If you’ve gotten this far into Nuru’s website, you most likely know about Nuru’s holistic model. Being part of a holistic model means that we have the opportunity to work with other program areas to enhance the impact of each individual program. The healthcare team is currently collaborating with Water and Sanitation, Education, Leadership, and M&E.

There is a lot of potential for overlap between the health and water and sanitation programs. The water and sanitation program produces hand washing stations and encourages community members to wash their hands with soap regularly. The health program’s CHWs teach hand washing as a way to prevent diarrhea, pneumonia, and other diseases. The water and sanitation field officers sell soap and Water Guard, just like the CHWs, but in the communities where we have not yet started CHW units. This helps the health program extend our reach with these important commodities, allowing more families easy access to an affordable water treatment option and soap for hand washing. It also allows for simultaneous messaging on some key health behaviors. Hopefully this repetitive messaging will encourage long lasting behavior change.

Over the last couple of months the healthcare field managers have also been training the water and sanitation team on our monthly health topics. So far they have been trained on malaria, pneumonia, and safe motherhood. After the pneumonia training, Rosa, one of the water and sanitation field managers, returned home and found a newborn baby in her area with all of the danger signs that she had just learned – fast breathing, nostrils flaring as the child breaths, gasping for air, chest in-drawing, cough, and fever. She urged the mother to rush the baby to the clinic immediately. The baby was diagnosed with pneumonia and everyone was amazed at Rosa’s ability to recognize it. Pneumonia is one of the leading causes of death of children under 5 in Kuria, so it’s extremely likely that Rosa’s advice saved that baby’s life. Teaching more people how to prevent, recognize, and treat these deadly disease will hopefully result in more lives saved.

The education team has recently started an outreach program in local schools. We are working together to design a health in the schools program to piggyback off of the education team’s work. The details still need to be determined, but we are looking forward to reaching a new audience. When our CHWs visit a home, they are typically talking only to the adults. Children are often around during these conversations, but are rarely part of the discussion. The health in the schools program will speak directly to the children about how they can prevent themselves from getting sick. Our hope is that school-age children will improve their own health behaviors while also encouraging their parents, siblings, friends, and neighbors to practice healthy behaviors. This program was successfully piloted last year during the cholera outbreak. The healthcare and education teams conducted awareness trainings at schools throughout the area, providing schools with information about cholera and teaching the students how to protect themselves and their families. The schools liked the training so much that they have asked for more. Now that the outreach program has begun, we finally have an outlet with easy access to the schools. Stay tuned for more information about this exciting new activity as it develops further.

In addition to their regular work, the healthcare field managers and program leader have been participating in the leadership trainings taught by the training team. After Basic Nuru Leadership Training, the first module has been focusing on feedback. Giving feedback effectively is important for every Nuru program area, but is especially important for the health team. In order to improve our CHW home visits, every week the program leader, field managers, and field officers attend home visits along with the CHWs. After each household visit, they conduct a debrief session to discuss what the CHW did well during the visit and what needs to be improved. At first this was extremely difficult for everyone involved. Giving effective feedback is a skill that needs to be developed. It took some time for our team to get to the point where everyone was giving decent, usable feedback. The feedback training from the leadership program has helped move the needle from decent feedback to effective, high quality feedback. Since I returned from break, I’ve seen a marked improvement in the feedback the field managers and program leader are giving to the CHWs and field officers. Their feedback is now consistently specific, actionable, and includes the reason why the necessary action is important. Although the feedback training thus far has only focused on giving positive feedback, I’ve seen improvement in both their positive and constructive feedback.

The feedback training has even spilled over into their personal lives. Nelly, the healthcare program leader, has taught her husband how to give her effective feedback and now insists that he gives her positive feedback before saying anything negative. Joseph, one of the healthcare field managers, has used the feedback techniques he’s learned about in the leadership trainings to give feedback to his children.

The healthcare team is just beginning to collaborate with the monitoring and evaluation team in order to better understand the impact our program is having on the community. We are working to develop an evaluation plan that will measure key indicators to tell us if community members are changing their behaviors toward those that reduce the disease burden on the community. We are also going to modify our current monitoring system to more thoroughly assess the most important activities of our program both for completion and effectiveness. This newly restructured monitoring system will provide continuous feedback to the healthcare team so that our programming and interventions can be regularly adapted to be as effective as possible.

If the healthcare team was working on our own in a little bubble, we would still have CHWs training the community and would still get our health messages across to many people. But we want to do better. The partnerships and collaborations we’ve developed with Nuru’s other program areas allow us to reach a broader audience with our health messaging. They also allow us to gain valuable skills that will make our programs the best they can be. We are doing the best we can to take advantage of as many aspects of Nuru’s holistic model as possible and allow our synergy to make us stronger.