Adjumani Design Challenge

Improving immunization data entry for front line health workers

Design without Borders (DwB) is currently engaged in a partnership between the  Makerere University - Johns Hopkins University (MUJHU) Research collaboration, where DwB is co-designing system requirements and front end user interaction through an e-solution to promote improved immunization data entry and use for decision making with a core focus on front line health workers (FHWs)

Partner: Makerere University - Johns Hopkins University (MUJHU) Research Collaboration Year: 2019 Sector: Health

The Challenge:

The combination of insufficient funding for immunization staff, bulky paper-based records and high volumes of patients in need of vaccination services in Uganda, leaves front end health workers overburdened with heavy workloads. This increases the risk of reporting inaccuracies and delays.

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The project sought to improve the quality, timeliness and use of clinic-based immunization data through a more integrated e-health solution. The idea was to use existing technologies and human-centered design methods to promote data entry and use for decision making by busy front line health workers and district managers so as to improve delivery and integration of immunization services. By integrating human-centered design approaches; DwB  worked to address two inter-related service delivery issues: 

  1. maximizing immunization opportunities at health facilities and
  2. provision of integrated service delivery.  

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Solution

Through field visits to all health center levels, we collaborated with all the key stakeholders in this process such as front line service providers, unit/facility heads and program managers, as well as users (women and children), and used tools such as visual mapping, cultural probing, critically observing the daily procedures through shadowing, tangible dialogue and co-creation to unearth critical barriers and opportunity areas. As a result, we developed a “Lean Protocol” that provided seven separate lenses through which the immunization system was being analyzed. 

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 We then designed several illustrative maps depicting data and communication flows, service delivery routines, roles and responsibilities at facility, district and national levels. These were used to facilitate constructive dialogues and validation sessions that brought together all the different stakeholders in the system. All the findings and data captured from these interactions was then organized using the “Lean protocol” and formulated into key design criteria to guide the development of potential solutions.

These actors were later engaged in co-creation sessions where they together came up with various ideas within the design criteria that could ably address the key challenges and system gaps. Their continued involvement although previously an unfamiliar approach, yielded better coordination and communication within their respective facilities and their relationship with the District level staff. This also yielded greater inter- and intra facility learning through adoption of successes and sharing from their different experiences. As a result, the previously underperforming facilities are now able to identify the necessary areas of improvement and devise solutions known to be working in the better performing facilities.

Currently the Uganda Vacc+ project is at the stage in the design process where we are combining and refining the proposed solutions that were a result of the stakeholder workshops. During this stage the multiple ideas are combined into concepts that are refined to better address the need, gaps and challenges identified. The purpose of this is to garner valuable feedback from the users, revise the concepts based on the feedback before large scale piloting.

Key activities

  • Ethnographic user and systems research and context analysis was conducted using interviews, workshops, surveys, site visits, current data management tools analysis, focus groups, observational studies, and contextual inquiry.
  • Facilitation of design thinking and co-creation workshops with HCII, HCIII and IV facility level Healthcare workers, and District level; Expanded Program on Immunization (EPI) focal person, Biostatisticians and Cold chain management, facility managers and other EPI implementation partners.
  • Co-design and identification of recommended User Experience (UX) and User Interaction Design data management tools, service interactions and data usability.

   

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