Thoughts from the Last Mile Welcome to the VillageReach Blog

Tag Archives: data collection

Feb 09 2015

VillageReach, in collaboration with D-tree, is proud to announce the implementation of a new mHealth application in Malawi. What an exciting partnership! During the first week of February 2015, 25 health surveillance assistants (HSAs), nurses and other health workers in Balaka District received intensive training on smartphone technology and the capabilities of a new maternal and neonatal health (MNH) assessment application developed by D-tree. Using smartphones to improve the assessment of pregnant women and their children will increase access to health care and improve the quality of care provided in rural villages.

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Dec 04 2014

The Role of Data Collection and One Community’s Path Toward Change

While working on the Kwitanda Community Health Project (KCHP), based in the Kwitanda catchment area, Balaka District, in southern Malawi, I have seen firsthand how critical the role of data collection is to improving health outcomes. In this rural and remote setting, the news of a maternal death spreads quickly, but quietly, almost like a rumor or story. “Did you hear? Another mother died in childbirth in that village. Another neonatal death occurred last week.” It is difficult to understand the causes of the death, or how often they occur because little information is collected and reported on these events.

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Jul 10 2014

BerturBy Beltur Alface
Medical Chief of Gaza Province in Mozambique
Reposted from Impatient Optimists.org

 

Change does not come easily, particularly to systems that have been operating in a specific way for a long time and where many people have a stake in the decision making. But sometimes it becomes clear that change is necessary to improve how things operate.

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Apr 23 2013

We often cite the challenges we see in determining optimal approaches to strengthening health systems, many of which are due to the lack of current data about the health of communities and the performance of the health system. This critical gap in useful data to inform better decision making led us to form the Information Systems Group (ISG) at VillageReach, charged with developing new innovations and approaches in information communications technology (ICT).

In many cases, the reporting and requisitioning of medical commodities in low-income countries has been driven by paper-based processes. These are labor intensive, and prone to communication delays and human errors, openLMIS-logobut remain the accepted practice in areas with minimal ICT infrastructure. Today, however, communication networks are being deployed in a growing number of rural communities in low-income countries, making the broad-scale deployment of an electronic logistics management information system (LMIS) not only practical but inevitable.

To address this opportunity, a significant amount of our work in ISG is focused on OpenLMIS, a collaborative, community-focused initiative to create an open source electronic LMIS for health commodity supply chains in low-income countries. With a growing number of partners, the initiative is focused on meeting our goal of designing, developing, and sharing open source software, tools and methodologies, from which Internet-enabled LMIS can be developed and customized for country deployments.

With OpenLMIS, we see the opportunity to enable ministries of health and their partners to improve their replenishment process, but also to gain access to critical information that contributes to optimal decision-making – this ranges from the facility manager at a health center who wants to submit a requisition, to a packing clerk at the warehouse who needs to fill an order, as well as related stakeholders who want real-time visibility into how well the supply chain is performing. With that greater amount of information at their disposal, we expect healthcare administrators to be able to make more accurate and timely decisions that improve health system performance, including limiting stock outs of essential medicines and vaccines, and reducing interruptions in service delivery due to stock shortages and health worker absences.

The OpenLMIS collaboration has made significant progress in software development over the past few months:

  • With our partners, we have developed a detailed set of requirements for a new electronic LMIS that can be customized, configured and deployed in multiple countries.
  • The first phase of software development has been completed, providing a core platform for future development of deployable LMIS solutions.
  • Development has started on the second phase – a general but configurable system that includes features and functionality needed to meet basic LMIS requirements. A number of countries and financial supporters have expressed strong interest in deploying the solution.

In addition to these software development milestones, the OpenLMIS community itself is expanding. The Bill & Melinda Gates Foundation, the Rockefeller Foundation, PATH, and USAID are providing essential funding for the initiative, and John Snow Inc., PATH, and the Tanzania and Zambia ministries of health are contributing valuable input to define requirements and functionality for the solution. Management Sciences for Health (MSH) has also recently joined the initiative.

We’re very excited about the new phase of work we’ve started and look forward to releasing updates later in the year. For those interested in more detailed tracking of OpenLMIS’ progress, please visit the OpenLMIS Repository regularly for updates.

Ron Pankiewicz
Technology Director &
Group Lead, Information Systems Group

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Apr 19 2013

A frontline perspective of the CCPF “Health Center by Phone” Program By Novice Gauti Hotline Supervisor VillageReach, Malawi

When I trained as a midwife, I had no idea that I would be helping deliver babies over the phone. Technology has come a long way, especially in the district of Balaka in Malawi.

In September of this year, Mercy, a 24 year old pregnant woman from Dailesi village in Balaka, told her family that she wasn’t feeling well, and set out for Kalembo Health Center seated on the back of a bicycle driven by her neighbor. Dailesi village is 12 km away from Kalembo, the nearest health center, and is located in a hilly area far from paved roads. The only transport available is by foot, by bicycle taxi, or – in case of emergency – by ox cart or bicycle ambulance.

After an hour of traveling, Mercy started feeling intense muscle contractions signaling the birth of her baby and could no longer sit on the back of the bicycle. Mercy asked the bicycle driver to stop in a nearby village so that the women living there could help her deliver her baby.

With no other transport available, still far from the health center, and without any skilled personnel nearby to help with Mercy’s delivery, her neighbor decided to call Chipatala cha pa Foni for assistance.

Chipatala cha pa Foni (CCPF), which translates to “health center by phone,” is a toll-free hotline that women in rural Malawi can call to speak directly with a hotline worker for information on pregnancy, newborn and child health, and reproductive health issues such as family planning. A VillageReach project, CCPF provides clients with advice they can follow at home, or refers them to a health center or hospital if they’re displaying “danger signs” which require further care. Women in the community can also sign up for CCPF’s “Tips and Reminders” mobile messaging service to receive regular text or voice messages tailored to their week of pregnancy or their child’s age.

Besides information and referrals, CCPF has also linked key services to the community, as in the case of transport. After visiting the CCPF Hotline Room, the Balaka District Transport Officer was so impressed with the potential of CCPF to save lives that he offered to assist in arranging transport logistics for callers in critical condition or in need of immediate care. He gave us his telephone number and requested that we let him know of any emergency transport needs.

Less than one week later, we took him up on his offer when Mercy called the hotline.

Rose Nkupsya, a nurse and CCPF hotline worker, answered the call from Mercy. Rose understood the urgency of the situation and informed the transport officer. He immediately responded by sending the district ambulance to pick up Mercy and bring her to the nearest health facility.

Before the ambulance could reach her, Mercy delivered a baby boy. Mercy was bleeding heavily when the ambulance arrived and needed to be helped by health workers. But she was afraid of being reprimanded by them for delivering her baby outside of a facility and was concerned that the nurses would not admit her. Over the phone, Rose reassured her, and Mercy agreed to go to the health center where the nurse on duty was able to stabilize her condition and successfully stop the bleeding. Had it not been for CCPF and the transport officer, Mercy would have suffered severe bleeding and infection. Fortunately, she and her baby boy received timely and appropriate care, and both are happy and healthy today.

Chipatala cha pa Foni provides an important service to women in four districts of Malawi, but our work is far from finished. I look forward to continuing to help women have safe pregnancies and deliveries and for children to grow up happy and healthy.

 

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May 25 2012

Rapid Diagnostic Test (RDT) Data and Distribution Systems.

As a partner in Mozambique’s health system, VillageReach is undertaking a study about the shortage of RDTs in the rural health centres. This is the second in a series of updates we expect to provide on the work – see the first post here. The study will conclude this fall.
The study involves gathering and analyzing data that health workers collect as they provide testing services, and using that data to analyze consumption as it informs the test distribution. Data about the use of RDTs is critical to operating a well-functioning supply chain and ensuring that health centers have the right tests at the right time. This data allows planners in the health system to purchase the right quantity of tests and distribute them throughout the health system while minimizing wastage and expiry.
Until now, the national health system in Mozambique has not distributed standardized forms for collecting this data. However, the lower levels in the government recognized the need and value of the data and implemented their own systems. In the first visit made by the study team in January this year, it was found that the data collected was of very poor quality, due to lack of standardized instruments or forms to use for recording data and a lack of training for the health workers. The forms used to collect the data were undergoing numerous changes, which complicates the process of data collection at the service delivery point.
Tim2
The system for distributing tests and collecting data about tests was designed with the following flow: the RDTs are amassed at a provincial medical store, redistributed to district storage facilities, and then transported to rural health centers. The image on the left represents the ideal.
Last week we visited again and found that key improvements had taken place in the last four months.
1. Systems and processes are in place to collect data about the use of tests. These are being used properly and routinely. This is no small feat in a country so vast and full of infrastructure challenges that can limit access to the health centers.
2. The Logistics Management Information System is installed and in use at the district level. That is a major accomplishment, and one that will improve the distribution and supply of medicines throughout the country.
But this visit revealed another fundamental observation. Despite improvements over the recording and availability of data about test consumption, there continues to be shortages and stock outs of tests in the health centers. Specifically, I observed situations where there were too few RDTs and a number of them had expired before being used. If the data is there to make the system work, then what is happening?
For many cases, we discovered the question can be answered by the following factors:
• A lack of vehicles for transport limits regular distribution of RDTs and medicines to health centers;
• Where there are vehicles available for transport, there is often a lack of fuel;
• Where there are vehicles and fuel, there is a chronic lack of allowances for personnel to carry out the distribution of medicines.
These factors greatly influence the availability of RDTs at the health center level. With delays in distribution, RDTs may expire before they are used, ultimately reducing the quality of service at the health centers. Tim1
All this ultimately results in poor distribution system of RDTs used in the province and a higher cost of distribution. In addition, the lack of regular distributions results in incomplete and inaccurate data about the health centers being reported back to administration levels within the health system. This image on the right represents what we see in reality.
These factors, all too common occurrences for health systems with limited resources, highlight the importance of improving the quality and capacity of the underlying infrastructure the health centers depend on in order to support so many remote communities.

Timóteo Eduardo Chaluco, Monitoring & Evaluation Officer

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Dec 09 2010

In the previous post, Nick shared the exciting news that data from health centers in Mozambique is now available for us to see. Living in an environment where information is easily available at our fingertips, we often take the availability of data like this for granted. In reality, obtaining data from a place where information systems and health records aren’t commonly used is quite challenging!

Yet, the information is crucial not only because it can strengthen the overall performance of the health system by enabling data-driven decision making by our partners on the ground, it is necessary in order to measure progress and impact. And as I’ve written previously, VillageReach is committed to monitoring and evaluating the progress and impact of the Dedicated Logistics System in Mozambique.

The key questions to ask when attempting to evaluate impact are whether or not the Dedicated Logistics System has met its objectives to improve health system performance and increase immunization coverage. In the baseline evaluation, we attempt to answer questions such as: how many children are immunized and how often do health centers run out of vaccines. Unfortunately, this type of information is just not available. There are no immunization registries to search. Health centers don’t keep patient records. Even if they did, we still wouldn’t be able to know how many children are not immunized because there are no vital record systems either. These things just aren’t tracked.

In order to get the information we believe is valuable to answer these questions, we went out and collected it. In order to estimate the immunization coverage, we conducted more than 800 household surveys in randomly selected villages across the two provinces of Cabo Delgado and Niassa. The sample size gives us enough statistical power to make an estimate of the true immunization coverage rate with 95% confidence and because the villages were randomly selected, the sample is representative of the population. In each household, we essentially asked whether or not the children living there had received certain vaccines. In addition, we conducted surveys in more than 60 health centers in those villages to get an idea of how the health centers were performing. We worked with a group in Mozambique who hired and trained local staff to conduct the surveys and complete the data entry. The process took about nine months from the time we first sought Ministry of Health approval for the study until we started seeing the data.

Despite a few challenges along the way including delays in schedules with field teams, traveling time to remote villages, and correcting for concerns with the data such as missing entries and incorrectly completed surveys completed, we have real numbers. We have real data from the very last mile. Finally, we can use this data to answer our questions regarding how many kids aren’t being reached by vaccination services and what we can do to improve this. Using this information, we can tailor our program activities in ways that can make the biggest impact and that is what we intend to do.

Before we can share the results publically, we need approval from the Ministry of Health. We’ve started the process and have already shared the results with provincial leaders in Cabo Delgado and Niassa. We will be presenting the results to the Ministry later this month or early next year. We are looking forward to sharing our results with you as soon as possible. Stay tuned.

Jessica Crawford
Program Associate
VillageReach

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