In 2016, we worked closely with the Ministry of Health in Mozambique and UNICEF to bridge the gap in community healthcare, developing the upSCALE mHealth app to assist community health workers, known locally as agentes polivalentes elementares (APEs), to quickly diagnose and treat malaria, pneumonia and diarrhoea and refer pregnant women and new-borns with danger signs to the nearest health facility for treatment.
The app also walks APEs through patient registration and allows supervisors to monitor their performance and stock levels. Data entered by APEs through the upSCALE app is visualised in the District Health Information System (DHIS2) at district, provincial and national levels of Mozambique’s health system. The ability to analyse local disease-specific trends in near realtime allows supervisors to maintain stock levels of drugs and equipment.
One of the day-to-day challenges APEs faced in using the upSCALE app was that frequent usage ran down device batteries quickly. After four hours of consultation, their phone batteries would drain completely, leaving them unable to enter data into the app in real-time, or access the app as a decision support tool during diagnosis. The solar panels provided were rarely able to charge devices above 65 percent before the APEs set out for further consultations. Based on anecdotal evidence, neither the home-based charger nor portable charging device provided were charging the phones adequately, with APEs often resorting to traditional paper-based reporting.
To enable APEs to access the app during all consultations, we worked in partnership with the Provincial Health Directorate of Inhambane (DPSI) to test and evaluate a selection of solar panels and power banks. The best perfoming and most effective equipment would be recommended to partners for large-scale acquisition so as to cover all provinces implementing upSCALE. In our plans to support the roll-out of nationwide coverage of upSCALE by 2022, it is essential that APEs have the most reliable charging equipment for the job.
Testing charger capability
Previously, APEs had been provided with the Sun King PRO e PROII, a three-watt solar panel that can charge two mobile phones at the same time. The majority of these solar panels had been used in the field for around three years and weren’t operating as well as they once did. In areas where the Sun King PROII solar panels were not operating well, APEs had been provided with an additional universal power bank.
The first phase of testing involved 11 randomly selected APEs with a Samsung J2 phone from four districts in the province of Inhambane; Zavala, Inharrime, Homoine and Morrumbene. Alongside the existing equipment, two new home-based chargers and one portable charger were selected through rapid market assessment, based on criteria such as the ability to source the items in Mozambique, a unit price of under US$100, and wattage equal or higher than the Sun King PRO e PROII. Based on the criteria, the Sun King Home 60 OR 120 and Villageboom High Power + home-based chargers were selected, alongside the RockA Surge portable charger.
The selected APEs completed half a day of training at the provincial health office. During this session, they were trained in using the devices and submitting data for reporting. The APEs were split into five smaller groups to test different combinations of equipment. For each of the home-based charger option, we tested them in isolation, as well as in conjunction with the RockA portable charger, to determine whether a portable charger was required to help supplement the charge.
The selected APEs tested the devices over a period of 43 days, they were instructed to submit text messages twice daily 12 hours apart, to record the level of charge on their device. For the second stage, semi-structured interviews took place with 18 APEs, to illicit feedback about the usability of selected devices and any recommendations.
Overall, it was established that the Sun King Home charger performed well, reaching on average above 70 percent overnight. The APEs were satisfied that charging devices to full capacity took between 1.5- 5 hours. From the tests, we determined that the APEs preferred Sun King Home to the previous home-based charger, the Sun King PRO e PROII as it retained power better and is made of strong, robust materials, ideal for intensive use during consultations. Using the Sun King Home charger in conjunction with the RockA Portable charger increased the mean cell charge both in the morning and afternoon.
Reportedly, the Villageboom charger, took five hours to charge on a sunny day, and four hours on a “very sunny” day. However, the pitfall was that the mean cell charge increased in the morning only. Two APEs surveyed did not recommend the Village boom home charger as it cannot be charged overnight, a major pitfall when compared to the other chargers, and not ideal for APEs whose days are often filled with travelling between household visits in remote areas.
The Sun King PRO came out in last place in terms of charging speed; during cloudy weather it reportedly took up to two days to charge the phone, and up to 15 hours on a sunny day – far slower in comparison to the other models. The APEs trialling the RockA charger in conjunction with the home chargers reported that they had no difficulty in using it and that it took up to five hours to charge their device. They also said they would recommend, where possible, using the Rock A charger to supplement the Sun King Home charger.
Ensuring APEs have charged devices that enable them to access the diagnostic tools and capture data on the upSCALe app whenever they need it is fundamental to the success of rolling out upSCALE nationwide. Heavy, continuous use of equipment deteriorates its ability to perform well and in rural, remote environments, accessing alternatives or replacements is particularly challenging, making large-scale procurement for effective solar chargers and batteries essential. Through this testing, our findings reveal the Sun King Home charger performed far better than the model previously used, and charged devices far more quickly. Making this small change in sourcing the best solar charging equipment will enable APEs to record results in real-time, provide accurate diagnosis, treatment and timely referral, and avoid stock outs of drugs and equipment.