TB eHealth System for Improved Service Delivery 2019 ENGINEERS CONFERENCE Maurice Rhema Fundani

Contents eHealth project introduction Project summary Problem definition Current Community TB cases management and reporting approach Current TB sample transportation interaction between health facilities Methodology Solution Overall solution architecture Mobile App eHealth Web portal Power and security issues Solar based back up system

iMoSyS was contracted by the National TB Programme to develop an eHealth system for TB data collection and monitoring. Project implementation period: 2017 to 2019 The Government of Malawi is among four countries (Lesotho, Malawi, Mozambique and Zambia) participating in the Southern Africa Tuberculosis and Health System Support Project (SATHSSP) funded by the World Bank (IDA). Introduction

Aim and Objectives of Project To provide improved community TB care interventions that shall seek to minimize diagnostic and treatment delays To provide strategic guidance and technical support to facilitate the introduction and use of eHealth strategies to strengthen health systems for the improvement of TB diagnosis and treatment outcomes especially for the SATHSSP target population namely miners, ex-miners and their communities. Contribute to the regional perspective on developing and using eHealth solutions to address HIS challenges including late reporting and poor patient follow up Outcome Timely information sharing and feedback for improved patient care and management at community level

Targeted facilities Northern Region KARONGA 1) Karonga District Hospital 2) Iponga HC 3) Nyungwe HC 4) Chilumba Rural H Southern Region BALAKA 1) Balaka Hospital 2) Mbera HC 3) Phalula HC 4) ChiendaUsiku HC BLANTYRE 1) Lirangwe HC 2) Makata HC 3) Zingwangwa HC 4) Chileka HC Central Region LILONGWE 1) Bwaila Hospital 2) Kabudula HC 3) Nathenje HC 4) Area 25 HC KASUNGU 1) Kasungu Hospital 2) Kaluluma Rural Hospital 3) Santhe HC 4) Chamama HC

Problem definition No accountability/ transparency If you can’t monitor it; you can’t manage it More time to reach out to the patient HSA requires airtime for communication Problem definition

Problem definition Current TB sample transportation interaction between health facilities - No accountability/ transparency - If you can’t monitor it; you can’t manage it - More time to reach out to the patient

Scope of Work Develop use of ICT to enable community engagement with TB community outreach programmes Develop use of mobile technologies to facilitate Record of TB outreach services Referral of samples and linkage with diagnosing health facilities Treatment initiation, follow up and defaulter tracing Produce reports and guidance Regular reports and feedback

Solution

Methodology Baseline Assessment – understanding the current TB system Use ICT solutions to solve challenges Inception Report System deployment in all the 20 Health facilities Trainings and orientation meetings with health facilities staff from the 20 facilities Deployment of equipment On Job trainings of system users in the facilities

Overall solution architecture

SOLUTION Tracking samples and facilitating reporting Built on top of cellular platform Android APP and SMS Module

SOLUTION SMS MODULE For results reporting For next Appointment reminders

Power Backup Solution for Health Facilities

Project Achievements

Fully functional e-health system developed and it is currently in use in the twenty facilities in five districts. More than 13, 000 cases have been processed through the system. All facilities are equipped with equipment to enable them to do their jobs Trainings of health facility staff was conducted Follow-up visits were undertaken in all the facilities to ensure users manage cases using the system. Review meetings took place where stakeholders provided feedback on the system itself. WhatsApp groups were created to enable system users to provide any challenges and updates to iMoSys and NTP from time to time Project Achievements

Web based dashboard for managing cases

Mobile App for managing TB cases

Some of mobile app functionalities

Benefits of the e-health system Improved decision making by management since information is available in real-time. Elimination on duplicate entries, patients are tracked using unique barcodes Improved reporting. Reports are generated automatically. Improved patient management, SMS's automatically sent to patients reminding them of their medication. Improved sample collection as reported by several Health Facilities at different review meetings Real-time tracking of sample status Timely feedback of information to the patient Benefits of the e-health system

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