Getting to scale with provider support tools

USAID Boresha Afya is a five-year (2016 – 2021) USAID funded program implemented in three geographical zones by Jphiego (Lake and Western), Deloitte Consulting Ltd. (Southern), and the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) (North and Central). The overall aim is to improve the quality and support of comprehensive services with bold, smart, targeted initiatives that concentrate on geographic regions with the highest need and potential to achieve wide coverage and improved outcomes. USAID Boresha Afya has created a dynamic, integrated platform for delivery of health services that emphasizes intensified coordination and collaboration between the government, health facilities and communities, towards achieving HIV epidemic control while integrating FP, TB, RMNCH, Malaria care, GBV and Nutrition through innovative integration approaches at all levels. To improve HIV diagnosis and treatment and achieve the country’s HIV treatment targets, USAID Boresha Afya developed a mobile-based referral and case management system linking community and facility-based providers. The program aims to strengthen existing systems by developing one tool for use across the continuum of care. The strategy focuses on strengthening the link between community and facility-based providers using Open Smart Registers Platform (OpenSRP). OpenSRP is an open-source software system designed for Ministries of Health to transition from paper registers to digital client/patient systems, to empower health providers to manage the health of their populations with decision-support and data monitoring in-line with WHO recommendations. OpenSRP modernizes the ubiquitous paper client registers and logbooks, enabling health workers to account for services and track the health of their patient population. The referral and case management system has been designed to improve the efficiency of health service delivery and data collection, facilitate the provision and exchange of patient information, and foster communications across health facilities and between community-based providers and their clients.

• Through 8 years of developing and implementing community-based family planning systems with four NGO partners, D-tree International has established the solution Family Planning Plus, a comprehensive digital system supporting community-based family planning service provision, based on the Balanced Counselling Strategy Plus (BCS+). This solution comprises of mobile applications for Community Health Workers and Supervisors, on-device reports and program dashboards. It proves to be flexible and impactful, as it has been modified for four different settings and shows sustained positive program outcomes. Specifically, in one intervention area in Shinyanga, Tanzania with partner Pathfinder International, there was 70% increase in contraceptive prevalence, 95% continuous use among clients and 15x increase in follow up visits across 4 years of performance since 2014. • What makes this solution particularly impactful across location and time, is the flexible configuration to fit the program context, as well as the systems approach to implementation, which considers motivation and supervision across program stakeholders, from the beneficiary to the health worker and program manager. • Regarding flexibility, D-tree worked closely with NGO partners and government entities to understand the context of the solution, and then configured the solution to meet the context. This included updates to the protocols for method distribution and referrals, workflows for at-risk first time mother populations, and training and monitoring strategies according to program staff capabilities. After flexible configuration and design, D-tree took a systems approach to implementation, considering different stakeholder motivations to ensure adoption of the solution through supervisory, motivational, and capacity building structures. • In this presentation, D-tree will share the evolution of the Family Planning Plus solution and the potential to sustain and scale digital programs through strong partnerships, configurations for the program context, and a systems approach to implementation and follow up.

Healthy Kids / Brighter Futures (HK/BF) is an organization based in Zambia training teachers to serve as frontline health workers in Zambian schools for their child and adolescent student populations. Having deep relationships with both the Zambian Ministry of Health and Ministry of Education, HK/BF has aligned stakeholders supporting their healthcare delivery model and their success in Zambia. In order to streamline both health worker training and data collection, HK/BF adopted THINKMD’s clinical assessment software and data analytics offering in 2019 and rolled it out to 200 of its teachers. In addition to clinical assessments and referral functionality, the software was also customized to support mass drug administrations for Vitamin A, Praziquantel (Schistosomiasis) and Albendazole (Helminths) and to report on suspected cases of high-risk diseases. The implementation of this digital clinical assessment and data analytics platform has significantly expanded clinical healthcare capacity and program monitoring and evaluation, has decreased reporting times by over half (from 1-3 months to 2-3 weeks) and increased the ability of program and government staff to visualize disease burdens within each school district through customized data visualizations generated specifically for this purpose. The partners believe that expanding this technology to include real-time population disease surveillance, predictive modeling algorithms, and an embedded automated alert system will dramatically improve the coordination between ministries, clinics, NGOs, and schools. Automating alerts from school health data will provide daily visual summaries of the temporal change in disease burden from which automatic alerts for infectious and high-risk disease sets can be generated. The partners are confident that this innovative school-based healthcare delivery model combined with advanced clinical software and data analytics capabilities will enable faster and more efficient scaling of the healthcare impact already being achieved.