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A small island region seeks to make a big change in health services

Vanuatu’s Tafea Health Services (TPHS) shares how they’ll leverage a new monitoring and evaluation (M&E) tool to strengthen and expand local health services.

Tafea Provinicial Health Services, the branch of Vanuatu's Ministry of Health (MOH) responsible for planning and managing public health services in the country’s southernmost province, wants to better support its 33,000 residents. There was just one challenge: the team didn’t have a tool to accurately monitor and evaluate the impact of their current activities. These activities include supervisory visits, public health services, and local curative and corporate services. Without an effective M&E tool, Tafea Provinicial Health Services (TPHS) couldn't identify areas that could be improved or expanded.

A man stands in flip flops
Jerry conducts a supervisory visit.

”We don’t have a standard assessment template or community health checklist template to use during our provincial supervisory visits to health facilities. Due to time constraints, flight restrictions in other countries due to COVID-19, and limited resources, we sought technical assistance from Peace Corps Vanuatu,” explained TPHS's provincial health administrator, Jerry Iaruel.

TPHS created a 27-week-long Virtual Service engagement, which would connect Jerry and TPHS's public health manager, Lolyne Jeremiah, with American Virtual Service Participants who had experience designing, implementing, and operating M&E tools.

The short-term project interested both Alexa Cline and Caroline Pascal. Based in London, Alexa is a health economist, so she regularly analyzes data to determine the clinical effectiveness and economic impact of innovative healthcare treatments in real-world settings. Caroline is a different type of analyst; she supports her Pennsylvania-based employer as a trained qualitative analyst, managing geriatrics-related health equity research and operations projects. While the two public health workers live worlds apart, they have a lot in common.

For one, the two were determined to serve with the Peace Corps from a young age. Caroline would go on to support a community in Ghana (2018-2020) as a rural health education facilitator, where she co-led community health initiatives with her Ghanian counterpart, such as a community latrine in addition to family planning and gender empowerment campaigns.

“Public health is in my bones. I was never able to articulate what I wanted to do in middle or high school, because I didn’t know public health was a career, but once I knew what it was about, I haven’t wavered,” shared Caroline.

Alexa served as a primary literacy teacher in St. Vincent and the Grenadines (2017-2019), co-facilitating interactive literacy sessions for kindergarten to sixth-grade students. She also supported teachers and community members in developing engaging after-school and summer programs. But it was one of her secondary projects – collaborating with local medical students and health organizations – that she credits for directing her towards her current public health career.

A woman stands in front of a Peace Corps Ghana sign
Caroline at her close of service in Ghana.

When the two returned Volunteers discovered that Peace Corps’ Virtual Service enabled them to donate their professional skills to support community health projects without leaving their current roles, they immediately expressed interest.

“I didn’t know if it was something that I would have time to do, or if it would be aligned with what I do now," confessed Alexa.

Alexa, Caroline, Jerry, and Lolyne met each other for the first time this past May. It was important to all parties that they take small, measured steps when developing the M&E tool. Rather than create all-new primary data sources that could burden the local staff, they focused on compiling current datasets into a general checklist that could easily be used during TPHS’s bi-annual visits to the province’s various health facilities – from provincial hospitals to sub-provincial clinics.

"[With Virtual Service,] you really need to rely on your local counterparts, because you're not there in person. It comes down to listening and learning from their experiences."

“A simple checklist can be used by the local team when they visit different facilities to highlight key health indicators and later analyze the data,” said Alexa. “Our local counterparts also are interested in creating a dashboard, which would transform the checklist information into actionable insights.”

The 52-question checklist covers staffing, patient demographics, emergency preparedness, and accessibility to services and supplies.

“Alexa and I started to identify additional questions that may be helpful, but our counterparts have a better idea of what’s already being collected and what the staff at the facilities have access to,” Caroline stated.

A blonde woman holds a certificate and flag
Alexa at her close of service

Jerry and the TPHS team are excited to use the M&E tool to help them meet the goals outlined in Ministry of Health’s 2021-2030 health sector strategy. In fact, the checklist is already being pilot tested in two communities. TPHS will then incorporate feedback from the communities and train its staff. Until then, Alexa and Caroline are developing an analytics dashboard to make data analysis easier.

“We will be able to analyze the current services at health centers, dispensaries, and aid posts. Lastly, the results will help our provincial health managers to properly plan activities and allocate budget to improve the quality of our community health services,” said Jerry.

When it came to creating a tool for local staff, Alexa stressed that Jerry’s guidance was essential, stating: “[With Virtual Service,] you really need to rely on your local counterparts, because you're not there in person. It comes down to listening and learning from their experiences.”

The engagement was also successful in part to Vanuatu’s program manager, Len Tarivonda, who regularly checked in.

“Len was a great resource; In addition to his role with Peace Corps, he is an experienced public health worker.” Alexa went on to add, “It's nice to work with people from different backgrounds and experiences – whether that's our local counterparts or Caroline. It’s an opportunity to learn and hear different perspectives.”

“Virtual Service clearly demonstrates that certain essential projects can be done without the technical person on the ground. It’s a new mode of operation which is good for Vanuatu because of our isolation,” Len shared.

Building relationships was a highlight for both Caroline and Alexa. The Participants expanded their professional network and gained additional intercultural experience.

“Getting to know Alexa has been one of the best parts of my experience. She has a strong background in public health, so I feel like I've learned a lot from her,” Caroline stated. “The quality of the work is more important than [we as Participants] know, but the relationships built [during virtual engagement] are perhaps even more important.”

As the engagement draws to a close, TPHS will consider opportunities for virtual engagement in the future.

“It was our first experience with Virtual Service; I really learned a lot. It costs less and meeting [online] is convenient as long as the network is working well,” stated Jerry.