0Project Mwana is one of e-Government service that Ministry of Health has implemented with the help of the cooperating partners to improve early infant diagnostics services, post-natal follow up and care using mobile phones.
1.19.1 Country Overview
Zambia has shown growth in attracting investment in the Information and Communication Technologies (ICT), Sector. The sector has recorded over 42 percent penetration rate growth compared to 0.02 percent recorded 14 years ago. The ICT sector have continued to pour in since the country launched the policy in 2007 adding that the policy has created an environment for the growth of the sector. Mobile manufacturing company and various internet and mobile service providers are some of the investments that the country has attracted. The unfortunate scenario is that most of development are concentrated along the line of rail, leaving large areas in the rural and remote place unserviced or underserved.
In Zambia, large numbers of infants are infected with HIV either at delivery or when breastfeeding. If no interventions provided, most of these children who contract HIV from their mothers die before the age of two years. These deaths contribute to the high levels of national under-five mortality rate. The government made it mandatory to test every infant born and begin treatment within the first twelve weeks of life.
The challenge faced by the Ministry of Health in particular area was how to transmit infant diagnostics services results from the three (03) test centres (Laboratories) in the country to the respective remote places within the shortest possible time. The turn-around time under the courier systems available would take an average duration of forty-two (42) days to complete the process, a period too long for a mother wait without breastfeeding. This challenge led to the birth of Project Mwana in 2009.
Objectives and Strategies:
To strengthen early infant diagnosis with an aim both to increase the number of mothers receiving results and to reach mothers in a faster, more efficient manner using the SMS application (m-Health).
To improve the rate of postnatal follow-up, increasing the number of birth registrations for clinic and community births, while also raising the number of clinic visits for mothers through community-health worker tracing using the “RemindMi” application.
To enhance service delivery of government to its citizens.
Procurement of ICT Infrastructure (Servers and Connectivity) for the project.
Development of Project Mwana using RapidSMS, a free and open-source framework for building mobile application for dynamic data collection, logistics coordination and communication, leveraging the basic short message service mobile technology.
Piloted in the project 6 provinces across Zambia, servicing 31 clinics and the pilot evaluation showed that it had substantial positive health impacts.
Scaling the project nationally between 2011‒2015.
Technologies and Solutions Deployed:
SMS technology ‒ powerful innovation that in Zambia has reduced delays in receiving early infant diagnosis (EID) DBS HIV test results, improved communication among health care providers and community volunteers, and more important, encouraged patients to return to the clinic for their test results with greater confidence.
RapidSMS Technology ‒ addresses Early Infant Diagnosis (EID) of HIV. SMS messages are used to send the HIV results from the labs where they are processed to clinic workers in facilities where the samples are collected. The results arrive on phones in smaller clinics and SMS printers in larger facilities. The system also tracks samples and provides real-time monitoring for the province and district officials.
RemindMI RemindMi addresses Patient Tracing for post-natal care. SMS messages are sent to Community Based Agents who seek out caregivers and infants and ask them to return to the clinic for 6 day, 6 week and 6-month post-natal check-ups or special circumstances, such as results arriving at the facility.
Changes and Outcomes Achieved
Project Mwana RapidSMS pilot reduced delays in transmitting results from the HIV test laboratories to the rural health facilities via SMS message from the average of 42 days to an average of 4 days. To date, the project has been piloted in 31 predominantly rural districts of Zambia and has produced desired results, which has prompted the government to schedule a national scale up program.
‒ Utilize the phones people have rather than purchasing and supporting a national phone system.
‒ Create district-level training teams.
‒ Make decisions based on identified needs of the end users.
‒ Create the tools with the people who are going to use them.
‒ Test early and often; don’t worry about failing and stay adaptable.
‒ Use open source tools that can be customized to local needs.
1.19.4 Next Steps
A national scale-up plan has been developed, commencing with a preparation phase and then shifting to an iterative phase where clinics are trained and added to the system and the problems and successes of the additions are evaluated. The aim is to achieve national scale by 2015, with health facilities offering early infant diagnosis services. The preparation phase will focus on solidifying the technical, physical, monitoring and human infrastructure to allow the system to handle the stresses of scale. Throughout the scale-up process, the project will be closely monitored to ensure the systems are having a positive effect on the targeted health challenges.