Grand Challenges is a family of initiatives fostering innovation to solve key global health and development problems. Each initiative is an experiment in the use of challenges to focus innovation on making an impact. Individual challenges address some of the same problems, but from differing perspectives.
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Chijioke Kaduru of Corona Management Systems in Nigeria will use a human-centered approach to develop a community theater production that showcases real stories to educate caregivers on the value of vaccinations and increase childhood vaccine coverage. Almost half of caregivers in Nigeria lack awareness of the value of vaccines, which has increased the incidence of childhood diseases. To address this, they will stimulate social change by showcasing aspects of immunization - identifying concerns and discussing potential solutions - in a community theater production based at the income and education level of caregivers. They will work with stakeholders including immunization teams, community health workers, women's groups, and religious leaders to develop the production. The cast will be made up of community members with real experiences, and performances will be held in public places, traditional meeting spaces, schools, and places of religious worship, and be recorded for future airing. By better engaging caregivers with their human-centered approach, they expect to generate a greater demand for immunization services.
Amos Kahwa of Damax Solutions Company Ltd. in Tanzania will use human-centered design principles to develop a community-supported, social marketing approach that breaks down misconceptions and psychosocial barriers to immunization in developing countries and thereby increases demand. Research has identified several causes of the current low demand for vaccinations including misconceptions about safety, inadequate knowledge of schedules, and negative experiences at clinics. Current approaches designed to increase demand such as better education and incentives have had a limited effect. As an alternative, they propose to directly target the misperceptions and societal influences and empower the communities to help. They will first consult with community members and local government to gain further insight into the drivers of low demand that will be used to design a prototype package of interventions in collaboration with the local community. They will perform several rounds of testing and refining this package, and they will evaluate its ability to improve perceptions and social norms towards vaccinations and ultimately to improve demand.
Joseph Tucker of the London School of Hygiene and Tropical Medicine in the United Kingdom will hold a national crowdsourcing contest to develop a social media-based intervention to improve confidence in childhood vaccines and boost coverage in China. Expert-driven strategies have been launched to promote vaccination coverage in China, but have had limited effect. As an alternative approach, they will apply crowdsourcing to tap into the knowledge of individuals to design a more effective, online intervention. They will open the contest with a call for new ideas that use text, images, and videos to promote vaccinations; enable online evaluation of those ideas by crowd and expert judges; and assemble a steering committee of health experts to produce the finalists. The final content of the intervention will be developed by the finalists in an intensive 'designathon' event. They will test the new intervention in select community health centers in three cities in China and analyze its ability to improve confidence in vaccinations.
Olukemi Amodu, Mofeyisara Omobowale and Folakemi Amodu of the University of Ibadan College of Medicine in Nigeria will develop a three-part intervention to provide more convenient and accessible vaccinations for children of working mothers to increase the timeliness and completion of childhood vaccinations. Despite education campaigns, the demand for childhood vaccination in Nigeria is low, partly because working mothers have limited time to attend vaccination clinics. The three-part intervention comprises priority and more convenient immunization services at existing clinics, mobile vaccine clinics for the many mothers who work long hours in the marketplace, and a smartphone-based application to send vaccine reminders. They will test their approach in the city of Ibadan by setting up mobile clinics at three market places to provide weekly vaccination services and education counseling for mothers in their own shops. These mothers will also be supported with a savings program (VaccoSavings) to help them track money saved to pay for vaccines not paid for by the government. They will also enable mothers working in the formal sector to book vaccine appointments at more convenient times at a child welfare center where they will be attended to promptly. All mothers with smartphones will be supported by the VaccApp application to track vaccine schedules and provide automatic reminders. The impact of these combined strategies on the demand for vaccinations will be evaluated after one year.
Tapash Roy, Subhash Chandir and Toufiq Rahman of IRD Global in Singapore will improve child immunization coverage among the homeless, or floating, populations in urban slums in Bangladesh by offering vaccines during evening sessions at existing shelters. The mortality rate for children under five in Bangladesh is high, and many deaths would be preventable with better vaccination coverage. The lack of an integrated public healthcare delivery system in urban areas has resulted in a large inequity between the rich and poor, and the vaccination rate among the floating population of approximately 25,000 is well below the national average. They will develop and test a plan to provide vaccination services using an unconventional gathering place of the floating populations (called Pavement Dweller Centers) during convenient hours. PDCs have been established on city property to provide temporary shelter, safe drinking water, and sanitation services to the homeless. They will use this infrastructure to provide free, mobile phone-based digital immunization registry vaccinations during extended hour clinics with evening shifts, so visitors don't need to miss work to spend time traveling to a healthcare center. The program will be executed by personnel trained in communication to pre-empt any apprehensions by caregivers, and will involve educating visitors on the importance of vaccination. They will evaluate the feasibility and cost-effectiveness of the program in three PDCs in Dhaka and assess community response by a post-intervention survey.
Caroline Aura from the University of Nairobi in Kenya will teach frontline health workers and caregivers new skills so they can apply simple techniques such as swaddling and rocking to lessen the pain and distress of infants during injections to improve vaccination rates. Vaccination rates are still too low in many low-resource settings, which may be due in part to the discomfort they cause infants. This in turn makes caregivers reluctant to obtain all the recommended vaccinations for their children. Methods exist to reduce the associated pain of injections, but health workers lack the knowledge and skills to implement them. To test their approach, they will recruit vaccinators and community health workers at four rural immunization centers and use seminars and workshops to teach them pain-relieving techniques, including using specific positions and making soothing sounds. They will also develop audio-visual training tools and illustrative guides to help teach the techniques to parents for them to use at home as well. All healthy children under 12 months old visiting the centers for a vaccination will also receive one of the pain relief techniques. They will evaluate the ability of the health workers to manage pain, the level of distress of the infants, and the experience of the caregivers.
Andrew Seal of the Institute for Global Health and Development in the United Kingdom will test whether traditional female social groups in Somalia can adopt a participatory learning and action (PLA) approach to improve vaccine knowledge and coverage in humanitarian settings. Vaccine-preventable diseases are prevalent in Somalia; measles is the leading cause of death in children under five, yet less than 40% of children are immunized. This is due in part to lack of knowledge about the benefits of vaccination. The PLA approach is based on the idea that sustainable social change is possible if teachers and learners engage in meaningful dialogue and share ideas and experiences. Abbay-Abbay groups, common throughout Somalia, are social groups of 10-20 women, led by an elected Khalifada (lead woman). They meet regularly and have a core interest in the challenges of child rearing, with most women having direct or indirect experience with losing a child to measles. They will recruit coordinators to support Abbay-Abbay leaders, providing information and facilitating learning around vaccinations. They will evaluate their approach for improving attitudes to vaccination and reducing the incidence of measles via a randomized cluster study.
Jessica Craig of the Center for Disease Dynamics, Economics and Policy in the U.S. will use existing food distribution networks in low-income countries to publicize the importance of vaccination and inform caregivers when, where, and how to access local vaccine services by printing them on food labels, food and water carrying tools, and receipts. They will test whether their approach can improve vaccination rates using one rural and one urban area each in Kenya and in the Central African Republic. They will map their food distribution systems and health service clinics and consult local healthcare workers on the design of vaccine information materials to reach both literate and illiterate populations. They will evaluate the number of caregivers interacting with the materials using surveys in clinics, as well as the change in vaccination rate before and after a six-month period with materials in circulation. The approach is relatively simple and cost-effective because it leverages an existing network with a wide audience, and requires no additional work from frontline healthcare workers. It is also adaptable to any setting with a food distribution network, and can be expanded to deliver other types of health information.
Anita Shet of Johns Hopkins School of Public Health in the U.S. will seek to increase childhood vaccination coverage in India and Nigeria by identifying opportunities for catch-up vaccinations when under-vaccinated children are hospitalized. Of the three million people who die each year from vaccine-preventable diseases, about half are children under the age of five, many of whom live in areas where vaccinations are available, but inequitably distributed. Inadequately vaccinated children frequently become sick and are hospitalized, yet most leave the hospital without receiving catch-up vaccines because of physical and policy barriers, or perceived contraindications. They will engage stakeholders, including hospital policy makers and community workers to launch MOVE (Missed Opportunities for Vaccine Equity) to identify and correct missed opportunities for vaccination by using child hospital visits to provide vaccine education and access. MOVE has three components: inpatient in-reach, where MOVE staff check immunization records and inform hospital personnel of missing vaccines; immunization service linkage to inpatient care, which ensures that vaccines are available and provides a vaccination schedule at discharge; and community outreach to provide follow-up reminders and education. They will modify an immunization application and reminder tool to record the data and maintain a cloud-based registry, and test their approach in two large community hospitals in India and Nigeria.
Ernest Darhok of Broadreach in South Africa will use mobile technology to improve access to child immunization services for populations living on the Kenya-Uganda border and help ensure all children are fully vaccinated. Refugee populations living in cross-border settings and migrant communities are particularly difficult to cover because of limited access, poor coordination across borders, and lack of efficient tracking. They have been using a human-centered approach to understand what these populations need to vaccinate their children, and have pilot tested the use of near-field communication cards with an immunization application that holds a child’s vaccination and health data for caregivers, which they can also use to plan more convenient appointments. This card can then be viewed and updated by health workers on both sides of the border using a mobile system. They will extend this pilot study to a wider population in Kenya and Uganda to evaluate the effect on vaccination rates against polio, and apply machine learning methods to better forecast vaccination needs at cross-border facilities to avoid stocks running out. They will obtain user feedback at all stages to help improve their approach.