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Thrive Thru 5: Mapping for Child Survival in Rural Kenya [Updated Jan 9]

Where you live should not determine whether you live, but too often location is the key challenge to child survival. We believe that by working with community health workers to create basic maps about household health behaviors and child illness and death, they will be empowered to provide more effective outreach to community members. Imagine a simple map of a rural Kenyan county showing all households and all cases of malaria in under-5 children over the course of one year. Now imagine how that information can be used for targeted education or bed net distribution. Our idea is to develop an effective approach for translating health and location data into meaningful information on a map that will help under-5 children survive and thrive.

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Mapathon Update for the IDEO Community [Updated Jan 13]:

What:
We are hosting a mapathon to generate a baseline map of the households, schools, and roads in Lwala, Kenya. We'll be coordinating volunteers to digitize (i.e. trace) these objects in Open Street Map, an online platform for crowdsourced maps. We hope to map a number of the sub-villages we serve in Lwala, so we can prototype and evolve our idea with our community health workers.

Who: We've recruited student volunteers locally in Nashville, TN (US) through our connections with Vanderbilt University. We also want to get interested members of the IDEO Community in on the mapping. If you are interested, email us at lwalamapathon2015@gmail.com and we will give you the details including instructions and contact info in case you have issues. All you need is an internet-connected computer, and no experience is required. You should be prepared to participate during the mapathon time, so we can be available to talk with you online and answer any questions.

When: Wednesday, January 14th. Starting at 7pm going to 9pm, U.S. Central Time (GMT - 6:00).

Where: Room 222 at the Owen School of Management on the Vanderbilt University campus (401 21st Avenue South, Nashville, TN 37203).
 

THANK YOU FOR EVOLVING OUR IDEA! [Updated Jan 6]
As the refinement phase of the zero-to-five IDEO Challenge winds down, we'd like to thank the IDEO Community for all the feedback that has helped us improve our idea. Here are the major ways it has evolved, thanks to your feedback.
 
  1. Incorporating human centered design, by putting our community health workers at the center of our idea. It is their active and regular participation in data collection, map creation, and process improvement that will yield the most meaningful results. Many of you highlighted the importance of this.
  2. By keeping the technology simple and inexpensive, we can better ensure success, sustainability, and repeatability for others. Thanks to your recommendations, we've moved from having CHWs do extensive mapping, to having volunteers map Lwala more quickly and effectively, using Open Street Map.
  3. Capturing the lessons learned and best practices of implementation in an implementation guide. We believe ours will be just one contribution to a much broader collection of technology-based ideas that are already improving public health in rural and poor communities.
  4. Involving the whole Lwala community in contributing to the "map" of Lwala. Many of you realized the value of engaging the whole community in understanding location as it relates to health outcomes. We think this is great, and have evolved the idea to be more community-driven.
  5. Paving a foundation to improve decision making and programs for many aspects of health in Lwala. The value of collecting location information extends beyond child health, and we intend to make sure the aproach we propose can meet the broader set of future requirements.
  6. Ensuring privacy is a central concern in all aspects of our idea planning and implementation. Many commentors noted the importance of privacy, and we've proposed a number of ways we plan to ensure we address privacy concerns, like involving our local village council.


Who we are: ​Lwala Community Alliance (LCA)
 LCA is a Kenyan-founded health and development agency that has proven success helping families make health seeking decisions. We know and serve 3,000 families with children in rural western Kenya, a region where children under 5 are 20 times more likely to die than their peers in the U.S.

Through recruiting, training, and deploying 100 community health workers to actively reach out to pregnant women in their homes from 2010 to 2014, we successfully increased the rates of hospital delivery from 26% of pregnant women to 96% of pregnant women. These community health workers have gained competencies in conducting home visits, community mobilization, data collection, defaulter tracing, and addressing cultural barriers to accessing facility-based care. As part-time stipended employees, they have been the primary agents of change regarding health-seeking behaviors in the community. [Updated Dec 17]

Now can we do the same for all children under 5? 

With this aim in mind, LCA has already launched a program called Thrive thru 5, an all-out effort to reduce under-5 mortality by 50% by the end of 2016. We utilize a community-facility approach. Frontline community health workers recruit and track a cohort of 3,000 families with children under 5 in the hospital catchment area while the Lwala Community Hospital serves as the primary care point. 


Our idea is to put the data collected by our community health workers about households and under-5 health on a map (think Google maps)- really a series of maps, and not just once, but every month. This data includes information we ask on household behaviors (Do you treat your drinking water?) as well as child illness and death (Was your child treated for malaria in the month?). We believe the insights provided by the exercise of mapping and reviewing household and public health data WITH our community health workers each month will transform the way they do their work, and will greatly improve outcomes for under-5 health. This process will also inform targeted outreach by our public health team to ensure all children in the community have access to adequate nutrition, medical treatment, safe water, proper hygiene, and immunizations. Furthermore, we believe that implementing a flexible approach that marries innovations in data and mapping technology with insights from CHWs and community members will result in a successful human-centered approach to design that can overcome unanticipated challenges and prove useful for tackling issues beyond those related to child health. Lastly, by mapping examples of health succusses in the community, known as positive deviants (check out the Positive Deviance Approach), we hope to understand what factors are positively contributing to health outcomes [Updated Jan 2].


This concept is not new. 
Lots of industries put information on a map (the “where” of their data) to do business more effectively. You probably use geographic information all of the time (think finding the best restaurant in an unfamiliar neighborhood on your smartphone). In rural, resource-limited settings, however, taking advantage of "geographic" information has often proven challenging.


This idea is not only about ensuring that children under 5 in Lwala, Kenya have access to health care. It is about demonstrating and documenting an effective approach to using technology and a basic map creation process in a rural public health setting, applying design thinking so that the outputs of this system are driven by our CHWs and Lwala community members and not dictated by limitations of the technology we use. We'd like to demonstrate, document, and share our approach to using technology in a way that helps combat the typical diseases that affect under-5 children in our region [Updated Dec 31].
How do we implement our idea? [Updated Dec 17]

One. Map our community. We'd like to crowdsource this task. What does that mean? Volunteers would use Open Street Map (check out openstreetmap.org) and map the 3,000 houses, roads, and buildings in our catchment. This same approach has been used to map countless urban and rural communities all over the world. Check out Map Kibera to see what they have done. Or zoom to Port-au-Prince, Haiti in Open Street Map to see what volunteers mapped after the devastating earthquake in 2010.

Two. Use community health workers and community youth to put meaning behind the map. While volunteer mappers will create a digital map of our community, we'll need to add context on the ground in Kenya. For example, where do under 5 children live, where are water sources improved, which areas are open defacation free (ODF) and which roads are not usually passable by vehicle. We'll utilize our CHW network and hopefully youth in the community- those with an intimate knowledge of the area- to accomplish this.

Three. Integrate into the map the public health data collected by our community health workers as part of their monthly outreaches. We would like to team up with our friends at Vera Solutions to create a suitable information management system and link this data to households that have been mapped. 

Four. Share the mapped data with the community health workers at a monthly meeting. For example, a map showing where each household in our Thrive Thru 5 program gets its water from. A map showing where each child treated for anemia in the month lives. A map showing which women who gave birth during the month delivered at home and which delivered in the safety of a health facility. We believe that by visualizing their own data on a map, community health workers will better understand the links between the environment, health-related behaviors, and child wellness. More importantly, they will be able to effectively communicate those relationships to community members they visit. Over time, we anticipate that CHWs will have increasingly valuable inputs on how best to visualize the data they are collecting, and can help evolve not only the maps themselves, but the processes we use to create the maps.

Five. Innovate and evolve what we map and how we share it each month to focus on solutions that are most beneficial, or to target particular issues. For example, if CHWs are seeing a spike in the number of under 5 typhoid cases at our hospital, we could map the households associated with those cases and try to identify the source. Or if we CHWs suspect that respiratory issues are occuring seasonally, we could work with community members to map where sugarcane fields are being burned, to 1) identify a link and 2) demonstrate the link so that the community can work to address it. We also believe that integrating other members of the community in the map development process will have unanticipated benefits for how our organization works in the community, and how the community deals with challenges beyond those related to child health [Updated Jan 2].
What does our idea look like in practice? [Updated Jan 2]
Here's a typical "use case" for an end user of our idea. It describes an example of how one CHW might benefit from a system that maps the data she collects.



Hellen is a community health worker (CHW). Every month, she checks in with families in her designated region to encourage and educate mothers on health-seeking behaviors and look for signs of disease or health issues in children under 5.  One month, Hellen observes that children in several families are showing signs of severe diarrhea. She records the number of sick children and household codes, and as part of her CHW responsibilities, reports the number of children with diarrhea and the household codes back to Lwala Community Alliance’s public health team.  At the next monthly CHW meeting, the public health team has put up a large map showing all of the households in the county as well as the known water sources that families in the community collect water from. Households reporting cases of diarrhea in the last month are marked in bright red. Some of Hellen’s fellow CHWs have also reported increases in diarrhea cases.  Using the map, the CHWs and the staff are able to identify a possible cause for the increased cases of diarrhea- a single, unimproved water source located near the center of the outbreak. The next morning, Hellen and her colleagues follow up with targeted outreach to families in the outbreak area. With a simple map in hand, she is able to demonstrate to the mothers the possible link between drinking untreated water from the identified source and diarrhea. She encourages the families to use an alternate water source and take extra precautions to treat their drinking water.  The next month, Hellen returns on her regular visits to the families in her region. Thanks to her outreach, the number of cases of diarrhea has decreased in that area, and community members are actively working with county officials to improve the condition of the water source.

Success is clear.
  1. Reach and exceed our goal of reducing under-5 mortality by 50% by the end of 2016.
  2. Demonstrate an effective approach to using basic maps of public health data with community health workers to improve health outcomes.
This means implementing flexible, inexpensive, and user-friendly technologies to collect, store, and map our community and household data. It also means ensuring that CHWs are fully involved in thinking through how we implement the idea, what their role is, and how we incorporate their feedback to improve the process.
Apple has noticed our innovative maternal and child health work, and we are excited to build on that success. 

 
How are we equipped to enact this work? [Updated Dec 18]

Lwala Community Alliance is a Kenyan-founded health and development agency with over 160 Kenyan team members on the ground and a 7-year history of delivering services in rural western Kenya, including robust IT, monitoring and evaluation, and public health departments. The organization was founded by Kenyan brothers Drs. Milton and Fred Ochieng’ who lost their parents to AIDS while studying in the U.S. Milton and Fred took this as a call to action and while medical students at Vanderbilt University, they raised funds to build their village’s first health facility. In order to address the holistic needs of the local people, LCA has multi-dimensional programming in clinical care, public health outreach, education, and economic development.

Project development and sustainability are bolstered by the level of community ownership demonstrated by our Kenyan constituents and staff. LCA was founded by Kenyans and continues to empower community leaders in the planning, implementation, and evaluation of all programs. The trust bonds that have been established over the last 7 years with thousands of local people, 13 local schools, parents, and government leaders aid implementation and growth of programming over time. In addition to a strong Kenya staff, our long-standing relationships with several U.S. universities will ensure we can innovate our approach for this idea and share the process so that others benefit from what we learn.

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

LCA’s catchment population - 3,800 families with almost 5,000 under 5 children - will directly benefit from this idea because it will make our community health workers more effective at ensuring they receive proper education, preventive care, and treatment. People of the Luo and Kisii tribes predominantly populate this rural region, which is well known for having child mortality rates that are double the national average and HIV prevalence rates that are triple the national average. This concept and the successes we anticipate could also be replicated by other organizations carrying out similar work, particularly because we will rely on a typical CHW network and simple technologies. Any organization with the desire and basic capacity could do the same. To help facilitate that, we'd love to document the process we develop, including the information management and map software applications, and the best practices for implementation. We could produce a a basic "How to Guide for Rural Public Health Mapping" to help others do the same [Updated Dec 17].

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

[Updated Dec 17] For almost two years, our CHWs have been collecting data on households to help us improve our public health and hospital activities. In addition, we currently collect some location data in the field (using handheld GPS devices) for our water, sanitation, and hygiene programs. Since the area we serve is divided into 24 smaller sub-villages, we plan to use Open Street Map to map a portion of the households in one of our 24 villages. We will then combine that data with the health data we've already collected using an open-source (free for anybody) map software called Quantum GIS, to produce a series of prototype maps of the chosen village. We will then hold a meeting with several lead CHWs to present our idea, collect feedback, and brainstorm how we can improve. We will also also gather input from our public health staff and our village development council to further understand how best to visualize the data on a map to inform CHWs and make a convincing case to community members about the links between health-seeking behaviors, the environment we live in, and child health.

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

[Updated Dec 18] The first step of this idea depends on volunteer mappers helping us put every household, school, and major foot path in Lwala on a map (using Open Street Map to facilitate the process). It is a large but not impossible task to map the 3,000 households targeted for Thrive thru 5, and help from the OpenIDEO community would be hugely beneficial in expediting the process. With enough help, we think this could be done in a week or two. We would then work on the ground to add context to that map, and to start integrating household behavior and health data into the maps. We think sharing those maps with the OpenIDEO community, with public health experts, and with peer organizations doing similar rural public health work would lead to insights about trends in communities similar to ours, and also innovations and improvements in how we visualize and communicate the data in maps to our CHWs. We plan to leverage our relationships with several U.S. universities and global health institutions to advance our idea and ensure the best approach to thinking about the data. Lastly, we would appreciate feedback from the community on the various technology options for managing data and mapping it- we have a number of ideas, but are looking to partner with organizations that specialize in this work, as well as explore recommendations and ideas from the community to make sure our chosen approach is as sustainable, flexible, and as low-cost as possible (especially using "open source" software that is free to all). The core of our idea is mapping health data and sharing it with our CHWs, whether that be on large paper maps or on mobile devices. We think to really innovate and take our idea to the next level, we could partner with organizations that are pioneering mobile health (think interactive maps on smartphones) to fully train and empower CHWs and our public health staff to collect, assess, and understand health information in the field.

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.

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