Since my last blog post, I have jumped into the deep end of process evaluation. Shifra used a human centered design methodology to create their app. (As a reminder- Shifra uses mhealth technology to connect refugees, migrants, and asylum seekers with sexual and reproductive health services in Melbourne, Australia) Human centered design prioritizes empathizing with the end user and getting a deep understanding of their lived experience, designing solutions that arise from the insights gained through empathy exercises, and then prototyping those solutions with the target population. However, most evaluation work has focused on evaluating the solutions generated rather than the process itself. In exploring how to evaluate whether Shifra engaged in a true human centered design process, I did a lot of research and talked with experts in the field including public health professors at UNC and design experts at Monash University in Melbourne.
Enjoying a sunset at the Port Campbell National Park along the great ocean road.
I ended up creating a checklist of requisite steps involved in a human centered design process and interviewed refugee end users, developers, and subject matter experts who all contributed to the creation of the app. My next step is to review Shifra’s records to help me understand the process and the steps they took. Then I’ll analyze the interviews to help me understand different co-designers’ experiences creating the app. Finally, I’ll synthesize the results and write up my findings. (Hello master’s paper!)
Team farewell dinner.
Throughout this evaluation process, I have been so impressed by Shifra staff’s openness and desire to learn from their experiences. They truly adopt several mindsets of human centered design: to learn from failure, embrace curiosity, and stay optimistic. I am so thankful for the chance to learn from this organization and I look forward to staying in touch with them in the future. 🙂
Snuggling a 2 year old baby kangaroo at an airbnb along the great ocean road.
The conclusion of my UNFPA The Gambia internship has crept up on me. In the process, I have become very attached to, what some of my UNFPA colleagues affectionately refer to as “[my] second office,” Bundung Maternal and Child Health (MCH) Hospital. The tentatively named Male Change Agent Initiative we have been working on has become fellow UNFPA summer intern, Jalang, and I’s blossoming project. We have dedicated much of our remaining time developing a concept note that considers the multiple factors involved in replicating Bundung MCH Hospital’s current male engagement clinic at other facilities. Since our first attendance at the hospital’s male clinic, we have participated in each weekly discussion-style session to observe how UNFPA could increase the current clinic’s capacity while preserving the elements that make it successful. It was also critical that the overall objective of encouraging men to be more involved during their wives’ pregnancies was not lost within any potential changes or improvements.
Man with baby at Bundung MCH Hospital following a male clinic. There were concurrent antenatal and postnatal visits occuring.First Lady of The Gambia (center), fellow intern Jalang (right), and I (left) taking a quick selfie before the First Lady departs from Bundung MCH Hospital.
The work at Bundung has been receiving much-deserved recognition for the implementation of the male health talk clinic. The Minister of Health and Social Welfare (MoHSW) and First Lady of The Gambia made a joint appearance at the hospital, along with the Global Alliance for Vaccines and Immunizations (GAVI) media team, to observe the initiated clinic and speak with families present. Prior to the event, Jalang and I were introduced to two representatives from the Gambia’s Extended Programme for Immunization (EPI), one of UNICEF Gambia’s governmental (i.e. MoHSW) implementing partners focusing on ensuring the timely vaccinations of Gambian children. The representatives were informed of UNFPA’s existing male involvement concept note and were interested in integrating childhood immunizations into the clinic talks and overall initiative. This has led to the Male Change Agent Initiative becoming a partnership between the MoHSW, UNICEF, UNFPA, and Bundung MCH Hospital.
Male clinic initiative meeting between UNFPA, EPI, Bundung MCH Hospital, and UNICEF to discuss a future partnership and changes to be made to the concept note (I am at the bottom right corner).Minister of Health, Dr. Isatou Touray, arriving at World Population Day commemoration.
It has been interesting watching the project gain magnitude and essentially have other agencies “buy in” to the significant role that males play in not only improving maternal health, but child health as well. The increased stakeholders in this project will allow for an increase in financial resources to implement male clinics in many other facilities around The Gambia. I intend to continue contributing to the project as it becomes a finalized proposal, and later, implemented initiative. Though male involvement became my internship focus towards the end, I have simultaneously ensured that I gained additional experience in other work that UNFPA supports. Experiences have included monitoring and evaluation treks to other facilities, trainings of community health workers on a variety of topics, and a march to celebrate World Population Day.
A representative of Gambian Family Planning Association (GFPA) setting out contraceptives during World Population Day events
To say that I have simply enjoyed working at a wonderful organization would be an understatement. I have greatly appreciated the opportunity to observe and learn from such highly qualified and passionate mentors. Here’s to hoping (as UNFPA mandate goes) that we all continue working towards a world where “every pregnancy is wanted, every childbirth is safe, and every young person’s potential is fulfilled.”
-Fanny
Enjoy some pictures:
One of the marchers at the World Population Day event held on July 11th.Me holding a mother’s baby. The mother was present for her well-child visit while watching the First Lady’s interview with media outlet.(from l-r) My preceptor, Lamin Camara-Programme Analyst for Youth and Adolescents, fellow intern Jalang, me and UNFPA Country Representative attending the wedding UNFPA Programme Analyst-Communications.
It has been an exciting month for the Sayana Press team in Uganda – and, tangentially, an exciting month for me!
The PATH vehicle parked in the staff quarters at Kityeyera Health Center IV, Mayuge district.
After successfully launching a nationwide scale up of the provider-injected Sayana Press drug in 2016, the PATH team has been focusing on introducing self-injection. After several months observing self-injection in four target districts, the team set out to conduct an evaluation with the goals of, 1) finding out whether self-injection is working for women in rural areas and 2) learning which variation is most cost-effective.
I joined the team as they were wrapping up their first phase of the evaluation: interviewing the providers who were training women to self-inject. In the second half of my internship, we were busy preparing to launch the second half of the evaluation: interviewing users themselves. Throughout both phases, the team also facilitated monitoring visits at each site to support the field teams. It turns out, starting when I did was a perfect time! I was able to observe the launches of both phases as well as join the team in the field for monitoring visits and jump in on some trainings.
Holding a case of Sayana Press to be delivered to field sites in Mayuge district.The PATH vehicle loaded up with cases of Sayana Press for delivery.
One of the trainings was conducted in July. I joined the team’s Scale-Up Manager, Edson Twesigye, to travel to Mayuge district in Eastern Uganda to orient new providers to the program and “train the trainers” in self-injection. We visited two facilities, Kityeyera Health Center IV: a bustling, district-level referral clinic/hospital, and Muggi Health Center III, a sleepier, more rural center still serving a fairly large population. Observing how Edson facilitated the training sessions offered a lot of insight into PATH’s training methodology, and I enjoyed the chance to also facilitate my own sessions as well. I spoke to the groups about the procedure for using the self-injection register, a reporting tool developed by the team to ensure accurate data collection. The team had found in other sessions that the register was sometimes confusing for providers and was being filled improperly, particularly a few vital questions. I enjoyed the chance to discuss their challenges with them and we were able to clarify several key points. This exercise was an informative opportunity to improve my understanding of data collection tools, especially as we focused on data entry at the point of service delivery.
Conducting a training session with self-injection providers. (From left: Kirsten Miner, Violet Asiimwe, Lydia Namuganza, and Jaliya Nabirye.)
A key component of training is reviewing and practicing the self-injection procedure with each training team. Self-injection is a 10-step process which is led by a “job aid” – a series of pictures, each with a corresponding instruction, that guides a user through prep up to completion of the injection. There are four critical steps: mixing the solution by shaking the vial, activating the device, pinching the skin at the injection site (abdomen or thigh) to make a “tent”, and then pressing the reservoir slowly to inject the drug. It was exciting and illuminating to watch the training team in action!
Research Assistant Violet Asiimwe makes a model using a condom and salt which is used to simulate an injection site for a training.
After returning to Kampala from Mayuge I joined the team in completing our remaining duties to prepare for Phase II of the evaluation: client survey administration. This training offered even further opportunities for observation, learning and practice. Overall, I had an amazing internship with the PATH team in Uganda. I look forward to following the Sayana Press project further and delving into the results of the evaluations!
