Fighting malaria in Mozambique — digital health, community engagement and collaborative partnership

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Mozambique has been in the news recently following arrests of senior officials and bankers in London, New York and Jo’burg on their alleged involvement with fraud and loan scandals, that led to a financial crisis in the impoverished country.

The country already has some of the highest debt-to-GDP ratio in the world, ranks high on the corruption index and among the bottom ten on the global human development index — leading to increasing and justified calls for the scandalous debts to be written-off by the creditors.

Health challenges for Mozambique are immense –

Mozambique has the highest burden of malaria in southern Africa, with over 8.5 million cases reported in 2016 and all provinces of the country are prone to high malaria transmission.

Nearly half of the population lives below the poverty lineand those in rural communities lack access to basic healthcare services contributing to excess morbidity and mortality.

Each year, over 80,000 children lose their lives before their fifth birthday — this accounts to one young life lost needlessly every six minutes — the time it’d take one to read this post.

Malaria, pneumonia and diarrhoea are attributable to over one third of under five deaths — common childhood illnesses that are easily preventable and treatable in similar settings elsewhere.

Maternal malaria and malnutrition are widespread, coupled with insufficient health infrastructure and low coverage of preventative services such as IPTp and immunisation, low exclusive breastfeeding rates and high childhood malnutrition — the odds of losing young lives remains very high.

Since 2005, Malaria Consortium has worked closely with the national ministry of health and partners, to help strengthen systems and improve access to life-saving services for children and communities, in particular at the last mile.

Visiting communities in Inhambane

Late last year, I visited the country to support colleagues and see for myself the impact we’re having on the lives of the most vulnerable across the country; and here’s what I found.

We are at the forefront of community and digital health work in the country — having developed and rolled-out with partners the mobile health app for community health workers (CHWs) over the past 10 years. The innovation enables CHWs, called the Agentes Polivalentes Elementares locally, to correctly diagnose and treat children with common childhood illnesses using the integrated community case management (iCCM) protocols.

Our flagship digital health intervention upSCALE consists of an interactive mobile phone app that guides CHWs through patient registration, routine health checks, diagnosis, treatment, referral and follow-up. The app automatically compiles CHW monthly reports for submission to supervisor online. A complementary CHW supervisor app supports two-way communication and feedback, while integration with the district health information system (DHIS2) enables easy visualisation of aggregated data.

Over the years, upSCALE has helped strengthen community service delivery in a low resource setting, significantly improved access to quality care at the last mile, improved availability of realtime data for monitoring, supervision and district planning. As a result, the government of Mozambique is planning to scale-up this evidence-based intervention across all CHWs and provinces over the next few years.

Adelia — one of the MC supported CHWs in Inhambane

One of our local health heroes, Adelia, is a single mother and committed CHW in Marange, Homoine district. She has been providing community health services over the past 8 years and sees around 300 cases pm. She was one of the first CHWs trained on the upSCALE mobile app and said that she finds it‘really helpful for correct case management and sharing health messages during home visits’.

Working closely with the national CHW programme and provincial health departments, upSCALE started with just 10 CHWs in Inhambane in 2009. Since 2016, the innovation has been scaled-up to 650 CHWs in all districts of Inhambane and Cabo Delgado provinces, and expected to increase to 2250 later this year with the addition of CHWs in Zambezia province.

Similarly, we are working closely with the national malaria control programme and partners to strengthen malaria surveillance across the country, contextualising strategies and interventions for the lower and higher transmission areas in south and north of the country respectively.

We recently completed a national landscape analysis and brought stakeholders together to identify and address bottlenecks in the national malaria surveillance system, and support the collaborative development of a Data-to-Action (D2A) framework to support progress towards malaria elimination by strengthening surveillance in Mozambique.

Awareness of childhood illnesses and health-seeking practices are low across rural communities and only about half of the young children are taken to a health worker for treatment of common illnesses. Nampula province in northern Mozambique has the highest burden of neglected tropical diseases (NTDs) in the country, with high co-endemicity of schistosomiasis, lymphatic filariasis and soil transmitted helminths.

Since 2014, we have worked closely with communities and local authorities in Nampula province using our innovative Community Dialogues approach to improve awareness, prevention and control of NTDs.

Working through community champions and facilitators across 600communities in 4 districts of the province, we have contributed to strengthen community engagement, ownership and capacity to overcome socio-cultural barriers for improved acceptance and uptake of NTDs prevention and control services in target communities.

Community facilitators leading on community dialogues session in Nampula province

Over the years, Malaria Consortium has worked to promote partnerships at community, district, provincial and national levels in Mozambique, collaborating with development partners, international agencies and local researchers such as the health research institute at Manhiça, generating credible evidence and learning that has informed policies and practices of governments and partners, both locally and globally.

Despite the widespread development challenges, Mozambique is blessed with immense resources, not just the minerals and spectacular landscapes, but the rich culture, cuisine and diversity of her people.

I returned greatly impressed with the ingenuity and resilience of the Mozambican people, who are striving to make a difference every day with limited resources — there is no doubt the country has the potential to make significant progress towards malaria elimination, improving health coverage and saving lives, if the current pace of progress is maintained over the coming years.

And it may be on the other side of the world, but I cannot wait to return soon!

Mozambique: A field officer developing community capacity in malaria prevention

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Field officer Castélio Muwasse

Story collected by Dorca Nhaca and edited by Fernando Bambo in November 2017

Ilha de Moçambique is an idyllic island for visitors; it was once the capital of Mozambique and is now a world heritage site. But for the local population as well as for visitors, there is a threat that darkens the picture: the risk of getting malaria, a potentially deadly disease that remains the main cause of health problems in Mozambique.

Castélio Muwasse, a Field Officer for Malaria Consortium, works in the District of Ilha de Moçambique. This 31-year old technician in preventive medicine and environmental sanitation joined the Malaria Prevention and Control Project team in 2016, motivated by the desire to work with communities and learn new experiences.

As a field officer, the responsibilities of Castélio included support for the District Health Services in the implementation of project activities, training of community structures and teachers on malaria prevention, collection and compilation of activity monitoring data, and coordination between health facilities and community structures, such as health committees and local organisations, and between district education and health services.

In addition to mobilising community structures for malaria prevention, he coordinated the training of teachers with the school health technician of the District Education Services.

“With the schools, I worked well without major constraints. We managed to train the teachers and they reported the work done monthly. There was good collaboration from teachers and school directors.”

Castelio is based at the District Health Services office, but actually spends a lot of time traveling on his motorcycle to reach the various communities and health facilities scattered throughout the district, even the most remote ones. With this knowledge of the terrain, he is able to draw a detailed map of the district in just a few minutes.

In order to work effectively with community structures, it is essential to build a trusting relationship. Castélio joined Malaria Consortium to replace a field officer who had worked with these communities for a few years so he had to use all his interpersonal communication skills to gain the trust of the volunteers.

”Throughout the project I have had good moments. One of these was when I was accepted by the communities and received a warm welcome. This was crucial as they were open to listening to the messages and to making use of them. ”

Castélio says that the communication activities for behaviour change carried out by community structures volunteers, teachers and students have contributed to the reduction of malaria cases, partly as a result of their collaboration.

“We have noted that there is a reduction in the number of malaria cases, a reduction in the misuse of mosquito nets, an improvement in environmental sanitation and a better uptake of the use of mosquito nets, Previously, families would take the nets to go fishing or cover their gardens.”

This is certainly the most rewarding part of being a field officer on the ground. This type of work also offers many learning opportunities for young professionals, such as Castélio, to grow.

“Personally, with the project, I learnt a lot, gained a lot of knowledge and experience. I learnt to be a more open person. One of the lessons I take with me is that working with communities is not an easy task, but humility, love, care and patience are key to success and to overcoming certain difficulties.”

The Malaria Prevention and Control Project has been implemented in nine of the 11 provinces of Mozambique by a consortium of civil society organisations  led by World Vision, with Malaria Consortium, Community Development Foundation and Food for The Hungry. Malaria Consortium carried out interventions in 17 districts of the province of Nampula and six districts in Niassa. Castélio Muwasse is one of the 23 field officers who worked with Malaria Consortium to implement communication activities to change behaviours at the community level.

Mozambique: The behaviour changing power of radio

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Story collected by Dorca Nhaca and edited by Fernando Bambo in November 2017

Ismael Janato is a presenter and technician at Ngauma community radio, Niassa Province, and Jonas Ali Mussa, director of the community radio on the Island of Mozambique. The Ngauma district, located in the midwest of Niassa Province, near the border with Malawi, has an estimated population of 86,000. The Island of Mozambique is part of Nampula Province with a population of about 53,000 inhabitants.

Despite the enormous distance separating Ismael and Jonas – over 700km – both have the same mission: to discuss the prevention of malaria on their community radio programmes.

Radio is recognised as the ‘African media’ for its broad accessibility and its ability to transcend cost barriers, geographical barriers and low levels of literacy, supporting listeners as they negotiate the challenges of everyday life. The Malaria Prevention and Control Project in Mozambique, implemented by Malaria Consortium in the provinces of Nampula and Niassa, has established partnerships with community radio networks to develop and transmit quality messages and programmes in local languages, promoting essential malaria prevention and treatment behaviours.

Ismael Janato from the Ngauma community radio talks about his experience with the activities:

“For the past three years, I have been managing the project activities. We received audio announcements on malaria, its transmission, signs and symptoms, the use of mosquito nets and the importance of seeking treatment. As a presenter, my job was to translate the spots into the local language, to broadcast the messages every 15 minutes, and to animate public debates live in the communities.”

Often malaria symptoms are not recognised, yet rapid and appropriate diagnosis and treatment of malaria are extremely important for reducing morbidity and mortality. Ensuring population access to essential information can substantially increase the effectiveness of existing interventions for malaria prevention.

Ismael explains that he gained knowledge about malaria through his participation in the training provided by Malaria Consortium, and thus developed the ability to discuss these issues properly. Besides broadcasting the spots, Ngauma’s community radio produces interactive programmes with the public through phone-in discussions on malaria issues and interviews with health technicians. Ismael continues, “With the work we do we have noticed changes in people’s behaviour regarding the use of mosquito nets, better hygiene at home, and there are more people who, when ill, go to the health centre and do not go to traditional practitioners anymore.”

Jonas Ali from the community radio of Mozambique Island also reports an improvement in the correct use of mosquito nets and reduction of malaria cases in the communities.

“With the work we have done, we have been able to see that there is a reduction in the use of mosquito nets for fishing and that fishing communities use the nets more responsibly. People are using the mosquito net correctly, malaria cases are also decreasing thanks to better knowledge of the consequences of malaria.”

Indeed, monitoring data and testimonies indicate an increase in knowledge about malaria and some behavioural changes in the project areas. These developments are likely to be the result of a number of complex factors and combined interventions of the Ministry of Health and its partners. The results of the Malaria Prevention and Control Project indicate that the significant expansion of intensive awareness raising, education and mobilisation activities combined with the mass distribution of long-lasting insecticidal nets may have contributed to this positive development.

Goncalves Bacar, Training Officer at Malaria Consortium Niassa, underlines that “the use of a combination of reliable sources of information – community structures, schools and radios – to disseminate harmonised messages at community level was certainly key.”

This story is part of a broader project documentation exercise; to read more and other lessons learnt, click here.

Leadership makes the difference in defeating malaria

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Story collected by Dorca Nhaca and edited by Fernando Bambo in November 2017

Nacala-Porto, on the northern coast of Mozambique, is the deepest natural harbour on the east coast of Africa. It serves as a terminal for the rail link to landlocked Malawi. Many goods transit through this district on their way to Malawi and other parts of southern Africa. The town is also known for its beaches and diving; this may be the district’s best known feature. What is less well known is the strong leadership within the District Health Service where there is an exceptional team dedicated to defeating malaria and saving lives.

The Nacala-Porto District Health Services were among the pioneers in the implementation of the Malaria Prevention and Control Project in 2011.  Malaria Consortium’s role, as one of the implementing partners for the project, was to support 17 districts of Nampula Province until 2017.

The main objective of the project was to contribute to the reduction of malaria through a combination of interventions aimed at improving malaria knowledge among the population and promoting the adoption of good practices in relation to malaria prevention and treatment at community level.

Successful implementation of this project required strong coordination between the district government and Malaria Consortium, health facilities and communities, as well as with schools and community radios. The excellent leadership of the Nacala-Porto District Health Services represented best practice in managing the partnership, including integrating the Project Field Officer into the district team, in line with the collaboration and coordination approach sought by the project implementers.

Janete Chau is the District Health Director at Nacala Porto. She is as charming and friendly as she is professionally demanding and rigorous, and she has embraced the project and managed to develop an effective partnership approach. It is for these qualities that she was awarded the title of ‘best district director of the province’ by the Nampula Provincial Health Directorate in October 2017.

“The Malaria Consortium Field Officer was actually working under our responsibility. He had to share his work plans and get involved in all the activities, and we had regular review meetings to look at the malaria situation here in the district. …My main role was to monitor and control project activities, see what was being done at district level, know where the activities were being done and what impact the project was having. ”

Janete Chau, District Health Director in Nacala Porto, Mozambique

The District Health Services’ team and Malaria Consortium worked together to map out community structure such as community health committees and local organisations, select and train them, and implement communication interventions towards behaviour change at community level. According to Ms Chau, malaria prevention activities carried out by community volunteers have contributed to increasing knowledge about malaria, care seeking and reducing malaria deaths in the area.

“People have gained knowledge about malaria, they now know how to describe it. They realise that malaria comes from the mosquito and that they breed in stagnant water. They now know they should go to the health centre if they present any malaria signs and symptoms and this has helped us to reduce malaria deaths.”

These efforts to promote good malaria prevention and treatment practices at the population level have also been accompanied by improved diagnosis and treatment of malaria patients at the health facilities level, as Ms Chau explains. “As an institution, through this project we became more aware that malaria is a serious problem and that we must keep it under control. It must be discussed. Our clinicians are more aware that they should not simply attribute malaria based on symptoms, but that we need to test for confirmation of malaria.”

These efforts are already starting to pay off but need to be maintained to achieve long-term impact. Nacala Porto’s team remains committed and motivated: “Every health professional is psychologically prepared to continue doing everything the project was doing so that one day malaria will be out of Mozambique.”

This story is part of a broader project documentation exercise; to read more and other lessons learned, click here.

Children who learn about malaria contribute to disease control in their communities

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Story collected by Dorca Nhaca and edited by Fernando Bambo in November 2017

Fátima Mário, 12 years old, Dinala Muhamudo Aid, 18 years old, Cristina Muanhar, 18 years old, and Carlitos Gabriel Tolembeta, 16 years old, are seventh grade pupils at Undi Primary School. The school is in Chimbonila District, Niassa Province, 30km from the province capital  Lichinga. At school, in addition to learning how to read, write and count, students benefit from educational activities on malaria prevention.

Fátima explains, “Everything we know, we learn at school with our teachers. During the lectures, we pay attention to the teacher’s explanation because in the end she asks us questions and we need to respond. We have learnt many good things. We learnt how to use and take good care of the mosquito net, not to wash the mosquito net in the river, not to accumulate water in the yard, and that when we get malaria we have to go to the hospital.”

In Africa, malaria accounts for up to 50 percent of all school-age deaths. Ensuring that children learn about malaria prevention practices will not only reduce malaria but also contribute to disease control in their communities.

Under the Malaria Prevention and Control Project, implemented in nine of the eleven provinces of Mozambique by a consortium of civil society organisations (2011-2017), one of the innovative interventions was to strengthen malaria education for students in the classroom. Undi Primary School is part of the schools reached by malaria prevention education activities implemented by Malaria Consortium under this project, in Niassa province.

At Undi Primary School, three teachers were trained on basic concepts of malaria, its transmission, signs and symptoms, prevention methods, and importance of early care seeking. In the classroom, teachers conduct interactive educational sessions using a flipchart that contains illustrations, questions and key messages about malaria prevention. Students are expected to share the knowledge they have gained with their families, friends and community.

“When we get home, we talk to our parents, they listen and follow the things we explain to them if they do not know already.” …Everyone likes to use the mosquito net now and last night everyone slept underneath because they know the net serves as protection against mosquito bites and malaria.”, says Carlitos

Helena Samuel, Undi Primary School natural sciences teacher acknowledges the project’s contribution to increasing knowledge about malaria, reducing school absenteeism and drop out.

“It was great to be a part of this project, because I learnt a lot, gained more knowledge about malaria and dispelled many myths that were in my mind. As a natural science teacher I transmit the concepts to the communities. …The project also brought advantages to the school and the students; now we have a low dropout rate because the students are healthier.”

Between 2011 and 2017, Malaria Consortium supported the provincial and district education directorates to train 1,682 teachers in 700 schools in the provinces of Niassa and Nampula reaching approximately 31,289 students on a quarterly basis with key messages on malaria, prevention methods and the importance of care seeking.

Project monitoring data show that school malaria education activities have contributed to increased knowledge of both teachers and students and better adherence to good malaria prevention practices in their homes and communities.

This story is part of a broader project documentation exercise; to read more and other lessons learned, click here.

Chimbonila: A district committed to fighting malaria

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The district of Chimbonila in Niassa province has a high malaria burden, which can be difficult to manage for a number of reasons.

The district itself is very large. It is located about 30 km from the city of Lichinga and covers an area of ​​8,075 km² with a population of about 87,000 inhabitants. Despite its proximity to the capital city, however, Chimbonila has the typical challenges of the other districts of Niassa: poor roads and high poverty rates, as well as a remote, mostly rural population which relies on an economy based on agriculture (population density of 15.8 inhabitants per km²).

Since 2014, the National Malaria Control Programme of the Ministry of Health and its partners (World Vision and Malaria Consortium) with funding from the Global Fund, has been implementing the Malaria Prevention and Control Project within local communities.

The project in Chimbonila District involves 22 community structures, 428 volunteers, 23 schools, 72 teachers, 14 health facilities and one community radio in a continuous effort coordinated by Health, Women and Social District Services to ensure the prevention and treatment of malaria.

Since 2014, Gabriela Nazaré has been the Malaria Consortium Field Officer assigned to this district. Her role is to coordinate the activities of all project stakeholders, ranging from health facilities to community volunteers.

Every day Gabriela visits the villages by motorcycle, ensuring that all project’s participants have the necessary tools for mobilisation work and that they have a correct understanding about how to prevent malaria and that they know what to do in the occurrence of malaria symptoms.

After three years as Field Officer, Gabriela feels integrated in the community: “I was born and raised in Lichinga. I moved to Chimbonila to work and today I feel at home. Despite the complexity of the job, knowing that I am contributing to the improvement of people’s living conditions is rewarding.”

Rain or shine, her activities don’t stop. Owing to the large number of beneficiaries, her schedule is very busy. “I try to spend as much time as possible in each community. My routine in each village is to visit schools, health facilities and work with community structures.

“Over the years we have been establishing work mechanisms and today it is amazing how communities are engaged in the project in such a way that they now bring in their own initiatives and suggestions for new approaches.”

 

Text and photos: Xavier Machiana

Distribution of LLINs in Niassa Province: mission accomplished

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After a year of intensive work, Niassa Province in Mozambique, an area with a high malaria incidence rate, has successfully completed its mass long-lasting insecticidal net (LLIN) distribution campaign in its 16 districts.

The Malaria Prevention and Control Project is part of the Universal Coverage Campaign (UCC),  a national initiative led by the Ministry of Health.  It is funded by the Global Fund, and implemented by World Vision as the recipient partner, with Malaria Consortium, Food for the Hungry and Community Development Foundation as secondary recipients.

The UCC aims to ensure that every Mozambican has access to a LLIN to protect themselves from malaria. In Niassa Province, the campaign has reached approximately 415,000 households in the 16 target districts, amounting to a total of 1,058,750 LLINs. Niassa Province covers an extensive area of ​​approximately 123,000 km², with around nine inhabitants per km² in some of the more remote areas.  Access roads are lacking and most are not tarred, which renders the UCC implementation a complex process.

To overcome these challenges and to meet the high demand, the campaign was cascaded down from the central level, on to the provincial level, and finally expanded to the districts, towns and villages. In a combined effort of thousands of people involved.  The local government, the Provincial Health Directorate, District Directorates, support teams, trainers, distributors, registrators and different service providers were all critical to the success of the mass distribution.

According to Dr. Inês Juleca, focal point of the National Malaria Control Programme of the Ministry of Health of Mozambique for the province of Niassa, “The distribution of LLINs is an activity that includes several steps and high-quality coordination, from the consultation of guiding documents, planning, procurement, transportation and packaging, to communication, engagement, mobilisation, training, population registration and distribution itself.”

In this process, the National Malaria Control Programme is responsible for the acquisition of LLINs and led overall planning and implementation through the decentralised structures of the health system. Malaria Consortium is responsible for operational support, which includes financial management, transport, logistics, training, management of service providers, efficient use of resources and effective coordination at provincial, district and field levels.

On the challenges encountered on the ground, Joaquim Chau, Interim Coordinator of the Malaria Consortium in Niassa province, says: “The challenge of coordinating processes is largely to achieve the commitment of all those involved, even with different procedures or practices, sensitivities and institutional hierarchies, to bring together an understanding of the common vision of what is to be achieved. This makes a difference in the process, and in the professional and individual expectations of all the actors involved.”

With the successful completion of the distribution, the team is planning a post-distribution campaign that will focus on effective messaging about the correct use of LLINs. Highlighting the importance of the post-distribution campaign, Dr. Juleca stated: “Malaria prevention does not end with distribution of mosquito nets. We are ensuring that, after the distribution phase, our beneficiaries are knowledgeable about the use of nets and that this process is effectively translated into behaviour change.”

By Xavier Machiana

Mozambique’s unrecognised malaria heroes

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Throughout Mozambique’s Niassa Province thousands of unassuming community members have given up their time to improve community health by volunteering in the distribution of long lasting insecticidal nets (LLINs).

 

The campaign, which is distributing over one million LLINs to 480,000 families in April and May is being organised by the Provincial Health Directorate, District and Community Leadership, civil society organisations, World Vision and Malaria Consortium under the leadership of the Provincial Government of Niassa.

So far, over 3,500 men and women from different ages and backgrounds have volunteered in the campaign, which has been crucial to the organisers efforts to reach all families in the province.

 

These malaria heroes have overcome many hurdles including inaccessibility due to lack of roads. They have walked on foot with bundles of nets on their heads and backs where their vehicles could no longer go. They took boats and canoes to reach remote villages on the islands of Lake Niassa. They have used motorcycles, tractors and all possible means to carry out their work, including crossing dangerous areas, such as Niassa Reserve, which is inhabited by many wild animals.

Community volunteers are essential to the success of many health campaigns. See our #MalariaHeroes webpage and support community health volunteers around the world.

The campaign is part of a national initiative led by the Ministry of Health with the support of the Malaria Prevention and Control Project, a project funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, and implemented by World Vision as the main partner,  Food for the Hungry, Community Development Foundation and Malaria Consortium.

World Malaria Day 2017: Mozambique’s Niassa province launches mass net distribution

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World Malaria Day ceremony, Metangula Village

To mark World Malaria Day on April 25, Niassa province Mozambique held an official launch ceremony for a campaign to distribute long lasting insecticidal nets across the provinces 15 districts. The ceremony was held at the distribution headquarters in Metangula and was attended by district leaders, provincial leaders, civil society organisations and community members.

Activities included the laying of flowers at Heroes’ Square and a march with different civil society players, delivering speeches to spread the message of malaria prevention.

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District administrator Sara Mustafa

The formal distribution of the mosquito nets was initiated by the district administrator, Sara Mustafa, who stressed the importance of using them correctly to a large audience of community members.

Her statements were echoed by Dr. Inês Juleca from the National Malaria Programme of the Ministry of Health, who said, “The distribution campaign needs to be complemented by ongoing mobilisation and awareness raising activities at the local level so it is effective and reduces malaria among the communities the campaign was created to reach.”

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Monica Saíde, mother of five, collecting her mosquito net

Malaria is a major public health issue in Niassa Province, with over 700,000 registered malaria cases in 2016 giving an incidence rate of 407 cases per 1,000 people. The campaign, run by the Ministry of Health and Malaria Consortium, is part of an effort to reduce this burden through wide spread national and local level programmes.

 

The campaign is part of a national initiative led by the Ministry of Health with the support of the Malaria Prevention and Control Project, a project funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, and implemented by World Vision as the main partner,  Food for the Hungry, Community Development Foundation and Malaria Consortium.

Text and photos: Xavier Machiana

Technology to save children’s lives

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Mobile health coverage is expanding in Mozambique. Following a successful pilot in a few districts of Inhambane province, the Ministry of Health, in partnership with Malaria Consortium and UNICEF, will scale up an innovative mobile health (mHealth) app-based system to all districts of Inhambane and to the northern province of Cabo Delgado, as part of our new upSCALE project.

In recent years, mobile Health, or mHealth, has emerged as an important innovation with tremendous potential to strengthen health systems in low- and middle-income settings. It achieves this by providing better access to knowledge and information by improving service delivery and reducing response time to crises. Mobile phone coverage is growing rapidly across the world, both in terms of network coverage and the number of users.

upSCALE aims to expand an mHealth system using an interactive mobile android application.  The app provides step-by-step guidance to community health workers, or agentes polivalentes elementares (APEs), in running procedures for diagnosing and treating common diseases that are addressed at community level by trained workers. In September 2016, 258 community health workers were trained on this mHealth system.

Salvador was the oldest among the trainees, demonstrating that age is not a limitation for successfully using modern mobile technology.

“My namAPE SALVADOR PICTe is Salvador Waciquetane. I am 56 years old and I have been doing community health work for many years in Inhambane’s Vilankulo district, community of Chelene. I started to volunteer as a health activist in 2006 and, at the time, I was giving health talks in my community about good health practices. In 2010, I was the one chosen by my community to participate in the training to become an APE, as part of the Ministry of Health revitalisation programme. From the training until today, the people of my community are counting on me to provide basic health care.

Each year, I participate in various refresher trainings; in September, I received a call from my supervisor, Valério, requesting me to come to the district headquarters to participate in a CommCare training, which involves using a mobile phone in my work as an APE. After the phone call, I was curious and I began to imagine that the cell phone would be the same as the ones I saw during the general population census, when I had to map the population of my community. But when the training started, I was very impressed. I saw that the phone is equipped to help me do much more than I had imagined: family planning activities, follow-ups of pregnant women, diagnosing and treating diseases such as malaria, diarrhoea and pneumonia, as well as tracking people with tuberculosis and HIV to refer them to the health centre. I am very happy because this phone is going to help me a lot in my work, as it is easy and it guides the APE well.

“When I return I will meet with my community leader to ask him to arrange a meeting so I can present my new device to the community members. I think they will react very well and this will increase the trust they have. Any novelty is a challenge at first, but as time goes by I will find my way and I will grow to understand it.”

 

By Éder Ismael Zerefos