The ultimate goal of immunization programs to reduce morbidity, mortality and disability from preventable diseases, but the intermediate objective is to deliver effective, safe, timely and affordable immunization services.
But what works? And under what conditions do innovations and good practices emerge, take root, and spread? What are the pre-conditions that we should cultivate to make innovations more likely?
Dr KO Antwi-Agyei from Ghana, which has one of the most successful immunization programs in Africa, shared his experiences through a presentation on ‘Making reaching every district (RED) work: an experience from Ghana.’ Country director of Maternal and Child Health Integrated Program for John Snow, Inc., in India, Dr Karan Singh Sagar, talked about ‘Performance improvement using supervision and monitoring: an experience from India.’ Both discussed the relevance of their innovative intervention and how it was designed, planned, implemented, adapted, and spread.
In the Volta Lake region of eastern Ghana, for example, the health authorities have devised strategies across districts to reach distant fishing communities residing around the lake. In some urban and adjoining areas in Kenya, health staff send SMS messages to remind mothers of immunization appointments. In India, supervision is organised in periodic pulses at district-level with results instantly analyzed, discussed and fed back to all staff. In Timor-Leste [East Timor] and some areas of India, health staff are experimenting with a combined monitoring and health education tool called “my village is my home,” which tracks newborns through completion of their vaccinations and establishes a new social norm of shared responsibility between individual families and their community.
A recent Bill & Melinda Gates-funded study by Arise found that well-performing districts in Ghana, Ethiopia and Cameroon could be distinguished from stagnant districts by having linked peripheral health services with communities in a variety of creative ways. Efforts are underway in several countries to use mobile phone technology to track vaccine supply levels and adjust re-supply accordingly. Opportunities for districts and health facilities to learn from each other are needed to accelerate replication of good practices.
I believe the ultimate innovation could be to deliberately create a stimulating culture of learning that seeks to do this! Such a culture of learning is more likely to emerge when it is inclusive of multiple perspectives, diverse disciplines and broad partnerships and when staff have an opportunity to learn from peers working on the same problems.
Innovation can also be thought of as a process leading to better learning of what works and how it works in given contexts. While we should more generally identify promising and proven approaches appropriate for our unique contexts, these may or may not be novel or innovative. Investments in incremental improvement in activities, processes and products operating at scale can also overcome programme stagnation, lead to significant performance improvement and produce value over time.
**This article was originally posted on The Guardian on Monday, December 10, 2012