%0 Journal Article %J Glob Health Sci Pract %D 2017 %T A Mobile-Based Community Health Management Information System for Community Health Workers and Their Supervisors in 2 Districts of Zambia. %A Biemba, Godfrey %A Chiluba, Boniface %A Yeboah-Antwi, Kojo %A Silavwe, Vichaels %A Lunze, Karsten %A Mwale, Rodgers K %A Russpatrick, Scott %A Hamer, Davidson H %K Community Health Services %K Community Health Workers %K Delivery of Health Care %K Health information systems %K Humans %K Mobile Applications %K Referral and Consultation %K Zambia %X

INTRODUCTION: Effective community health management information systems (C-HMIS) are important in low-resource countries that rely heavily on community-based health care providers. Zambia currently lacks a functioning C-HMIS to provide real-time, community-based health information from community health workers (CHWs) to health center staff and higher levels of the health system.

PROGRAM DESCRIPTION: We developed a C-HMIS mobile platform for use by CHWs providing integrated community case management (iCCM) services and their supervisors to address challenges of frequent stock-outs and inadequate supportive supervision of iCCM-trained CHWs. The platform used simple feature mobile phones on which were loaded the District Health Information System version 2 (DHIS2) software and Java 2 platform micro edition (J2ME) aggregation and tracker applications. This project was implemented in Chipata and Chadiza districts, which supported previous mHealth programs and had cellular coverage from all 3 major network carriers in Zambia. A total of 40 CHWs and 20 CHW supervisors received mobile phones with data bundles and training in the mobile application, after which they implemented the program over a period of 5.5 months, from February to mid-July 2016. CHWs used the mobile phones to submit data on iCCM cases seen, managed, and referred, as well as iCCM medical and diagnostic supplies received and dispensed. Using their mobile phones, the supervisors tracked CHWs' reported cases with medicine consumption, sent CHWs feedback on their referrals, and received SMS reminders to set up mentorship sessions.

OBSERVATIONS: CHWs were able to use the mobile application to send weekly reports to health center supervisors on disease caseloads and medical commodities consumed, to make drug and supply requisitions, and to send pre-referral notices to health centers. Health center staff used the mobile system to provide feedback to CHWs on the case outcomes of referred patients and to receive automated monthly SMS reminders to invite CHWs to the facility for mentorship. District- and central-level staff were able to access community-level health data in real time using passwords.

LESSONS LEARNED: C-HMIS, using simple feature phones, was feasible and viable for the provision of real-time community-based health information to all levels of the health care system in Zambia, but smartphones, laptops, or desktop computers are needed to perform data analysis and visualization. Ongoing technical support is needed to address the hardware and software challenges CHWs face in their day-to-day interaction with the application on their mobile phones.

%B Glob Health Sci Pract %V 5 %P 486-494 %8 2017 09 27 %G eng %N 3 %R 10.9745/GHSP-D-16-00275 %0 Journal Article %J J Telemed Telecare %D 2012 %T A telemedicine network to support paediatric care in small hospitals in rural Tanzania. %A Krüger, Carsten %A Niemi, Mauri %K Child %K Child, Preschool %K Electronic Mail %K Female %K Hospitals, Rural %K Humans %K Internet %K Male %K Pediatrics %K Physician's Practice Patterns %K Referral and Consultation %K Retrospective Studies %K Rural Health Services %K Tanzania %K Telemedicine %X

We reviewed our experience with the Tanzanian Telemedicine Network in supporting paediatric care at 40 small, rural hospitals in the country. The network began operating in 2008. Store and forward telemedicine was provided via the open source software iPath. The 33 volunteer consultants were based in several countries, although most of them had practical experience in Tanzania. During the first three years of network operation there were 533 referrals. There were 159 paediatric cases (median age five years). Three paediatric specialists provided most consultations (64%), but other specialists provided recommendations when required. The response time was usually less than two days (median 6 h; inter-quartile range 2-24 h). A precise recommendation was not always provided, but since all consultants had an intimate knowledge of the state of health services in Tanzania, their advice was usually well adapted to the local circumstances of the hospitals. Referral to a higher level of care was recommended in 26 cases (16%). A simple web-based telemedicine system combined with email alerts is feasible in remote locations in Tanzania, even where fast Internet connections are not available.

%B J Telemed Telecare %V 18 %P 59-62 %8 2012 Jan %G eng %N 1 %R 10.1258/jtt.2011.110312 %0 Journal Article %J Int J Med Inform %D 2007 %T The RAFT network: 5 years of distance continuing medical education and tele-consultations over the Internet in French-speaking Africa. %A Geissbuhler, Antoine %A Bagayoko, Cheick Oumar %A Ly, Ousmane %K Africa %K Computer Simulation %K Computer-Assisted Instruction %K Curriculum %K Education, Distance %K Education, Medical, Continuing %K Educational Technology %K Humans %K Internationality %K Language %K Referral and Consultation %K Remote Consultation %X

Continuing education of healthcare professionals is a key element for the quality and efficiency of a health system. In developing countries, this activity is usually limited to capitals, and delocalized professionals do not have access to such opportunities, or to didactic material adapted to their needs. This limits the interest of such professionals to remain active in the periphery, where they are most needed to implement effective strategies for prevention and first-line healthcare. Telemedicine tools enable the communication and sharing of medical information in electronic form, and thus facilitate access to remote expertise. A physician located far from a reference center can consult its colleagues remotely in order to resolve a difficult case, follow a continuous education course over the Internet, or access medical information from digital libraries or knowledge bases. These same tools can also be used to facilitate exchanges between centers of medical expertise: health institutions of a same country as well as across borders. Since 2000, the Geneva University Hospitals have been involved in coordinating the development of a network for eHealth in Africa (the RAFT, Réseau en Afrique Francophone pour la Télémédecine), first in Mali, and now extending to 10 French-speaking African countries. The core activity of the RAFT is the webcasting of interactive courses. These sessions put the emphasis on knowledge sharing across care professionals, usually in the form of presentations and dialogs between experts in different countries. The technology used for the webcasting works with a slow (25 kbits/s) internet connection. Other activities of the RAFT network include visioconferences, teleconsultations based on the iPath system, collaborative knowledge bases development, support for medical laboratories quality control, and the evaluation of the use of telemedicine in rural areas (via satellite connections) in the context of multisectorial development. Finally, a strong emphasis is put on the development of capacities for the creation, maintenance, and publication of quality medical didactic contents. Specific courses are organized for the national coordinators of the network to develop these competencies, with the help of the Health-On-the-Net Foundation. The richness of the plurality of knowledge and know-how must be steered towards emulation and sharing, respectful of each partner's identity and culture. Collaborations with UNESCO and WHO have been initiated to address these challenges.

%B Int J Med Inform %V 76 %P 351-6 %8 2007 May-Jun %G eng %N 5-6 %R 10.1016/j.ijmedinf.2007.01.012