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 mediums or mechanisms do you use to collect feedback? (check all that apply)
Paper, Phone or voice, Physical gathering.
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.
If other, please specify
Often those providing the feedback are likely to be the ones receiving the requested services.
If other, please specify
The services are received.
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.
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.