Mother-Mother Teaching expands MNH care

About 20 million infants missed out on routine immunization last year, posing challenges of vaccine access and vaccine hesitancy. Efforts to achieve and maintain high vaccination rates for rural women and children, new mothers are tainted by rumours, misinformation, limited access to high quality care leading to vaccine hesitancy.

We aim to train and equip mothers/caregivers  and low/middle health workers attending immunization services in rural clinics with knowledge, tools, equipment, to provide group or one-one health education to other mothers at the facility/community. This will result in improved quality access to life saving immunization information to mothers/caregivers, strengthening their capacity complement nurses/midwives in immunization service delivery to transform lives of rural people served by local facilities struggling with human resource gaps and difficult economic conditions

Enhancing women's access to safe information, will contribute to health sector government's strategy towards reduction of maternal and neonatal mortalities, and  improved healthcare services delivery.

Despite the low cost of childhood immunisations, nearly 3 million children still die each year from vaccine-preventable diseases. Notwithstanding the widespread national Expanded Program on Immunization, immunization completion rates is persistently low in Uganda where 55% completed vaccination schedule. This is partly attributable to vaccine hesitancy and weaknesses in delivery of child immunization services.Vaccination education and information, to improve vaccination uptake, has mainly targeted communities and not individual parents, a serious problems needing corrective action

Our recent  child immunization delivery project in rural and urban healthcare settings in Uganda revealed  that face to face messaging lacked information regarding vaccine side effects and their management. Mothers’ knowledge was adequate for return date and use of the card, but inadequate on vaccine given, diseases prevented, side effects and management. The site of vaccine administration was the most commonly given message, during vaccination sessions.There were rural/urban variation in terms of infrastructure and skill set of workforces to provide quality health education and service.

Inadequacies still exist in the information given by health workers to mothers during the immunization sessions. Strategies to improve the missing content within group and one-on-one interaction between the health work and mothers are needed, hence this project.

Mother-mother teaching to improve routine immunization coverage is innovative initiative to engage caregiver in the entire immunization process. Mothers/caregivers will be trained to deliver group/one-one health education talks and support other immunization activities. The mothers/caregivers will be clustered based on their locality, a selected peer educator will be assigned to each cluster.

Recruitment and training of selected peer caregiver on immunization and techniques for sharing information using illustrative lectures, motivational talks, and demonstrations using audio-visuals, posters, role plays. Trained peer caregivers will be provided with educational materials (hand bills, leaflets, posters). The peer mothers/caregivers will be mentored and tutored by health care providers(HCP) to use this innovative approaches to address the immunization needs and concerns of caregivers in their communities and during immunization sessions(static or outreach). Trained mothers will teach designated clusters. 

Out team  will trained cohorts HCPs  and peer mothers/caregivers.  The trained HCPs will tutor, coach and provide support supervision to peer mothers. Peer caregivers will meet regularly to discuss their progresses, challenges, report issues to HCP or our team. Qualitative assessments will be conducted with caregiver evaluate the effectiveness of peer caregiver led health education and cluster in improving uptake, coverage and completion of immunization services.

We shall design high-quality messages that will be delivered by trained mothers/caregivers during health education talks. The talks shall be developed based on feedback obtained from mothers/caregivers to ensure relevancy. Random evaluation of health education talks will be done to ensure quality. The clustering of caregivers and ensuring that caregivers are responsible for one another is a unique, feasible and complemental mobilisation strategy. Conducting health education sessions using a peer-to-peer teaching approach enriches the current HCP-caregiver health education

Developed mothers/caregiver  capacity building materials will be made available on our website and promoted for local, national and global use in collaboration with the ministry of health.  Wider dissemination will strengthen relevance and timeliness of this child immunization innovations, its  adaption into maternal newborn health policy and practice. Evidence  from evaluation of this project will inform national policies to improve routine and equitable, effective immunization systems to better serve difficult-to-reach populations. We anticipate this approach will foster caregiver participation and engagement in the process of immunization, thereby offsetting some of the power relations and issues of decision making that they might face.

Our work will help enhance skills, who will in turn meet needs of underserved, in urban, rural extreme poor populations.

Immunization aligned with 14/17 SDGs and global vaccine action plan- equitably extending the benefit of immunization to all people

Uganda has highest number of un-immunised children, coverage for DPT3 was 78%, measles was at 82% which shows that 22% and 18% respectively of the children are still missed for these vital vaccines. Strengthening peer to peer learning and clustering caregivers will  improve uptake of immunization services and ensure completion of schedule. The Uganda health sector development plan  highlights strengthening of routine immunization services in districts with high drop-out rates, as a key priorities to reducing child mortality and morbidity

Our project approach and events focus on identification of persistent gaps, cause analysis, selection of interventions, verification visit, recognising achievements, community involvement, scaling up and sustainability. Caregiver clusters in their respective teams will review results, successes and challenges, identify and plan for persistent gaps and community involvement. 

Follow-up of our peer caregivers and clusters to assess transfer and applicability of learning after few months of training combined with other capacity building services will both establish performance challenges in service delivery and solutions to inform policy and action development. The study results will be availed to districts, MOH, and other implementing institutions to inform activities geared towards improving immunization service delivery.

 Benefits of creation of caregivers’ clusters -child immunization knowledge enhancement, retention of information shared during health education may compel adoption of this to national immunization strategy. Our team is committed to facilitating use of research evidence, knowledge, and recommendations to inform national policies on strengthening equitable health systems for better health outcomes in Uganda.

Caregivers will be trained to deliver health education talks and support other immunization activities to improve health of moms and babies, bolster the health programs and coverage. 

Integrating capacity building and skills development model for mothers and caregivers seeking routine immunization services within primary health care service delivery will protect the safety and health security of workforce.

Our work will help enhance skills, employment potential of health care workers at all levels, who will in turn meet needs of underserved, in urban, rural extreme poor populations.

Vaccination education and information is one of the strategies that have been used to improve vaccination uptake. Literature shows a positive correlation between parental education level and full vaccination status of children in low and middle income countries. Lack of clarity of vaccination calendar is major reasons for non-vaccination,  reasons for vaccination drop out were caretaker’s lack of knowledge of schedule, fear of reactions[11]. These studies highlight the role of communication and messaging in immunization.

Parent-provider interaction is important in maintaining the public’s confidence in vaccinations and thus improves uptake [12]. Vaccine messaging is a key player in ensuring access, awareness, acceptance and activation since these all require understanding of immunization and change of behavior[13]. Immunization communication interventions largely targeted at communities in polio mass campaigns and rarely to individual parents[14]. According to the communicate to vaccinate taxonomy (COMMVAC), purposes for messages given in face to face interactions; inform/educate, remind/recall and offering support[15]. Ugandan Ministry of Health highlights key messages which caregivers attending an immunisations should receive: 1) information on the vaccines given and the disease they prevent, 2) return date for the next visit, 3) vaccine side effects and their management and 4) safety and use of the child immunization card [16]. The ‘inform and educate’ purpose is achieved by providing caretakers with information regarding vaccines available and the diseases they prevent. 

We hypothesised that parent communication during an immunization session influences mother’s understanding of immunization and in turn completion of the schedule. 

The cluster and peer to peer caregiver model are scalable innovations across health facilities/community on a wider scale, provided there is supervision, integration of such activities in the district work plan/budget, the skills acquired are transferrable and replicable to reach a wider community. 

Working with MOH partners, efforts to ensure resource packages caregivers in clusters for events and the use of the results for organisational improvement and efficient service delivery will be prioritised. Furthermore, district health teams and MOH partnerships in the project; might catalyse, adoption and integration of the innovation across different health facilities with minimal resource needs. For example, the skills that the peer caregivers will acquire can be used to address service delivery needs in RMNCAH. Research questions or additional opportunities for innovation that will arise from will potentially be proposed for continued funding scale up the best practices. In addition, there is a possibility of integrating this project to the already existing funding steams in government. Opportunities to work with implementing partners and target user communities will be explored during the review sharing, stakeholder workshops

Instructional materials and products from this project will be posted on our website an social media, print and broadcast media conference presentations, policy briefs and digital stories (uploaded on our website) and peer review publications to disseminate the findings to wider audiences.

Both the due diligence, pre and post evaluations will capture the effectiveness, relevance, efficiency and scalability of the mother-mother teaching initiative to improve immunization service delivery

The theory of change on which our approach is built is that if HCP and mothers/caregivers acquire knowledge, skills and attitudes, they are able to effectively and efficiently manage health education during immunization sessions and community mobilisation, collaboratively improve immunization delivery. Through community engagement we shall collective identify knowledge gaps, rumours, misinformation strengths, weaknesses and develop customised HCP and mothers/caregiver trainings, mentorship, coaching, benchmarking capacity building package as well as assumptions to be tested. Develop more coherent capacity building programme constructed from logically developed benchmarks informed by this due diligence exercise. This will be used as means of institutionalisation of learning/processes to scale the intervention.

The project learnings will be analysed in context of COM-B(Capability-Opportunity-Motivation-Behavior) model which  recognises that change in behavior results is linked to interaction between capability(knowledge and skill to perform an action); opportunity  (social norms, physical resources); and motivation(inner drive, conscious decision-making).

Our initiative will increased level of knowledge, integration of services, participation of mothers/caregivers(capability). Mothers/caregivers will be given tools, equipment, information education and communication materials to support their activities in addition to the mentorship, coaching and support supervision from trained HCP(Opportunity), couples with incentives (motivation) will led to change in behavior and thus increase uptake of services, completion of vaccination schedules and reduction in coverage

Preference for design/adaptation of peer caregiver learning and instructional materials will be containing the theoretical content and the tools needed to facilitate quality improvement process. Change management, stakeholder analysis, and use of tools for quality assessment, gap identification and initial cause analysis will be done. 

 Emphasis on feedback and operational action plan, and formation of facility level implementing teams, pre- and post-evaluations will be done. Dissemination events with districts, national stakeholders and implementers of immunization programs to share findings/implications of the innovations, generate and share robust actionable recommendations with a wider forum and network of immunization service delivery.

Participatory action approach working with mothers/caregivers , formed clusters and HCP involved in cascade activities to deliver information about child immunization thru small manageable groups linked to the health facility and existing VHT network will reinforce knowledge transfer and translation at community.

The pilot project will be conducted in two health subdistricts(500,000 people) in two districts, covering more than 10 health facilities and their respective catchment populations. Mothers/caregivers, new mothers and their babies in catchment populations will be reached. The caregiver clusters will be community based. This will ensure sustainability since the members are based in the community and will be able to provide ongoing support to other group members even when the project ends. The caregiver clusters will be supervised by members of the Village Health Team (VHT) who are already a sustainable and established community structure. MOH level that will continue to be leveraged after the project ends. Participatory instructional materials development for health education talks will foster ownership and sustained use.

The primary caregivers bringing their children for immunization are mostly women (Mothers, in-laws, siblings). By implementing the innovations that increase their awareness and knowledge about child immunization delivery, this project will contribute towards increasing their self-efficacy and empowerment in taking informed decisions on issues of child immunization. 

Likewise, in instances where men are the primary caregivers, the project will embolden them to take on the role of peer-to-peer teachers. This will further the current efforts of the Ministry of Health in encouraging male participation in infant and child care. The creation of caregiver clusters will also take consideration of both males and females. Thereby no one will be left behind, this initiative is in line with efforts towards universal health coverage and sustainable development goals.

Our foundation is deeply rooted in building capacity of local communities and best positioned to lead resilience to   crises affecting poor and vulnerable people, in remote location. Addressing social, cultural and ecological contexts reinforce community long-term participation and build community resilience, for a holistic response to public health situations.

We shall continue to look for financial support to scale up the intervention  thru private-public partnerships, grants, donation, and service delivery.

 Will provide  traditional and e-learning options for delivery of the trainings  Position the institution as a leader in efforts to advance health workforce capacity building and community engagement in rural hard-reach communities, bringing health care with in a walking distance.

Collaborate with, community members, district health teams, ministry of health and implementing partners and programs engaged in related forms of experiential, community-based teaching, learning, scholarship to bring the innovation to scale

To strengthen such efforts we shall generating new models for effective community engagement across a range of environments garner external funding in support of the teaching, learning,  activities associated with maternal and newborn health.

There is a civil service attitude among many public service health facilities staff at times do not take changes seriously. There is a fear that the quality of training and transfer of learning could be affected by non-consistence in implementing the initiative 

The fear that public servants may not want to adapt to new evidence based innovations

Accessibility of the institution and availability of the trainees for mentorship
and follow-up sessions may prove a challenge. This could affect transfer of skills.

The risk of inadequate financial flows/disbursements that may affect
implementation of works

Liaise with facility in-charges and districts to emphasise the importance of the exercise to nominated staff to attend. The residential nature of the training events may improve commitment of the trainees. The due diligence exercise will also emphasise the need for reinvigorate public performance (mindset change)

The training design will emphasise key evidence based performance indicators and result areas with our public service  HCPs, planning and working closely with  them in monitoring and follow up so that institutional programs do not the mentorship events.

The team of professionals to undertake the project are renowned program implementers, innovators, researchers and pedagogical experts with experience in child immunization, quality improvement, global health, public health, reproductive maternal newborn, child and adolescent health, and midwifery. The PI will provide mentorship and guidance to the junior researchers   on the team, engaging them in the process of developing and implementing them will foster learning in the area of research grant development and execution, the policy expert will do the same for knowledge translation aspects. The best practice model will be scaled up and implemented in other health facilities in Uganda.

5

Team has public health specialist, researchers and educationist. With experience in development and implementation of projects, analysis of quality of service delivery. The team lead guides identification of competency gaps, guide capacity building initiatives, and develop and manage training activities.  One team member is a social behavior researcher, with vast experiences in health programs design, and implementation, a  researcher and evaluator. Another team member has deep knowledge of the local context, business administration, international relations and diplomacy. Graduate nurse/midwives on our team, with clinical , training, and research skills including qualitative and quantitative approaches. The Masters prepared midwife team member is a , practitioner, educator and researcher.A secondary school teacher and administrator has vast experience in community engagement initiatives, public relations and social mobilisation. We work closely with Ministry of Health partners who ensure relevance of our innovations in line with the policy directions as well as building on existing initiatives. Provide input  and guidance in development of the innovation and research design in the context of Uganda; and in the implementation of the research projects; collaborate in facilitating the research to policy structures and uptake of results into policy and practice.

We seek mentoring from Multi-tech Business School who offers us direction, enhancing our knowledge on how to sustain asset relating to our status and identity, and business skill enhancement.

Makerere University: collaborate on research, training and community service

Ministry of Health- policy and knowledge translation

Multi-tech Business School- financial management

Nurses, midwives, medical doctors, village health teams, health facility in-charges in rural and urban health facilities

District health teams : bottleneck analysis and work in line with districts priorities

Civil society organisations- private not for profit alliances, consortia

Secondly  and primary schools

Luziibangi Foundation Limited is a private-note for profit NGO based in Uganda. LFL secures and will potentially secure most of its funding from private foundations and governments. In recent year LFL  received funding from consultancies/technical assistance, loans to develop infrastructure. Financing will be thru internal sources like fees, donations, subscription charges; and external sources like grants in the form of aid from the Government, private organizations or foreign sources. Relying on donations of regular users is an envisioned revenue model for nonprofits.

We shall adapt with modifications the Environment-Strategy-Structure-Operations (ESSO) Business Model (Lim 2010) which takes into consideration the alignment of the organization’s strategy with the organization's structure, operations, and the environmental factors in achieving competitive advantage in varying combination of cost, quality, time, flexibility, innovation and affective.

We shall launch short courses, tools, online resources, certificate/ diploma courses,  accessible in resource-constrained contexts to build sustainability of our initiatives.

With support for infrastructure expansion, equipment cost, labor cost, advertising, operations we aim to establish a health center for training, research and service delivery. We hope to partner with the government thru public-private partnerships and other stakeholders to support the health service delivery, operations research and  community engagement initiatives

The foundation school buildings are a hub to attract  faculty, staff, students, and community members work in a collaborative environment to create rich, service/engaged learning and teaching experiences. This will contribute to significant increases in student retention and graduation rates; and thus establish the LHL as a leader in these areas. We shall further make our initiatives known thru media-print and broadcast, our website, and community campaigns.

We are already active in the country of origin in consultancy e.g recently partnered on the Analysis of child immunization delivery project, referral for RMNCAH projects. LFL took over a secondary school that has been running since1990, we shall thru our work packages and measures of project implementation strengthen and expand the secondary school.

We project to run: Nursing, midwifery, comprehensive nursing programs at diploma/certificates, short courses in public health nursing; women’s Health, pediatric/child health, critical care, oncology, mental health, community health. Upon securing additional space we hope to expand to exploit the potential for cross disciplinary training, research and services and collaboration with researchers from other institution. The envisioned expansion will further strengthen research capacity, and position our institution as a hub of national research, evidence based practice.

Despite the low cost of childhood immunisations, nearly 3 million children still die each year from vaccine-preventable diseases. Notwithstanding the widespread national Expanded Program on Immunization, immunization completion rates is persistently low in Uganda where 55% completed vaccination schedule. This is partly attributable to vaccine hesitancy and weaknesses in delivery of child immunization services. Vaccination education and information, to improve vaccination uptake, has mainly targeted communities and not individual parents, a serious problems needing corrective action

Our recent  child immunization delivery project in rural and urban healthcare settings in Uganda revealed  that face to face messaging lacked information regarding vaccine side effects and their management. Mothers’ knowledge was adequate for return date and use of the card, but inadequate on vaccine given, diseases prevented, side effects and management. The site of vaccine administration was the most commonly given message, during vaccination sessions. There were rural/urban variation in terms of infrastructure and skill set of workforces to provide quality health education and service.

Inadequacies still exist in the information given by health workers to mothers during the immunization sessions. Strategies to improve the missing content within group and one-on-one interaction between the health work and mothers are needed, hence this project.

a)     To establish, create and run a skills training center for face- to-face/ online skills based training and continuing professional development courses and programs in health, nutrition, and population.

b)    Design research initiatives to build and strengthen the organization’s research infrastructure and capacity.

c)     To collaborate with CSO, NGO’s, development partners, implementing partners in education and health, nutrition and population related activities.

We would like to partner with organisations, individual, funders and donors focussing on high-impact health training, research and health service care delivery to the hard-to-reach communities.

How can they help?

Thru funding, donations, sharing expertise on business development, research and development collaborations

To adequately serve Uganda’s rapidly growing population and in keeping with national aspirations of transforming the country into a Middle- Income status, there is need to support tertiary/community based training. Support local governments and community driven solutions, communities engagement thru capacity building, facilitating ownership and use of technology to amplify local efforts. Ensuring that public health measures are underpinned by actions that facilitate hard-reach equitable health coverage, collaboration with health care providers and community groups to ensure affordable access to health information, care and services.

Provide research for evidence based practice, mapping and knowledge for informed decision making. Mobilize local and international partners to support research, technical assistance and health care service , enabling a more targeted response to hard-to-reach emerging priority needs including health services, water and sanitation, food/nutrition. Foster learning, training and capacity building and knowledge translation to inform policies and programs. Mitigate and expand access to quality education by enhancing  capacity of municipalities and local service providers to ensure the availability of essential services, prioritize actions to improve health, education, and prosperity. Nurture multi-stakeholder partnership with not-for-profit initiatives to develop new insights and knowledge on longer-term policy

To adequately serve Uganda’s rapidly growing population and in keeping with national aspirations of transforming the country into a Middle- Income status, there is need to support tertiary/community based training. Support local governments and community driven solutions, communities engagement thru capacity building, facilitating ownership and use of technology to amplify local efforts. Ensuring that public health measures are underpinned by actions that facilitate hard-reach equitable health coverage, collaboration with health care providers and community groups to ensure affordable access to health information, care and services.

Provide research for evidence based practice, mapping and knowledge for informed decision making. Mobilize local and international partners to support research, technical assistance and health care service , enabling a more targeted response to hard-to-reach emerging priority needs including health services, water and sanitation, food/nutrition. Foster learning, training and capacity building and knowledge translation to inform policies and programs. Mitigate and expand access to quality education by enhancing  capacity of municipalities and local service providers to ensure the availability of essential services, prioritize actions to improve health, education, and prosperity. Nurture multi-stakeholder partnership with not-for-profit initiatives to develop new insights and knowledge on longer-term policy