Testing Interventions in Livingstone
By Fred Njobvu, Provincial Coordinator, Peter Sichilyango, Systems implementation Specialist, & Masaina Bwakya, Change Management Associate, BID Initiative
Dec 19, 2014
Last month, we joined our colleagues from both the Lusaka and Livingstone offices to visit four health facilities in Livingstone. The purpose of our visits were to test the proposed product vision and change management interventions in the facilities and obtain feedback from health care providers.
One of the facilities, Maramba Health Centre, is one of the largest health facilities in the Livingstone district and serves approximately 29,000 people. In addition to immunization and other health services, it’s also a diagnostic center for various diseases such as Tuberculosis, Malaria and HIV. Maramba Health Centre operates as a hospital since there is no first-level district hospital in Livingstone. Furthermore, it provides laboratory services with basic tests, such as CD4 count, hematology, parasitology, serology and Bio-chemistry.
Like most facilities in Livingstone district, Maramba Health Centre uses a paper-based immunization registry system. During our visit, we observed that the data management processes had substantial room for improvement. For example, due to capacity issues, some health workers had not completed the immunization registry forms. Instead, they opted to complete the forms at the end of the day, thereby compromising the quality and accuracy of the data.
As part of the BID Initiative product vision, we tested several proposed interventions. This involved capturing immunization data in the electronic immunization register using ICT tools such as barcode scanners, laptops and tablet PCs. Additionally, we tested the use of simplified paper registers to capture a child’s first under-five visit and immunizations.
As part of the change management strategy, our team engaged facility staff on their immunization service roles and responsibilities and discussed the feasibility of reorganizing the flow of clients, thereby enhancing service delivery. The health workers expressed excitement about the proposed interventions. The question we continued to get was, “When are you coming with these interventions–can we start tomorrow?” They felt that the system would help them become more efficient and improve the accuracy and quality of the data.
However, we sensed that retaining trained health staff and managing high turnover would be one of the biggest challenges we will face when implementation begins. Moreover, we will need to train staff extensively, especially in basic computer skills, as some lack the experience. We will also need to sensitize health workers to the BID Initiative’s objectives, how it will benefit the community, make their work easier, and ultimately, result in better health outcomes.
Going forward, we will continue testing other proposed BID Initiative interventions and refine the tools with feedback received from facility staff and the User Advisory Group, which is based in the Livingstone district. In addition, we are currently conducting a Project Analysis to map out stakeholders carrying out immunization-related activities and those that may have interest or influence on the BID Initiative.