In collaboration with the London School of Hygiene and Tropical Medicine and University College of London, the inSCALE project aims to increase access to care for children under five in Mozambique
The inSCALE project seeks to demonstrate that government-led Integrated Community Case Management (iCCM) can improve healthcare services and expand coverage in Mozambique, a country where only 52% of the population has healthcare coverage. The project adopted CommCare and CommConnect to strengthen communication between community health workers (CHWs) and health facility supervisors, and with heavy involvement of the Ministry of Health, inSCALE has the potential to expand into other areas of the health system, with the goal of improved diagnosis, treatment, and monitoring of disease throughout Mozambique.
At a Glance
Implemented: Mozambique, since 2013
Sectors: Child health, pneumonia, malaria, ICCM
Features: Active data management, decision & diagnostic support, respiratory tracker, motivational messages (for CHWs & Supervisors), case management, multimedia, custom reporting
Number of users: 179
Around the world over six million children under the age of five lose their lives each year to diseases that are preventable and treatable. These deaths occur primarily in poor rural settings, particularly in sub-Saharan Africa, often as a result of strained health systems and limited access to simple, affordable interventions. One approach to improving these systems is integrated Community Case Management (iCCM), a strategy that extends case management of childhood illness beyond health facilities and into communities [MCHIP]. Through the iCCM model, community health workers (CHWs) are trained to diagnose, treat, and refer children with key childhood
illnesses, including diarrhea, pneumonia, and malaria, and have demonstrated potential to reduce childhood mortality by 60 percent. In Mozambique, a national network of 1,950 CHWs provide iCCM services to the country’s four million children. However, the program’s effectiveness can been negatively impacted by low CHW motivation, limited availability and usage of health information, and limited support and supervision of CHWs.
MHEALTH FOR IMPROVED ICCM
To address these challenges, Malaria Consortium developed a mobile health (mHealth) system
with Dimagi in 2013 to enhance the country’s iCCM program, and boost CHW performance levels, morale, and job satisfaction. The project was first implemented as a 16-month randomized control
trial in Inhambane Province, Mozambique. The RCT’s aim is to study the effects of mHealth applications on CHW performance, including analyzing data to better understand the accuracy of CHWs’ patient diagnosis and prescribed treatment. The project is Mozambique’s largest Android deployment to date and an opportunity to explore the potential impact of mHealth on a national system of childcare.
THE TWO MOBILE APPLICATIONS
Malaria Consortium’s mHealth system consists of two mobile applications.
• Integrate CommCare
(mobile app for CHWs) and CommConnect (SMS based-system).
• Were designed with input & feedback from Ministry of Health officials and CHWs to ensure they remain consistent with preexisting protocols.
• Work offline and save data on the phone until there is a network connection. This is crucial for CHWs, who work in rural regions of Mozambique.
The system currently centers upon a primary application for CHWs, with a complementary application developed for supervisors. There is also an Active Data Management (ADM) component to help district level supervisors analyze child health data collected by CHWs, by providing timely, interpretable report outs. Malaria Consortium’s system also utilizes custom reporting features, a web-based reporting dashboard, and monthly SMS motivational messages provided through CommConnect to better support both CHWs and health facility level supervisors.
Respiratory Rate Counter
In order to diagnose pneumonia, CHWs are trained to determine a patient’s respiratory rate during home visits. This is often one of the most challenging tasks for CHWs and can result in improper diagnoses.
To address this challenge, a respiratory timer has been integrated into inSCALE’s CommCare application. The timer enables CHWs to tap the phone screen each time a patient breathes, and automatically produces a respiratory rate for the patient at the end of the minute, improving
CHWs’ ability to diagnose symptoms of pneumonia.