It’s been a busy few months here at Clear Solutions and we have lots of news to share!
First, co-founder Charlie and I are thrilled to welcome new team members, Umar, Sahar and Oli (see Team page), joining in London, UK and Kano, Nigeria. With their wealth of experience in public health, community initiatives, education, and government, their skills and perspectives will be key in advancing our mission.
I’d like to thank again everyone who applied for the roles: it was a pleasure to meet so many talented people driven by social impact!
Phase 2
Our last major distribution, “Phase 2”, in partnership with iDevPro Africa, reached an estimated 20,000 children under-5 in Wudil and Dambatta local government areas (LGAs) in Kano, Nigeria. We had survey teams visit communities before distribution, and monthly afterwards June to August '24, to observe our impact upon rates of ORS and zinc treatments of under-5 diarrhoea. Surveys extended to nearby communities outside of the distribution scope, to provide comparison for a quasi-experimental evaluation.
In Phase 2 we integrated as much as possible with the local primary healthcare system, with a supervisory structure run by the ward and LGA primary healthcare teams, and distribution by government community health workers (CHWs) of the VCM and CHIPS cadre. We also trialled hybrid paper-digital “machine readable distribution tracker” forms for CHWs to record their distribution.
Our full analysis is in progress, and we will publish more soon, but here are some learnings that we take forward:
The increased operational scale, across 8 wards in 2 LGAs, went smoothly, with the teams taking in their stride the practical challenges like heavy rain and the more rural locations.
Leadership and supervision by the State Primary Healthcare Management Board and LGA Primary Healthcare teams was a key component, and we thank again them for their support. We see this integration with the health system as a foundation for scalability and sustainability going forward.
Preliminary analysis of the survey data suggests impact (increase in % of children under-5 diarrhoea cases treated with ORSZ) was comparable to our pilot: more on that coming soon!
The machine readable paper monitoring forms (scans processed by a machine learning system) was of mixed success: certainly more scalable than human data entry, and extraction of records into a digital structure worked well, but handwriting remains challenging even for modern systems to recognise reliably. This and other limitations are a focus in Phase 3.
Phase 3
The next iteration of the distribution program, “Phase 3”, starts this month, November 2024, in Dambatta LGA, Kano. Our focus is on establishing final missing pieces for growth to large scale: distributing to whole wards at once (to then combine to LGA-level coverage), and digitising monitoring of the distribution. (For context, our surveys have all been digital, but distribution involved paper trackers.)
To record distribution paths, and aggregate these to determine coverage across a population, we are partnering with Novel-T, former WHO engineers who have built tools to support the Global Polio Eradication Initiative. There are many operational similarities between door-to-door polio vaccinator teams and ORSZ distribution that lend themselves to a common digital toolkit.
The CHWs distributing ORSZ in Phase 3 are equipped with smartphones running Novel-T GTS tracker, giving detailed insights into geographic coverage. We will be using these insights to tune the operation to reliability and transparently reach whole populations.
Preparing settlement extents and target areas for distribution in Dambatta
We plan to post more on our experiences with GTS, and the GIS data that powers it, in a future blog. Watch this space.
Thank you!
A huge thank you again to everyone who has supported our mission against preventable child deaths from diarrhoea! To our health system partners, local partners iDevPro, our advisors, and the financial supporters who enable all of this: thank you, it really wouldn’t be happening without you!