A year ago, a new electronic health care system was introduced in six districts of Inhambane province, where community health workers, locally known as Agentes Polivalentes Elementares (APEs) in Mozambique, have been trained to diagnose and treat pneumonia, diarrhea and malaria in children under five years at the community level. The inSCALE CommCare system aims to resolve some of the major challenges of the APEs programme, using a model of supervision based on mHealth technology.
The implementation of community health programmes in several countries, including Mozambique, have been limited by lack of motivation and retention of community health workers, irregular and often poor supervision , and suboptimal flow and use of data. The inSCALE CommCare system was developed to overcome these barriers, taking into account various studies and consultations with the main programme’s stakeholders.
In June 2013, 132 APEs and their supervisors began using the system consisting of:
• A solar charger and a smart phone with the inSCALE CommCare software
• The inSCALE CommCare software is an application on an internet enabled Android phone, which is a flowchart of care for patients, enhanced with audio features and colourful images.
• The system also has a closed user group that allows an unlimited communication between APEs and their supervisors at the health facility
Preliminary analysis of the data and feedback from users has been encouraging. It shows that the application has the potential to improve the quality of care provided by APEs. About seven in 10 APEs (67.8%) always use the inSCAE CommCare application in their consultations with sick children. The three functions that APEs report appreciating the most in the system are: the guidelines for the diagnosis and treatment of patients; their new respiratory rate counter which is built into the phone’s software; and the audio messages which they use to play health promotion and education messages to caregivers. These are seen by the APEs’ as increasing their credibility in their communities.
The inSCALE CommCare app improves and increases the contact between the APEs and their supervisors: six in 10 APEs (60.3%) received one or more calls from their supervisor and eight in 10 APEs (80.2%) used the phone to make calls to their supervisors to ask for support in the 30 days before they were interviewed.
All the data from the consultations conducted using the inSCALE CommCare app are recorded and immediately sent using the 3G network to a server. The system allows reports to be sent to the supervisor at the health facility and also to the district, provincial and central level so that they can easily use the data submitted by the APEs and troubleshoot if necessary. This allows data to be available immediately for prompt action. In the future, this could also be used to create a system for community-based surveillance of diseases.
“We are pleased to see that APEs have been using their mobile phones in such large numbers, contacting their supervisors, receiving support and improving their performance,” says Dr. Karin Källander, Malaria Consortium’s Senior Research Advisor. “These preliminary results show the impact we believe such an intervention can have on both APEs as well as the children they serve.”
This intervention is part of an operational research being conducted by the inSCALE project to understand what influences motivation, performance and retention of APEs and how addressing these areas improves the quality of care they provide to patients. The final evaluation will use qualitative and quantitative methods of data collection, to compare results between six intervention and six control districts. The review will examine whether the technology-based intervention resulted in improved motivation and performance of APEs and their supervisors. The results will serve as an evidence base to help the Government decide on most appropriate systems to expand the coverage and effectiveness of the APEs programme. The final evaluation results will be available in mid-2015. For more information visit the inSCALE website.