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

Hello listeners and welcome to the Connecting

Citizens to Science podcast.

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, 125 years!

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, and are continuing to shape global

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

engaging communities and people.

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

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

and Kaalmo Youth Development.

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

for continuous quality improvement in health services at LVCT Health.

Mandela also has an experience in community development and will be

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

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

Amina Ismail, welcome to the podcast.

Tell us about yourself and about the project.

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

My name is Amina Ismail.

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

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

Liverpool Vaccine Equity project.

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

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

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

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

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

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

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

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

They tried lots of different things around basically convenience and arranging

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

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

those areas and achieving health equity.

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

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

Global South, as I've mentioned before.

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

and yourself about the projects.

I can really hear your passion to really have that connection

with communities and people.

The Vaccine Equity Programme.

How did it go in practice?

Did vaccine inequity decrease?

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

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

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

team in South Liverpool.

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

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

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

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

stories to get people talking about vaccinations and their experiences.

Fantastic.

I look forward to hearing more about that.

Let's meet our guests; Mandela from Nairobi.

How are you today?

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

Hello Kim.

Hello everyone.

Thank you for welcoming me to this podcast.

I am Mandela Oguche.

Uh, I work at LVCT Health Organisation.

I serve as a project officer for continuous quality improvement.

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

service delivery at all levels.

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

as a research officer in community development interventions in Kenya,

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

Thanks very much.

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

What is the context like there?

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

connecting with communities to understand their needs for services?

For this particular podcast, my interest will be to

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

Migori County communities are predominantly from low middle

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

This is because Migori has a set of several tribes.

The study was joining three approaches.

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

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

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

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

to services of the primary facilities.

These are dispensaries and health centers.

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

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

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

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

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

quality improvement aspect of it.

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

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

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

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

in their respective health facility.

Thanks very much.

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

Moving over to Zak.

Zak, welcome to the podcast.

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

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

engagement ideas over to Liverpool.

So tell us about yourself and tell us about Liverpool.

Hello Kim, and the guest and the listeners.

Nice to meet you all.

I'm Zak from Liverpool.

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

It is in partnership with another organisation called

Kaalmo Youth Development.

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

inequalities by using the community.

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

to the community, so I'm more trusted.

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

I went into community and I started working with the local

residents in translation services and going to appointments with

people that needed support.

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

of kids; inspiring the next generation.

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

health sports organisation.

Two things that I love is community and sport.

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

in mental health during Covid-19.

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

organisation to support the community.

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

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

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

barriers and religious barriers.

There's so much of interest there.

I think Mandela shares your basketball interest there as well.

So that's, that's one connection!

Your passion for community development comes through really strongly.

What do you get from being a community champion?

What are the benefits for you on a personal level?

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

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

My parents, they wanted me to go into accountancy.

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

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

It's just helping people.

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

gives me personal satisfaction and I enjoy doing good things.

Thank you very much for sharing that with us.

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

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

draw from other contexts like Kenya?

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

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

The community innovation team involved community champions like myself and

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

jobs working in the community.

Then I had people with different occupations in completely

different walks of life.

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

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

We was all so happy with it.

It wasn't easy.

It took hard work.

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

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

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

That's why the project was so successful.

Thank you.

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

might have around Covid vaccine hesitancy.

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

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

get them engaged in a behaviour change?

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

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

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

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

we're not going to trust the services".

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

had the tough end of the stick.

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

"Listen, the vaccine's okay".

All these rumours that were going around.

My community is WhatsApp.

People were going on WhatsApp and spreading WhatsApp broadcast.

"Oh, the vaccine will give you infertility".

"Oh, the vaccine has gelatine in it".

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

not allowed gelatine and pork.

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

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

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

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

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

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

bust and giving out cards and leaflets.

Thank you very much.

That's really useful.

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

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

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

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

You find the myths are diverse.

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

It doesn't have to be formal.

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

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

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

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

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

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

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

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

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

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

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

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

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

That's why we feel community empowerment is very paramount

to developing a community.

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

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

there's need for a lot of communication.

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

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

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

community had a religious background.

The religious background was actually deterring their followers to accept

medical services from facilities.

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

or whoever it is that they're following.

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

accept health services at the facilities.

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

It could lead to postnatal deaths or prenatal deaths and certain

complications at facility level.

What we did is actually engage the TBS.

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

you have conversations with them.

You actually train them on the importance of receiving medical

services at facility level.

So you realise that TBS helped us tremendously to change the

narrative at the community level.

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

handles a lot of capacity.

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

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

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

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

level and at the facility level.

I think Zak's experience resonates with mine.

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

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

I think the comparison between two different communities

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

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

That's what this project has done.

I think that's wonderful.

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

share more so I'm going to hand over.

Thank you for highlighting also that the community has its own

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

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

in different communities that resonates with their beliefs and their systems

of learning and systems of culture.

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

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

you've given me so much to think about.

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

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

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

and communities and recognising the expertise within communities,

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

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

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

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

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

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

at convenience complacency, looking at collective responsibility, looking

at calculation and confidence.

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

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

it was framed around this 5Cs model.

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

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

think is going on in the community?".

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

communities that you are working in?".

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

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

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

were able to support that with data.

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

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

communities to other service providers?

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

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

I think the biggest separation is probably the trust that the

community have on me as a local member.

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

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

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

Also, the approach is different.

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

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

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

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

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

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

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

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

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

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

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

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

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

It's called Granby Toxteth Athletic.

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

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

maybe they wouldn't typically talk about.

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

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

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

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

Thank you, Zak.

I think it is, definitely.

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

that you should be proud of.

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

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

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

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

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

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

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

their ways of life or their cultures.

We really rely on research to actually give us information of

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

particular, say, county or community.

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

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

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

in terms of service delivery.

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

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

up with a tool that is very vital.

It's called Community Follow Up tool.

Community Follow Up tool helps us to get the experiences.

It gives us an opportunity to have conversations with beneficiary of

certain services in a community.

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

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

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

health interventions in their areas.

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

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

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

Thank you, Mandela.

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

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

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

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

experience was working predominantly in South Liverpool and predominantly

with minority ethnic communities.

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

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

the ages of 18 to 50 years of age.

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

which I've never worked with before.

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

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

of communicating with one another.

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

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

Look forward to hearing your thoughts.

I think I learned quite a lot.

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

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

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

of the people towards health services.

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

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

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

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

starting antenatal care visits early.

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

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

So for example, let me use me Mandela.

I am a mother.

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

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

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

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

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

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

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

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

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

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

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

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

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

interests and, those health systems?

When you're doing community engagement, you need to

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

to provide at the community level.

So every step you work towards intervention, the county person

should be a long with you.

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

should also be in copy of whatever interventions you have.

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

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

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

within the communities that we work in.

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

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

these commodities from other sectors or from other facilities that the

interventions are not taking place.

Thank you ever so much, Mandela.

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

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

those conversations with multidisciplinary stakeholders, and it not just being

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

coming down from the health providers.

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

service delivery and allocate resources.

I'm going to move on to Zak.

Zak.

Um, going to ask you the same question.

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

Liverpool Vaccine Equity project?

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

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

together, as you said about the hierarchy.

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

the decisions coming together.

Thank you very much.

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

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

funding with the other organisations.

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

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

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

that must present some real challenges.

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

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

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

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

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

The project started in 2019.

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

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

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

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

the right ways of communication.

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

we can get a good outcome out of it.

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

place, they help support the services.

The services such as the primary care network.

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

of communities champions.

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

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

and the inequalities will show.

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

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

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

should be embedded within those wider health systems, and this

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

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

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

they're coming to you first now.

There's been a shift in that sense.

Am I right?

A hundred percent.

Over the past year we've seen the difference.

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

We're helping make it more representative of communities.

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

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

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

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

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

That's something that I'm passionate about.

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

core of everything you're doing.

Thank you for answering the question.

I'm going to move over now to Mandela.

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

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

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

sell the value of what you are doing?

Thank you.

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

of our interventions to the existing Ministry of Health structures.

We tap the capacity of the community members.

This is a situation where the community members themselves accept

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

solutions towards their challenges.

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

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

They lobby to channel some of their resources towards improving quality

of health at particular communities or particular health delivery points.

During this lobby, they will use our interventions.

Just like Zak's, they have innovation teams.

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

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

for a long duration of time.

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

actually know the needs of people.

That data is always disseminated in stakeholder platforms and

maybe in blogs or YouTube.

Thank you, Mandela.

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

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

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

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

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

the information that you've provided.

That's true.

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

of life in that particular community.

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

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

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

they prioritise the ones they have.

Thank you very much.

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

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

turned in and got me thinking a lot.

Which brings me to my next question.

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

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

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

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

data in a understandable format.

Can you give me an example?

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

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

talk about what people are thinking.

We delved into the data, numbers and statistics.

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

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

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

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

Thank you Zak.

I'm going to ask Mandela the same question.

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

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

who worked alongside you in the project.

Were there any other contexts that you felt that you learned

from, that you could share?

I know she will be listening someday.

My supervisor, she's called Linet Okoth.

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

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

have not been prioritised in Kenya.

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

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

quality, we can actually act upon it.

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

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

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

complications that reach referral stages.

I absolutely love that for a final answer.

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

Mandela, the 'quality revolution'.

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

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

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

and engaging communities and moving things forward and including communities

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

today, what both of you been sharing.

Now, I'm going to thank you.

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

you over to my co-host Kim.

So welcome back, Kim.

Thank you very much.

So, the conversation has been wonderful.

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

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

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

Mandela; a piece of advice for others.

One piece of advice I will give is tap the

capacity of the community members.

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

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

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

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

we go to paperwork data collection.

That's my advice to the world.

Thank you.

Wonderful.

Thank you very much.

Some really key points there.

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

Zak, one piece of advice please.

My piece of advice would be partnership and

networking is so important.

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

and get different voices and different studies and different things involved

makes projects and studies always better.

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

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

and degrees and things like that.

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

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

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

Thank you very much.

Trust the communities.

I like that a lot.

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

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

communities are really hard to reach.

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

actually are not hard to reach.

A community centered approach is the way that works.

So yeah, that's my piece of advice.

Thank you.

Thank you Mandela.

Thank you Zak, and thank you Amina.

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

Thank you to our listeners.

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

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

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

So thank you again and see you next time.

Bye for now.

Thank you, Kim.

Bye