Putting It Together: Hauwa's Dropout Problem
Goal Walk one problem through the working cycle, and pick the right tool for any question.
Illustrative caseHauwa runs a rural PHC in Kano State. Last quarter she gave Penta1 to 120 children and Penta3 to 78. Her dropout rate is (120 − 78) ÷ 120 = 35 per cent. WHO's Immunization in Practice guide rates dropout of 10 per cent or more as poor use of services.
- Define. Target behaviour: caregivers bring their child back for Penta2 and Penta3 on time. Staff trace every missed child within a week.
- Diagnose. A CFIR scan and BeSD questions find a faulty fridge (inner setting), an unreviewed defaulter list (implementation process), a rumour (thinking and feeling) and long waits (practical issues).
- Design. Each barrier gets a function and an ERIC strategy, such as "change physical structure and equipment" for the fridge and "audit and provide feedback" for the defaulter list.
- Deliver and track. Hauwa tracks fidelity (was the list reviewed every Friday?) and cost per outreach session.
- Evaluate and sustain. Implementation: weekly reviews held as planned. Reach of the tracing strategy: the share of missed children traced within a week. Maintenance: the routine still runs six months later. Effectiveness, reported on its own line: dropout below 10 per cent.
Framework Chooser
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