By Saumu Juma, Implementation Specialist, BID Initiative Tanzania
Mar 15, 2017
We are constantly learning and tailoring our approach to more effectively and efficiently roll out BID interventions. As we began implementing in Tanzania, we saw the need to adjust our strategy based on lessons learned from the early district implementations. Our refined strategy involves selecting district immunization mentors from district health staff to play a key role in implementing interventions, whereas initially, the BID team led these activities. After the mentors undergo a thorough training, they provide direct support to health workers at facilities in their districts. This approach ties in to our plans to ensure country ownership and sustainability and helps instill confidence in the health workers who are adopting the interventions.
I recently sat down with Anna Nanyanje, one of the new immunization mentors in Meru district in Arusha region. Anna currently serves as the malaria focal person who coordinates all malaria and integrated management of childhood illness (IMCI) including vaccine preventable diseases in Meru DC. Her interest and tremendous improvements in understanding the electronic immunization registry (EIR) is a testament to the district’s commitment. She is very happy with how the system will improve data use and is an expert at reinforcing to nurses the importance of better data for decision-making.
What are some of the successes as a mentor to date?
In each health facility, there is at least one health care worker (HCW) who knows how to use the system. This makes the job easier because at the end of the session, there is a champion who supports others. Some of the nurses appreciate having the system and really enjoy using it, but for others, it can be more difficult. One of the older nurses explained how hard it was to adopt the EIR. “I did not want to see this thing,” she said. She believed it was meant for the young generation and not old people like herself. However, recently she asked me, “When are we finally going to stop using these papers and continue with only our electronic system?” And added, “We do not want the paper anymore, this thing (referring to EIR) is amazing!” She even told me that when she visited Nkoaranga hospital (her former facility) and she told a colleague jokingly, “I am using the system now, what are you afraid of?”
Additionally, the introduction of mentors like myself helps the HCWs understand that the system is here to stay and not just a pilot from PATH. My role and encouragement instills motivation in the HCWs to adopt the new solutions. The best part is that now they know how to access and analyze immunization data, use the data in decision making, and use this newly learned skill in other areas such as annual plans and budgets, which are now prepared at the health facility level.
What are some of the challenges you have faced?
A few challenges we faced during visits to the facilities include staff turnover requiring additional training of new staff, staff shortage in some facilities where nurses are working in multiple departments, some HCW apprehension with the new technology and fear that they might ruin the tablet, and complaints from HCWs about the work load since they’re currently using two systems (paper and electronic) in parallel, until the ministry of health decides to make the full transition.
What are you looking forward to in your role?
After implementing BID, I am looking forward to a new Meru District with everyone using better immunization data to make decisions. I see myself, as well as other mentors, continuing to train HCWs in new facilities in our district. When I close my eyes, I see people visiting my district from different parts of the world to learn how we improved immunization data. I also see government officials using our data to stress the importance of childhood vaccination.
I also see the council taking over the responsibility of moving this initiative forward, ensuring they include different BID Initiative activities in the comprehensive council health plans (CCHP) which involves purchasing devices for facilities, maintenance and repair for those devices, and setting aside funds for continued mentoring and coaching. Last but not least, I see Meru being the best performing district!