The Challenge

Reaching a 100% vaccination rate has been difficult throughout the Third World for a variety of social, medical, economic, political and logistical reasons. Our client, The Gates Foundation, sought to study the overall mechanics of the vaccination process itself to gain an in-depth understanding of how vaccines are administered to patients in rural countries. In doing so, they hoped to identify areas of sub-optimization in the immunization process, ways to increase patient compliance, and additional areas for further research and hypotheses.

What We Did

The Gates Foundation chose to conduct ethnography in rural Uganda to achieve their goals, engaging Applied Marketing Science (AMS) to oversee the fieldwork and analysis of the research. The use of ethnography ensured that a scientific and systematic process was being used to observe the process for an extended period of time to extract key insights. Additionally, visual data recorded helped to capture unarticulated, latent needs of the patients and medical professionals.

The first step in the ethnography process was to obtain permission from the government, as well as the medical professionals and patients involved in the vaccinations. Working with local research partners in East Africa, AMS was able to obtain permission and arrange for filming of the vaccination process.

Videos of the vaccination process were filmed at a cross-section of immunization sites throughout Uganda, including rural outreach sites and static clinics. Our videos, which were later sub-titled, recorded the behavior, communication patterns, and workflows of the medical professionals as well as patients going through the immunization process. These videos were brought to life with 1-on-1 interviews of the medical professionals and patients, which were later translated and transcribed for analysis.

Next, we analyzed the ethnographic videos and interview transcripts and stratified the findings by district location and hospital types to identify patterns observed in the process and to understand the challenges and issues surrounding the vaccination process.

In addition, AMS moderated a one-day summit at The Gates Foundation U.S. headquarters, where medical and academic experts were asked to provide their commentary on the insights and brainstorm ideas for improving the process.

The Outcome

Through the use of ethnographic research, The Gates Foundation achieved a deeper understanding of the immunization process in rural Uganda, and identified possible areas for future immunization research and hypothesis.

Outcomes of the research analyses included:

• A time frequency analysis of immunization session activities and medical professional’s workflow
• Description of work patterns and challenges/inefficiencies observed
• A summary of attitudes/perceptions/observations from medical professional and patients perspective and insight into implications on compliance
• Video footage, ethnographic observation notes, and research artifacts that can be further broken down and analyzed to enable a better understanding of the different stages of immunization. These videos have been compiled into a database that will be a continuing resource for the NGO and other researchers to study.

Given the effectiveness of the research methodology implemented by AMS, The Gates Foundation plans to expand this research into other countries and aspects of healthcare with the goal of using the insights to improve healthcare outcomes around the world.