Novel Approaches for Improving Timeliness of Routine Immunization Birthdose and Healthcare Worker Skill in Low-Resource Settings (Round 20)

The Opportunity

Adoption of the Millennium Development Goals (MDGs) as a global framework for action mobilized unprecedented amounts of resources and resulted in impressive global improvements on maternal and child mortality. One criticism of the MDGs, however, is that the gains were largely made by focusing on specific diseases and populations and favoring vertical strategies, done at the expense of comprehensive measures to strengthening health systems and health care delivery. The follow-on call to action to the MDGs, the Sustainable Development Goals (SDGs), shifted the global focus to quality of services, which should translate specific intervention coverage to stronger systems and good health outcomes. One important strategy for improving the quality of service delivery is the support of healthcare workers by ensuring that they are properly mentored to utilize the knowledge, supplies, and equipment that they have, and that they link effectively with communities so that caregivers access services they need. This may be particularly true for families who give birth at home or are not initiating their infants first round of vaccines. Most settings rely on supportive supervision, which is supposed to effectively mentor and build capacity of frontline health workers, improve the quality of services they provide, and positivity impact health outcomes.

However, evidence on the role of supervision has been inconclusive despite the urgent need to capacitate the workforce in low-resource settings. If we are going to continue to make gains on mortality, there is a need to move away from the reliance on traditional check-list based supervision models common in many settings, and explore approaches for sustainable and effectively provide on-the-job training or mentoring of health care workers in a way which results in the delivery of quality health care. Additionally, there is a need to identify infants left out of immunization programs and find strategies to ensure they receive their vaccines on time.

The Challenge

Within this call to reduce child mortality through novel approaches that improve quality of care in primary health facilities and prevention of vaccine preventable deaths, we are looking for innovative ideas in the following specific areas:

• Innovative ideas for improving timeliness of birth doses for routine immunization of all infants—including infants at risk for being left out of immunization programs from birth.
• Novel approaches to provide on-the-job training/mentorship to health care workers to improve quality of service delivery through enhancing or updating health care worker skills on an integrated and routine basis.

What we will consider funding:

• Innovative ideas for improving timeliness of routine immunizations, specifically targeting those infants at risk for being left out of immunization programs from birth.
  • Interventions that identify infants at risk for not receiving their first round of birth immunizations and improve the likelihood they receive them on time;
  • Approaches to link home-births to health facilities or vaccine outreach sessions to ensure infants receive their first round of immunizations on time; and,
  • Cost-effective, scalable approaches to improve the timeliness and coverage of infants receiving their first round of immunizations Approaches that focus on continuum of care linkages within the health sector (e.g. ANC connected to routine immunization follow up).

Note: The effectiveness of the proposed approach on timeliness should be evaluated in Phase I, and a clear plan for the impact of the approach on population level timeliness and coverage should be evaluated in Phase 2 if subsequent funding is awarded.

• Novel approaches to provide on-the-job training/mentorship to health care workers to improve quality of care through enhancing or updating health care worker skills on an integrated and routine basis.>
  • Alternatives to support supervision that improve management and delivery of routine immunization (either outreach or fixed site) and/or healthcare worker skills/quality of patient care. This could be done with workers at the community, health facility, or district/equivalent level;
  • Approaches that take into consideration the latest literature on effective adult learning strategies; and,
  • Approaches that are not disease-specific, designed to be done in parallel with government-lead supportive supervision, vertical in nature, or rely exclusively on a checklist;
  • Solutions that improve quality of service delivery and have the potential to be taken to scale by low-resource governments, evaluated using DHIS2 or other government owned and collected data, and be focused on the public sector.

Note: The effectiveness of the proposed approach on quality of care and/or health care worker skills should be evaluated in Phase I, and a clear plan for the impact of the approach on client outcomes should be evaluated in Phase 2 if subsequent funding is awarded.

What we are looking for:

Successful proposals will include:

• A clear hypothesis underlying the proposed approach to improve uptake and timeliness of birth dose vaccination or healthcare worker skills and/or quality of care provided;
• Details on the design and pilot testing of the approach in their application.
• A plan for evaluating the effectiveness of the approach in improving timeliness of birth dose vaccination or health care worker quality of care and/or skill using established metrics;
• Outline of the design of the proposed approach/intervention; and,

Additionally, we will consider proposals identifying in low income countries that support:

• Capacity building or new skills training—especially focusing on human-to-human interaction, with less reliance on digital technology;
• Innovations that involve building on, disrupting, or adapting existing systems. Successful proposals will describe how their approach would work within existing health systems or what change would need to occur within health systems for their approach to be effective; and,
• Projects that constitute transformative rather than incremental improvements and are deliverable and scalable in low-income countries.
• Preference will be given to proposals where the field work is done in India, Nigeria or Ethiopia.
• No additional preference will be given to proposals that address both timeliness and on-the-job training.

We will not consider funding for:

• Innovative ideas without a clearly-articulated and testable approach;
• Approaches not directly relevant to low-income settings;
• Approaches for which proof of concept cannot be demonstrated within the scope of the GCE Phase 1 award ($100,000 over 18 months);
• Secondary analysis of existing studies or systematic reviews;
• Proof of concept studies that do not clearly consider the current context of available financial systems and infrastructure for resource poor health settings. For example, ideas that are tested using expensive devices or require government-issued IDs in a country where few people have them, or to populations which require a hospital deliveries in settings where this is not the norm;
• Approaches that circumvent the public sector completely;
• Approaches that overly rely on digital technology, mHealth or eHealth applications;
• Approaches that present significant data safety risks (for mobile solutions, these risks must not be greater than the relative risk inherent in developed world mobile payment systems);
• Approaches which would require a donor’s long-term financial support to sustain; or,
• Innovative ideas that repeat conventional approaches without novel application.