From 2012 to 2016 in Mozambique, Malaria Consortium developed and tested a mobile-phone based application to increase community health workers’ capacity to manage clinical cases better. The app reinforces their connection to the wider health system and particularly to their direct supervisor based at health facility level. It also provides a mechanism for them to receive recognition for what they do well and to pay attention to what remains problematic, as well as boosting their motivation and performance.
Malaria Consortium and the United Nations Children’s Fund (UNICEF) have been working together since August 2016, with support from UK Aid from the UK government, to further develop this app and form a comprehensive mobile phone-based digital health platform, called upSCALE, for the national Community Health Workers’ programme.
Community health workers (CHWs) in Mozambique, locally known as Agentes Polivalentes Elementares, are community members who are trained to provide basic healthcare to the remote in which they live. They conduct health promotion activities and provide integrated community case management for malaria, pneumonia and diarrhoea for children aged 2-59 months. The CHWs also treat all age groups for malaria and diarrhoea and refer acute malnutrition cases, newborns, and pregnant women with danger signs to the nearest health facility.
In 2014, their services were expanded to include family planning, pregnancy tracking, antenatal care, post-partum care, healthy child check-ups, as well as tuberculosis and HIV patient follow-up for treatment adherence counselling.
The CHW app has been refined to cover all services offered by CHWs. In addition, an integrated tablet-based application has been developed for CHW supervisors at health facility level to strengthen the links between the CHW and the health facility. The application enables supervisors to monitor CHW case management, stock management, performance, and phone troubleshooting.
The upSCALE platform is currently being implemented in all districts of two out of 11 provinces of Mozambique, Inhambane and Cabo Delgado. The national Community Health Workers’ programme envisions that this platform should be scaled up nationwide by 2020.
Malaria Consortium's Senior Research Advisor, Dr Karin Kallander, presented the upSCALE platform at the 7th MIM Conference on Malaria in Dakar, Senegal in April 2018 - view the presentation here.
Dr. Humberto Rodrigues, Director of the National CHW Programme, is keen on materializing this process. "Our aim is that by 2020 we would have the complete platform where we can visualize in the National electronic Health Information System all the data produced by CHWs and managed by the app, to ensure that all CHWs, their supervisors and district and province level managers have access to the application nationwide."
The renewed cooperative agreement between Malaria Consortium and UNICEF runs from November 2017 to November 2018 and allows to incorporate statistical data produced by the upSCALE platform into the National Electronic Health Information System for Monitoring and Evaluation, and to facilitate integration and management of the upSCALE mHealth system to the Mozambique Ministry of Health. These are two critical steps towards scaling up a fully functional mobile health platform.
CHWs in Mozambique are increasing access to basic health services and managing a significant burden of cases. Integrating CHWs data from the upSCALE platform into the national health information system will enable all relevant stakeholders in the Ministry of Health to view CHW data in real time for analysis, interpretation and timely decision-making and monitoring of public health policies. Malaria Consortium has been working with Saudigitus on this technical component of the project.
In 2018, Malaria Consortium is focusing on building the capacity of district, provincial and national level stakeholders within the Ministry of Health to maximize the use of the upSCALE platform. This is essential to prepare for handing over its management to national health authorities.
Mozambique is about to become the first country to scale up a digital community health system to this extent.