Hi, Guys, thank you so much for being here! So I want to talk to you about all this.
Kirobel: Great Quote! I guess it happened gradually and then suddenly. As part of our work, we conduct field visits quite often to health facilities and one thing I quickly noticed was that many of the mothers in rural areas were illiterate i.e. they couldn’t read or write. In fact research shows that only around 52% of people in Ethiopia are literate.
However, the health system in Ethiopia provides mothers with EPI reminder cards to assist them in knowing when they should come in for their next appointment. This immediately was a red flag to me because here we are working to improve EPI performance but we’re not looking at things from the patient/consumer perspective. It led me to believe that this was possibly a big reason why we see high defaulter rates in the rural areas!
So after weeks and weeks of silently thinking about this, I realized on one of our next field visits that many mothers in rural areas would wear cultural bracelets. Therein was the spark for the idea!! The aha moment! That we could create ‘reminder bracelets’ which resemble the cultural ones and they could be used to assist mothers in knowing when to take their children to the health facility for immunizations.
And with all journeys, you need a bit of luck, and it was just our luck that Acasus at the time was funding innovative ideas to pilot, so it was the perfect opportunity!
So the team and I, then went about designing and developing the reminder bracelets, and the rest is history!
Tsion: So a funny but interesting challenge we encountered early on in the launch of the pilot happened in Afar. The reminder bracelets were so colorful and appealing that the mothers and even health workers wanted to keep them/not remove the beads after the sessions! This of course caused a dilemma as the reminder bracelets are designed in a way where each bead on the bracelet represents a vaccine and is supposed to be removed after each session.
Sadly, another big challenge we have faced is the ongoing conflict in northern Ethiopia which has led to the damage of more than half of the health facilities in Afar. This meant we had to postpone the launch of the pilot in Afar and evaluate where we could then launch the intervention to.
Guluma: We first started to see results around October/November last year. It was really encouraging to see both strong quantitative and qualitative findings coming out of the pilot as we were all so excited to see if this intervention would work.
Due to the design of the intervention, it generally takes 20 or so weeks to see the initial impact the reminder bracelet is having on the mothers. This is because many of the child vaccinations happen in this timeframe and we can calculate a key indicator (Penta dropout rate) after obtaining this data.
However, to see the full impact of the reminder bracelets, it takes around 12 months as we wait for the child to complete all routine immunizations, and this then allows us to also calculate the second key indicator which is the Measles dropout rate.
Tsion:Yes, I remember when we first started designing the bracelet and implementing the pilot, everyone on the team at the time was so excited and keen to see how this would pan out. This meant we all wanted to be a part of the approach and see it succeed!
So what this meant initially was that we each focused on a separate part of the work i.e. designing the bracelet, discussing with RHBs, selecting pilot sites, getting feedback from health workers, managing the launch, etc.
Having a collaborative approach here really helped us in launching successfully but also in pivoting when the conflict began in Afar and disrupted our work there.
Kirobel:To date, I believe there have been a couple of impacts observed both from the data and the rhetorics.
Firstly, we’ve seen that approximately from the mothers who have been given reminder bracelets, 9 in 10 children have been fully vaccinated. This is quite outstanding! And when we look at the administrative data, for both of our pilot sites, we have also seen a 29 ppt and 60 ppt improvement in the Penta 1-3 defaulter rates. Of course, this is amazing but cannot be fully attributed to the bracelets, as there are other things happening simultaneously such as health extension workers tracking down dropouts.
Secondly, a couple of anecdotes we’ve received so far from the mothers.
Kirobel: I feel the intervention is going great and now at a critical juncture. We’re looking to finalize the results of the pilot at the two initial sites over the next 1-2 months.
Once we do that, we will be looking at how we can expand the pilot to other areas in Ethiopia (so far we’ve only tested it in Oromia region). We will of course need to obtain funding and backing so that will be a main focus too, however, it’s recently been great to see that Gavi and the Ministry of Health are fond of the project and really behind us seeing this thing through.
I really feel we are solving a large bottleneck which is impacting EPI performance in Ethiopia and that this intervention will also help in areas which are relaunching health services post conflict.
Guluma:I guess similar to what Kirobel was saying, we’re
Kirobel:My favourite memory of the project to date would have to be when we went to the field to record the short documentary on all of this. It was amazing to see an idea come to fruition and just see all the mothers wearing the bracelet holding their babies. And then hearing the impact of it through the interviews we had with the mothers. Very fulfilling!
Tsion:I guess my favourite memory would be going to deliver the bracelets in our pilot HCs in Afar, it was great to see the response of the HC staff when they saw the bracelet and how excited they were to implement this tool to minimize dropouts in their catchment area.
Guluma:Conducting a field trip to capture the progress and showing decision-makers about the impact of the study makes the pilot study more interesting and favourite for me. I always gain new insight from the project.