those needs.
My own mother was a birth attendant when she was able to move around. She had no training but local women and men trusted her to care, love, and deliver babies. She is it for free. With few incentives, improved technology, and great ideas as suggested we will have a healthier community and healthy babies and mothers.
My mother also did something many people don't do, she used to feed her children before feeding adults. Kale, and other greens can easily grow in this area. Nyaka village is over populated and so we must find ways to grow small gardens and vegetables are the best solution.

Spam
Photo of Bettina Fliegel
Team

Hi Ellen and Twesigye!
Thank you for the background information on your organization in the comment above. It is so interesting to learn about how this work started! I think a big strength of this initiative is that it a local program built on the learnings of the community.

The user experience map is great and the questions answered in the PDF really help. Some questions that came up for me while reviewing these:
1 - Where will the antenatal, post natal, and pediatric care be delivered? The reason I ask is that you have identified travel as a roadblock to care and are offering incentives for travel to the hospital for delivery. Will women be able to get to appts?
2 - You plan to accept women at the beginning of their pregnancy if possible. If these women already have children will you be able to accommodate their children in the program? Sending alerts for their medical appointments? Engaging these children in play during meetings etc.?

Looking forward to learning more!

Spam
Photo of Bettina Fliegel
Team

Hi all.
Check out this mobile technology service (see links below) that has been piloted in South Africa as "Mom Connect". The technology is also available in other countries in Africa, including Uganda. Maurizio - https://openideo.com/challenge/zero-to-five/refinement/modular-packaging-for-joyful-families-and-happy-children (also a great shortlisted idea...) posted this in a comment here:
Maurizio Bricola
December 24, 2014, 17:04PM
https://openideo.com/challenge/zero-to-five/refinement/shishu-information-and-delivery-ecosystem-for-first-48-hours-of-newborn-care

Sharing his share with you. Perhaps adaptable for your needs? It is an open source mobile technology network. "Mom Connect" looks great.
http://vumi.org/
http://www.unicef.org/southafrica/SAF__infrographics_momconnect.pdf

Spam
Photo of Ellen Taetzsch
Team

Woah! That" mom connect" program is exactly what we are hoping to implement here! Thanks for that resource. We will definitely be contacting them and learning from them. Thanks for that resource.

Spam
Photo of Ellen Taetzsch
Team

As for your other questions. They were great. Here are the responses:

1. The hospital and the Mummy Drayton School Clinic (the Nyaka clinic) are 2km apart on a newly finished dirt road. We were going to give the women a choice of whether they wanted to go to the hospital or our clinic for ante natal and postnatal care. The women, currently, will have to deliver at the hospital since the Nyaka Clinic does not have the infrastructure for that service yet. We think that most women will choose the Mummy Drayton School (MDS) Clinic since the wait isn't as long. The travel for those who live far away will still be a struggle. Women often come by foot or on a motorcycle taxi.

2. Our ideal women will be young women especially first time mothers because that will have the biggest long term impact. We will also include young mothers. Those mothers with children that are too young to stay with others will of course be welcome. We want to discourage older children for coming for fear of distracting the mothers. However, in understanding that this is not an ideal world, we will never turn any children away and especially when the groups get into play they will be included. As for the mobile service and sending reminders for medical appointments, we will start just with the mothers and the child enrolled. Hopefully as our capacity expands we can also expand this program.

3. Our long term plan is not to have the “grannies” participate. They currently have their own program within the Nyaka AIDS Foundation that addresses how to care for orphans, health education, and how to be elderly in a community. Ideally, as the program expands we would hire an individual who would be responsible facilitating the program from the field office. All front line health workers will undergo a training on topics that we want discussed, how to run a group meeting and positive teaching techniques to reduce the shaming that is currently used. The Global Health Corps fellow will be responsible for coming up with this manual and training the initial wave of front line health workers. However, when we are able to hire a full time staff member that responsibility will be passed on to that individual. The first few comprehensive care group meetings will be co facilitated so that we will ensure the health worker knows what is expected of. From then on the worker will be observed occasionally and evaluated noting any improvements that could be made. The Global Health Corps fellow will remain more of a supportive role for those in the field.

Spam
Photo of Bettina Fliegel
Team

Hi Ellen.
Thanks for answering the questions.
I came across this model of group Pregnancy Care yesterday. Might be a resource for your team?
http://centeringhealthcare.org/pages/centering-model/pregnancy-overview.php
http://centeringhealthcare.org/pages/centering-model/parenting-overview.php

Looks like you have been busy prototyping! What happened during the education session? What did moms say about it?

Spam
Photo of Meena Kadri
Team

Way to go on the User Experience Map video!

Spam
Photo of Bettina Fliegel
Team

I agree! It is great Ellen!

Spam
Photo of Ellen Taetzsch
Team

Thanks! It was a but tricky to figure out but luckily I have some really smart friends.

Spam
Photo of Daniele Reisbig
Team

Hi Ellen,

I love this program idea you came up with! Can you expand a bit about initial outreach for this program? There are Grandmother Groups who meet in a similar fashion as a part of Nyaka program already. Could that existing system be used to help reach out to mothers in the community? (sorry if that's already been asked. I didn't see any discussion about that but I might have missed it.)

Thank you!

Daniele

Spam
Photo of Ellen Taetzsch
Team

Thanks for the question Daniele,

Initially, we will start with one group close to the field office where we will recruit at the churches. I didn't think about asking the existing grandmothers who participate in the program in this community. I knew that I wanted to use them when we expanded to other areas since they know the communities so well. I think that you are right and we should use them initially. They are testaments to what Nyaka can do for an individual and family and they will know the women who are pregnant. We also want to model these groups heavily after the granny groups since they have been so successful.

Ellen

Spam
Photo of Daniele Reisbig
Team

Very true. They would be able to help spread the word and encourage mothers to come to meetings.

Spam
Photo of Chioma Ume
Team

Building on this, it would be really interesting to get a better understanding of some of the other motivations mothers might have to participate. The hospital workers think that a kitenge is an incentive, but do the women? Are there ways to get a sense of this beyond waiting for them to give birth?

I think you've taken a look at the Group Pediatric Care idea, but just in case, they've started to do some thinking about incentives for mothers that you might find interesting: https://openideo.com/challenge/zero-to-five/refinement/we-need-to-deliver-group-pediatric-care

Spam
Photo of Bettina Fliegel
Team

Hi all. One suggestion to engage and enroll women in this initiative is to provide free pregnancy testing at the current local Nyaka Clinic, or in the villages - perhaps provided by community health workers. as part of this program's outreach. At a local community health center that I previously worked at in Harlem, NY pregnancy testing was available free of charge as a walk in service everyday. In this way if a woman tested positive she could be engaged on site and enrolled in prenatal care.
Thoughts?

Spam
Photo of Ellen Taetzsch
Team

Thanks for all of the insight. I am sorry I couldn't respond earlier. I just got access to internet.

Bettina,

That is a great suggestion. We currently provide free pregnancy testing at the clinic but we do not bring it into the community. I wonder if doing an outreach program regarding pregnancy testing would be beneficial. I will have to do some research about that.

Chioma,

I've talked to the mothers and one of the larger incentives, even more so than the kitenges, for coming to Nyaka for ante natal care is the fact that the waiting time is much smaller at the clinic that Nyaka runs. The kitenges provide incentive for those who are reluctant to attend or stay further away. We have also been contemplating the idea of allowing those mothers enrolled in these programs to "cut" the line which would make the wait time even smaller. However, we are not sure if this will make a big difference. We are hiring a midwife this month and that is when we will begin ante natal services. Another incentive for individuals to attend ante natal already in place by the Ministry of Health is the mama kits which women receive when attending ante natal at any government run facility (Nyaka clinic is registered under the government) which includes items the hospital requires mothers to bring when giving birth.

As for testing out the kitenge incentive, what we have done is simply talking to mothers and pregnant women. We will be willing to revise the incentive if we think that it would be necessary. Since the ante natal visits take place between 2 and 3 months, if everything is as expected, we could not test the re-attendance rate in this time frame, which is ultimately what we would like to influence.


I hope that this answers your questions. Thanks for giving us things to think about.

Spam
Photo of Chioma Ume
Team

Thanks for your response Ellen!

Spam
Photo of Richard Zulu
Team

Ellen, you developed a great user experience map for the idea. How about sharing it so that others can understand your idea further and what you have prototyped?

Spam
Photo of Ellen Taetzsch
Team

Richard,

Thanks. We have posted the pictures of the user experience map in the beginning. I am still trying to figure out how to post the video we made of that in the beginning but I have attached the file for people to watch. It is just not located in the right section, instead it is under the document postings.

We have prototyped how to advertise the program to pregnant women through the churches which proved to be very successful giving us the number we desired of 10 with the understanding that once the program is implemented more women will try to join.

We have also prototyped a health education lesson with women who attended the clinic.

We also have performed a taste test with a few women about using spinach for the green vegetables. unfortunately, it was unsuccessful, so we decided to stick with the traditional green vegetable called doo do which does provide many nutrients. I have no idea the other name for it.

Spam
Photo of Diini Omar
Team

This scheme idea is out of the ordinary to help community drive and carry out the struggle of children's communication with the environment, plus remaining in deficient of green vegetables in their diet along with life knowledge for together parent and child, by making plans for pregnant women in rural southwestern Uganda into comprehensive care groups where health education, life skills, developmentally appropriate games and parenting techniques are taught by front line health workers. As this part of Uganda women don’t visit and many still decide home is serious and life threaten and encouraging women to came and joining the health facilities clinic will absolutely save their child life as well as the mother.

Spam
Photo of Ellen Taetzsch
Team

thanks for the support Diini

Spam
Photo of Chioma Ume
Team

Hi Ellen! Thanks for adding your idea to the challenge! I see that you are working in Uganda already. Further to Meena's comments, it would be really interesting to understand the context that you see your idea fitting into? For example, have you seen similar types of services (even if they are not related to ECD) gain traction in rural communities? If not, how could you test some of the assumptions behind your idea (for example, to know whether or not mothers might be interested)?

Spam
Photo of Twesigye Jackson Kaguri
Team

Ellen will answer but let me say that we have been asked about this for many years. We even had a student from Michigan State University who interned and that is what mothers asked her. Nyaka has been in this village for 14 years, our nurses and all staff are trusted and community members are our greatest stakeholders.

Spam
Photo of Anne Riitho
Team

Hi Ellen,

This looks like a great, very well thought-out idea! I love how you have already talked with the community to develop your idea. One quick question- how do you plan to market the idea to women to attract the remaining 50% that do not currently deliver in hospitals?
Also, do you have any ideas on how women could join the program later, e.g., if they hear about it after they give birth, are they allowed to join for the incentives surrounding the post-natal visits?
I think the idea of texting health information is a great way to keep the program sustainable.

Good luck!

Anne

Spam
Photo of Ellen Taetzsch
Team

Thanks for the questions Anne,

When talking to the women it seems that the biggest reason that people don't deliver at the hospital is transport not because they don't want to. By putting the incentive of a free motorcycle taxi ride if the women attends 4 meetings while pregnant then we hope that this will give the women the ability to get to the hospital. Also the women who have the most trouble tend to live further from the hospital. Having these front line workers being in these communities and holding the meetings in these communities the women will have an easier time qualifying for the vouchers.

We are initially just targeting women who are pregnant. We think that this will have the highest impact on the community and the well being of the children. In a situation where a mother did approach we would have to advise them to join the program during their next pregnancy. Perhaps, when our capacity expands we could accommodate these women.

Ellen

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Anne, the other reason women don't get to hospitals is cost. Cost sharing is huge. With Nyaka's existing micro finance women are able to earn money and save for their hospital visits.
Nyaka is also increasingly raising awareness of health and food security. Through granny groups we will be able to reach more women. Radio programs and use of cellphones will be applied.

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Congratulations on making it to the Zero to Five Challenge Refinement List, Ellen! We are particularly impressed by all of the work you have done to understand the needs of the community you are working in and commitment to developing a human centered approach. We also love the collaboration and smart feedback your idea has generated. Lastly, Nyaka’s integrated approach and intention to leverage existing resources and relationships is great to see. Being as involved as you are in your local community, do you have a sense of how many mothers could possibly participate in this program if it were to start early next year? Would you expect that number to be consistent over the years? It’s great that you have been speaking with women and health care workers about what would incentivize women to participate in the various components of your proposed program. We’d really like to hear about the outcomes of some of the short term prototypes you’ve described in your idea (e.g. around attendance at women’s groups). On a broader level, how do you see this program fitting into Nyaka as an organization? How would this program be administered? Can you give us a clearer picture of how you think mobile services could work and what challenges you expect? What could you do to begin investigating potential partnerships, like the one you suggest with Text to Change? Check out more Tips for Refinement http://ideo.pn/0to5-tips-refine.

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Ellen, were you able to incorporate my lenghty feedback into your idea above after our meetup?

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I think so. Thank you for all your advice!

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Hello Ellen, is there a way we can partner, I see a relationship between what you are doing and my group idea about using local food

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We can definitely partner. I think the more collaborative the better the idea becomes!