This project is strengthening the immunization services being provided at public health facilities in two sub-counties in Kenya by leveraging the demonstrated competence of frontline health workers (nurses) to mentor their peers in critical immunization skills and processes while also working closely with the nurses’ supervisors to ensure they are able to support mentors in their new role.
Our goals are twofold: 1) to identify, address, and resolve several current performance gaps among nurses providing immunization services by introducing peer to peer mentoring, and 2) to reinforce learning and improved performance. The project is strengthening networking and communication among nurses using closed WhatsApp groups in the two selected sub-counties, with a view to developing a process that could be expanded to have an impact on the Expanded Programme on Immunization (EPI) system on a larger scale.
In March 2018, JSI Research & Training Institute, Inc. (JSI) received a Next Generation Immunization Training Grant from Bull City Learning (BCL) to launch a “Peer Mentorship and WhatsApp” initiative in Kenya. The Next Generation Immunization Training Grants, sponsored by the Bill & Melinda Gates Foundation, fund innovative training and capacity building solutions to strengthen national immunization programs in meaningful and measurable ways.
Through the Peer Mentorship and WhatsApp in Kenya project, JSI worked with Kenyan health workers to develop locally acceptable ways to improve providers’ immunization knowledge, skills, increase their motivation, and improve performance. By involving providers in early assessment, JSI identified a combined approach, using both human- and technology-based learning that has been proven successful in endline assessments.
The project builds on past JSI work with the Ministry of Health in Kenya since 2012, including improving quality of review meetings and peer exchange, strengthening immunization pre-service, education, and learning, and to reduce under-vaccination. The work was conducted at facilities in two Kenyan sub-counties in Machakos and Kiambu counties. JSI leveraged the demonstrated competence of frontline health workers to mentor their peers in critical immunization processes.
From March 2018 – May 2019, JSI followed and measured the impact of this user-centered initiative with 40 health workers, addressing four key performance gaps:
- Inaccurate, incomplete data recording
- Inadequate data use for decision-making
- Failure to forecast vaccine needs due to incorrect use of stock data
- Ineffective interpersonal communication with caregivers
JSI, in partnership with Thinkplace Kenya, used a human-centered design assessment as part of a baseline assessment to identify these gaps. With the users, JSI then implemented a two-pronged adult learning approach, addressing the gaps and building capacity through face-to-face peer mentorship with the use of a digital checklist and WhatsApp groups to provide follow-up between sessions and facilitate group learning.
WhatsApp was already being used by Kenyan health workers for communications, but not as a learning exchange opportunity. WhatsApp is a fit-for-purpose, inexpensive, and practical tool for peer mentorship. JSI’s approach uses private WhatsApp groups as a forum to discuss technical questions among peers and increase knowledge remotely, thus offering a low-cost supplement to less frequent supervision visits. Achievements to date include:
- Opportunities for daily exchange between immunization expert mentors and mentees, including more frequent sharing of technical tools and resources on WhatsApp for discussion and rapid learning.
- Enhanced direct skills building through practical networking among nurses who provide immunization services.
- Ease of technical information exchange, which enables health professionals at different levels of experience to communicate and absorb and apply to learn at their own pace and locations.
During the life of the project, JSI conducted baseline, midline, and endline assessments of the peer mentorship interventions. Through a combination of interviews, mobile surveys, focus group discussions, and analysis of administrative data, the results showed successes in improved monitoring and use of data, improved documentation, and improved knowledge among health workers.