Deliverable: Performance support app
Running a district immunization program in a low-income country is not an easy job. You are expected to ensure that the twenty or more clinics in your district are immunizing 90% or more of the children in the area. Most of your clinics are nowhere near this rate, and the list of reasons why is long and hard to pin down. Figuring out how best to focus your time is very difficult, yet doing this will be a large determinant in whether you make progress or just fall into an endless pattern of churn, chasing one problem after another.
The CDC, which supports health systems both inside and outside the U.S., wanted to help. Like many global health organizations that are invested in improving the rates of routine immunization, they know that if you can get results at the district level, you can improve immunization coverage across an entire country. Supporting district level managers has the potential to make big impacts. The CDC brought BCL in to help accomplish this.
Once we began to dive in, we learned that one of the biggest challenges for managers at the district level is prioritization. Each clinic will have its own set of barriers getting in the way, from supply shortages, lack of demand for immunization, lack of vaccine knowledge, or any host of other potential issues. With twenty or more clinics to manage, making progress can feel like a never ending game of wack-a-mole.
From research as well as its vast experience, the CDC knew which questions district-level managers needed to be asking and what to do with the answers. They just needed a way to deliver this expertise to them that would be practical, easy to use, and would not disrupt the flow of their work. Enter the EPI Rapid Performance Support Tool.
A tool for prioritizing time
The Rapid Performance Support Tool is an online decision-tree application that helps district level immunization managers prioritize their time. It does this by asking them questions, converting their answers into a list of priorities, and pointing them to tools and resources they can use to address those priorities.
The first thing managers do when using the tool is to assess their situation. They answer a series of questions about the extent to which their clinics have specific problems and the urgency with which they need to be addressed. This is fed into the algorithm which outputs a prioritized list of the challenges they should address. The challenges are organized into a standard set of performance management categories including resources, staffing, skills and knowledge, motivation, incentives, etc. Managers then jump to a resource library with tools, templates, and other guidance on how to address the various problems they face. From start to finish, the process takes ten to fifteen minutes.
From the start, we knew that making the tool would only be the first step. If we wanted it to have an impact, we would need to build awareness in the community. We worked together to design a comprehensive change management campaign to gain traction. The goals were to build awareness and educate district level managers about how to use the tool, when to use it, how frequently, etc.
A plan for generating demand
To help generate demand for the tool, we helped design a promotional campaign. For any promotional campaign to work, you need to get the message, media, and distribution right. We knew the messaging would center on connecting product benefits to the work lives of managers in additional to providing practical guidance. Thus, to make sure we framed our messaging properly, we got input from numerous district managers via market research interviews. Once we had more messaging down, we translated it into a variety of media. We created videos of district managers in the field talking about it, designed infographics, wrote a press release, and designed a webinar series, among other things. And finally, we relied on two major channels for distribution, the first being WhatsApp. WhatsApp is in widespread use in the global health community with many immunization-focused groups available, including one managed by the Immunization Academy, which is operated by BCL. WhatsApp is being used as the channel for an extended, months-long campaign pushing out our various media assets. The other distribution channel is the network of partners with boots on the ground advisors working with the health systems in many of these countries.
The distribution campaign is currently underway and BCL and the CDC are enthusiastic about the impact this tool will have in improving immunization coverage.
