By: Jessi Hanson, M&E Manager during her December 2014 baseline implementation in Benin
Tchonvi Health Clinic sits off a dusty road in the region known as Seme Kpodji, in Porto Novo, Benin. It first opened in 1985. The clinic services anywhere from 5 to 50 child patients a day. Of the 6 health workers in the clinic, most have been at the center for a few years. The health workers say their clinic has a few more amenities than some of its sister clinics in the region. The electricity is on most days for a couple of hours. They can sometimes turn the television on to provide entertainment to the mothers of the children coming for vaccines that morning. Generally, the power is on long enough to provide the facility refrigerators just enough time to bring the cooling temperature for the vaccines inside to an acceptable level. On days where there is not enough power, the refrigerators’ cooling dies out, and the ice inside turns to a pool of water. This puts the vaccine vials inside at risk of spoiling. But the health workers monitor the refrigerators each day to make sure this doesn’t happen. When the power is out too long, the staff will put ice packets inside to keep the vials cool.
On average, the health workers spend about 2-4 hours of their normal work day filling out vaccination records on paper to keep accurate track of the vaccines they distribute to children. The task is not light. There are multiple registries and lots of counting by hand. It can be a tedious process and errors can often be made. It adds to the number of difficulties like power that the clinic faces.
Eight months ago, Tchonvi joined other clinics in Seme Kpodji that are a part of the VaxTrac project. The health workers underwent a multi-day orientation on the VaxTrac system. The VaxTrac system contains the vaccination history records of child patients in clinics like Tchonvi. After the training, the Tchonvi health workers received weekly support visits by VaxTrac area staff, a technician who monitors the VaxTrac laptop and provides any repairs that are necessary, as well as a field supervisor who monitors and mentors the trained health workers to employ the system in their clinic.
“The VaxTrac team is a great support [to us],” remarks one of the nurses. “We enjoy having VaxTrac as a part of our clinic services.”
As a part of providing onsite support, the field supervisors check for a list of actions that the health workers should be doing. For example this week on a support visit, the field supervisor, Landry, checks the total number of reported vaccines used in a week recorded inside the VaxTrac system against the total number recorded on the paper records sent to the District Health Office. Tchonvi is doing well. The totals in both the system and the DHO paper records are an almost exact match. When the supervisor of the clinic hears this from the field supervisor, he congratulates his staff for doing an accurate job.
Even though it is still a recently new addition to the VaxTrac project, Tchonvi and its staff are one of the best performing clinics in the area. The staff team works hard to apply what they learned in training, and they continue to improve each month. Despite the difficult conditions in which its health workers work, Tchonvi strives to provide the best vaccination services that it can to its child patients in this remote region of Benin.
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!
VaxTrac is excited to announce a $2.5 million investment from the Bill & Melinda Gates Foundation to support development and implementation of improved technology for our ongoing childhood immunization project in Benin, West Africa. Since 2012, VaxTrac has been equipping and training frontline health workers in Benin to use a mobile vaccine registry system, with the goal of improving record-keeping, reducing vaccine waste, and improving vaccine schedule adherence among caretakers of children under five.
While historically the VaxTrac system has used netbooks and an attached fingerprint scanner, this award will enable our team to roll out a new Android-based iteration that can be used on any Android smartphone or tablet. The new system will be designed entirely on feedback from frontline health workers and decision makers from Benin and will allow for a more intuitive work flow and data management process. It will include updated versions of key features, such as parental fingerprint scanning, callback lists, and user-friendly data formatted specifically to the needs of decision makers. This most recent investment will also allow us to expand our coverage, ensuring that more children are immunized accurately and on time.
While we are currently serving 120 health facilities across two health zones in the coastal region of the country, the ongoing support of the Bill & Melinda Gates Foundation will allow us to add an additional zone in the dynamic resource setting of northern Benin, bringing an additional 126 frontline health workers from 25 health centers serving 148 villages into our scope. This award is the result of continued collaboration among VaxTrac, the Benin Ministry of Health, UNICEF, and the World Health Organization. We are thrilled about the continued support of the Bill & Melinda Gates Foundation and look forward to continuing our work to improve child health in Benin.
As an occasional pro bono consultant to VaxTrac (and Meredith’s maman), it was an enormous privilege for me to join the team on their recent trip to Benin. First impressions – warm welcomes from the Benin staff, red dirt streets, and sooo many motos – soon became the comfortable backdrop for our 10-day stay. With a few well-placed compliments of my fractured French, the Beninois basically had me at “Bon arrivee”.
I was a highly-interested observer of the two user-feedback sessions, in Cotonou and Porto Novo, where local health workers gave honest opinions and asked some tough questions about VaxTrac. Although the local staff were a little unnerved by the unstructured discussions, they did a terrific job facilitating and presenting the outline of the new tablet-based system. All of this gave Shawn and Duncan lots of great input for product development and refinement.
But the best was yet to come. Thursday morning, we set out on a three-day journey to Djougou, in the northwest area of Benin, near the border with Togo. Thanks to my cat-like curiosity, we made a detour to Abomey, the historic capital of the Kingdom of Dahomey. From 1625 until 1900, twelve kings ruled from here; their military victories and commercial skill made the kingdom one of the most powerful on the west coast of Africa. All twelve kings built their palaces on the same site, which is now a UNESCO World Heritage site.
We spent a couple of hours admiring the architecture and artifacts in the enormous palace complex – 12 palaces X 3 courtyards per palace = a long hot afternoon. Then, we had a five-hour drive ahead – several hours of it in the dark, over some of the roughest roads you can imagine. Ah, but the stars! Everything has its compensations.
Djougou was (mostly) a wonderful contrast to the big-city vibe of Cotonou. The health department staff are dedicated professionals, and were very helpful. The area director joined us for breakfast, and gave great insight into conditions in the area. We visited the department statistician, who shared a huge trove of data on the 33 health center locations in the region. Visits to two clinics rounded out the day.
Then there was the return trip. Eight hours, rough roads, although this time in daylight. Made it back to Cotonou just in time for Shawn and Duncan to catch their flight home.
Thanks to all: Meredith, Shawn Duncan, Fidele and toute l’equipe for including me in a great adventure!
– Doreen Baker
Hello VaxTrac community! As my first full week comes to a close I’m happy to announce how thrilled I am to be a part of such a hands on and collaborative team. From the beginning I’ve been excited to work for a group that is directly impacting others around the world in such a positive way. I come from a Marketing and Business Management educational background and bring accounting and financial experiences from several different industries, including construction and legal practices. To finally have the opportunity to apply my office skills and creative passions for a worthy cause is a dream come true. I am in awe of the WeWork Wonder Bread facility we get to work in. We are definitely surrounded by a dedicated group of talented people that cultivates an inspiring work environment. Great for the coming winter months!
I moved to DC a year ago and originally hail from Seattle, Washington. I grew up there, as many others from the Pacific Northwest, with a huge love for the great outdoors. Anytime I can get to go hiking, running or swimming I’m a happy camper. As a little girl I wasn’t allowed to come inside unless it was time to eat; I miss those days! I have enjoyed the east coast and try to see as much of this side of the country as I can. It’s amazing how much ground you can cover in just a short weekend trip. Everything is so close to each other! I love photography and I’ve been blessed with a lot of opportunity for adventure in the area. I’ve been camping on a beach with wild horses on Assateague Island, went rock climbing over a lake at New River Gorge, visited George Washington’s home in Mount Vernon and hope to have many other photo ops in this coming fall season. I also love food. I know it isn’t all that original, but I do enjoy playing around with different things and getting to eat, eat, EAT.
All in all, I’m pretty open to new things and the fact that I get to work with an organization directly impacting places and improving the lives of people around the world is just wonderful. I am beyond grateful and humbled to work with such driven and established people. I look forward to supporting all of our teams in administrative, HR and accounting roles. I’ll also be working with our team to upgrade our website. We’ve got a lot of great ideas and with the implementation of tablets in Benin and new project in Nepal coming up soon we’ll have a lot to share. As I continue to learn more about VaxTrac’s endeavors I’ll be sharing them with all of you on our social media platforms! Stay tuned, I think it’s going to a lot of fun!