Skip to main content

Main menu

  • Content
    • Current Issue
    • Advance Access
    • Archive
    • Supplements
      • The Challenge Initiative Platform
      • Call for Abstracts
      • The Responsive Feedback Approach
    • Topic Collections
  • For Authors
    • Instructions for Authors
    • Submit Manuscript
    • Publish a Supplement
    • Promote Your Article
    • Resources for Writing Journal Articles
  • About
    • About GHSP
    • Editorial Team
    • Advisory Board
    • FAQs
    • Instructions for Reviewers
  • Webinars
    • Local Voices Webinar
    • Connecting Creators and Users of Knowledge
    • Publishing About Programs in GHSP
  • Other Useful Sites
    • GH eLearning
    • GHJournal Search

User menu

  • My Alerts

Search

  • Advanced search
Global Health: Science and Practice
  • Other Useful Sites
    • GH eLearning
    • GHJournal Search
  • My Alerts

Global Health: Science and Practice

Dedicated to what works in global health programs

Advanced Search

  • Content
    • Current Issue
    • Advance Access
    • Archive
    • Supplements
    • Topic Collections
  • For Authors
    • Instructions for Authors
    • Submit Manuscript
    • Publish a Supplement
    • Promote Your Article
    • Resources for Writing Journal Articles
  • About
    • About GHSP
    • Editorial Team
    • Advisory Board
    • FAQs
    • Instructions for Reviewers
  • Webinars
    • Local Voices Webinar
    • Connecting Creators and Users of Knowledge
    • Publishing About Programs in GHSP
  • Alerts
  • Visit GHSP on Facebook
  • Follow GHSP on Twitter
  • RSS
  • Find GHSP on LinkedIn
FIELD ACTION REPORT
Open Access

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

Amanda Ottosson, Joyce Draru, Luseka Mwanzi, Stella Kasindi Mwita, Sara Pappa, Krista Odom and Taroub Harb Faramand
Global Health: Science and Practice June 2022, 10(3):e2100623; https://doi.org/10.9745/GHSP-D-21-00623
Amanda Ottosson
aWI-HER, Stockholm, Sweden.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: aottosson@wi-her.org
Joyce Draru
bWI-HER, Mbale, Uganda.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Luseka Mwanzi
cWI-HER, Nakuru, Kenya.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Stella Kasindi Mwita
dWI-HER, Dar es Salaam, Tanzania.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Sara Pappa
eWI-HER, Vienna, VA, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Krista Odom
fWI-HER, Addis Ababa, Ethiopia.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Taroub Harb Faramand
eWI-HER, Vienna, VA, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
PreviousNext
  • Article
  • Figures & Tables
  • Info & Metrics
  • Comments
  • PDF
Loading

Figures & Tables

Figures

  • Tables
  • FIGURE 1
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 1

    iDARE Methodology

  • FIGURE 2
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 2

    Percentage of Enrolled Men and Children Active in Care Who Were Virally Suppressed During iDARE Implementation, Nagongera Health Center and Mulanda Health Center, Tororo District, Uganda

  • FIGURE 3
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 3

    Gender-Based Violence Cases Identified and Managed by iDARE Teams, by Sex, in 8 Facilities in Nakuru, Laikipia, and Kajiado Counties, Kenya, January 2020–March 2021

Tables

  • Figures
    • View popup
    TABLE 1

    Nagongera Health Center IV, Uganda, iDARE Baseline Assessment of Clients Virally Suppressed, August 2020

    Total Clients Active in CareTotal Suppressed, No. (%)
    Women (age 20 years and older)883811 (92)
    Men (age 20 years and older)550357 (65)
    Children (age 19 years and younger)10362 (60)
        Girls5640 (71)
        Boys4722 (47)
    • View popup
    TABLE 2

    Mulanda Health Center IV, Uganda, iDARE Baseline Assessment of Clients Virally Suppressed, September 2020

    Total Clients Active in CareTotal Suppressed, No. (%)
    Women (age 20 years and older)637536 (84)
    Men (age 20 years and older)347296 (85)
    Children (age 19 years and younger)5238 (73)
        Girls2921 (72)
        Boys2317 (74)
    • View popup
    TABLE 3

    Sample Issues and Solutions Applied During iDARE Implementation to Improve Viral Load Suppression Among Children Active in Care, Nagongera Health Center and Mulanda Health Center, Uganda

    IssueSolution TestedFacilitySuccessful/Not Successful
    Lack of support from parentsCase-by-case basis: One community linkage facilitator and the pastor (influencers) encourage parent(s) to bring children to the facility for their appointments, ensure they have food to take with medication (see below), and provide transport (if they are unable to come, they send the child with a responsible person or organize transport). See children and adolescents on Thursdays at the facility.NagongeraSuccessful
    Staying with elderly (such as grandparents)Community linkage facilitator (also the identified community influencer on iDARE team) takes medication to child at home; pastor (influencer) also conducts home visits with these children. Pastor organizes transport (when needed) to the facility for their appointments.NagongeraSuccessful
    Lack of foodReligious leader, identified in both areas as a community influencer and recruited for iDARE team, designated to lead support for the children. The religious leader has done outreach and lobbies community members during designated Sunday church services to contribute food for the children.NagongeraSuccessful
    MulandaNot successful
    • View popup
    TABLE 4

    Monthly Number of Survivors of Violence (All Ages) Identified and Managed in 8 Facilities During Baseline by iDARE Team, 3 Counties, Kenya, 2020

    JanuaryFebruaryMarchAprilMay
    Monthly PEPFAR target2,494
    Female survivors7971897095
    Male survivors946127
    Percentage of monthly (male and female) PEPFAR target, %43434
    • Abbreviation:; PEPFAR, U.S. President's Emergency Plan for AIDS Relief.

    • View popup
    TABLE 5

    Gaps and Successful Sample Solutions Applied In Identifying and Managing Survivors of Gender-Based Violence, Recorded by Provincial General Hospital County Referral iDARE Team, Kenya

    Gaps in GBV Identification and ManagementSuccessful Solutions
    Lack of identification pointsSensitize management and other departments, including training on screening and referral of survivors to the GBV clinic.
    Lack of provider knowledge and skill to care for GBV survivors
    Reporting tools only identify sexual GBVImplement new registry that reports on physical, emotional, financial, and sexual violence.
    Single GBV registry for case reporting, and no registry at the drop-in centerProvide expanded GBV registry for each department.
    Provide expanded GBV registry for the drop-in center.
    Staff shortage and high workload, especially during COVID-19 pandemicSensitize and train community health volunteers and community health workers on GBV care.
    Lack of community knowledge of resourcesProvide health talks to the community, targeting survivors.
    Provide literature to survivors with information on services.
    Disorganized GBV data management across departmentsForm a WhatsApp group to assist in the management of data.
    • Abbreviations: COVID-19, coronavirus disease; GBV, gender-based violence.

    • View popup
    TABLE 6.

    Enrolled School Children Who Received MDA for NTDs and Those Who Missed in 13 Primary Schools in 2 Zones of Mwera and Mkwaja, Pangani District, Tanzania

    ZonePrimary SchoolTarget PopulationMissed MDA
    MaleFemaleTotalMale, No. (%)Female, No. (%)Total, No. (%)
    MweraMweraa38440879228 (3.5)79 (10.0)107 (13.5)
    Mzambarauni465410081119
    Ushongo137131268271946
    StahabuaN/AN/A45053 (11.7)29 (6.4)82
    (−18.2)
    Mikinguni789016881523
    Mtonga133106239353469
    Mtango194176370181836
    MkwajaSange141119260191130
    Makorora113107220437
    Mikocheni115872028311
    Mkwaja1411312722810
    Mkalamaa5915751166196 (16.8)175 (15.0)371 (31.8)
    Mbulizagaa17316934247 (13.7)28 (8.2)75 (21.9)
    Total224621534849453 (20.1)433 (20.1)886 (18.3)
    • Abbreviations: MDA, mass drug administration; NTDs, neglected tropical diseases.

    • ↵a School selected for application of iDARE implementation to improve access and uptake of MDA.

    • View popup
    TABLE 7.

    Results of iDARE Team Assessment for Proxy Indicator of Intention to Take MDA

    Primary SchoolGroup Who Did Not Take Last MDA for AssessmentIntent to Take MDA
    MkalamoParents of school children51/52
    School children34/35
    MbulizagaParents of school children22/22
    School children17/17
    MweraParents of school children17/17
    School children28/30
    StahabuParents of children13/13
    School children26/26
    Total assessed for intent to take MDA208/212
    Intend to take next MDA, %98
    • Abbreviations: MDA, mass drug administration.

    • View popup
    TABLE 8.

    Results From 4 Pilot Schools Utilizing iDARE to Improve School MDA Coverage

    Primary SchoolNo. EnrolledNo. Not EnrolledPreviously Missed MDA, %No. Children Treated (March MDA)Not Treated March 2021 MDAMarch 2021 MDA Coverage, %
    EnrolledNot Enrolled
    Mkalama1,18539321,185390100
    Mbulizaga36602236600100
    Mwera84801482102797
    Stahabu45201845002100
    • Abbreviations: MDA, mass drug administration.

    • View popup
    TABLE 9.

    Similarities and Differences of iDARE Implementation in Uganda, Kenya, and Tanzania During the COVID-19 Pandemic

    Step 1: Identify
    AllInvolvement of local stakeholders to:
    • 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.

    Uganda
    • 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.

    Kenya
    • 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.

    Tanzania
    • 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.

    Step 2: Design
    All
    • 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.

    Uganda
    • 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).

    Kenya
    • 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.

    Tanzania
    • 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.

    Step 3: Apply and Assess
    AllRegular iDARE team meetings with coaching support to:
    • 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.

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

    Kenya
    • 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.

    Tanzania
    • 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.

    Step 4: Record
    All
    • 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.

    Kenya
    • Conducting study on impact of iDARE during COVID-19.

    Step 5: Expand
    AllExpansion of learnings through:
    • Internal and external presentations – for example, shared results during conference sessions, including GHTechX.

    • Webinars and blogs.

    Uganda
    • 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.

    Kenya
    • 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.

    Tanzania
    • 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.

    • Abbreviations: COVID-19, coronavirus disease; DHIS, district health information system; GBV, gender-based violence; GESI, gender equity and social inclusion; GHTechX, Global Health Tech Exchange; MDA, mass drug administration, NTD, neglected tropical disease; SBCA, Social and Behavior Change Activity; TZNTDCP, Tanzania National NTD Control Program; USAID, U.S. Agency for International Development.

PreviousNext
Back to top

In this issue

Global Health: Science and Practice: 10 (3)
Global Health: Science and Practice
Vol. 10, No. 3
June 29, 2022
  • Table of Contents
  • About the Cover
  • Index by Author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word about Global Health: Science and Practice.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Applying the iDARE Methodology in Uganda, Kenya, and Tanzania to Improve Health Outcomes During the COVID-19 Pandemic
(Your Name) has forwarded a page to you from Global Health: Science and Practice
(Your Name) thought you would like to see this page from the Global Health: Science and Practice web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Applying the iDARE Methodology in Uganda, Kenya, and Tanzania to Improve Health Outcomes During the COVID-19 Pandemic
Amanda Ottosson, Joyce Draru, Luseka Mwanzi, Stella Kasindi Mwita, Sara Pappa, Krista Odom, Taroub Harb Faramand
Global Health: Science and Practice Jun 2022, 10 (3) e2100623; DOI: 10.9745/GHSP-D-21-00623

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Applying the iDARE Methodology in Uganda, Kenya, and Tanzania to Improve Health Outcomes During the COVID-19 Pandemic
Amanda Ottosson, Joyce Draru, Luseka Mwanzi, Stella Kasindi Mwita, Sara Pappa, Krista Odom, Taroub Harb Faramand
Global Health: Science and Practice Jun 2022, 10 (3) e2100623; DOI: 10.9745/GHSP-D-21-00623
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Statistics from Altmetric.com

Jump to section

  • Article
    • ABSTRACT
    • INTRODUCTION
    • IDARE METHODOLOGY
    • iDARE IMPLEMENTATION IN UGANDA, KENYA, AND TANZANIA
    • IMPROVING HIV HEALTH OUTCOMES IN UGANDA
    • IMPROVING IDENTIFICATION AND MANAGEMENT FOR SURVIVORS OF GBV IN KENYA
    • IMPROVING MDA COVERAGE FOR NTDS IN TANZANIA
    • DISCUSSION
    • CONCLUSION
    • Acknowledgments
    • Funding
    • Author contributions
    • Competing interests
    • Notes
    • REFERENCES
  • Figures & Tables
  • Info & Metrics
  • Comments
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Experiences, Challenges, and Lessons Learned During Implementation of a Remote Monitoring Program for Home-Isolated COVID-19 Patients in Chennai, India
  • Design, Development, and Deployment of an Electronic Immunization Registry: Experiences From Vietnam, Tanzania, and Zambia
  • The Quality Management Improvement Approach: Successes and Lessons Learned From a Workforce Development Intervention in Rwanda’s Health Supply Chain
Show more FIELD ACTION REPORT

Similar Articles

Subjects

  • Health Topics
    • COVID-19
    • Infectious Diseases
  • Cross-Cutting Topics
    • Gender
US AIDJohns Hopkins Center for Communication ProgramsUniversity of Alberta

Follow Us On

  • Twitter
  • Facebook
  • LinkedIn
  • RSS

Articles

  • Current Issue
  • Advance Access Articles
  • Past Issues
  • Topic Collections
  • Most Read Articles
  • Supplements

More Information

  • Submit a Paper
  • Instructions for Authors
  • Instructions for Reviewers
  • GH Journals Database

About

  • About GHSP
  • Advisory Board
  • FAQs
  • Privacy Policy
  • Contact Us

© 2023 Creative Commons Attribution 4.0 International License. ISSN: 2169-575X

Powered by HighWire