The past few weeks have been some busy ones with many discoveries and preparations for reinstating homevisits and scaling to two new divisions later this year.

I’ve been working hard with Matt Lee and Lindsay Cope to make the necessary changes and additions to our programs, which we will blog about in in more detail in our next entry. For now I would like to walk you through the recent vetting of our Field Officers.

Realizing gaps in the local leadership of our program has been a hard truth to swallow and subsequently unveil to Nuru as a whole. We recognize the potential implications of letting people go and shifting roles around, and are doing our best to be sensitive and creative with our solutions. We also know that if we don’t make these important changes our program will not be executed properly or be sustainable.

We currently have 11 Field Officers. Given that we are only planning to visit the families of our 450 active Nuru Farmers in Isibania Division, we only need 5-6 Field Officers in that division.  Our goal is to maintain the highest standard for the communities we serve by filling these positions with the best officers from the team.

For the last month, we have been assessing our FOs on many different categories of performance, such as: program knowledge, health and behavior knowledge, interpersonal skills, counseling technique, feedback style, and organizational skills. A weighted rubric for all the activities in the vetting process was created, and we used it to grade and calculate scores for performance comparison. This was then used choose the 6 most qualified individuals, and the other five will be able to apply for other new positions in Nuru that might be a better fit.

Our staff celebrated the extended Easter weekend, and on Tuesday we resumed with the final formal process of vetting homevisit capabilities. We organized mock homevisits using the traditional house located on the grounds of the RTC, and asked 11 non-Healthcare Nuru employees to study homevisit scenarios and serve as a mock community member. Unaware of the scenario, each FO was given 1 hour to assess the home and tailor their communication to the individual situation.

Assessing a home involves observing and asking the appropriate questions in an effective way to identify what health problems their children are experiencing, what their current practices are, and where they stand on the ‘Stage of Change’ scale for particular behaviors.

As they assess the home, they are meant to tailor their health messages based on the household’s specific situation, taking into account barriers they face when considering adopting or maintaining good health behaviors. If one of our commodities, such as WaterGuard or mosquito nets, would enable the family to adopt the behavior the FO identifies is needed, then the Field Officer should also pitch the product accordingly.

For example, our Field Officer, James, visits Boke, whose 2-year-old, Rioba, is suffering from diarrhea. James should ask a series of questions to try and identify how serious the case is and what the next steps for treatment should entail. James should also try to identify the potential causes of diarrhea and counsel Boke on how to prevent it in the future.  Hopefully, James would ask the right questions, and find that Boke always boils her water, but he sees that their drinking water is in an uncovered container that allows for recontamination after boiling.  She might mention she ran out of soap last week and hasn’t had a chance to purchase a new bar for the handwashing station.

James would identify that Boke is practicing some of the steps for healthy behaviors that prevent diarrhea, but there are some gaps in her routine. Therefore, he may remind her of the potential for recontamination and suggest she use a lid for her container (which James sees she already owns). Then he might suggest she only use a specific cup to dip to keep the water as clean as possible. He has to be sensitive to incremental change, as to not overwhelm her on his first visits. Eventually, he could propose, she consider purchasing a container with a spigot. He would let her know he has soap to purchase at that time, and also give Boke his mobile number so if she is unable to make it to the market he can go to her.

He would congratulate her on the efforts she’s already taking to keep her children, husband and herself healthy, and assure her that maintaining good health will keep expenses down so she can save to qualify for the loan she mentioned she would like to take from Nuru to start her own shop.

Now snap back to the vetting process–

The Field Managers evaluated the Field Officers performance in the mock homevisit.  Unfortunately, we found that most of the FOs were more driven by the commodity sale than by assessing the household to identify the current situation. They often began by introducing several commodities and telling the community member why the needed to use them.

We have a long way to go, but the good news is we are able to see who has the basic interpersonal skills to do the job. Also, we have been developing a participatory curriculum that will equip our Field Officers with the adequate practice and tools to guide this homevisit process more effectively.  We have also found a dynamic candidate for a Training Manager whom we have extended an offer to.

The Training Manager will be fully devoted to further developing the initial curriculum for FOs, organizing and facilitating trainings, and creating refresher and new short courses based on needs and challenges faced in the field.

Next week we will welcome Advocate Creative, our media consultants, and Lindsay Cope, the Healthcare Senior Program Manager into the field. More news to come soon about our new Training Manager!