Improving Community Health Reporting : The case of m-JALI, Makueni County Mbinda, M (AMREF Kenya) Gitimu, A (AMREF Kenya) Ofware, P (AMREF Kenya)

Background Information -CHS seeks to strengthen linkages between communities and the formal health systems -Within its framework lies the CBHMIS – for providing information to monitor and evaluate the CHS -Policy makers and health service providers at all levels need accurate data in order to gauge the effectiveness of existing policies and programs and to shape new ones

-This information needs to be – not only accurate – but also reach the decision maker(s) soon enough to be meaningful (timeliness) Time lapses Background Information (cont.)

Issues -Accuracy and timeliness of community health reporting has been one of the primary challenges – hence a major drawback for the CHS -Structures for capturing this data have been largely manual and where efforts have been made to automate, these efforts have been partial -In most cases the time lapses indicated in the figure above range between a few days to several months -There have been calls for efforts to improve efficiency of the systems by innovating to cut these time lapses

Description -AMREF has designed and developed an initiative aimed at further cutting these time lapses -Working within a MNCH project being implemented under 3 building blocks -HRH -CSS -HMIS -Mobile technology has revolutionized nearly every area of life – from health to education to finances…..

-Recent advances in mobile technology have made it practical to automate some aspects of health care delivery in low-income countries -With universal coverage and decreasing costs, mobile phone access and use has substantially improved over the past half decade (ITU, 2014). -The use of mobile phones to support the practice of medicine and public health (m-Health) has seen an increase in intervention in the past few years -One of the objectives of the HMIS building block is to improve reporting rates and timeliness of information to support planning and decision making Description (cont.)

Approaches for Automating CBHMIS DHIS2

CBHMIS on Mobile (M-JALI) -M for Mobile and JALI for (Jamii Afya LInk) -The software package consists of two applications Device-sideServer-side Transmission Retrieval

Device-side application -Easy to use application (running on Android platform) incorporating all tools for CHS data -Capture, transmission and retrieval of data to and from the server/web database -Runs on both 2G and 3G networks – with best performance on 3G -Offline capability – access network, download existing data to the phone memory, go to the field -Timed synchronization to the CBHMIS database/web application CBHMIS on Mobile (M-JALI) …….cont.

Server-side application -Runs on a web server with a SQL Server database and application code in ASP.NET -The API handles device authentication and provides a set of functions for devices to transmit data to and from the server -Web pages enable users at higher levels to monitor, view and verify data uploaded to the database CBHMIS on Mobile (M-JALI) …….cont.

-Application has been developed, tested, commissioned and fully functional -1 CU is fully implementing paperless reporting (50 CHWs, 3 CHEWs trained and using the application and implementing paperless reporting for CHS data -Substantial improvement on timeliness, accuracy and mechanisms for validating data collected by CHVs CBHMIS on Mobile (M-JALI) …….cont.

Sample Screen-Shots – mobile application Home ScreenLogin Screen Tools Home

Sample Screen-Shots – mobile application Household List previewSpecific household summary

Sample Screen-Shots – mobile application

Sample Output Screen-Shots – Web Application

Lessons Learnt -Solutions developed for communities need to offer more value than merely automating manual processes -Wide opportunity for incorporating other functions of community health e.g. diseases surveillance to benefit from improved timeliness of reporting -On-ground support can be better managed by building champions from among the users (CHWs and CHEWs)

Next Steps -Roll-out to other CU’s -Complete reporting cycle – production of MOH 515 summary (automated) through the web-based CBHMIS under development -Web-API to push/pull data to/from DHIS -Research to gather scientific evidence on the cost- effectiveness of the three approached for managing community health data – in progress