DIGITAL HEALTH APP TRANSFORMING HEALTH CARE AT COMMUNITY

KANANGA Community Health Africa Foundation (KCHAF) developed a new model for deploying and managing CHWs that delivers dramatically better health outcomes at a significantly lower cost than alternatives. This game-changing model reimagines community health systems by blending the best practices and research from public health with effective performance management and incentives from the business sector, a powerful mobile platform, and an entrepreneurial earned revenue model reaching over 2 million people. 

As the global community prepares to renew and refine commitments to universal health coverage (UHC) and primary health care (PHC), we have the opportunity to recognize the importance of quality community health programs in realizing a PHC-driven UHC agenda. Decades of evidence indicate that community health programs can extend quality primary health care services to rural populations. Functioning and effective community health programs depend greatly on the performance of community health workers (CHWs), who play a key role in connecting rural communities to the formal health system and the full spectrum of PHC services. Over the past several decades, training, mobilizing and organizing CHWs in many countries and communities has greatly improved. However, as discussed in the Lancet, Editorial Section, May 2017, “community health workers are desperately needed globally” but “often still stand…at the fringes of the health system, undefined and unsupported and therefore unable to completely fulfill their potential.” 

At present, global funders and country MOHs are not prioritizing and including community health and CHWs in their plans and budgets, missing out on a key opportunity to ensure that low-cost health services reach the last mile. 

KCHAF uses Kazinga Community Health App. KCHAF recruits and manages local women and men as CHWs. They go to door-to-door in their own neighborhoods, providing free health education and diagnoses and selling life-saving medicines, contraceptives, and life-changing health products—such as fortified foods, solar lanterns, and clean water filters. CHWs host regular community health talks, leveraging connections with local community groups, schools, and places of worship, with support from local leaders and council members. CHWs focus their efforts on the areas where they can make the biggest difference at the lowest cost: providing pregnancy and newborn care; diagnosing and treating malaria, pneumonia, diarrhea; family planning; and promoting healthy nutrition. In addition to directly managing networks of CHWs, KCHAF is also leveraging its experience to help strengthen the community health networks of other implementers, including governments. We seek to bring the innovative elements of our model to our partners, and provide focused technical assistance and capacity building to them, especially in the areas of mhealth implementation, performance management, and incentive-based pay for CHWs. 

KCHAF using Kazinga Digital Health App has reached over 2,000 Community Health Workers reaching a population of 2,000,000 women and children.

• KCHAF has grown rapidly while maintaining impact. KCHAF has grown  five-fold in Uganda to support more than 2,000 CHWs serving more than two million people. And crucially, KCHAF proved we can consistently achieve key impact metrics while growing rapidly. 
• Reduced cost per capita to less than $2 per person reached annually.
• Earned the trust and support of key district, country, and national governments. We have secured MOUs at the national level and county/district level serve as their primary implementing partner managing government CHWs. We have also won permission from local regulators to expand the list of regulated medicines, diagnostics, and services CHWs can offer, thereby enabling permission for CHWs to offer antibiotics to treat pneumonia and rapid tests for malaria. 
• Expanded the model to a new country. KCHAF brought the CHW model to other areas, demonstrating the model’s transportability to new places. 
• Won recognition from government, Africa Center of Disease Control.

Our teams include Community Health Workers and Supervisors who on a daily serve communities at the last mile. 

CHWs have Kananga Digital Health App that supports them to record women and children. Using this App, they are able to get adequate community data that is submitted in the Ministry of Health records VHT 097b). 

We also have Quality Assurance Officers who support with ensuring data quality. This data from validation is submitted to MoH. we also support the Ministry with data visualisations and dashboards to enable them make informed decisions.

CHWs have perfomance matrices that they on a daily work towards. They are compensated based on attainment of these metrics.

We hold community dialogues every month where we get to hear from the people who we serve about the most pressing needs and also getting feedback on how we can empower them to continue doing a sustainable job.

KCHAF has proven to be the tool that is an enabler for CHWs.

We would like to grow our reach of this intervention to more areas where child death rates are high.

The Government of Uganda has asked us to scale our intervention to other sub counties of the island. Beyond Bukasa to Bumangi and Kalangala main land.

This financial support will help us procure phones and have the App on so that CHWs can offer the service. In addition we will be able to get CHW kits that have thermometer, weighing scale, fortified porridge. We will get essential medicines for treatment of malaria, rapid test for malaria, diarrhoea and pneumonia treatment for the first 2 months after which Govenment has committed to give CHWs these essential medicines so that they treat the community members.

These funds will help us create dashboards at community, facility and district level for decision makers to have real time data for decision making.

Kazinga Community App has proven to work offline yet once data access is possible syncing happens. In addition, CHWs have moved away from carrying heavy books to have all data in one place. Real time data given to leaders at district and country level has enabled planning. The use of dash boards has been a game changer in planning and budgetary processes at community, district and budgetary processes.

We are at a transformative time in our path as KCHAF. KCHAF will not only continue changing and shaping markets but also increased impact in the CHW programs in Africa.

Our goal is to ensure that high-impact community health is widely recognized as an important part of achieving UHC and strengthening health systems; and creating an enabling environment for the scale-up of high-impact community health delivery through supportive policy and dedicated funding on both the global and country level. 

In addition we seek to grow our work to enable us deepen our impact.

By 2023, we would like to grow our work beyond 1 district to atlas 2 other districts.

By 2025, we envisage entering a new country and using Kazinga Community Health App.

Child mortality: Before our intervention, child mortality in the area was 134/1000 compared to the national average of 54 per 1,000 but now with our intervention and other partners we have been able to decrease child mortality to 98/1000.

Antenatal care was at 14% for the 4 recommended visits. with our intervention and other partners, ANC has increased to 54%

This theory of change highlights what we envisage building on from where we are now.

We will continue to work with Ministry of Health (MoH), KANANGA Community Health Africa Foundation (KCHAF) and Kalangala District Local Government (Kalangala DLG) to influence community health policy, train government ToTs, manage supply chain for essential commodities, provide digital tools (Kazinga CH Digital App, provide CHWs incentives and provide supervision for the CHWs.

Through this 6 step process, we will have a policy or strategy approved, CHWs supervised, compensated, digital and with essential medicines. 

All these will ultimately lead to increased investment from donors and the government of uganda hence leading to a sustained community health program.

All these will lead to better health outcomes specifically reduced maternal mortality, reduced under 5 mortality and decreased child stunting.

Our Kazinga CH App is a tool built on open MRS. It has artificial intelligence to support with reminders, predictability algorithms for CHWs.

It can work on offline mode as CHWs in the field cannot access power and internet everywhere. The tool gives the option to sync data as and when the CHW accesses power and internet.

The tool can easily integrate with DHIS2 which is what Governments are using for their health information systems.

Community Health Workers collect the data using the Kazinga CH App. This data goes through the data quality team for cleaning before it is then submitted to government.

In the past CHWs used big books to collect the data. It was a lot of work and the books were heavy to carry.

With the smart phone having Kazinga CH App, CHWs and it easy to collect the data when using the phone in offline mode. When they get access to internet and power they are able to sync the data.

On a monthly basis, we review the data with the CHWs. The CHWs are able to see how we use the data to have dashboards that can tell the full story at the community level.

The CHWs then present this data to community leaders and make asks to them such as increased investment in maternal and child health programs.

What motivates them?

1. Them being apart of the process for collecting data and using it to tell the story for policy makers to make an informed decision makers.
2. CHWs are motivated by the presentations they make at community, district and national levels
3. CHWs are paid a stipend based on their key performance indicators.

These motivate them to collect the data because they know it will be used for a greater good.

DEI is a critical component of our work that we are still building out.

We use the tool; "who is at the table and who is not"

We are intentional in our work on DEI and hope with the MIT support we can even grow in this approach.

KCHAF was a small community based organisation on the islands in Kalangala. Over the years, we have developed a solid set of programs with a strong track record of results. We have kept heavily concretrated on the islands because of the huge need there and with the low service provision. 

We have learnt that our work makes impact and are ready to accelerate our growth. We are deeply inspired by our impact and want to reach more communities on the island.

we want to reach an extra 3,000,000 people by June 2023. 

we also want to scale our work to Burundi in 2023/2024. communities are our biggest customer.

We also believe that governments and partners will pay us to use our App so that we are generating income to sustain our work.

Our core customers are:-

1. Governments

2. Partners

3. CHWs

4. Communities

Our scale up plan is in 3 ways.

1. Scale through Governments

2. Scale through partners

Governments are already knocking on our door to support them with Kazinga CH App. 

we are looking forward to being a contractor with government and partners so that we can sustain our work.

We also are doing technical advisory services and advocacy to governments. We are pushing governments to invest more in CH.

through these ways our work will be sustainable. 

Through selling of porridge we have been able to get income to do our work.

But its not enough.

This is why we are applying for funding to give us a push into our next phase of growth.