Piecing Together the Nepali Project
By: Lauren Spigel, Program Associate
Part I: Vial to Child
Many moving parts must come together to execute a project. Imagine a puzzle in which all the pieces are constantly evolving and changing shape. How do you put it all together to form a cohesive end product? How do you know which pieces are the corner pieces—vital for defining what the picture should look like? How do you adapt when some pieces no longer fit within the scope of the puzzle?
Managing a project is a lot like this.
When Meredith, Shawn, Amelia and I traveled to Nepal in November, we were faced with the challenge of filling in a lot of missing puzzle pieces in order to prepare for the launch of our new project called Vial to Child.
Vial to Child will use Optical Character Recognition (OCR) technology to link each vaccine vial to the children that receive their dose from that specific vial. OCR works just like your mobile banking app. Take a picture of your check and the software will capture the words and turn it into text. Similarly, our OCR app will capture crucial information from each vial, such as the lot number, batch number, and type of vaccine simply by taking a photo of the vial. The idea of this is that if there is a bad batch, the Nepali Ministry of Health will be able to track it and see which children received a dose from it.
In early 2015, we will train health workers in two districts of Nepal—Nawalparasi and Dadeldhura—to use our Android-based app to register each child that receives a vaccine and to record which vial is used for their vaccine. We will be implementing Vial to Child in 45 health centers between the two districts, serving a population of roughly 36,000 children under five. Since Meredith and Mark visited Nawalparasi in August, this trip focused on finalizing plans with our partners in Kathmandu and doing a site visit to Dadeldhura.
Dadeldhura is located in the Far Western Region of Nepal. Whereas Nawalparasi is in the terai, a flat area of Nepal, Dadeldhura is located in the hills. This means that we must account for the difference in access when considering how to roll out Vial to Child in each district. Although the population in Dadeldhura is smaller than in Nawalparasi, people are dispersed throughout the mountains and sometimes must walk several hours to reach the nearest health center.
Part II: Site Visit to Dadeldhura
To get to Dadeldhura, we took a small plane to Nepalgunj where we met up with our UNICEF colleague, Meena Thapa, who works in the region. From Nepalgunj, we drove for seven hours. The first four hours were easy because the roads were flat, but the last three hours felt like being in a perpetual roller coaster as our car made its way up the windy mountain roads.
I slept most of the trip, mostly to avoid car sickness, and awoke only to eat at Meena’s favorite spots along the road. We stopped in one village to eat the typical Nepali dish, Dal Bhat, which is comprised of lentils, rice, spinach, and curried vegetables. We stopped a second time part way up the mountain to eat rice pudding from a man who cooks it in a giant iron pot on a wood-burning stove, carefully stirring the rice and milk together until they merge into a perfect gooey creation.
Even though we left Kathmandu in the morning, we did not arrive in Dadeldhura until dark. The next morning we got see how beautiful the town was. Dadeldhura looks like it’s in layers because it’s built on hills, and is surrounded by white-capped mountains. The buildings are four or five stories tall and are painted in bright pinks, greens, blues, and yellows.
Our objectives for this site visit were to meet with the District Health Office (DHO) to present the project to them and to coordinate with them to see some of the health centers. While the DHO was optimistic about the project, within five minutes of talking to them, we learned that they are facing a significant staffing shortage—13 out of the 20 vaccinator posts are unfilled. This is will present an interesting challenge from a training perspective because we need to train someone from each health center on how to use the Vial to Child system.
Luckily, UNICEF is running a pilot project in which they have already trained a number of women to be Auxiliary Nurse Midwives (ANMs). The ANMs are based in each of the health centers and are sometimes involved in the vaccination clinics. We will be able to train the ANMs to use the Vial to Child program in the clinics that do not already have a dedicated vaccinator.
We made trips out to three different health centers while we were in Dadeldhura. At each health center, we interviewed the person in charge, the person responsible for giving the vaccinations, and when available, we also interviewed mothers of children under five as well as Female Community Health Volunteers (FCHVs). There is a FCHV in each of the nine wards served by each health center. Since they know all of the women and children in their respective communities, they work with the health center staff to notify families of upcoming vaccination sessions.
Interviewing staff and patients at the health center helps us understand how the vaccination system works: when and how often there are vaccination sessions, who administers the vaccines, if the health center counsels families on the vaccines, general attitudes towards vaccines, how the cold chain works, what happens when a child misses a vaccination session, etc. Health workers were generally very excited about the idea of using tablets to register the children. Their main concerns were not about the technology itself, but about keeping the tablet dry during the rainy season and how to store it so it is safe from theft. All of this information informs the way we design the Vial to Child app as well as how we implement the project.
Part III: Back in Kathmandu
After Dadeldhura, we returned to Kathmandu for one final week of orchestrating meetings with our project partners, including UNICEF, WHO, the Ministry of Health and local tech companies. Working with the Ministry of Health is the key to executing a successful project in Nepal. If Vial to Child works, we want the Ministry of Health to have ownership of the project so they can incorporate it into their national plan. We are thus relying on them to put together a Technical Advisory Group (TAG) of our key partners to direct and manage the project.
We experienced a slight hiccup with the Ministry of Health just a few days before leaving for Nepal. Nearly the entire staff of the Child Health Division (CHD) within the Nepal Ministry of Health changed hands suddenly. Thus, a major challenge of this trip was reestablishing contact with CHD. It was difficult timing-wise because the new CHD director started his post during the second week of our trip. We were finally able to meet with him and solidify plans on our last day in Nepal, which happened to be his third day of work.
We left it to CHD to organize a TAG meeting between all of the project partners in December. Our new Nepal Project Coordinator, Amelia, will be moving out to Kathmandu in January to oversee the project, and a small contingent of us will be back in Nepal in February to begin rolling out Vial to Child.
It is going to be a busy and exciting couple months, but to be perfectly frank, I’m happy to leave DC winter behind. Until next time, Namaste!