Mobile App Technology Improves Health Delivery in Rural Madagascar
Mobile App Technology Improves Health Delivery in Rural Madagascar
In Madagascar, accessing quality health care presents a significant challenge, especially in remote areas. Community health volunteers (CHVs), who play a vital role in the national health system, are working to change that—with the help of an exciting digital tool.
The Ministry of Public Health, with support from the Accessible Continuum of Care and Essential Services Sustained (ACCESS) Program, is dedicated to significantly enhancing health care services, particularly in remote regions. ACCESS is funded by the US Agency for International Development (USAID) and implemented by Management Sciences for Health (MSH) and its partners, one of which—Dimagi—has introduced innovative technology to digitize the health care sector that is already being used by CHVs and heads of health centers.
“USAID initiated the use of CommCare in Madagascar back in 2017, partnering with MSH and Dimagi. Positive outcomes led to its expansion and, presently, the application boasts more than 4,300 users and is the sole platform nationally recognized as an electronic community health information system, encompassing care, surveillance, and reporting. It seamlessly integrates data into the national health information management system.”—Stéphanie Ranaivo, Health Technologies Director, USAID ACCESS
The CommCare mobile application streamlines routine tasks for CHVs, guiding them through diagnosing and managing common childhood illnesses, offering family planning counseling, and facilitating continuity of care at health centers by making sure pregnant women and individuals suffering from severe illnesses are referred to appropriate providers.
“I regularly receive contraceptive services from the community health volunteer in my village. Since she started using her smartphone with the CommCare application, I’ve noticed an improvement in her services. She asks similar questions, but now she is able to provide more precise advice and her mobile device automatically displays our next appointment date. I can also tell that our CHV has gained a lot of confidence and trust from our community members.” —Josia, regular family planning user, Andrapengy Village in Andasilava, Antalaha District, SAVA Region
Many villages in Madagascar are physically situated kilometers away from the nearest health center, but CommCare has built a digital bridge over this divide. In addition to enabling health volunteers to input data in real time during consultations, the app also helps them complete and submit monthly reports, awareness calendars, and various other required documentation to their health center heads, saving hours of time trekking back and forth with cumbersome paper-based records.
“Using CommCare was challenging at first because I had never owned or used a smartphone before. Now that I’m accustomed to it, I’m delighted because it greatly helps with caring for children and reporting. It significantly improves my work quality because following the instructions keeps me from making errors as the application will promptly flag them. It also sends reminders for tasks like weekly reporting to avoid delays. CommCare has truly eased our workload!” —Raozimanana Evelyne, community health volunteer, Marofody Village in Ambinaninony, Brickaville District, Atsinanana Region
CommCare also empowers the heads of health centers to gather community health data and receive timely alerts for referrals. Having access to community health data helps them make important decisions about how to allocate resources and services to meet demand.
“CommCare has really helped us manage childhood illnesses in our area. If a child exhibits severe malaria symptoms, the application prompts me through administering a rapid diagnostic test, and if necessary, referring them directly to the health center after administering the appropriate referral treatment [as suggested by the app]. The head of health center receives an instant alert, and we can track the referral process through CommCare.” —Sonia, community health volunteer, Ambondrona Village in Dzamandzar, Nosy Be District, Diana Region
!["CommCare has really helped us manage childhood illnesses in our area. If a child exhibits severe malaria symptoms, the application prompts me through administering a rapid diagnostic test, and if necessary, referring them directly to the health center after administering the appropriate referral treatment [as suggested by the app]. The head of health center receives an instant alert, and we can track the referral process through CommCare." —Sonia, community health volunteer, Ambondrona Village in Dzamandzar, Nosy Be District, Diana Region.](https://msh.org/wp-content/uploads/2024/05/CommCare-CHV-Sonia.webp)
This community health data gives decision makers the ability to plan for the future. By identifying emerging or persistent health issues in their areas, the heads of health centers can devise preventive and curative action plans to keep their communities as healthy as possible.
“CommCare makes it easy to monitor all community activities. It helps us meticulously document patient information, making it easier to follow up with individuals. From this data, we can develop action plans that may include awareness campaigns, targeted vaccination drives, or regular screening programs. Additionally, tracking CHV activity reports linked to the health center in CommCare is just a few clicks away. We sincerely hope that CommCare’s usage will be widespread across all communities in Madagascar.” —Mandimby Tanjoniaina Nirintsoa, Head of Vohindava Health Center, Vohipeno District, Fitovinany Region
CommCare has enhanced access to high quality and timely data for community-based care and surveillance. By making real-time data more available for use, it allows decision makers to make more informed choices when addressing pressing health concerns. This has had a substantial impact on public health—not only at the district level but also beyond, reaching wider communities.
“Community health volunteers are able to deliver their activity reports to the health center promptly, and the services these individuals provide have notably improved, especially for children and women,” says Dr. Jocelin Razafindrakoto, District Medical Inspector in Brickaville , Atsinanana Region. “Furthermore, the availability of community health data allows us to coordinate better across different health care system levels. By sharing this data with district management teams, the heads of health centers contribute to informed decision making at all levels, fostering an integrated and comprehensive approach to public health. We hope to continue using this application even if there are changes in the technical and financial partners supporting us. We are committed to the maintenance and upkeep of equipment to sustain the enhancement in the quality of care for the most vulnerable populations.”
“Community health volunteers follow the application’s step-by-step instructions, which help them provide appropriate treatment. The services these individuals provide have notably improved, especially for children and women.” —Dr. Jocelin Razafindrakoto, District Medical Inspector, Brickaville District, Atsinanana Region
Originally crafted by Dimagi to enhance care quality and streamline access to vital community data, CommCare has swiftly adapted to meet evolving public health needs. Its flexible nature has enabled the integration of essential features catering to decision makers across all tiers. CommCare’s role in reshaping health care in Madagascar is undeniable, offering a gateway to a more innovative, inclusive, and efficient public health framework.
“CommCare was initially conceived to elevate care standards and streamline access to data for managing women and children under 5. Its versatility has allowed for content expansion, encompassing disease surveillance and early warning systems, including tracking COVID-19 and plague cases. Serving as a global benchmark for case management, it’s been feasible to include community health volunteers’ Monthly Activity Reports into the national health information management system, generating interactive dashboards for stakeholders to facilitate strategic and operational decision making.” —Fatou Sow, Project Manager, Dimagi
In the intricate health care landscape of Madagascar, the digitalization of priority sectors is in its early stages but is gaining traction. Dimagi’s CommCare mobile application has shown itself to be a tried-and-tested tool to bolster health care delivery at the grassroots level. Today, CommCare stands as an industry-leading digital platform, making notable strides in interoperability and effective health data management in Madagascar.
“Capacity-building workshops, server acquisition, and assistance for local hosting of the application and its data made government adoption possible.” —Stéphanie Ranaivo, USAID ACCESS
The introduction of the CommCare application in Madagascar marks a significant leap forward in the realm of community health care. Equipped with this innovative technology, community health volunteers and heads of health centers are now better poised to address the health care needs of vulnerable populations, even in the most remote regions. Following the successful deployment and scaling of the application, the Ministry of Public Health wholeheartedly embraced CommCare, laying the groundwork for a more inclusive, effective, resilient, and sustainable public health system in Madagascar.