Applying the iDARE Methodology in Uganda, Kenya, and Tanzania to Improve Health Outcomes During the COVID-19 Pandemic

Establish main goal using most recent available data.

Determine priority gap(s) affecting the goal using most recent available data.

Establish initial local iDARE team.

Use iDARE journal to record team goal, indicator, and regularity of tracking progress.

Used the 2020 USAID SBCA gender youth and social inclusion analysis to identify gaps in health outcomes based on social determinants, health, and geography as opposed to additional in-person focus group discussions and/or key informant interviews due to COVID-19 regulations.

Reviewed with district local government DHIS2 data looking at all district progress to health goals – HIV (adherence and viral load suppression identified).

Identified gaps and barriers experienced by nonsuppressed, actively enrolled clients through the formation of a small cohort using iDARE guide.

Identified influencers of the cohort's men, children, and their caretakers to join iDARE team using iDARE guide.

Analyzed information from cohort members using root cause analysis tool.

Virtually reviewed program data on GBV service delivery performance and identified large GESI and service delivery gaps in GBV as opposed to in-person focus group discussions and/or key informant interviews due to COVID-19 regulations.

Health workers submitted facility data as a baseline on GBV identification and management via email before training and informed iDARE training design as well as iDARE goals. Assessment also included input from the health workers on their biggest needs to improve GBV care in their health facility.

Conducted desk review of national GBV service delivery tools, policies, guidelines, and standards, in comparison to international GBV standards.

Identified capacity of health workers through a virtual assessment sent via email.

Used findings from the 2019 Act East GESI analysis as opposed to additional in-person focus group discussions and/or key informant interviews due to COVID-19 regulations.

Virtual consultations with TZNTDCP staff on key socioecological factors impacting MDA coverage.

Reviewed latest coverage evaluation surveys to identify patterns of groups missed during MDA to dig deeper.

Identified gaps and barriers experienced by community members who had previously missed MDA through the formation of cohorts using iDARE guide.

Identified influencers of the community members using iDARE guide.

Analyzed information from community members using root cause analysis tool.

Locally designed solutions to GESI identified gaps by iDARE team with support from iDARE coach.

Expanded iDARE team to prepare for applying and assessing solutions.

iDARE teams assigned roles and responsibilities to all team members.

Used iDARE journal to log and track barriers and designed solutions to test.

Virtual iDARE training on GESI concepts with supervisors and iDARE teams.

Short, high-frequency sessions and telecoaching designed to support iDARE implementation.

In-person coaching with team leader if restrictions did not allow for full group.

Hybrid and purely virtual coaching when interdistrict travel was not allowed.

Expanded iDARE teams included community influencers, identified by actively enrolled male and children clients, using semistructured interviews with nonsuppressed clients (using iDARE guide).

Virtual GBV training designed to be staggered over 6 weeks, intentionally designed to be mindful of re-traumatization and do no harm.

Virtual training designed as low dose, high frequency with practical “homework” for health workers to utilize skills learned in virtual training.

Training content designed based on the capacity assessment taken by health workers in advance.

iDARE training sessions designed based on the health worker capacity assessment and baseline data submitted by facility teams.

Three health workers specifically selected for each facility by county government supervisors based on their role in GBV identification, management, and response. Additional team members were added to iDARE team after the training.

Connected all training participants via WhatsApp groups to share experiences and solve issues together.

Mixed virtual and in-person national training of trainers (TZNTDCP staff).

Virtual collaboration and development with national trainers on GESI tools and materials for national trainings.

Revised all in-person trainings to have multiple rooms (in same location, so minimal participants in a room) connected virtually.

Team members established at start of implementation.

Review progress against set indicator.

Establish if solutions are successful or not successful and next steps.

Design new solutions to existing and or new gaps identified.

Established learning session between Kenya and Uganda iDARE coaches to share experiences in supporting iDARE implementation during COVID-19 lockdowns and restrictions.

Established learning session between Kenya and Uganda iDARE coaches to share experiences in supporting iDARE implementation during COVID-19 lockdowns and restrictions.

Incorporated feedback into every day of training (logistics, content, etc.) to adapt and revise the next day's content and plan.

Used facility data on GBV identification and management to inform progress of health workers' application of new skills and knowledge gained throughout trainings.

Rapidly adapted planned 4-month behavior change work plan to be completed in 3 weeks once approval was granted.

Revised all meeting and informal interview (using iDARE guide) plans due to regulations in place on meeting sizes. Formed multiple smaller cohorts to conduct informal interviews.

Progress on iDARE journals recorded by iDARE team lead.

Qualitative and quantitative data regularly captured by iDARE team and coach.

Training and coaching reports by iDARE coach.

Data dashboards developed for iDARE coach to see progress.

Pre- and post-capacity assessments recorded to measure progress of trainings and capacity-building sessions.

Conducting study on impact of iDARE during COVID-19.

Internal and external presentations – for example, shared results during conference sessions, including GHTechX.

Webinars and blogs.

Learning sessions between Kenya and Uganda iDARE coaches to share and expand learnings.

Expanded iDARE solutions beyond initial cohort to all active in care male and children clients.

Both facilities expanded iDARE work to additional issue areas, TB case notification, and lost to follow-up.

Learning sessions between Kenya and Uganda iDARE coaches to share and expand learnings.

iDARE teams worked on expanding their efforts in the community to ensure that individuals who have been subjected to violence know there are support services available to them at the facility.

Applied lessons learned and adapted tools to Uganda under NTD work (and currently adapting for Nepal).

Use the lessons learned for expansion to 6 additional councils in Tanzania.