Child Status Index & Community Case Management mobile applications Marije Geldof D-tree International

Background IMPACT IMPACT is a USAID/PEPFAR-funded GDA serving 100,000 OVC and PLHIV Funding: $28 million – half provided by alliance partners as privately leveraged funds Duration: 4 years (July 2010-June 2014) Designed to complement WALA Program 9 implementing partners & 3 technical assistance partners 9 districts in central and southern regions In collaboration with Government of Malawi and relevant ministries

The IMPACT Consortium National Partners Chikwawa Diocese Dedza Catholic Health Commission Lilongwe Catholic Health Commission Zomba Catholic Health Commission National Association of people living with HIV (NAPHAM) International Partners Africare Emmanuel International D-Tree International CRS (Prime) Opportunity International Bank Project Concern International Save the Children World Vision

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 Goal IMPACT

D-tree’s role in IMPACT Developing 3 mobile applications to support the IMPACT program at community level: 1.Child Status Index (CSI) Supporting OVC committees 2.Community Case Management (CCM) Supporting Health Surveillance Assistants 3.Mother-infant pair follow up (MiP) Supporting Health Surveillance Assistants Working in IMPACT catchment areas in three districts: Lilongwe, Ntcheu and Zomba

ICT implementation Mobile applications developed on CommCare platform Applications run on Nokia 2700c with GPRS data transmission at $ /Kb Basic troubleshooting once application is developed and users are trained Capacity for continuation of applications being transferred from D-tree to CRS Malawi

CSI application Child Status Index (CSI): case management tool for assessing the well-being of children IMPACT CSI forms collected every 6 months by community volunteers for beneficiary children Mobile application in Chichewa to enter CSI forms, which prompts for referrals & follow-up Data from paper forms entered into application by OVC secretaries Currently 82 OVC secretaries trained

CSI application

Registration CSI form Main menu Important events Follow up

Why the CSI application? Data entry at community level Increased data completeness Increased referrals through referral prompts Reduced loss to follow up through follow up prompts

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 30 HSAs trained

CCM application

Registration Screening childTreatment 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 reminds you of everything’ Caregivers: – Caregivers from other areas come to the village clinics with the mobile application, because they feel these are now providing better care – ‘When the phone was used my child got a proper examination’

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 (1% vs. 5% 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

Challenges CSI application – (Literacy) level of CSI users – Phone theft – Data entry not at point of care CCM application – Paper register and application used concurrently – MOH reporting and supervision General – Eyesight problems

Conclusion CSI application has potential to improve support to vulnerable children and reduce loss to follow up. CCM application has potential to improve the effectiveness of service delivery at village clinics in Malawi. Partnership between CRS Malawi and D-tree International successful