Nursing for All

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Nursing for All

Monrovia and Ganta , LiberiaMonrovia and Ganta, Liberia
Year Founded:
2013
Organization type: 
nonprofit/ngo/citizen sector
Project Stage:
Start-Up
Budget: 
$10,000 - $50,000
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

Nursing for All's flagship program, the Nurse-lead Public Health Initiative Program, has seven programs operating in two cities in Liberia. NFA asked local nurse leaders to submit their ideas for public health programs their communities need and selected the seven strongest proposals for funding.

WHAT IF - Inspiration: Write one sentence that describes a way that your project dares to ask, "WHAT IF?"

What if you asked nurses in the developing world to design and implement community-based public health initiatives that they believe provide the right solutions to their communities' public health challenges?
About Project

Problem: What problem is this project trying to address?

NFA addresses two problems with one solution: one, the lack of needed public health programming in the developing world, and two, the lack of opportunities for nurse professional development. Public health programming is sorely lacking in Liberia, and nurses frequently emigrate, citing a lack of professional development opportunities as a major reason for leaving. NFA believes it can address both issues with our Nurse-lead Public Health Program.

Solution: What is the proposed solution? Please be specific!

In summer 2013, NFA solicited proposals from nurses in Monrovia and Ganta, Liberia for the public health programs these nurses believed would benefit their communities. The ideas varied: family planning, substance abuse education, hypertension screening. In September, NFA reviewed the applications and picked the seven strongest, then held a launch weekend in Monrovia, when participants worked together to refine their ideas, finalize their budgets, and develop plans for program evaluation. Since then, NFA has received biweekly updates from each participant describing their program's successes and challenges. Each participant receives a salary based on the number of hours per week they spend on their initiative, as well as money for supplies.
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

One of NFA's programs, run by Solomon Yah and Clinton Zeantoe, operates at the preschool Clinton's children attend. This initiative's aim is to reduce transmissible illness at the preschool through cleaner water and better hand hygiene. Clinton and Solomon first replaced the school's drinking water system, installing water coolers that are easier to clean and harder to contaminate. They then held classes for parents, teachers, and kitchen staff about hand hygiene and proper food prep. They also began to participate in morning assemblies to teach the children the importance of hand hygiene as well as the proper way to wash. They school's administrators have reported a drop in school absences due to illness since the initiative began.

Impact: What is the impact of the work to date? Also describe the projected future impact for the coming years.

Although NFA's programs have been operating only since September, they each have already made an impact. The adolescent sexual health class has held weekly sessions since October with about 16 attendees per session. The family planning program in King Gray has started 67 women on birth control and held six community meetings to educate interested women about their options. The hypertension screening program has screened 137 adults and identified 27 for follow-up due to elevated readings. The peer education for reproductive health program in West Point trained 20 adolescent peer educators in a three day session in October, and since then each pair of educators has gone out at least weekly to educate other teenagers and distribute condoms. The anti-substance abuse program in Ganta has held weekly meetings at a local high school and also done weekly radio programs on Voice of Gompa 106.5.
Sustainability

Financial Sustainability Plan: What is this solution’s plan to ensure financial sustainability?

In 2013, 100% of Nursing for All's support came from individuals. In 2014, while we plan to double our budget, we hope only 66% of it will be raised from individuals, with the remainder coming from a combination of corporate and foundational support. To do this, we need to boost individual gifts by only 25% while raising $15,000 from corporations and foundations. In the long term, NFA hopes about a third of its budget will come from each source.

Marketplace: Who else is addressing the problem outlined here? How does the proposed project differ from these approaches?

Nursing for All is proud to be the world's only nonprofit focused exclusively on supporting nurses, and, as best we know, no other program exists that operates as our Nurse-lead Public Health Initiative Program does. A similar model can be found at the Dreyfus Health Foundation's Problem Solving for Health program. However, this model differs in that DHF does not offer participants salaries or material stipends for their programs: rather, they encourage them to work with resources at hand. Unfortunately, DHF is no longer offering new PSH trainings and does not operate in Liberia.
Team

Founding Story

Nursing for All was conceived on two principles: one, that there should be an organization dedicated to supporting nurses in the developing world, and two, that that organization should impact health. NFA considered several models before settling on our current one. Two things pushed us to do so: one, we were confident a program like the Nurse-lead Public Health Initiative Program could measurably impact health, and two, when discussing the idea with local nurse leaders in Liberia, we were met with considerable enthusiasm. Many of the nurses we spoke to as part of our informational visit went on to become NLPHIP participants, including Cecelia Morris, the Chair of the Liberian Board of Nursing and Midwifery.
About You
Organization:
Nursing for All
About You
First Name

Laura

Last Name

Ridge

LinkedIn URL
About Your Organization
Organization Name

Nursing for All

Organization Country

, Monrovia and Ganta

Country where this project is creating social impact

, Monrovia and Ganta

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Impact
Full Impact Potential: What are the main spread strategies moving forward? (Please consider geographic spread, policy reform, and independent replication/adoption of the idea or other mechanisms.)

NFA plans to expand the number of programs it's operating in Liberia before expanding to other regions. We have already received applications from nurses for our next round of funding. We're also considering adding another nurse participant to certain already operational programs which have expressed interest in expanding their services or covering a greater area. We also plan to partner with iLab Liberia to develop mobile applications to help participants track their program's progress daily, rather than relying on biweekly reports.

Barriers: What barriers might hinder the success of your project and how do you plan to overcome them?

NFA has two main concerns: one is sustainable funding and the other is maintaining program quality. While we have developed a fundraising plan we believe is sustainable, there is always some anxiety, especially for an all-volunteer administrative staff. To maintain program quality, especially as we expand our portfolio of programs, NFA is planning to hire an employee in Liberia in April 2014. We believe this additional assistance in overseeing our programs and collecting program evaluation data will be critical is ensuring our programs have the support they need to continue to move forward.

Sustainability
Partnerships: Tell us about your partnerships.

NFA has two major partnerships: one is with the Liberian Board of Nursing and Midwifery, and the other is with United Methodist University's Winifred J. Harley College of Nursing, which has campuses in both Monrovia and Ganta. Staff members from each organization are among our program's participants, and the LBNM distributes the NFA's salaries in Liberia. NFA has also made in-kind donations to UMU's library and clinical midwifery lab.

Closing the Loop
How does your project primarily ensure that feedback delivers results?

Facilitate a conversation that combines wisdom of the crowds with the perspective of experts.

Please elaborate on your answer to the above question.

NFA's Nurse-lead Public Health Initiative Program is founded on the idea that nurses, as both public health experts and integral community members, are perfectly situated to devise solutions for their communities' public health problems. Eight of our nine participants either lived or worked in the communities in which they now operate their initiatives, and the ninth has worked hard to develop strong neighborhood partnerships. NFA has also sought feedback from participants about our support of their work both in their biweekly reports and in their interim report, due at the end of this month.

Languages: In what languages are you able to read and write fluently?

English.

2nd Round Questions
Thinking about your feedback loop; what information are you trying to get from whom, to whom, and to bring about what change?

Nursing for All's feedback loop has two stages: the first takes place as nurses design their programs, and the second is after those programs have launched. In the first phase, nurses interested in running their own public health initiatives work with their communities to develop a program to submit to NFA for funding. The vast majority of NFA's nurses design programs for communities they either live in (five of nine) or have worked in for a long time (three of nine). How they work with those communities to design their initiatives varies--some chose to dovetail with preexisting public health programming, others opted to work with current community structures that were not public health oriented. For example, one of our nurses developed her idea for group HIV/AIDS prevention trainings when she observed a large group gathered at a local bar to watch a soccer game. She approached the bar's proprietor and asked if he was willing to play a short informational video prior to the start of each game. He said he would, and this became one of the strategies her program uses to provide community-based prevention education. None of the nurses wanted to reinvent the wheel--they all saw the necessity of real partnership with the community for success. The second phase of feedback is after the program has started, as the nurses assess how their impact model is playing out in the real world. During this phase, the nurse gets more feedback from the community, which s/he then uses with NFA to refine his/her program to maximize community impact. For example, one nurse performs hypertension screenings in the VOA Community. She intended to just screen and diagnose, and then refer to the hospital for treatment. However, over time she discovered that many of the people she referred to the hospital cannot go due to cost. So, she applied to NFA for additional funding so that she could prescribe and administer hypertension medication in the community. (The nursing scope of practice in Liberia permits this, and she has the necessary experience and training to do it safely.) She received her funds, and is now treating hypertension as part of her initiative.

What is the purpose of your feedback loop?

Improve quality of programs

If other, please specify
What mediums or mechanisms do you use to collect feedback? (check all that apply)

Paper, Phone or voice, Physical gathering.

If other, please specify
Could you briefly describe the way you collect the feedback?

Nurses collect this feedback from their communities through a variety of informal mechanisms, primarily personal conversations. It is communicated back to NFA via each project's biweekly written report. If a program modification has been suggested, NFA requests a budget from the nurse for this change. NFA then follows up with the nurses with either request for more information, the funds, or a rejection. Thus far, NFA has only rejected one request for a program addition, because we simply did not have the funds. Of the seven programs Nursing for All has run, four have applied for and received additional funding after receiving feedback from the community.

What mechanisms are in place to protect people from retribution?

Option to provide feedback anonymously

If other, please specify
What are the immediate benefits or incentives for people to provide feedback?

None

If other, please specify

Often those providing the feedback are likely to be the ones receiving the requested services.

How do you ensure new and marginalized voices are heard?

None

If other, please specify
What are the incentives for the intended recipient to act on the feedback?

They understand that feedback is necessary

If other, please specify
How does the feedback mechanism close the loop with those who provided feedback in the first place?

Other

If other, please specify

The services are received.

How is feedback published/transparent?

Written report

If other, please specify
Give two concrete examples of how feedback loops have brought a program or policy more in line with citizens’ desires.

A great example of program modification is a peer-lead sexual health education initiative run in the West Point Community of Monrovia. Shelly, the project's leader, had the initial vision was that she would work with Planned Parenthood Liberia to train twenty adolescent peer educators, who would then work in pairs to provide sexual health education and distribute condoms in West Point. She also had weekly meetings of the peer educators so that they could support each other and receive additional training. At one such meeting, Shelly's peer educators came up with the idea for a community day in West Point, when members of the community could come to a centralized location to receive services, based on their conversations with local residents. On February 15, the community day took place. NFA provided the funds for Shelly and her peer educators to rent a hall, market the event, purchase additional contraceptives to provide to the community, and feed attendees. 60 people came, and 22 women received family planning medication. These events have now been incorporated into Shelly's program model permanently. Another example is Cecelia's adolescent sexual health education class, which she believed her community needed badly due to the number of adolescent pregnancies. However, when Cecelia was designing her program, she came across many opportunities for teenagers to learn about sexual health in her community. She realized that the problem might not be that students didn't know about the importance of, for example, condom use, but that they didn't know how to negotiate using a condom at the critical moment. So, she designed her class with that in mind, and designed a pre-test for students that included questions like, "I believe condoms are important" and "I have trouble asking my partner to use a condom." Sure enough, the pre-tests showed many of her students had received sexual health messages, but struggled to actually use them. So, Cecelia committed to using her class for empowerment exercises like role-playing to help students implement what they already knew.

If there was one thing you could change to increase the impact of your feedback loop, what would it be?

Our major issue with our feedback loop is that it is so informal. One of NFA's goals for 2014 is to develop tools to give participating nurses so that they can capture feedback more easily and transmit it more directly to Nursing for All than is currently possible. To that end, we are looking into working with iLab Liberia, in Monrovia, which has worked with many small NGOs in the past to develop user-friendly mobile platforms for data capture.

What are your biggest challenges or barriers in “closing the feedback loop”?

Lack of funding for feedback data collection

If other, please specify
Are you aware of The Feedback Store?

No, but I can see myself using it as a resource

What are the main uses you can envision for the Feedback Store?

Browsing the options to see what kind of functionality current products offer in gathering data.

What is the one thing you would most like to see changed to improve the competition process?

I had a lot of trouble with the website, but I was very grateful that Ashoka took my concerns seriously and asked me for more information about them.

What are you doing to make sure that feedback providers know that they are empowered by the information they can give and that they know exactly what the information they are providing?

NFA has until now relied on participating nurses to gather feedback as they have been able, which means the process has been somewhat informal. However, every single participating nurse has nevertheless provided some feedback to NFA from the community, largely because each nurse wants his/her program to be as effective as possible. Each of the nine nurses is very invested in community feedback as a practical mechanism for making sure the project into which s/he has poured so much of his/her time and effort is as strong as possible.