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S10E1: Health Equity - Trust Communities and You Can Do Big Things
Episode 12nd November 2022 • Connecting Citizens to Science • The SCL Agency
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We're really excited to be entering a new phase of the podcast series where we will be celebrating the 125th anniversary of the Liverpool School of Tropical Medicine.

To do this, we will be hosting conversations about the ways in which the Global South and the Global North have learned from each other and the valuable collaborations that have shaped global health policies and practices and continue to influence them. These conversations, will of course, have a specific focus on engaging with communities and people.

This episode examines how The Liverpool Vaccine Equity project applied lessons learned from the Global South, specifically Kenya, to reduce vaccine hesitancy in Merseyside and how the methods have created a legacy that is improving uptake of other health services.

The episodes guests:

Amina Ismail

Community Mobiliser, Liverpool School of Tropical Medicine

Amina is a Community Mobiliser at the Liverpool School of Tropical Medicine working on the Liverpool Vaccine Equity Project. She is a qualified Primary teacher and understands the positive impact of supporting communities to address inequality.

Amina has over 25 years’ experience in the UK and Saudi Arabia working with communities across both the education and health sector. She has supported multidisciplinary Community Innovation Teams (CITs) working in deprived areas of Liverpool to identify reasons for vaccine hesitancy.

Amina has provided coaching and support to the Community Innovation Teams. She is committed to working with the CITs and engaging with different stakeholders to improve collaborative working reflective of a community-led approach to achieve vaccine equity.  

 Relevant links:

About The Liverpool Vaccine Equity project

Project

Approach (video)

I did if for……photo exhibition

22 Vaccination Stories

Zakirya Hassan

Community Champion, Merseyside Somali and Community Association and Kaalmo Youth Development

The aim of Zak's role is to reduce health inequalities and increase health equity and support his community. At Kaalmo Youth Development, Zak supports young people working as a sessional youth worker arranging trips, group activities and after school classes.

He supports a community drop-in service held in the Merseyside Somali and Community Association helping people with benefits services, debt advice, support with translation and school admissions.

Zak also runs his own organisation on the side Granby Toxteth Athletic a mental health sports organisation tackling mental health through physical activity they have as a walking club a football team and a basketball team.

Relevant Links:

Granby Toxteth Athletic Project

Mandela Oguche

Project Officer, Continuous Quality Improvement, LVCT Health

Mandela serves as Project Officer for continuous quality improvement at LVCT Health Organisation based in Kenya, Kisii County. He has previously worked on mixed methods research projects around quality of care in community health programs in multiple low- and middle-income community settings.

His work provides a unique platform that empowers community health workers, community health extension workers and peer educators to acquire feedback directly from the beneficiaries (clients) on how to improve quality health services at the community level. This enables improved access and provision of quality and equitable health service provision at the primary and secondary health facilities.

He also worked as a Program Officer for 4byFour model; a maternal health system strengthening intervention which builds on the flagship SQALE quality improvement intervention. It combines quality improvement with roll out of antenatal facility point-of-care testing for HIV, syphilis, anemia and malaria, and community pregnancy testing and referral.

He was part of the team that supported the success of USAID SQALE Program in Migori County.

Relevant links:

USAIDSQALE

Transcripts

Kim Ozano:

Hello listeners and welcome to the Connecting

Kim Ozano:

Citizens to Science podcast.

Kim Ozano:

We're really excited to be entering a new phase of the podcast series

Kim Ozano:

where we will be celebrating the 125th anniversary of the Liverpool School

Kim Ozano:

of Tropical Medicine, 125 years!

Kim Ozano:

To do this, we will be hosting conversations about the ways in which

Kim Ozano:

the Global South and the Global North have learned from each other and the

Kim Ozano:

valuable collaborations that have, and are continuing to shape global

Kim Ozano:

health policies and practices, and of course, specifically related to

Kim Ozano:

engaging communities and people.

Kim Ozano:

This week's guests, we have Zakirya Hassan from Liverpool here in the

Kim Ozano:

UK, who is a community champion for Merseyside Somali Community Association

Kim Ozano:

and Kaalmo Youth Development.

Kim Ozano:

We also have with us Mandela Oguche from Nairobi, Kenya, who is a project officer

Kim Ozano:

for continuous quality improvement in health services at LVCT Health.

Kim Ozano:

Mandela also has an experience in community development and will be

Kim Ozano:

sharing that with us today; but as always, we have a brand new co-host to

Kim Ozano:

really help us steer the conversation in an interesting and meaningful way.

Kim Ozano:

Amina Ismail, welcome to the podcast.

Kim Ozano:

Tell us about yourself and about the project.

Amina Ismail:

Hi Kim, thank you for welcoming me to the podcast.

Amina Ismail:

My name is Amina Ismail.

Amina Ismail:

I am a community mobiliser at the Liverpool School of Tropical Medicine,

Amina Ismail:

and for the past eight months, I've had the pleasure of working on The

Amina Ismail:

Liverpool Vaccine Equity project.

Amina Ismail:

It is a project that has basically taken lessons learned in Kenya

Amina Ismail:

and the Global South, adapted them to a Liverpool context.

Amina Ismail:

The project saw some of the similarities that existed between experiences in terms

Amina Ismail:

of accessing health systems in the Global South and the experiences of communities

Amina Ismail:

here with a focus on uptake around vaccination uptake in light of Covid-19.

Amina Ismail:

So the project itself, one of the things that the local authority here, the

Amina Ismail:

council in Liverpool, Liverpool City Council, identified was they saw that

Amina Ismail:

in the most deprived areas in Liverpool, that people were not getting vaccinated.

Amina Ismail:

They tried lots of different things around basically convenience and arranging

Amina Ismail:

vaccination popups, and other things, but people still were not getting vaccinated.

Amina Ismail:

So it was around looking at an alternative way of increasing vaccination uptake in

Amina Ismail:

those areas and achieving health equity.

Amina Ismail:

LSTM has been using community-based approaches to improve health equity for a

Amina Ismail:

long time, and it's been brilliant working here and taking those lessons from the

Amina Ismail:

Global South, as I've mentioned before.

Amina Ismail:

I'm really looking forward to having a conversation with Mandela, Zak,

Amina Ismail:

and yourself about the projects.

Kim Ozano:

I can really hear your passion to really have that connection

Kim Ozano:

with communities and people.

Kim Ozano:

The Vaccine Equity Programme.

Kim Ozano:

How did it go in practice?

Kim Ozano:

Did vaccine inequity decrease?

Amina Ismail:

The teams that I've worked with have been across the

Amina Ismail:

city and they had a real impact in terms of vaccination uptake.

Amina Ismail:

You're going to meet Zak, who is in our community innovation

Amina Ismail:

team in South Liverpool.

Amina Ismail:

There was an 11% difference in vaccination uptake from the innovations, the

Amina Ismail:

activities that the teams, you know, came up with and delivered in the local area.

Amina Ismail:

So yeah, it's been absolutely brilliant and they created some real assets, that

Amina Ismail:

hopefully we'll be able to talk about later as well in the form of good news

Amina Ismail:

stories to get people talking about vaccinations and their experiences.

Kim Ozano:

Fantastic.

Kim Ozano:

I look forward to hearing more about that.

Kim Ozano:

Let's meet our guests; Mandela from Nairobi.

Kim Ozano:

How are you today?

Kim Ozano:

Tell us a little bit about yourself and the work you do.

Mandela Oguche:

Hello Kim.

Mandela Oguche:

Hello everyone.

Mandela Oguche:

Thank you for welcoming me to this podcast.

Mandela Oguche:

I am Mandela Oguche.

Mandela Oguche:

Uh, I work at LVCT Health Organisation.

Mandela Oguche:

I serve as a project officer for continuous quality improvement.

Mandela Oguche:

In the project that we do, basically quality improvement, we ensure that

Mandela Oguche:

service delivery at all levels.

Mandela Oguche:

Pretty much I have a background in community development and I've served

Mandela Oguche:

as a research officer in community development interventions in Kenya,

Mandela Oguche:

mostly in Migori County and a part of Kisii and Laikipia counties.

Kim Ozano:

Thanks very much.

Kim Ozano:

I wonder if you could just tell us a little bit more about Kisii County.

Kim Ozano:

What is the context like there?

Kim Ozano:

What are the things that you have to consider when you are

Kim Ozano:

connecting with communities to understand their needs for services?

Mandela Oguche:

For this particular podcast, my interest will be to

Mandela Oguche:

talk about a programme that we actually did in Migori County.

Mandela Oguche:

Migori County communities are predominantly from low middle

Mandela Oguche:

class and then they have a lot of diverse kind of cultures.

Mandela Oguche:

This is because Migori has a set of several tribes.

Mandela Oguche:

The study was joining three approaches.

Mandela Oguche:

The approaches was one; doing what we call point of care testing.

Mandela Oguche:

So in point of care testing, we were trying to ensure that pregnant mothers

Mandela Oguche:

at the community level do not have a long waiting hours at the facility level.

Mandela Oguche:

In our communities, we use community volunteers to actually enable access

Mandela Oguche:

to services of the primary facilities.

Mandela Oguche:

These are dispensaries and health centers.

Mandela Oguche:

So in this intervention, (the four 4x4 pilot study), we ensure that our CHVs

Mandela Oguche:

were involved in this pilot study were issued out with pregnancy testing kits.

Mandela Oguche:

The aim for this was to make sure that we are able to detect pregnant mothers

Mandela Oguche:

early enough so that they can start an antenatal healthcare at the facilities.

Mandela Oguche:

Then the last bit that this project was actually involved with was the

Mandela Oguche:

quality improvement aspect of it.

Mandela Oguche:

This is just to ensure we were just trying to make the community know

Mandela Oguche:

that if you train the community people and then you integrate the trainings

Mandela Oguche:

they have towards giving key messages at the community level, then we will

Mandela Oguche:

have a different, change of mind of towards access of quality services

Mandela Oguche:

in their respective health facility.

Kim Ozano:

Thanks very much.

Kim Ozano:

Just to clarify, ANC is antenatal care and CHVs is community health volunteers.

Kim Ozano:

Moving over to Zak.

Kim Ozano:

Zak, welcome to the podcast.

Kim Ozano:

It is the time for you to tell us a little bit about yourself, but also,

Kim Ozano:

I think the work you're doing is very similar in taking some of these community

Kim Ozano:

engagement ideas over to Liverpool.

Kim Ozano:

So tell us about yourself and tell us about Liverpool.

Zak Hassan:

Hello Kim, and the guest and the listeners.

Zak Hassan:

Nice to meet you all.

Zak Hassan:

I'm Zak from Liverpool.

Zak Hassan:

I'm a community champion for Merseyside Somali Community Association.

Zak Hassan:

It is in partnership with another organisation called

Zak Hassan:

Kaalmo Youth Development.

Zak Hassan:

My role as a community champion is literally trying to reduce health

Zak Hassan:

inequalities by using the community.

Zak Hassan:

I'm a member of the local community, so I have a strong residency and I'm closer

Zak Hassan:

to the community, so I'm more trusted.

Zak Hassan:

The worst impacted communities of Covid in Liverpool was the most deprived areas.

Zak Hassan:

I went into community and I started working with the local

Zak Hassan:

residents in translation services and going to appointments with

Zak Hassan:

people that needed support.

Zak Hassan:

My work at Kaalmo Youth was mainly working with the youth and the next generation

Zak Hassan:

of kids; inspiring the next generation.

Zak Hassan:

From all of this I created my own organisation which is a mental

Zak Hassan:

health sports organisation.

Zak Hassan:

Two things that I love is community and sport.

Zak Hassan:

So I, I kind of like put them together and also like you, there's a rise

Zak Hassan:

in mental health during Covid-19.

Zak Hassan:

That's how I realised that there was an opportunity to open a mental health sports

Zak Hassan:

organisation to support the community.

Zak Hassan:

We have a football team, have a basketball team, we have a walking

Zak Hassan:

club, and hopefully in the future we're going to have woman specific things,

Zak Hassan:

such as was yoga for Muslim woman who can't attend gyms due to cultural

Zak Hassan:

barriers and religious barriers.

Kim Ozano:

There's so much of interest there.

Kim Ozano:

I think Mandela shares your basketball interest there as well.

Kim Ozano:

So that's, that's one connection!

Kim Ozano:

Your passion for community development comes through really strongly.

Kim Ozano:

What do you get from being a community champion?

Kim Ozano:

What are the benefits for you on a personal level?

Zak Hassan:

On a personal level, it's mainly just satisfaction.

Zak Hassan:

I could have went into accountancy and probably earned double, triple, maybe.

Zak Hassan:

My parents, they wanted me to go into accountancy.

Zak Hassan:

They fled the war in Somalia 30 years ago, for me to be maybe like

Zak Hassan:

try to do the best I could, but for me, it's not about the money.

Zak Hassan:

It's just helping people.

Zak Hassan:

That's something that's part of me and who I am, so that it

Zak Hassan:

gives me personal satisfaction and I enjoy doing good things.

Kim Ozano:

Thank you very much for sharing that with us.

Kim Ozano:

In terms of just listening to Mandela in Kenya and some of the things that

Kim Ozano:

are being done there, is that similar to Liverpool and what lessons did you

Kim Ozano:

draw from other contexts like Kenya?

Zak Hassan:

One of the things that I forgot to mention was the community

Zak Hassan:

innovation teams that we had in Liverpool, it was inspired by Kenya.

Zak Hassan:

The community innovation team involved community champions like myself and

Zak Hassan:

are just like local residents and just normal people that have normal

Zak Hassan:

jobs working in the community.

Zak Hassan:

Then I had people with different occupations in completely

Zak Hassan:

different walks of life.

Zak Hassan:

You had people like doctors, GP doctors, you had them, the likes of the LSTM

Zak Hassan:

community mobilisers like Amina, and you had different types of people on a table.

Zak Hassan:

We was all so happy with it.

Zak Hassan:

It wasn't easy.

Zak Hassan:

It took hard work.

Zak Hassan:

I could go to my neighbours or organise a health event and speak.

Zak Hassan:

It's a blessing to be honest that I'm in a position like that where the community

Zak Hassan:

will talk to me about the issues on why they're not taking the vaccine.

Zak Hassan:

That's why the project was so successful.

Kim Ozano:

Thank you.

Kim Ozano:

For our listeners and myself, paint us a picture of the day-to-day thoughts you

Kim Ozano:

might have around Covid vaccine hesitancy.

Kim Ozano:

What kind of cultural things and what kind of social norms and economic

Kim Ozano:

factors do you have to consider when you're talking to people and trying to

Kim Ozano:

get them engaged in a behaviour change?

Zak Hassan:

I think when Covid-19 came out, there was so many myths

Zak Hassan:

that were going round, and my job as a community champion was myth busting.

Zak Hassan:

For a community that's always been pushed down, it's easy for them to not trust the

Zak Hassan:

governments and to not trust NHS and put them all in the same bracket and say, "Oh,

Zak Hassan:

we're not going to trust the services".

Zak Hassan:

Overall, it's easy for them because they've had the worst and they've

Zak Hassan:

had the tough end of the stick.

Zak Hassan:

It was on us to really just go listen to them and explain to them.

Zak Hassan:

"Listen, the vaccine's okay".

Zak Hassan:

All these rumours that were going around.

Zak Hassan:

My community is WhatsApp.

Zak Hassan:

People were going on WhatsApp and spreading WhatsApp broadcast.

Zak Hassan:

"Oh, the vaccine will give you infertility".

Zak Hassan:

"Oh, the vaccine has gelatine in it".

Zak Hassan:

That was one of the big ones for the Muslim community because we're

Zak Hassan:

not allowed gelatine and pork.

Zak Hassan:

There's so many things that was spread that way incorrect.

Zak Hassan:

It was on us to go into the communities and myth bust and explain to the people

Zak Hassan:

that this is not true and tell them what's going on and what's in the vaccine.

Zak Hassan:

The likes of the community innovation teams, we all came together; the primary

Zak Hassan:

care network, the doctors, the GPs, the communities, LSTM, we all came together

Zak Hassan:

to do popup events so we can get people in, getting people vaccinated, also myth

Zak Hassan:

bust and giving out cards and leaflets.

Kim Ozano:

Thank you very much.

Kim Ozano:

That's really useful.

Kim Ozano:

Mandela, does this resonate with you in Kenya as well?

Kim Ozano:

This issue of trust and myth building and understanding kind of cultural

Kim Ozano:

factors, is that something that you have to think about on a daily basis when

Kim Ozano:

trying to engage with communities around antenatal care and other health services?

Mandela Oguche:

You find the myths are diverse.

Mandela Oguche:

For me, in my experiences, there's a lot of capacity in the community level.

Mandela Oguche:

It doesn't have to be formal.

Mandela Oguche:

It could be informal, the level of experience of the community is quite huge.

Mandela Oguche:

They might not put it into paper or they might not put it in a formal way,

Mandela Oguche:

but then if a community mobiliser or a community developer just has a time

Mandela Oguche:

to sit down with community members, you actually learn a lot from there.

Mandela Oguche:

If I can give, for instance, uh, the Covid-19 issue in Kenya; there

Mandela Oguche:

was a lot of restraint in terms of "do we trust the vaccine?"

Mandela Oguche:

"Do we believe it's actually in Kenya?"

Mandela Oguche:

or "this is a foreign disease, it cannot affect Africans" or something like that.

Mandela Oguche:

So it takes a lot of convincing and talking to people so that they

Mandela Oguche:

can actually accept vaccination and try keep Covid measures at bay.

Mandela Oguche:

One other factor that sometimes affect the communities is the fact most

Mandela Oguche:

community members actually observe what 'quote' the bright people do.

Mandela Oguche:

You remember some of our healthcare providers, they also resisted?

Mandela Oguche:

That's why we feel community empowerment is very paramount

Mandela Oguche:

to developing a community.

Mandela Oguche:

There's a an element of mistrust and a lot of communication that needs to go around.

Mandela Oguche:

So for me, I think because of the diverse tribal or cultural practices

Mandela Oguche:

there's need for a lot of communication.

Mandela Oguche:

Uh, there are those practices that you can actually keep, and then there are

Mandela Oguche:

those cultural practices that are a bit harmful to the community members.

Mandela Oguche:

I'll give a lived example to a community that I worked, in Kenya; this

Mandela Oguche:

community had a religious background.

Mandela Oguche:

The religious background was actually deterring their followers to accept

Mandela Oguche:

medical services from facilities.

Mandela Oguche:

In this sense, they will tell them that actually God will heal you, or Jesus,

Mandela Oguche:

or whoever it is that they're following.

Mandela Oguche:

In the aspect of antenatal care, you realise that mothers will not go to

Mandela Oguche:

accept health services at the facilities.

Mandela Oguche:

This was leading to a lot of medical problems for mothers.

Mandela Oguche:

It could lead to postnatal deaths or prenatal deaths and certain

Mandela Oguche:

complications at facility level.

Mandela Oguche:

What we did is actually engage the TBS.

Mandela Oguche:

The 'TBS' we call traditional birth assistants so you bring them on board,

Mandela Oguche:

you have conversations with them.

Mandela Oguche:

You actually train them on the importance of receiving medical

Mandela Oguche:

services at facility level.

Mandela Oguche:

So you realise that TBS helped us tremendously to change the

Mandela Oguche:

narrative at the community level.

Mandela Oguche:

This is very key for our listeners to know that the community

Mandela Oguche:

handles a lot of capacity.

Mandela Oguche:

If it is tapped in the right way, we'll have a lot of change in our

Mandela Oguche:

community setups and then people will start accepting proper ways of life

Mandela Oguche:

and ensuring that they have healthy living and then they can also demand

Mandela Oguche:

for their rights in terms of quality of healthcare, both at the community

Mandela Oguche:

level and at the facility level.

Mandela Oguche:

I think Zak's experience resonates with mine.

Mandela Oguche:

It's just that in ours we have, you have to deal with different tribes differently

Mandela Oguche:

because they come with different religious beliefs on something like that.

Zak Hassan:

I think the comparison between two different communities

Zak Hassan:

so far apart across the world in Kenya and in the UK shows if you

Zak Hassan:

trust the communities and you go into communities, you can do big things.

Zak Hassan:

That's what this project has done.

Kim Ozano:

I think that's wonderful.

Kim Ozano:

I know Amina, you have shared similar experiences and are probably itching to

Kim Ozano:

share more so I'm going to hand over.

Kim Ozano:

Thank you for highlighting also that the community has its own

Kim Ozano:

strengths and its own capacities and drawing on that is a key part of it.

Kim Ozano:

I really like this concept of influencing the narrative, changing the narrative

Kim Ozano:

in different communities that resonates with their beliefs and their systems

Kim Ozano:

of learning and systems of culture.

Kim Ozano:

Amina, over to you to explore a little bit more.

Amina Ismail:

Thank you very much Kim, and thank you Mandela and Zak,

Amina Ismail:

you've given me so much to think about.

Amina Ismail:

There were lots of times that I wanted to interject and you know,

Amina Ismail:

totally agree with your point of view and support what you were saying.

Amina Ismail:

Um, but I feel that last part of the conversation around capacity

Amina Ismail:

and communities and recognising the expertise within communities,

Amina Ismail:

I think it leads perfectly to what the question I'm going to ask you.

Amina Ismail:

In terms of the Liverpool based Vaccine Equity Project we took the quality

Amina Ismail:

improvement model that was used in Kenya and we applied that here in Liverpool.

Amina Ismail:

Part of that was creating these community innovation teams that Zak talked

Amina Ismail:

about earlier with all these different representatives sitting around the table.

Amina Ismail:

But also we used the five Cs model which was really great around looking

Amina Ismail:

at convenience complacency, looking at collective responsibility, looking

Amina Ismail:

at calculation and confidence.

Amina Ismail:

Using that 5Cs model, that's where the behavioural insight survey that

Amina Ismail:

the community innovation teams here in the UK and Liverpool, that's where the

Amina Ismail:

it was framed around this 5Cs model.

Amina Ismail:

One of the things that I noticed was that in the early stages when we sat in

Amina Ismail:

those community innovation team meeting, we were asking the teams, "what do you

Amina Ismail:

think is going on in the community?".

Amina Ismail:

"Why do you think there's such a low vaccine uptake in those

Amina Ismail:

communities that you are working in?".

Amina Ismail:

After the survey was conducted, it blew my mind that actually the things

Amina Ismail:

that you'd identified, as community champions and as people working within

Amina Ismail:

those communities, actually were the things that people said, and we

Amina Ismail:

were able to support that with data.

Amina Ismail:

So, keeping that in mind, what separates (and I'll start off with

Amina Ismail:

Zak), what do you think it is that separates the way that you work with

Amina Ismail:

communities to other service providers?

Amina Ismail:

So here, at primary care networks or public health providers or hospitals or

Amina Ismail:

GPs; what is it that separates your way of working with communities to theirs?

Zak Hassan:

I think the biggest separation is probably the trust that the

Zak Hassan:

community have on me as a local member.

Zak Hassan:

They probably see me grow as a young lad and they've seen me develop and

Zak Hassan:

they know me personally, they know my family, they know my parents.

Zak Hassan:

So that, that's probably the biggest separation and the biggest difference.

Zak Hassan:

Also, the approach is different.

Zak Hassan:

For example, sometimes we'd put on like community events and different

Zak Hassan:

get togethers, maybe like a party, and then at the end of the party

Zak Hassan:

there's blood pressure checks or, there's a vaccinations bus outside.

Amina Ismail:

Just as a quick follow up to that; you are known to that

Amina Ismail:

community, you've lived in that community, you've grown up in the communities

Amina Ismail:

that you are working in and that you are basically connecting with now.

Amina Ismail:

How much of an impact do you think that's had?

Amina Ismail:

You've kind of suggested it's impacted in terms of vaccination uptake earlier

Amina Ismail:

on, but in terms of people getting their BP checks and other health

Amina Ismail:

priorities, how do you think it made a difference to those communities?

Zak Hassan:

It's all about different ways of engaging with the community.

Zak Hassan:

Mental health has a massive stigma in the communities that I work with.

Zak Hassan:

I've targeted to community free sports with my own personal organisation.

Zak Hassan:

It's called Granby Toxteth Athletic.

Zak Hassan:

We put on training sessions and we go on walks to nice places that people have

Zak Hassan:

never been, just to get people talking and just to get people discussing things that

Zak Hassan:

maybe they wouldn't typically talk about.

Zak Hassan:

It's slowly increased from the beginning when we first started.

Zak Hassan:

Now I get messages all the time; "when's the next walk?"

Zak Hassan:

or "When's the next health event?".

Zak Hassan:

That means what we're doing is good and it's working.

Amina Ismail:

Thank you, Zak.

Amina Ismail:

I think it is, definitely.

Amina Ismail:

Listening to yourself and Mandela today, I think it's something

Amina Ismail:

that you should be proud of.

Amina Ismail:

I'm going to build on that with Mandela, because Zak talked a little bit about

Amina Ismail:

conversations now and Mandela, you were talking about conversations earlier and

Amina Ismail:

the importance of having conversations within the communities that you know.

Amina Ismail:

So could you please also give some examples of what separates your way

Amina Ismail:

of working with communities to the other service providers in Kenya?

Mandela Oguche:

One thing that separates us from what others do, it is because

Mandela Oguche:

we get into communities that sometimes we do not have a clear understanding of

Mandela Oguche:

their ways of life or their cultures.

Mandela Oguche:

We really rely on research to actually give us information of

Mandela Oguche:

their needs in regard to a project that we are implementing in that

Mandela Oguche:

particular, say, county or community.

Mandela Oguche:

So using research to really know the community's need is key for us to

Mandela Oguche:

know what we are going to support in terms of changing or in terms of

Mandela Oguche:

implementing a project that is aiming at improving their health or sustainability

Mandela Oguche:

in terms of service delivery.

Mandela Oguche:

In communities we have a tool that we developed and I know LSTM,

Mandela Oguche:

the team, Vicky Doyle and Miriam Taegtmeyer and the rest, they came

Mandela Oguche:

up with a tool that is very vital.

Mandela Oguche:

It's called Community Follow Up tool.

Mandela Oguche:

Community Follow Up tool helps us to get the experiences.

Mandela Oguche:

It gives us an opportunity to have conversations with beneficiary of

Mandela Oguche:

certain services in a community.

Mandela Oguche:

Once we get this, the research angle, then we are able to also give the community

Mandela Oguche:

members a platform to actually identify their own problems within that project so

Mandela Oguche:

that they come up with solutions in their own way on how we can improve certain

Mandela Oguche:

health interventions in their areas.

Mandela Oguche:

So I think that is what separates us, uh, with other people because giving them a

Mandela Oguche:

platform to change the narrative in their communities or to give solutions to what

Mandela Oguche:

they're supposed to be doing rightly in terms of health service delivery.

Amina Ismail:

Thank you, Mandela.

Amina Ismail:

I think you have just read my mind with the next direction that I'm going to go in

Amina Ismail:

because the next part of the conversation is going be looking at adapting.

Amina Ismail:

When I joined this project, The Liverpool Vaccine Equity project, and

Amina Ismail:

I started working with the Liverpool School of Tropical Medicine, my

Amina Ismail:

experience was working predominantly in South Liverpool and predominantly

Amina Ismail:

with minority ethnic communities.

Amina Ismail:

Since joining the project, my horizons have been broadened because I worked

Amina Ismail:

in the North of Liverpool with a target audience of white men between

Amina Ismail:

the ages of 18 to 50 years of age.

Amina Ismail:

Then I worked in central Liverpool working with the Chinese community,

Amina Ismail:

which I've never worked with before.

Amina Ismail:

All of these experiences actually, I was able to gain a lot from them and adapt

Amina Ismail:

my way of working and recognise that each community has different methods

Amina Ismail:

of communicating with one another.

Amina Ismail:

On that same line of questioning, what did you learn from your experiences

Amina Ismail:

working on this project or working on the project that you are in at the moment?

Amina Ismail:

Look forward to hearing your thoughts.

Mandela Oguche:

I think I learned quite a lot.

Mandela Oguche:

We realised that working directly with the communities has an impact, but when

Mandela Oguche:

we come to dealing with, let's say, health services, you can have a situation where a

Mandela Oguche:

community member or a project has actually changed the narrative or the perception

Mandela Oguche:

of the people towards health services.

Mandela Oguche:

For instance, I'll give an example of antenatal care.

Mandela Oguche:

So a situation where in Kenya, most mothers present late for their first

Mandela Oguche:

antenatal care, you find that you can have an intervention that actually changes,

Mandela Oguche:

you know, the mindset of the community, now they have an interest towards

Mandela Oguche:

starting antenatal care visits early.

Mandela Oguche:

But this is a situation where they're willing to change, but then the

Mandela Oguche:

systems, the health systems along the way is not really favorable.

Mandela Oguche:

So for example, let me use me Mandela.

Mandela Oguche:

I am a mother.

Mandela Oguche:

I am willing to start my antenatal care early and then I go to a health

Mandela Oguche:

facility and then I'm not able to still receive health services at

Mandela Oguche:

this particular facility because they do not have adequate capacity, or

Mandela Oguche:

they do not have adequate, uh, say, testing materials that I really need.

Mandela Oguche:

So what we learn from there is it is quite important to align the existing

Mandela Oguche:

um, Ministry of Health Structures and align it with the community needs.

Mandela Oguche:

So as much as you are trying to change the community, it is also very key

Mandela Oguche:

to strengthen the systems, uh, that provide services to the communities.

Mandela Oguche:

So that is one key lessons that we learn from it.

Amina Ismail:

On that point, Mandela, I'm so engaged with what you're

Amina Ismail:

saying, and I'm really interested, and I'll probably have you talking to

Amina Ismail:

me far longer than I should, but I'll follow up with a point of interest.

Amina Ismail:

Can you give an example of how you were able to align those two; the community

Amina Ismail:

interests and, those health systems?

Mandela Oguche:

When you're doing community engagement, you need to

Mandela Oguche:

have an agreement with the county in terms of the services that you intend

Mandela Oguche:

to provide at the community level.

Mandela Oguche:

So every step you work towards intervention, the county person

Mandela Oguche:

should be a long with you.

Mandela Oguche:

The county focal person, for let's say community quality improvement,

Mandela Oguche:

should also be in copy of whatever interventions you have.

Mandela Oguche:

So, in this regard, the Ministry of Health should take the other bit of

Mandela Oguche:

trying to ensure that commodities like test kits (HIV test kits, malaria test

Mandela Oguche:

kits, syphilis test kits) are actually available in the link facilities

Mandela Oguche:

within the communities that we work in.

Mandela Oguche:

Of course, this comes with a lot of political influence or social influence.

Mandela Oguche:

So in cases of that, we talk to the county to actually lobby for

Mandela Oguche:

these commodities from other sectors or from other facilities that the

Mandela Oguche:

interventions are not taking place.

Amina Ismail:

Thank you ever so much, Mandela.

Amina Ismail:

So much commonality between what's happening here in Liverpool with the

Amina Ismail:

community innovation teams and what's happening in Kenya, especially around

Amina Ismail:

those conversations with multidisciplinary stakeholders, and it not just being

Amina Ismail:

a top down where the information is coming down and the instructions are

Amina Ismail:

coming down from the health providers.

Amina Ismail:

It's also coming from the community about how best to implement and apply the

Amina Ismail:

service delivery and allocate resources.

Amina Ismail:

I'm going to move on to Zak.

Amina Ismail:

Zak.

Amina Ismail:

Um, going to ask you the same question.

Amina Ismail:

What did you learn from your experiences throughout being involved in The

Amina Ismail:

Liverpool Vaccine Equity project?

Zak Hassan:

I think one of the main things I learnt from the project was

Zak Hassan:

the importance of community and the importance of sitting at the table

Zak Hassan:

together, as you said about the hierarchy.

Zak Hassan:

Being more with the level playing field, with different people making

Zak Hassan:

the decisions coming together.

Amina Ismail:

Thank you very much.

Amina Ismail:

When you are delivering projects of this kind, we suffer something

Amina Ismail:

called 'projectitus'; short term funding you're competing with for

Amina Ismail:

funding with the other organisations.

Amina Ismail:

You know, all of these things, affect the sustainability of the project.

Amina Ismail:

I know that within the project that you've been working on, that your

Amina Ismail:

work's commissioned year on year, and in terms of planning moving forward,

Amina Ismail:

that must present some real challenges.

Amina Ismail:

So in terms of the sustainability, where do you think this work that

Amina Ismail:

you've been doing sits within the wider health systems framework?

Amina Ismail:

How can we sell the value of what you've been doing?

Amina Ismail:

And within that, if you could just touch on how it's helping to

Amina Ismail:

address some of the wider health and equality work that's going on.

Zak Hassan:

The project started in 2019.

Zak Hassan:

Up until June 2020, it was all about vaccinations, it was all about Covid-19.

Zak Hassan:

The project was successful, and we'd done a fantastic job.

Zak Hassan:

That was because we went into communities and all the things that I talked

Zak Hassan:

about, different events explaining to people, myth busting and using

Zak Hassan:

the right ways of communication.

Zak Hassan:

We're going to use the same things that have shown to be successful and hopefully

Zak Hassan:

we can get a good outcome out of it.

Zak Hassan:

That's the aim really because as long as the community champions are in

Zak Hassan:

place, they help support the services.

Zak Hassan:

The services such as the primary care network.

Zak Hassan:

They've all shown, and they've all accepted, the importance

Zak Hassan:

of communities champions.

Zak Hassan:

They need us as much as we need them, and the communities need both of us.

Zak Hassan:

Otherwise, the communities are going to be abandoned and they won't understand

Zak Hassan:

and the inequalities will show.

Zak Hassan:

It's really important for community champions and projects such as

Zak Hassan:

the community innovation teams, to be extended and to be recognised.

Amina Ismail:

On that note, you've actually stated that this project

Amina Ismail:

should be embedded within those wider health systems, and this

Amina Ismail:

way of working should be embedded within those wider health systems.

Amina Ismail:

Rather than organisations coming to you (such as Public Health)

Amina Ismail:

after they've thought of an idea to engage with those communities,

Amina Ismail:

they're coming to you first now.

Amina Ismail:

There's been a shift in that sense.

Amina Ismail:

Am I right?

Zak Hassan:

A hundred percent.

Zak Hassan:

Over the past year we've seen the difference.

Zak Hassan:

Now services are coming to us before they've put out the information.

Zak Hassan:

We're helping make it more representative of communities.

Zak Hassan:

We're working alongside different health organisations (Primary Care Network,

Zak Hassan:

Public Health England); these are massive organisations and now they're working with

Zak Hassan:

the communities and community champions to make sure people are not left out.

Zak Hassan:

One of the quotes that I use for my own organisation is

Zak Hassan:

"giving a voice to the voiceless, representing the unrepresented".

Zak Hassan:

That's something that I'm passionate about.

Amina Ismail:

You know what, Zak, I feel that is actually at the

Amina Ismail:

core of everything you're doing.

Amina Ismail:

Thank you for answering the question.

Amina Ismail:

I'm going to move over now to Mandela.

Amina Ismail:

So, Mandela, in terms of sustainability, how do you think this sits within

Amina Ismail:

the wider health systems framework and actually, more of a challenge

Amina Ismail:

for Kim and I and the listeners to the podcast, how do you think we can

Amina Ismail:

sell the value of what you are doing?

Mandela Oguche:

Thank you.

Mandela Oguche:

In terms of sustainability, one of our main successes is aligning some

Mandela Oguche:

of our interventions to the existing Ministry of Health structures.

Mandela Oguche:

We tap the capacity of the community members.

Mandela Oguche:

This is a situation where the community members themselves accept

Mandela Oguche:

that there's need for change and there's need for coming up with

Mandela Oguche:

solutions towards their challenges.

Mandela Oguche:

The community has accepted that, ideally, we need this to bring

Mandela Oguche:

change or to bring development in our community so they will lobby.

Mandela Oguche:

They lobby to channel some of their resources towards improving quality

Mandela Oguche:

of health at particular communities or particular health delivery points.

Mandela Oguche:

During this lobby, they will use our interventions.

Mandela Oguche:

Just like Zak's, they have innovation teams.

Mandela Oguche:

For us in Kenya, we use teams that we call work improvement teams.

Mandela Oguche:

Once we develop a quality improvement team they tend to remain intact

Mandela Oguche:

for a long duration of time.

Mandela Oguche:

The other way we use to show value; we use research to

Mandela Oguche:

actually know the needs of people.

Mandela Oguche:

That data is always disseminated in stakeholder platforms and

Mandela Oguche:

maybe in blogs or YouTube.

Amina Ismail:

Thank you, Mandela.

Amina Ismail:

So it's actually, in terms of a sustainable model, it's a sustainable

Amina Ismail:

model because that's utilised now as a way of working and understanding where

Amina Ismail:

the community needs are, and actually even when something's being missed off,

Amina Ismail:

that it's a chance to pick up on those things and prioritise the needs of

Amina Ismail:

those communities, basically taking into consideration the data and research and

Amina Ismail:

the information that you've provided.

Mandela Oguche:

That's true.

Mandela Oguche:

The twist with the work improvement teams is their members are from different walks

Mandela Oguche:

of life in that particular community.

Mandela Oguche:

It's a group of several people at the community level that have

Mandela Oguche:

powers to influence, uh, the ideology that the communities have.

Mandela Oguche:

So they sit together, they discuss some of their challenges, and then

Mandela Oguche:

they prioritise the ones they have.

Amina Ismail:

Thank you very much.

Amina Ismail:

I have absolutely thoroughly enjoyed listening to you, Mandela and Zak, and

Amina Ismail:

I really appreciate all the answers that you've given, which have got the cogs

Amina Ismail:

turned in and got me thinking a lot.

Amina Ismail:

Which brings me to my next question.

Amina Ismail:

I'm going to direct this one to Zak first.

Amina Ismail:

How do you think, Zak, learning has been applied from other contexts like Kenya?

Amina Ismail:

So, for me, one of the biggest things that I picked up on was how

Amina Ismail:

the quality improvement model worked in Kenya in terms of getting local

Amina Ismail:

data in a understandable format.

Amina Ismail:

Can you give me an example?

Zak Hassan:

I think you took the best one about the data, the fact that normally as

Zak Hassan:

communities, we won't delve into the data; you'll talk about opinions and you'll

Zak Hassan:

talk about what people are thinking.

Zak Hassan:

We delved into the data, numbers and statistics.

Zak Hassan:

That's something that they'll never have access to.

Zak Hassan:

They could never go into communities and get those sorts of surveys filled in.

Zak Hassan:

We went into communities, and we asked the people the reasons why they weren't

Zak Hassan:

getting the vaccinations and I think that was the same process in Kenya.

Amina Ismail:

Thank you Zak.

Amina Ismail:

I'm going to ask Mandela the same question.

Amina Ismail:

How do you think learning has been applied from other contexts?

Amina Ismail:

I know that you had different individuals like Miriam Taegtmeyer and Vicky Doyle

Amina Ismail:

who worked alongside you in the project.

Amina Ismail:

Were there any other contexts that you felt that you learned

Amina Ismail:

from, that you could share?

Mandela Oguche:

I know she will be listening someday.

Mandela Oguche:

My supervisor, she's called Linet Okoth.

Mandela Oguche:

She's the senior technical advisor for community health in LVCT Health.

Mandela Oguche:

She will attest to the fact that for quite some time community engagements

Mandela Oguche:

have not been prioritised in Kenya.

Mandela Oguche:

What we've learned from Liverpool, especially from Vicky and Miriam is what

Mandela Oguche:

we call 'quality revolution'; whereby let's not do a lot of talk about improving

Mandela Oguche:

quality, we can actually act upon it.

Mandela Oguche:

So what we learned is if you actually engage the communities, most diseases

Mandela Oguche:

can be recognised at the community level, but because we do a lot of talk, talk,

Mandela Oguche:

talk, and we don't actually act upon it, that's the reason why we have certain

Mandela Oguche:

complications that reach referral stages.

Amina Ismail:

I absolutely love that for a final answer.

Amina Ismail:

I think that's a new phrase that I will definitely be borrowing from you

Amina Ismail:

Mandela, the 'quality revolution'.

Amina Ismail:

I think what's been core throughout the conversations, and I'm sure you'll agree

Amina Ismail:

Kim in a minute, is that definitely it's not been about talk, talk, talk.

Amina Ismail:

It's been the complete opposite and I think action and empowering communities

Amina Ismail:

and engaging communities and moving things forward and including communities

Amina Ismail:

priorities have been at the heart of both of what you've been sharing

Amina Ismail:

today, what both of you been sharing.

Amina Ismail:

Now, I'm going to thank you.

Amina Ismail:

I'm finished with my questions and I'm going to gladly pass

Amina Ismail:

you over to my co-host Kim.

Amina Ismail:

So welcome back, Kim.

Kim Ozano:

Thank you very much.

Kim Ozano:

So, the conversation has been wonderful.

Kim Ozano:

I love the, the cross contextual learning and how you've both reflected on that.

Kim Ozano:

We end the episode by asking you for one piece, piece of advice that

Kim Ozano:

you would give to others who want to work in a similar way to yourself.

Kim Ozano:

Mandela; a piece of advice for others.

Mandela Oguche:

One piece of advice I will give is tap the

Mandela Oguche:

capacity of the community members.

Mandela Oguche:

In terms of how they know their communities, the needs of their

Mandela Oguche:

communities, what their community really wants, it's good to tap on that.

Mandela Oguche:

For Kenya or for African setups, another piece of advice is try to grow towards

Mandela Oguche:

digital platforms of collecting community data because a lot of data is lost when

Mandela Oguche:

we go to paperwork data collection.

Mandela Oguche:

That's my advice to the world.

Mandela Oguche:

Thank you.

Kim Ozano:

Wonderful.

Kim Ozano:

Thank you very much.

Kim Ozano:

Some really key points there.

Kim Ozano:

Look at community capacity and think about digitisation of data and acting on that.

Kim Ozano:

Zak, one piece of advice please.

Zak Hassan:

My piece of advice would be partnership and

Zak Hassan:

networking is so important.

Zak Hassan:

Networking and meeting different people and making projects bigger, better,

Zak Hassan:

and get different voices and different studies and different things involved

Zak Hassan:

makes projects and studies always better.

Zak Hassan:

My advice to services, the governments, and the hierarchy and those on top

Zak Hassan:

would be to trust the communities as it's not always about education

Zak Hassan:

and degrees and things like that.

Zak Hassan:

I'm educated and I've got a degree, but some of the most knowledgeable

Zak Hassan:

people I've ever met don't have degrees and don't have things that

Zak Hassan:

probably in this world would make them recognisable, make their opinion matter.

Kim Ozano:

Thank you very much.

Kim Ozano:

Trust the communities.

Kim Ozano:

I like that a lot.

Kim Ozano:

Amina, take us home with one final piece of advice.

Amina Ismail:

I think my final piece of advice is there's this perception that

Amina Ismail:

communities are really hard to reach.

Amina Ismail:

I think one thing that this project has showed me is that communities

Amina Ismail:

actually are not hard to reach.

Amina Ismail:

A community centered approach is the way that works.

Amina Ismail:

So yeah, that's my piece of advice.

Kim Ozano:

Thank you.

Kim Ozano:

Thank you Mandela.

Kim Ozano:

Thank you Zak, and thank you Amina.

Kim Ozano:

What a great episode this has been and for sharing that learning across the waters.

Kim Ozano:

Thank you to our listeners.

Kim Ozano:

As always, the voices you heard today cannot continue to be heard unless you

Kim Ozano:

follow, like, share, subscribe, sign up your dog, whatever you need to do

Kim Ozano:

to get more followers so that we can continue learning from each other.

Kim Ozano:

So thank you again and see you next time.

Kim Ozano:

Bye for now.

Kim Ozano:

Thank you, Kim.

Kim Ozano:

Bye

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