The Applied Practicum Experience Journey took place from Monday, February 27, 2023, to Friday, March 17, 2023. The total duration of the experience was 80 hours and 30 minutes.Throughout this period, I participated in three key activities: the district’s annual performance review, NHIS accreditation, and a visit to the zipline at Anum. As part of the NHIS accreditation process, I was tasked with providing protocols for the maternity ward.

During the annual peer review, two main issues were identified: nonadherence to TB treatment and low uptake of the COVID-19 vaccine. To address these problems, we planned two interventions. First, a stakeholder engagement was organized to increase vaccine uptake, and second, a reminder system was developed for TB clients to adhere to their treatment. The reminder system took the form of a voice campaign delivered in the local language. The voice campaign was designed to play at 6 am each day for three weeks, as most TB medication is taken early in the morning on an empty stomach.

It targeted a group of 14 individuals, including 13 clients and the TB Institutional Coordinator of Peki Government Hospital. After the three-week period, the campaign's effectiveness was evaluated by placing mobile phone calls to the participants. Out of the 14 individuals, 8 responded and expressed high appreciation for the campaign, requesting its continuation.

Participants provided some recommendations for improvement:

1. Two participants suggested running the campaign twice daily, in the morning and evening, to accommodate those who take their medication in the evening. The TB Coordinator explained that medication timing depends on the clients' ability to remember and use prompts/cues in their environment, such as school bells, drums, or the Muslim adhan.

2. A two-way campaign was also recommended, as one client expressed a desire to call and show appreciation but was unable to do so.

3. The institutional TB coordinator suggested including information on good nutrition or healthy dietary practices for the clients.

The outcome of the evaluation was shared with my preceptor, Mr. Norvor. He expressed satisfaction with the results and assured me that he would share them with the health directorate. He also promised to discuss the way forward after sharing the evaluation findings. The outcome of the evaluation was shared with my preceptor, Mr. Norvor. He expressed satisfaction with the results and assured me that he would share them with the health directorate. He also promised to discuss the way forward after sharing the evaluation findings.

Competencies Attained: I achieved three foundational competencies and two concentration competencies, which are as follows:

 

1. Assessing population needs, assets, and capacities that affect communities' health:

• Conducted a needs assessment of the population of TB clients receiving treatment in the South Dayi district.

• Identified the need for reminding clients to take their medications.

• Discovered that clients possess mobile phones, which can be utilized as an asset and medium for intervention.

• Noted that clients could easily respond to a form call.

2. Selecting communication strategies for different audiences and sectors:

• Developed protocols and displayed them on the walls of the maternity ward.

• Engaged with community heads to ensure stakeholder involvement.

• Sent invitation letters to stakeholders for a meeting.

3. Communicating audience-appropriate public health content (non-academic, non-peer audience):

• Delivered the message in the local language of the clients, ensuring effective communication with the target audience.

4. Applying health promotion skills specific to low-resource settings to improve community well-being:

• Implemented a voice campaign that involved answering a phone call.

• Delivered the message in less than half a minute, considering the limitations of low-resource settings.

• Addressed the public health issue of non-adherence to treatment, which can potentially spread drug-resistant strains of TB to the entire community.

5. Applying tools and concepts beyond the traditional public health scope to solve health challenges at the district level:

• Introduced an innovative voice campaign as a solution to the problem of non-adherence to treatment at the district level.

Attached is a sketch of the graphical representation of how the voice campaign works, the voice message, and a sample of the protocol.