Zahanati

Millions of people living in remote rural communities across Tanzania lack physical access to primary health care because they live out of reach of the nearest clinic. The most remote communities in Tanzania are where mortality is highest, access to health care is the most limited, quality of care is the worst, and progress takes the longest to reach. These communities are called missed communities. This is because they face multiple deprivations and vulnerabilities, including poor or non-existent roads, telecommunications, electricity, and other basic infrastructure introducing several challenges in delivering health services, socio-economic inequities, and often cultural-related barriers to access health services.

The longer distances between patients and the point-of-service increase the time from onset of a patient’s symptoms to diagnosis and treatment, there is a disproportionate lack of skilled health care providers in remote, isolated districts, and there are low investments in public health systems.

The last-mile remote rural communities are rarely consulted about the decisions on the performance of primary healthcare that affect their lives, particularly in hard-to-reach places. Where information is collected from them, the process is extractive, with very little feedback on how this data is used;

Making data-driven decisions for performance in primary healthcare facilities in remote rural communities is challenging when the data is incomplete and unreported. The traditional data collection approach is expensive and unsustainable – especially on a national scale, suffers from limited coverage, and the information collection protocol is too narrow. This causes challenges to obtain accurate, real-time performance measurement data in remote rural communities/Missed communities.  

This is a problem since primary healthcare data are essential in the lives of remote rural communities: Think about a pregnant mother who delivers at home under traditional midwives, the process of identification of unvaccinated children (zero-dose children), identification of high-risk and under-served populations, identification of vulnerable areas, identification of neglected disease and high-risk nomadic populations in health databases, identification of behavioral insights of health workers and primary healthcare users feedback in need of a specific health service in remote rural communities/missed communities, patients seeking care through rural traditional healers, mothers of children who miss out on basic vaccines due to long traveling distance, physical access to emergency health services in remote rural areas. These important data remained unreported by the current mainstream data collection systems and hence they are unable to play their role in evidence-based planning, performance, and decision-making in primary healthcare.

Moreover, Health misinformation and disinformation data which are unverified information in form of claims, statements, and discussions centering on primary health care activities in remote rural communities/Missed communities are usually dismissed, underrated, and go unreported even though will affect the overall performance of health-related activities.

The rumors cause the community anxiety, fear of community, mistrust, and lack of confidence pose a challenge to primary health care performance in remote rural communities/Missed communities. The World Health Organization (WHO) also recognized misinformation and disinformation as a new threat to disease surveillance, outbreak investigation, and prevention, and highlighted rumor control as one of the key facts to epidemics management. In Tanzania, there are reports of people not participating in primary health programs such as vaccination campaigns due to rumors, such as the vaccine contains infertility agents, or spreads the human immunodeficiency virus. For example in the Democratic Republic of Congo and Guinea, rumors that health workers were deliberately spreading the Ebola virus resulted in violence, civil unrest, and targeted attacks on healthcare facilities. Several healthcare workers were killed due to this type of misleading information and community mistrust towards outbreak response teams.  Currently, in Tanzania, there is no surveillance platform that detects, assesses, and responds to rumors which are critical for all primary health care services performance.

Zahanati ('Dispensary' in Swahili) is a mobile phone-based primary healthcare-centered platform that gathers or crowdsourced unreported community health data, reports primary healthcare Quality irregularities, and provides feedback for primary healthcare facilities' performance improvement.  Our platform works as follows:

• The Last mile remote rural communities can submit unreported community health data, Quality irregularities of primary healthcare facilities via feature mobile phones Unstructured Supplementary Service Data- (USSD) and calls for feature phone users which are then pinpointed on the government information system platform. We inform last mile remote rural communities about the need for proper primary healthcare performance and empower them to request services from the government
• The Last mile remote rural communities also can submit unreported community health data, Quality irregularities of primary healthcare facilities through the community primary healthcare monitors act as the go-between linking communities and primary healthcare service providers. They receive unreported community health data, and Qualityirregularities of primary healthcare facilities from community members, and lodge them on the zahanati platform. They receive unreported health data and lodge them on behalf of those people who do not know how to read or write or do not have a phone. This they do through their own phones or through open data Kit platforms. The community primary healthcare monitor's role is critical to ensuring that communities understand their primary healthcare performance– including the right to file unreported health data, and irregularities and are informed of primary healthcare facilities' performance in their locality. Community primary healthcare monitors mobilize community members to participate in the monitoring of primary healthcare facilities and produce community auditing reports.
• Our team verifies whether, given unreported community health data, Quality irregularities of primary healthcare data are true via local government authorities, primary health supervisors, and community leaders. Once accepted, the complaint enters the resolution stage, wherein the respondent will address it and provide feedback for improvement. Our platform enables citizens to understand primary health care performance and share their feedback on quality improvement and policy decisions in local languages while providing an avenue for the government to understand citizens’ priorities and gather feedback on the action in real-time. Our team then collaboratively combines the unreported community feedback and Quality irregularities of primary healthcare with available government data sets to improve primary healthcare performance. Both these data will be integrated with information that describes the performance and to monitor coverage that is affected by certain health challenges with appropriate messaging delivered through channels similar to the last mile remote rural areas reporting mechanism.

Accessing unreported community health data, and Quality irregularities of primary healthcare data put primary healthcare facilities in a stronger position to improve their performance and make data-driven decisions at speed.  Our platform has three parts:

• Data collection tool for unreported community health data and Quality irregularities of primary healthcare: We allow the last-mile remote rural community users to unreported community health data and Qualityirregularities of primary healthcare. We will track their coverage both geographically and its effect on primary health care performance while government medical supervisors verify whether a given report is true via WhatsApp, calls, SMS, or mobile app or trained volunteer community ambassadors, local government partners, community leaders, and other NGOs.
• Primary healthcare organizational learning tool: This tool will enable primary healthcare facilities to draw on their experiences, improve their performance, and enhance their overall impact. Through unreported community health data and Quality  irregularities in primary healthcare data means primary healthcare facilities can generate new insights and augment their reporting by conducting more efficient practical performance.
• Using Behavioral Insights to Improve the performance of primary healthcare: After we integrate unreported health data with the government existing systems, we will use a benchmarking approach to guide primary healthcare workers in order to improve their performance and encourage behavioral changes. We will use a benchmarking technique that shows individuals that their peers behave in the desired way.

Our goal is to aggregate the unreported health data at the primary healthcare facilities to see the patterns of performance and to determine where their services should be concentrated.

• Last mile remote rural communities: We increase community participation for sharing unreported community health data and Qualityirregularities of primary healthcare, access and use for measuring the performance of primary healthcare. We create demand of unreported qualitative health data by fostering recognition of its potential to transform the performance of primary healthcare facilities.
• Local government: We will enable local governments to improve the performance of primary healthcare facilities and efficient integrating new data set to improve their planning.
• Patients: Our platform will improve the ability of Last mile remote rural communities to access to health services. More people will be able to access information, allowing them to make informed decisions about where to seek medical care, including locating nearby facilities
• Primary healthcare workers: Changes in data strategy are expected to result in better data-driven decisions and resource allocation. By improving data awareness, building staff data skills and increasing the amount of relevant data collected, we will improve not only the quantity but also the quality of the data that are used to inform their facilities. An improved data use strategy will also be a powerful tool for advocacy among both traditional and new partners. Example the expansion of outreach campaigns in Last mile remote rural communities.

We are a passionate and driven team that devotes its time to the collection of unreported community health data and Quality irregularities of primary healthcare in the last-mile low-income remote rural communities. Our team is composed of experts in Health Quality assurance, Data collection volunteers, Data analysts, Field managers, Government liaisons, and Facilities Performance Advisors.

We have the practices and experience to generate insights needed to solve the primary healthcare challenges in last-mile remote rural communities.  Marginalized last mile remote rural communities have been excluded from the mainstream health data. 

Our teams meet with district officials to inform them of the importance of performance in primary healthcare facilities and this acts as a way to inform people of our work and opportunities to serve their communities. Our strength as an organization lies in our ability to listen to and from the communities we serve, and have these people lead the change themselves. We have a great understanding of the communities we serve and it would be wrong not to utilize their knowledge

We are an early-stage organization. We will benefit from utilizing the MIT Solve network of professionals and peer organizations to enable us to learn, potentially collaborate and create change in the performance of primary healthcare sectors. We request assistance in those skills that will support us in the whole process of data collection to the performance improvement outcomes in primary health. This helps the health facilities to make fully informed decisions.  We would like to gain support from the Solve network to liaise with other organizations and with potential like-minded unconventional data collection methods and performance improvement in primary healthcare facilities. 

Our solution has major things that set us apart from our competitors. The first is our focus on last-mile remote rural communities. Our platform is tailored to the realities of last-mile remote rural communities that are excluded from mainstream data collection services.  We’ve chosen last-mile remote rural communities (missed communities) because face a triple bias. (1) The public sector, which favors areas that are easier to reach to maximize limited resources, is unable to prioritize these remote populations. (2) The private sector, which favors areas with high concentrations of customers, doesn’t see market potential. (3) The social sector, which favors reaching more people in fewer areas at less cost, deems it too expensive to serve them. By focusing on remote rural communities, we’ve set ourselves up to grow alongside those communities. 

The second is the quality of our data. Unlike other organizations, we ensure our data is high quality, complete, and reliable. This starts with market research, then moves into data production, and then, ongoing data maintenance. It's the ground truth and means that projects and initiatives that emerge as a result of it are much more likely to succeed.  

Finally, technologies fail in the Global South because they were built in the Global North under very different conditions; they don’t consider limitations of connectivity/digital literacy. Our systems of data collection are designed iteratively, around the needs of grassroots organizations.

The following impact goals for ourselves are all part of our mission and vision:

Goals for the next 12 months

• Piloting, user testing, and product-market fit:  We will onboard 500 primary healthcare facilities, to strengthen their efforts to use the data for improving their performance. We will launch a better version of the platform and train Volunteers and the community to collect the data.
• User acquisition/growth: Our user acquisition strategy is mainly through the network of primary healthcare facilities. The primary healthcare facilities are the point of contact in the communities they are integrated into.
• Over the next year, our big goal is to refine our model and internal processes. We want to ensure that our internal processes and model are able to scale and utilize technology in an efficient way that ensures the data collection process improves the performance of primary health care services. 

Goals in the next 5 years

• We have scaling plans and goals: To accomplish this we are building our team and expanding partnerships including strategic partnerships with primary healthcare facilities, government, and civil society organizations. We believe the sustainable impact is best achieved through partnerships and have as a result embed our platform into government institutions and processes.
• Support systems change activities: We will increase attention to data to action through improving the performance of primary healthcare services including working with governments to develop policies, sharing expertise to support innovation, and collaborating with researchers, policymakers, and implementers.
• User acquisition/growth: Our user acquisition strategy will expand to village and community leadership through different public and private organizations. The community health agents, health centers, and traditional leaders are the point of contact in the communities.

We will measure our progress through qualitative and quantitative methods which will include feedback from beneficiaries before, during, and after the implementation. Our key performance indicator include:

•  Increased utilization of services – Our mechanisms build clients’ trust in the healthcare system making them more likely to use the services which are available to them
• Facility quality and performance improvement –Our data can be used by healthcare workers in facilities to identify high-priority issues for improvement and necessary action plans
• Local government supervisions – unreported health data can be used by local government healthcare officials within their facility supervision processes to help them identify, prioritize and monitor challenges
• Budgeting and resourcing – unreported health data can be used to improve resource allocation and monitoring allowing for more effective quarterly budgeting and resource planning

We believe impact can be driven through a number of channels, at a low cost, and by integrating into existing decision-making processes.

If we present enough unreported community health data and Quality irregularities of primary healthcare, in customized and understandable formats to community-facing primary healthcare workers, the local and national government health officials, policymakers, and civil society partners, we can incentivize and advocate for concrete primary healthcare improvements, monitor the performance and quality of primary healthcare facilities over time.

We use the Unstructured Supplementary Service Data (USSD) code: The Last mile remote rural communities or their community primary healthcare monitors will be able to report the unreported health data by querying “Zahanati” through an Unstructured Supplementary Service Data (USSD) code. Sending a USSD request is as simple as making a phone call or sending a text message. The user dials the USSD code (e.g., *140*150#) and a series of prompts guide him/her through a menu to retrieve the desired information. To eliminate the language barrier, the Our interface and database contents will be available in both English and Swahili, and the simplicity of the menu will allow even those with low literacy to access the system. We are now piloting where the system will be ready for launch as the team acquires a USSD code from the Tanzania Communications Regulatory Authority (TCRA).

We now develop the MVP Dashboard that shows real-time feedback that is gathered at primary healthcare facilities. After iterations and improvements, the dashboard will compare the satisfaction rates at different primary healthcare facilities, over time, and also automatically detect fraudulent feedback points. 

Our data about the primary healthcare performance will be collected in two pathways:

1. Through Community themselves: The Last mile remote rural communities can submit unreported community health data, Qualityirregularities of primary healthcare facilities via feature mobile phones Unstructured Supplementary Service Data- (USSD) and calls for feature phone users which is then pinpointed on government information system platform. We inform last mile remote rural communities about the need for proper primary healthcare performance and empower them to request services from the government
2. Through community primary healthcare monitors: The Last mile remote rural communities also can submit unreported community health data, Quality irregularities of primary healthcare facilities through the community primary healthcare monitors act as the go-between linking communities and primary healthcare service providers. They receive unreported community health data, and Quality irregularities of primary healthcare facilities from community members, and lodge them on the Zahanati platform. They receive unreported health data and lodge them on behalf of those people who do not know how to read or write or do not have a phone. This they do through their own phones or through open data Kit platforms. The community primary healthcare monitor's role is critical to ensuring that communities understand their primary healthcare performance– including the right to file unreported health data, and Quality irregularities and are informed of primary healthcare facilities' performance in their locality. Community primary healthcare monitors mobilize community members to participate in the monitoring of primary healthcare facilities and produce community auditing reports.

We believe that every activity should be focused on ensuring the collection of quality data. This begins with the preparation of well-thought-out, effective and implementable plans. 

Diversity and inclusion have been always our focus. We aim at creating a diverse environment where people can flourish knowing that diversity of thought is key to creating a successful business. A number of interventions have aimed to address a perceived imbalance in the representation of some groups.

We are dedicated to creating a diverse environment and are proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. We have also in place a periodic review to explore the state of diversity inside the company. This is carried out by our 'diversity committee' which systematically looks at specific trends and how these have changed over time, to highlight any bias and take the appropriate actions.

We collect critical unreported community health information solving daily health services problems for the community and closing the loop on challenges related to primary health services. It consists of the community themselves or primary healthcare monitors who act as two-way unreported community health data collection and dissemination units. We survey the primary healthcare facilities and communities to identify critical problem areas and relay this information to local and national "decision makers "; We ensure that validated information about these critical issues is fed back to communities through mobile phones, community meetings, and other media, especially in local languages.

This process is used to ensure that everyone understands how and when the quality and improved performance will take place, to build accountability into local decision-making in real-time, and to close the feedback loop between primary healthcare facilities, communities, and governments. Our goal is to keep growing. To expand into other communities that need us most. To bring our solution into these communities so they can have access to quality services.

We are currently an organization that exists entirely on donations. From grants to the generosity of individual donors, the kindness of friends has kept us moving forward. 

Our plan for financial sustainability includes expanding our grant pipeline, building our revenue-generating activities, ensuring field operations are covered by earned revenue, and decreasing the cost of data collection so that we can scale while still providing quality services to Primary healthcare facilities. 

Build evidence and Increased donations

As we increasingly generate rigorous evidence of the efficacy of our approach, we will be able to attract investment from larger funders and we will secure larger-scale implementation opportunities. As our offer grows, and we demonstrate the value our tools deliver, we convert our pilot projects into rolling government contracts making our approach fully sustainable.

Building partnerships

Developing our tools in close collaboration with Ministries of Health and established NGO partners will help us ensure that we keep building tools that there is a strong demand market for and quickly achieve product user fit. By supporting partners in parallel, we ensure that our income streams are adequately diversified while expanding our impact and creating cross-subsidies between programs that enable us to provide our tools more affordably than they could be built by anyone partner. 

Business Plan

Finally, we are building a business plan that incorporates both the nonprofit and for-profit sides, to facilitate growth and sustainability. We are excited about the future and more importantly, we believe our solution will improve the performance of primary healthcare in rural areas.