1. A Framework for Digital Tool Use in Malaria Surveillance Programs
Jessica Long
Technical Project Manager

2. Outline
Overview of two widely-adopted digital tools in low-resource settings:
CommCare
DHIS2
A Malaria Surveillance Digital Toolkit
How can digital tools make vector control more effective?
Detailed case study:
SMS support for Indoor Residual Spray (IRS) operations with Abt Associates
Moving towards a holistic technology system: Cross-border surveillance work between Senegal and The Gambia
PNLP Senegal
NMCP Gambia, in partnership with Catholic Relief Services (CRS)
Cross-border collaboration

3. Digital tool overview

4. Mobile Data Collection Platform for Remote Workforce Management

6. Active in 60+ countries 20+ implemented at national scale
National Health Data Collection and Analytics Platform

7. How does DHIS2 work? Possibility for: Local hosting Cloud hosting
District facilities enter the paper data into a national DHIS2 instance once per month
Health facilities send monthly paper-based aggregate reports to district centers

8. Why focus on CommCare and DHIS2 as digital intervention tools?
CommCare: Mobile Data Collection Platform for Remote Workforce Management
DHIS2: National Health Data Collection and Analytics Platform

9. DHIS2 and CommCare are the most common health information system platforms in West Africa

10. Innovation work: ATLAS data visualization and predictive analytics platform
Interoperable platform allows it to read from any data source (DHIS2, CommCare, etc) and layer analytics on top of very detailed satellite images.

11. A Malaria Surveillance Toolkit

12. Malaria Surveillance Toolkit
Mobile and SMS-based Data Collection for a remote workforce
Web-based Data Collection for Health Facilities
Data analysis and visualization
Predictive analytics
Creating an interoperable data pipeline allows malaria surveillance programs to get the most out of each tool in this toolkit.

13. Questions about the digital tool landscape?

14. How can digital tools make vector control more effective?

15. Identify target regions for intervention
Take a region that looks like this on Google Maps:
Take data previously recorded on paper:
Compare census data:
And see richer details:
And see GPS coordinates on a map:
To dynamically-predicted population density:

16. Plan household-level interventions and assess level of coverage achieved
Count number of households in a remote area with detailed satellite images to assess targets and results for sensitive interventions like:
Indoor Residual Spray (IRS)
Distribution of Long-Lasting Insecticide Nets (LLINs)
Record data about each household-level intervention in a mobile data collection app, to enable surveillance teams to track exactly which households were covered.

17. Coordination between on-the-ground intervention implementers in remote areas

18. Track malaria incidence and prevalence via regularly reported clinical indicators
Moving from paper systems to digital systems ensures timely, reliable reporting of clinical indicators via DHIS2 on a monthly basis
Certain indicators can be tracked more frequently with SMS-based reporting (i.e. weekly reporting of clinical indicators via CommCare-enabled SMS on a weekly basis)
Having a shared, regularly updated source of truth for national malaria incidence and prevalence allows National Malaria Control Programs to monitor intervention efforts and ensure progress towards incidence reduction

19. Summary
Timely, accurate clinical indicators reported from health facilities gives national malaria control programs up-to-date information that they can use to plan interventions
More granular GPS information allows control programs to monitor interventions at a household level rather than a district level
SMS functionality allows implementers to coordinate time-sensitive activities in the field

20. Digital Intervention for IRS

21. PMI: Africa Indoor Residual Spraying Program (AIRS)
Digital intervention
PMI: Africa Indoor Residual Spraying Program (AIRS)
-Dimagi began working with Abt Associates in 2014 to implement, train on and support the mHealth system for the monitoring of spray campaigns under the AIRS project.
- By 2018, Dimagi implemented mHealth system in 12 Abt Africa Indoor Residual Spraying countries - all malaria- endemic countries in Sub-Saharan Africa
-Dimagi will continue to support the qualitative and quantitative supervision of IRS campaigns under the VectorLink contract, which will bring the digital intervention to 14 Sub-Saharan countries in the years ahead
-The intervention is 4-pronged, touching on all actors who support IRS. We will look at the four main components next. The key take-away is that we want to target an intervention that supports and facilitates the work of each actor, whether that be receiving job aid messages or reinforcement of supervision protocol.

22. Designing an mHealth system for IRS
1. Supervisory
Checklist Application
2. Structured SMS for Spray Progress Monitoring
3. Broadcast SMS job aid messages
4. Daily reports
“Good morning! Remember the spray target is 30 structures per day. Thanks for the good job!”
“Full PPE use remains mandatory for the duration of the spray operation.”
Mobile application with 8 checklists and one data collection verification form for environmental and operational teams. Used by supervisor to oversee activities, identify red flags. For example, reporting if a home was sprayed without food removed or if a spray operator was eating while in uniform.
SMS system for team leaders/storekeepers to send in daily spray data about team progress, spray coverage and insecticide usage. Each number refers to a VectorLink indicator.
A= trigger to tell CommCare that it is receiving a structured report
First indicator = number of spray operators who worked that day
Second indicator = number of structures found that day
Third indicator = number of structures sprayed that day
Forth indicator = number of insecticide units used
Daily broadcast reminders with advice, sent to different groups including supervisors, SOPs, mobilizers, etc.
Daily reports include progress updates against spray target and flagging supervision concerns. Sent to Abt Home Office, program staff, supervisors and Ministry of Health stakeholders.

23. The value of digital solutions of IRS campaigns
Why use digital tools for IRS campaigns? Well, IRS campaigns have unique challenges that can helped, supported or facilitated by the implementation of a mobile data collection and supervision system
#1: Teams work in remote locations with limited connectivity. It can be hard to receive data and information from teams. CommCare leverages SMS and mobile data, to allow for the daily transmission of information - even in situations with limited connectivity. CommCare works offline and will never lose your data; it will be sent upon establishment of an internet connection.
#2: Tight implementation windows. IRS campaigns are ambitious undertakings, and they are all hands on-deck. Dimagi works with country teams to prepare the mHealth system ahead of the start of the campaigns and ensure the teams are trained on the use of the tools.
#3: Large seasonal teams. The core members of the IRS campaigns - spray operators, team leaders and storekeepers, may be a seasonal workforce. It’s important that whatever system implemented is intuitive for the user and easy to use - especially given all the other trainings teams are receiving. Digital solutions also provide visibility into the remote management of your workforce.
#4: Limited group training opportunities. With the quick start-up of IRS campaigns, there are few opportunities to come together and receive training as a group. Leveraging the power of SMS, we can continue to provide reminders for job performance best practices and ensure that campaigns are implemented safely, via digital supervision checklists.
#5: Data requires daily follow-up action. Whether it’s understanding your team’s spray progress or reporting supervision concerns from the observation visits, it’s critical that information is shared timely with the right stakeholders for follow-up. Digital tools can provide for real-time follow-up to ensure a proactive supervision and enhance visibility into campaigns.

24. Questions about the PMI VectorLink project?

25. Programme Nationale de Lutte contre le Paludisume (PNLP) in Senegal

26. In the past 18 years, Senegal has seen a 91% reduction in malaria incidence

27. Reductions in malaria incidence have been focused in the west of the country

28. Existing Digital Infrastructure: District-level web-based DHIS2 reporting on a monthly basis (national scale)
District facilities enter the paper data into a national DHIS2 instance once per month
Health facilities send monthly paper-based aggregate reports to district centers

29. Existing Digital Infrastructure: Sentinel sites use CommCare to report malaria incidence on a weekly basis (pilot)
A small number of health posts are chosen as sentinel sites. These health posts report malaria incidence directly to a national database using a weekly CommCare-based SMS process

30. Existing Digital Infrastructure: Use of ODK to capture real-time data about case investigation (pilot)
CHWs record information about active case investigation that’s reported directly to DHIS2

31. National Malaria Control Program (NMCP) in The Gambia
In partnership with catholic relief services (crs)

32. In the past 8 years, The Gambia has seen a 95% reduction in malaria incidence4%
0.2%
2018
2010

33. Areas with high malaria prevalence lie in the east of the country and along the border

34. Existing Digital Infrastructure: District-level web-based DHIS2 reporting on a monthly basis (national scale)
District facilities enter the paper data into a national DHIS2 instance once per month
Health facilities send monthly paper-based aggregate reports to district centers

35. Existing Digital Infrastructure: Use of DHIS2 Mobile to change reporting cadence from monthly to weekly (pilot)
Health facilities enter weekly aggregate reports into DHIS2

36. Existing Digital Infrastructure: Use of iForm Builder to record IILN (bed net) distribution

37. The vision for cross-border data-sharing

38. Background
Many of the most high-incidence areas of malaria (especially for The Gambia) are located along border regions
In October, 2017, the governments of Senegal and The Gambia formed a cross-border malaria surveillance working group to specifically address this problem
One goal of this working group was to develop a shared data visualization that could be used by both National Malaria Control Programs
What does this entail?

39. 1) Strengthen data collection at a district, facility, and community level
2. Allow health facilities to report clinical indicators directly to DHIS2 via mobile or web-based data entry.
1. Expand the use of mobile phones for real-time tracking of community interventions, like case detection and bednet distribution.

40. 2) Ensure all mobile data collection tools integrate with a national DHIS2 platform

41. 3) Define a shared set of indicators to establish a data exchange protocol
Examples:
Number of children under 5 who had a positive TDR test at a health facility in the past month
Number of women who report that they are pregnant who had a positive TDR test at a health facility in the past month

42. 4) Design a data visualization interface that can be used to evaluate the effectiveness of malaria interventions and identify potential new areas for intervention
Gambia DHIS2
Use of predictive analytics allows ATLAS to identify risk areas
Senegal DHIS2
Map data
ATLAS

43. 5) Establish a set of criteria for how a shared data visualization will guide action
Example: Set incidence thresholds per district for active vs. passive case detection

44. THE GAMBIA SENEGAL Data Exchange Protocol Facility Community ATLAS
DHIS2
DHIS2
SENEGAL
THE GAMBIA