Home-based Records Revitalisation Workshop

Workshop Report | April 2017

Table of contents

1. Introduction………………………………………………………………………………………………..…….03

2. Why home-based records?....................................................................................06

3. The challenge around home-based records……………............................................12

4. HBR revitalization workshop for the Africa region…………………………………………….21

5. Opportunities identified……………………………………………………………………….……..…..29

6. Key lessons for HBR revitalization………………………………………………………….……..….45

7. Appendices guide………………………………………………………………………………….……...…48
1 | Introduction
Home-based records (HBRs)
are a vital tool that can
support countries in achieving
and sustaining high levels of
vaccination coverage.

However, many countries

continue to face challenges,
including low retention rates
by parents, difficulties in the
printing and distribution of the
document, and training health
workers in its appropriate use.
Following the success of a similar initiative in South Asia The workshop focused on improving:

1
in 2016, the WHO Regional Office for Africa (WHO/AFRO),
UNICEF, and the Bill & Melinda Gates Foundation (BMGF)
organized a cross-country workshop focused on the Africa
region. The goal of this Home-based Records The design of the record from
Revitalization Workshop was to improve the design and
functionality of countries’ home-based records, with a the immunization program
focus on both the design of the record and the system
that supports it. perspective.
The focus on immunization was chosen as an opportunity

2
to demonstrate a systemized approach that can be
applied to other elements of integrated health systems
and materials.
The workshop brought together health administrators The broader system that
from Cameroon, Ethiopia, Liberia, Nigeria, Rwanda, and
Uganda with regional and global experts from
supports the HBR, from
organizations such as UNICEF, WHO, and JSI. This report is
based on the discussions, strategies and solutions that
approval and production to
came out of this workshop. distribution and use.
2 | Why home-based records?
What are home based records?

Home-based records (HBRs) are medical

documents issued by a health authority. They
provide a record of an individual’s history of
primary healthcare services (e.g., vaccinations)
received. They are maintained in the household
by an individual or their caregiver.

HBRs date back to the 19th century, and have served an

important role in the recording of vaccinations around the
world. Since the beginning of the Expanded Programme
on Immunization (EPI) in 1974, HBRs have reached a
global adoption rate of approximately 80%. However,
retention rates in many countries remain significantly low,
which is prompting the global community to seek ways to
help improve the use and availability of this important
tool.

Home-based record vaccination section from Liberia.

There are 3 main kinds of records:

• Vaccination only: Record of basic identifying

information and immunization services
received.
• Vaccination-plus: record of child growth and
development, immunization services, and a
limited set of basic information related to child
survival.
• Child health book: record of birth
characteristics, health services received
(including immunization), and detailed
guidance to parents (growth, feeding, family
planning, etc.)
Some countries use other integrated formats such
as mother and child health booklets.

Ethiopia’s current home-based record is an example of a vaccination only record.

WHO has compiled a digital HBR collection, with exemplars from a variety of its Member States
This collection is available at: http://www.who.int/immunization/monitoring_surveillance/routine/homebasedrecords/en/
There are multiple ways
that HBRs can function to
increase the effectiveness
and efficiency of
immunization programs. Care Reminders Continuity of Care
Provide a record of the care given, and a Document services that have been
When widely available and reminder for future health care (e.g. provided to support health care
effectively used, HBRs provide upcoming immunization visits). workers in provision of continued
care reminders, support effective care.
continuity of care, reduce
inefficiencies (e.g. over-or
under-vaccination), and provide
evidence of services.

Evidence of services Reduced inefficiency

Act as a source of individual patient- Provide information at the time of
level data to cross check during care to reduce unnecessary re-
national surveys and other data vaccination and minimize missed
collection events. opportunities for vaccination.
Simultaneously considering and addressing the needs of HBR’s three primary user groups is
vital to improving the availability, utilization, and adoption of HBRs. *

Caregivers Health workers Health administrators

Parents, grandparents, aunts,
uncles, siblings, any other primary
care provider responsible for the
child’s health and immunization.
Responsibility
Advocating for HBR availability,
keeping HBR safe and brining it
to immunization visits and
other healthcare encounters,
retaining HBR.
Vaccinators, midwifes, nurses,
community health workers, or other
individuals directly involved with
delivering immunization services.
Responsibility
Updating HBR at each visit with
child, use HBR for counseling
with caregiver, and including
data from HBRs in reports to
health administrators.
Facility managers, health officials at
district, regional or national level,
international community committed
to immunization initiatives.
Responsibility
Verifying HBRs are available and
in use by caregivers; conducting
quality assurance and
supervision of their use with
health workers.

*WHO Practical Guide for the Design, Use, and Promotion of Home-based Records in Immunization Programs
3 | The challenge around home-based records
Challenges facing HBR use and adoption Current HBR ownership prevalence for the WHO
African Region
HBRs are unable to fulfill their critical functions when:
• They are not readily available in the right place, at
the right time, and in the right quantity
• The document is not adopted, valued, and retained
by caregivers, nor appropriately utilized by
healthcare workers

Many countries continue to face challenges related to:

• Retention and use of HBRs
• Printing, supply, and distribution of the document
• Training of health workers in the appropriate use
of the record

Nearly 25% of the countries with an HBR

retention rate lower than 50% are in the
0 50% 80%
Africa region.
Prevalence
Graphic courtesy of David Brown, Brown Consulting Group Int’l, LLC
The prevalence of home-based records varies across geographies

90%>, 13
<50%, 22

80%-89%,
22
50%-79%,
37

No DHS or MICS
<50%
50-79%
80-89%
90-99%

Source: Latest national estimated prevalence of home based vaccination cards based on MICS or DHS survey results
for the period 2000-2015, 21 December 2016 https://sites.google.com/site/vaccinationcardprevalence/
Low HBR retention is particularly worrying in countries with high birth cohort

Several countries
with low current HBR
ownership levels
have large birth
cohorts; thus, the
Half of the birth cohort in 32
burden of absent countries in the AFRO region
documented lack home based records
vaccination history is
of great concern.

Graphic courtesy of David Brown, Brown Consulting Group Int’l, LLC

Most governments still depend on complex multi-partner financing of HBRs

HBRs might be financed by EPI/MoH

alone, or depend on the funding
from a development partner. In most
countries however, financing of HBR
comes from a combination of
EPI/MoH and different partners.

Legend
EPI/MoH alone (20 countries)
Development partner alone (12 countries)
EPI/MoH + Development partners (31 countries)
EPI/MoH and partners exclusive of development partners (53 countries)
Other combinations of partners (19 countries)
HBR not used (2 countries)
No response to question (3 countries)
Non-respondent country (55 countries)

Young SL, Gacic-Dobo M, Brown DW. Results from a survey of national

immunization programmes on home-based vaccination record
practices in 2013. Int Health. 2015;7(4):247-55.
HBRs are often damaged due to environmental conditions, or not wholly completed by
health care workers
HBR prevalence, funding models, and
retention might often feel like complex
administrative challenges, with unclear
entry points to begin to solve for.

However, there are often

challenges that can be identified
and addressed that can improve
availability, functionality, and
utility of the HBR for each of the
three key user groups.
Improvements in HBRs should address the challenges of the three key users

Some commonly identified challenges of HBR users

Health workers’ Health administrators’

Caregivers’ challenges challenges challenges

• Illiteracy makes it hard for some
caregivers to understand the
HBR.
• Caregivers may have trouble
preserving the HBR due to rough
environmental conditions (see
page 18).
• Health workers struggle with the
workload of filling out all the
sections in the HBR.
• Quality and availability of HBRs
is often an issue that health
workers try to resolve with their
own work arounds.
• Lack of resources makes it hard to
ensure the availability of stocks at
all times.
• Low HBR retention can
negatively impact coverage
estimates due to lack of
verifiable data for surveys.

To improve the availability,
utilization, and adoption of home-
based records, countries need to
ensure that their HBR meets the
needs of its three key user groups;
and that it is available at the right
place, at the right time, and in the
right quantity.
This requires:
1
A user-centered, needs-
driven approach, which has
proven track record of
success in many industries.
2
A system perspective that
looks beyond the HBR to
improve the broader system
that supports it.
4 | HBR revitalization workshop for the Africa region
The HBR Revitalization workshop for the
Africa region
Took place between 21-24 February in Kampala,
Uganda, and brought together health administrators
from Cameroon, Ethiopia, Liberia, Nigeria, Rwanda
and Uganda with regional and global experts from
organizations such as UNICEF, WHO, and JSI to:

1 Improve the design of the record, with a focus

on the sections related to immunization.

2
Identify and prioritize challenges, and design
improvement strategies for parts of the
broader system that supports the HBR,
including printing, supply, and distribution of
the document, as well as the training of health
workers in the appropriate use of the record.
We can learn from the
experiences of countries
(e.g. Rwanda) with high HBR
ownership and low drop-out 5%

rates, and apply these

lessons to countries facing 39% 39%

HBR ownership prevalence (%)

35%
challenges with HBR
retention and maintenance. 55%
loss
rate
For this reason, participants 45%

from Rwanda were invited to

the workshop to share their
best practices with the five
countries whose ‘ever’ and
‘current’ HBR ownership
birth
levels posed opportunity for cohort
2013 2010 2010 2012 2012 2010

improvement.
Graphic courtesy of David Brown, Brown Consulting Group Int’l, LLC
Data source: Re-analysis of DHS and MICS
The workshop objectives included:

• To use well-established and proven design principles to

develop a redesigned paper-based prototype of an HBR
that better suits the identified needs of caregivers,
health care workers, and health administrators.

• To identify a clear roadmap for further country

engagement and eventual implementation of the revised
HBR, with a goal of improving adoption, perceived value,
retention by caregivers, and appropriate utilization by
healthcare workers.

• To identify challenges in the HBR supply chain, and

develop a plan to increase the likelihood that HBRs are
available in the right place, at the right time and in the
right quantity.

Participants adopted a user-centered

approach and a system perspective to reach
these goals.
The workshop was one element of a longitudinal process that included pre-workshop field work
and post-workshop implementation activities. This integrated, cross-cutting process is essential to
the success of the initiative.

1. 2. 3.
Knowledge Cross-country Implementation
Gathering Workshop
1. Knowledge gathering

Understanding and addressing the needs of the

three user groups is key to making the HBR
more effective and to improve utilization.

To gain this understanding, participants:

• Visited and observed vaccination activities in
health facilities
• Interviewed caregivers and health workers
• Mapped out how home-based records are
prepared, produced, distributed, and used in their
countries.
Through these activities participants better
understood the needs of and developed empathy for
other user groups; and questioned their pre-existing
assumptions regarding challenges to effective use and
adoption. This knowledge was used to inform
decisions made in the workshop.
2. Cross-country workshop

Throughout four full days in the workshop, participants worked in their country teams to move through a
stepwise process from identifying user needs to creating a practical and actionable implementation plan.

Day 1 Day 2 Day 3 Day 4

Define Explore Build Implement

Frame the challenge Empathize with users Generate a concept Create a prototype Plan and pitch

Align on the challenge

Communicate the Plan for next steps to
for the workshop and Empathize with the needs and challenges
team’s solutions and support implementation
build a common of HBR users and generate solutions both for a
iterate based on of the revised HBR and
understanding of needs revised HBR design and for system improvements.
feedback. systems solution(s).
and potential solutions.
3. Implementation

Participants came out of the workshop with three key

outcomes:
• Paper prototypes of refined HBRs, with improvements
based on design principles tailored to identified user
needs.
• A roadmap to address identified challenges in the HBR
system (preparation, production, distribution and use
of the HBR)
• An implementation plan for the paper prototype and
system solution with immediate, actionable, next steps

Following the workshop, teams will engage with decision-

makers and key stakeholders in their countries to build on
work completed during the workshop and support
implementation. Regional and local partners will work
with each country team to support this process.
5 | Opportunities
The opportunities identified during the workshop can be grouped in two categories, which complement
each other to maximally impact the utilization of HBRs.

Country teams in the

workshop also developed
clear implementation plans to
realize the identified
opportunities for Improvements on the
improvement. Improvements on the
DESIGN
SYSTEM
In the following sections we share of the HBR tool
common themes that emerged
across countries, as well as
identified potential solutions.
Individual accounts of each
country’s outputs are available in
the appendix.
Re-thinking the
Home-Based
Record design
To ensure that HBRs meet the needs of the users on the ground, their design should follow well established and
proven design principles that reflect the rules of effective communication in printed documents.

1 2 3
Offer information hierarchy Make the ‘date of next Provide space for notes
that accounts for needs of vaccination’ highly visible & additional vaccinations
multiple users

4 5 6
Consider color, contrast, and Make the record recognizable Use illustration and imagery
format for reproduction as an official health document to support text descriptions

For more detail on design guidelines see Practical Guide for the Design, Use and Promotion of Home-based Records in Immunization Programmes,
available at http://apps.who.int/iris/bitstream/10665/175905/2/WHO_IVB_15.05_eng.pdf
 Following these principles, and based on their learnings from interacting with users on the
ground, country teams reviewed the design of their HBRs and identified opportunities for
improvement.

1. How can we use design features to increase the perceived

Some of the challenges that
emerged as common patterns,
which the teams addressed
through the design of the HBR
were:
value of the HBR for caregivers?
2. How can visual language increase the usability of the HBR?
3. How can we reduce the burden of completing the card for
health workers?
4. How can we leverage an understanding of user needs and
design to reconcile the optimal degree of integration
(stand-alone vaccination cards vs integrated handbooks)?

In the following pages we present example cases and potential solutions for each.
1 How can we use design features to increase the
perceived value of the HBR for caregivers?

Many countries were challenged by the lack of caregivers’

awareness of the importance and value of retaining the HBR.
In the workshop, teams explored design solutions that would
increase the perceived value of the HBRs.

EXAMPLE SOLUTION: The Ethiopia team developed a

prototype where they:
• added the national logo on the cover of the HBR to
stress the official importance of the card
• added a fingerprint of the child to build emotional
connection with the caregiver
• incorporated the vaccination certificate as the last
page of the card to encourage caregivers to keep the
card after full vaccination is achieved.

Images from Ethiopia’s redesigned prototype.

For more details on the prototype developed by Ethiopia, see appendix 7
2 How can visual language increase the usability
of the HBR?

Given low literacy rates in many African countries, improving

illustrative visuals was a primary area for improvement.
Illustrations that were more user friendly and clearly described
complex issues could help improve usability for caregivers and
health workers alike, and increase retention. Illustrations can
also help non-literate caregivers better understand and act on
the information in the card.
EXAMPLE SOLUTION: The Liberia team developed a
prototype where they:
• Added a visual representation of a mother and a father
to highlight the importance of both caregivers
contributing to the health of the child.
• Re-designed the vaccination information page with an
illustrative image that provided information on the
locations where different vaccines are given.
• Re-designed the growth chart examples that illustrate
different stages of child development. Images from Liberia’s redesigned prototype.
For more details on the prototype developed by Liberia, see appendix 7
3 How can we reduce the burden of completing
the card for health workers?

In the course of their daily work, many healthcare workers have

so much paperwork to complete that they don’t have time to
provide education messages to caregivers, nor to fill in all
sections of the home-based record.
EXAMPLE SOLUTION: The Nigeria team developed a
prototype where they:
• Removed the batch number which often wasn’t used
and was duplicated in the register.
• Separated the information flow so that components
inside the document are for health-workers and those
on the outside are for caregivers
• Added instructions and increased the size of the boxes
to improve legibility.

Images from Nigeria’s redesigned prototype.

For more details on the prototype developed by Nigeria, see appendix 7
4
How can we leverage an understanding of user Stand-alone
needs and design to reconcile the optimal immunization card
degree of integration?
Front (child information
and vaccine schedule)

There is a global conversation about the potential utility of

moving towards integrated health books, and Africa is not an
Back (growth chart,
exception. Participants found they were able to manage some supplements, feeding)
of these tensions through design.

EXAMPLE SOLUTION: The Cameroon and the Uganda

team separately developed prototypes that:
Immunization card integrated to the MCH health book
• Can both be printed as a stand alone card, or be
integrated into the MCH book.
• Include all the relevant information, without
repeating data that is contained in other sections of
the MCH health book.

Folded design staples Unfolds for use, or can be

into center of book detached from book

Images from Uganda’s redesigned prototype.

For more details on the prototypes developed by Cameroon and/or Uganda,
see appendix 7
Re-thinking the
Home-Based
Record system
 To ensure the HBR is available at the right place, at the right time, in the right quantity,
countries need to work to ensure that the preparation, production, distribution and use of the
HBR is planned and executed in the most effective manner.

1. Awareness and advocacy building

The most common system 2. Building a business case for HBRs

challenges that emerged during 3. Obtaining sustainable funding
the workshop included: 4. Designing effective supply and distribution
5. Defining and negotiating the level of integration

In the following pages we present example cases and potential solutions for each.
 Awareness and advocacy building CONSISTENT COMMUNICATION ARCHITECUTRE

1 Building awareness through the design and

implementation of a clear communication
DEMAND
CREATION
ENSURING
SUPPLY
strategy that drives demand from all three user
groups 1.
DGHS
Influence/
contact with
2. DHO politicians
CASE: Uganda passed legislation guaranteeing vaccination as a
and media
right to all children in their country. To support this legislation, (national and
they need to increase caregivers’ awareness of the value of the DISTRICT
COMMUNITY MANAGER regional)
HBR.

PROPOSED SOLUTION: By focusing on the need for ‘awareness’ 3. FACILITY MANAGER

at different levels, the team devised a clear communication
strategy to drive demand, from caregivers to central
management. This focus on creating bottom-up demand through 4. HEALTH WORKER
caregivers is expected to have a ripple effect throughout the
entire system, and push decision makers to pay closer attention
to HBRs. This may increase the likelihood that funding, supply
and distribution meets the newly created demand. 5. CAREGIVER

KEY SUCCESS FACTOR: Identify key stakeholders and a tailored Primary focus on the base is critical
communication strategy for each.
Summary of Uganda’s discussion on system improvements.
For more details on the strategy developed by Uganda, see appendix 6
 Building a business case for HBRs

2 Providing a compelling business case to

catalyze system changes

↑ maximize human
economic potential
CASE: One root challenge identified in Nigeria was that HBRs had
not been sufficiently prioritized by senior decision makers.
Because of the variety of competing priorities for resource
allocation, they knew it would be useful to present data behind
the potential value of an improved HBR. ↓ associated outbreaks
↓ campaigns
PROPOSED SOLUTION: The team outlined a business case that
described the efficiencies that could be gained by reducing over-
vaccination and missed opportunities for vaccination, as well as
the downstream positive impact of increasing coverage (e.g.
↓ over-vaccination
fewer outbreaks, reduced necessity for campaigns). This is
especially relevant given withdrawing GAVI support. This data ↓resource allocation
inefficiency
was presented to key decision-makers in the week following the
workshop, and their buy-in has already led to action. ↓ facility workload

KEY SUCCESS FACTOR: Use clear and actionable data that Follow-on effects of
reveals the human and fiscal benefits of improving HBR improved HBR system
availability and utilization.
Summary of Nigeria’s discussion on system improvements.
For more details on the strategy developed by Nigeria, see appendix 6
 Obtaining sustainable funding

3
DESIRED STATE
DESIRED STATE
Developing country capabilities to sustain long- Country’s self-sufficient funding and
term funding for HBR distribution of HBRs

Transition partner budget from direct funding of

CASE: In Ethiopia, HBRs are being printed using funding provided HBRs to capacity building around printing and
by a partner organization. Even though the country seeks to distribution at regions
become financially self-sufficient, a lack of advocacy around
HBRs, insufficient planning, and sustainable budgeting has kept
the HBR from being included in the CMYP & annual plan Put HBR in the agenda for key meetings and
budgeting. build advocacy at national level

PROPOSED SOLUTION: The team is forming an HBR revitalization

working group to build advocacy among key decision makers at Form HBR revitalization working group
the national level, and as a first step towards sustainable funding.
As the MoH starts accounting for HBR budget needs, the partner
organization will transition their funding to support capacity
CURRENT STATE
CURRENT STATE
building for the HBR supply chain.
Printing of HBRs funded by partner
KEY SUCCESS FACTOR: Think beyond short-term solutions and organization
make a step-by-step plan for long-term fiscal sustainability.

Summary of Ethiopia’s discussion on system improvements.

For more details on the strategy developed by Ethiopia, see appendix 6
 Designing effective supply and distribution

4 Creating a sustainable distribution strategy

that assures HBR availability at all times for
DIVERSIFY FUNDING DIVERSIFY DISTRIBUTION

every health facility GFF MCH week

CASE: At the moment, no government entity or external partner Immediate

resources Canadian Polio
funds HBR production in Cameroon. This has lead to nation-wide Fund campaign
HBR stock-outs during 2016 and 2017. When HBRs were available, for 2017
a gap between regional and district level distribution emerged,
making distribution and funding two very intertwined challenges.
Polio Fund
PROPOSED SOLUTION: The Cameroon team developed a unified
funding and distribution strategy, which included short-term
emergency measures for 2017, as well as goals for 2018. In the Strategic HBR funds as part HBR distribution
short term, they will leverage new partners and two existing goal for of the EPI/MOH integrated with
annual events for HBR distribution. In the longer term, they plan 2018 yearly budget vaccine delivery
on returning to the integrated approach to HBR and vaccine
distribution that existed prior to the stock-outs. They will also
integrate HBR funds to the MOH’s yearly budget. • Re-design of blue card to improve retention
Baseline
• Cost-analysis for district distribution
supporting
KEY SUCCESS FACTOR: Develop a holistic approach to distribution • Update stock management system
measures
to improve efficiencies within the supply chain. • Develop training for health workers (…)

Summary of Cameroon’s discussion on system improvements.

For more details on the strategy developed by Cameroon, see appendix 6
 Defining and negotiating the level of integration

5 Understanding the benefits and risks of

integration: cost benefit analysis, and
improving coordination within the MoH
MoH

CASE: Liberia’s current Child Health Booklet includes vaccination,

growth monitoring, and child & maternal health information, but
neither caregivers nor health workers make full use of the card.
Often only the vaccination pages are referenced and filled out Maternal
Nutrition EPI
Health
during health consultations.

PROPOSED SOLUTION: After considering the costs and benefits Ministry level
of the integrated booklet, the team decided to pursue a more coordination
holistic and inclusive approach to the HBR, one where they build and buy-in
relationships with the nutrition and maternal health
departments at the MoH in order to improve stakeholder AGREED UPON NEXT STEPS
coordination, buy-in, and capacity building efforts at the district • Update inventory templates and supervision tools to
and health facility levels to use all parts of the record. include HBR and other child maternal health
information
KEY SUCCESS FACTOR: Understand which parts of the HBR is • Develop holistic training packages for Community
being utilized/not utilized by its users, and coordinate with Health Assistants
MoH departments to prioritize minimum necessary fields in the • Reinforce HBR messaging during SIA trainings
HBR.
Summary of Liberia’s discussion on system improvements.
For more details on the strategy developed by Liberia, see appendix 6
6 | Key lessons for HBR revitalization

Home-based records are a vital
tool for increasing vaccination
coverage.
However to reach their full
potential, they need to be
understandable, usable and useful
for caregivers, health workers and
health administrators.
Any efforts to revitalize the HBR should:
1
Begin with a focus on clearly
defining and understanding
user needs and experiences.
2
Focus on not only the HBR,
but also the system that
supports it.
 • Check your prevalence and drop out rates, and think about how they can be
improved.

To better • Evaluate the HBR for changes that could positively impact its use and effectiveness.

understand the • Seek to understand if the design of your HBR is effective in meeting user needs:
Engage users on the ground; observe how they’re using the record and what they’re
status of HBRs in struggling with; identify the main challenges and why they occur.
See appendix 5: “Immersion pack” for a guide on how to engage users
your country’s • Explore ways to improve funding, printing, distribution systems, and how the
context and caregivers and health workers are trained to use the HBR
See appendix 3: “Workshop exercise templates” for structured exercises on systems thinking
improve it, there • Build a business case for HBR funding in your country.
are some • Identify and work with other stakeholders in your country (e.g. nutrition, primary
immediate actions care).

you can take:

For more information check WHO’s website dedicated to resources on HBRs and their
improvement at:
http://www.who.int/immunization/monitoring_surveillance/routine/homebasedrecords/en/
7 | Appendices guide
Appendices guide

1. Read me:
Provides detail about the content and use of appendices 2-7
2. Workshop presentation:
Full set of slides presented in the four-day workshop in Uganda
3. Workshop exercise templates:
Printable templates used to structure workshop activities
4. Facilitator’s guide:
Explanations on how to effectively conduct each activity and use the templates
5. Immersion pack:
Suggested activities for engaging users with observation and conversation guides for each
6. Country final presentations:
Each country’s pitch of their new record concept, with prototypes, system improvements and
implementation plan
7. Country prototypes:
Digital versions of each country’s refined home-based record
For more information, please contact:

Blanche Anya | WHO

anyab@who.int

Kendall Krause| Bill and Melinda Gates Foundation

kendall.krause@gatesfoundation.org

Rich Radka | Claro Partners

Rich.radka@claropartners.com