Improving quality of care at community level in Malawi with the

help of mobile phone based applications

Webinar

IMPACT Background• USAID/PEPFAR-funded GDA serving 100,000

OVC and PLHIV, July 2010 - June 2014• Designed to complement WALA Program in 9

districts in central and southern regions• Collaboration with Government of Malawi

through MoGCSW, MoH, NAC & OPC/DNHA and US Peace Corps

• Improve wellbeing of OVC and increase access to treatment and care for PLHIV– SO1: Improved wellbeing of 60,000 OVC– SO2: Access to treatment and care for

40,000 PLHIV enhanced

IMPACT Background - IMPACT Consortium Members

Mobile applications• Three mobile applications to support the

IMPACT program at community level:1.Child Status Index (CSI)

• Supporting OVC committees2.Community Case Management (CCM)

• Supporting Health Surveillance Assistants3.Mother-infant pair follow up (MiP)

• Supporting Health Surveillance Assistants

• Working in IMPACT catchment in three districts: Lilongwe, Zomba, Ntcheu

ICT implementation• Mobile applications developed on

CommCare platform• Applications run on Nokia 2700c and

C2-01 with GPRS data transmission at $0.00003/Kb (compared to $0.03 for single SMS)

• Data send to cloud server• Basic troubleshooting once

application is developed and users are trained

CCM application• Health Surveillance Assistants (HSAs) conduct

Community Case Management (CCM) protocol for children from 2 months up to 5 years at village clinics in hard to reach areas

• Mobile application implements Government of Malawi protocol

• Mobile application guides HSAs through protocol, enforcing better adherence to the guidelines

• Currently 53 HSAs trained and using application• Over 7000 children assessed with the application

CCM application

CCM application

Registration

Screening child Treatment

Main menu

Perceptions about CCM application• HSAs:

– ‘The phone is like a colleague reminding us about things we would otherwise forget’

– ‘The phone prevents you from making mistakes’– ‘The phone guides us, it tells what to prescribe according to the age

of child treated’

• Caregivers:– ‘When a child is sick, the doctor can sometimes mistakenly prescribe

wrong medication as he is human but when they use the phone, they confidently prescribe or send the child to a referral hospital.’

– ‘Changes which I have observed with the introduction of the phone is that we are now receiving the correct quantity and type of medication because it’s the phone that guides them.’

Why the CCM application?• Better adherence to the sick child form, insight

in deviations from the protocol– Increased completeness (90% vs. 100% of visits)– Increased referrals (5% vs. 11% of visits)– Increased follow-up (0% vs. 26% of visits)

• Real-time service data, also about drug consumption and stock outs

• Increased satisfaction caregivers about services

MiP application• Mobile application implements Government of Malawi

protocol for mother-infant pair follow up by HSAs, for following up infected women and their exposed infants during antenatal, post-partum and postnatal home visits until child is aged two

• Application guides HSAs through content on each home visit• Currently 65 HSAs trained and using application • 187 women registered of which 134 HIV positive:

– 64 antenatal visits– 9 postpartum visits– 111 postnatal visits

MIP application

Registration Antenatal visit

Main menu

MIP application

Postnatal visit

Post-partum visit

Postnatal visit

Why the MiP application?• Application has helped HSAs understand CBMNC

guidelines better• Improved adherence to protocol• Application has improved relationship between HSAs

and clients: clients more open to HSAs during follow-up visits

• Continued counseling on drug adherence for both mother and child at each visit to avoid defaulting

• Referrals are being made during home visits

Challenges• CCM application

– Paper register and application used concurrently– MOH reporting and supervision

• MIP application– Time span for testing application (pregnancy – 2 years)– Confidentiality issues

• General– Eyesight problems– Life time batteries

Lessons learned• CCM application has potential to improve the

effectiveness of service delivery at village clinics in Malawi.

• MiP application can help improve PMTCT when exposed women are fully followed up and visits done correctly as per protocol

Conclusion

Mobile applications improving quality of care at community level

Acknowledgements:

CHIKWAWA DIOCESE

CHIKWAWA DIOCESE