Individual monitor of COVID-19 symptoms

Jembi aims to help control the pandemic in Mozambique by developing a mobile app that allows the user to track the symptoms through a simplified automated self-monitoring process. The solution could help save lives by informing governments in real time where the potential COVID-19 hotspots are for massive testing, surveillance and epidemic control based on the symptoms reported by individuals at the community level. In African countries and the rest of the developing world, the fastest vehicle of COVID-19 spread will be community level infections, which could have devastating effects to the social and economic development of these countries. These communities have underfunded, poorly equipped and understaffed hospitals. Therefore, this could lead to millions of deaths in the African continent in a short period of time. 

Jembi is solving the current problem absence of data from poor communities that are highly vulnerable to the effects of COVID-19. In addition, Jembi is equipping the Ministry of Health with the necessary tools to bridge this data gap at the central, provincial, district and community levels. The absence of credible data limits the interventions of the government of Mozambique in taking evidence-based decisions and enacting laws that are based on credible and vetted information. The solution will impact 1,309,517 people who routinely access the web via mobile phone in urban centers, communities in the outskirts of the main towns and some rural areas. In 3 months, Mozambique has only been able to test 20,000 people in the country with more data accessed in real time, the country will have reliable information and evidence on the priority communities to test. 

Considering that the pandemic is a matter that requires quick action, Jembi proposes a technical solution that can be executed and implemented in 33 days.  The source of the data would be a mobile app (Android or iOS), that is within the reach of the end users. There would be a web based application that would regularly connect and sync data from these mobile apps. The web based application would be developed using open source technologies known and supported by the MOH such as DHIS2 with a specific metadata for COVID-19, which gives the possibility to keep track of the clinical history of the patient and at a later stage to produce statistics for data analysis for health authorities to take evidence-base action. This would bridge the data availability gap, which is one of the critical problems in the Mozambican health system that needs to be addressed swiftly using fast to develop and implement solutions. 

The aim of the solution is to impact the lives of the most at risk communities and lessen the effects of COVID-19 in Mozambique. This solution specifically targets people who have access to android applications iOS applications, which are about 1,309,517 according the national Institute of Statistics. This population ca be found in urban centers, outskirts of the main towns and rural areas.  Being able to report all their symptoms into the mobile in real-time will allow the target group to have privileged access to testing and treatment if need be. It will also allow the other target group, which is health authorities, to identify the areas that are more prone to a rapid spread of COVID-19 and take the necessary action in a timely manner. We have had meetings with the Health Information Department of the Ministry of Health who have expressed the need to have visualize potential hotspots of COVID-19 at the community level. Our developer responsible for this project works for us at the Mozambican Ministry of Health and worked with the Ministry to understand this problem to be able to draft the current proposal for funding. 

This solution will help the Ministry of Health authorities detect and respond early to possible cases of COVID-19 in areas where the pandemic could develop at a rapid rate. This tech innovation will provide health authorities data for evidence-based decision making and allow the common population to report their symptoms for a faster response in their communities.

This solution appropriate for the Ministry of Health of Mozambique because it has very few mobile health technologies that allow for case tracking and surveillance at community level. The MOH lacks such technologies and has expressed to us the need to develop and implement a mobile app that will close this gap at the community level. The main stakeholder in Mozambique developing community level apps for the Ministry of Health is Dimagi which is one of our partners in the development mHealth systems. 

The Ministry of Health does not have mobile apps for COVID-19 that offer real time information on a dashboard for health authorities to take decisions. They have a web app that does so for monitoring and evaluation purposes called SIS-MA, which was developed by our team in collaboration with the private sector. This technology reuses open source systems (OpenMRS and DHIS2)  that we have implemented with the MOH in the past and are well known in the Mozambican health informatics ecosystem. This solution is innovative for Mozambique because there are no free MOH apps in the google play store or apple store for download by the common population to track COVID-19 symptoms and provide filtered information to the MOH. 

The Open source systems that will be configured for the proposed solution are OpenMRS and DHIS2. These systems have been implemented in Mozambique, Kenya, Haiti, Nigeria, South Africa, Uganda and other Low Middle Income countries with similar socioeconomic backgrounds. Jembi has used these technologies for other systems implemented nationwide that respond to other needs of the national health system. Jembi has implemented DHIS2 in 161 districts of Mozambique and is currently supporting the use of the system by hospital, district and provincial level health tehnicians. Jembi is a lead member of both OpenMRS and DHIS2 communities and has organized international conference to bring together these communities to improve their technologies.  These systems will be customized to support COVID-19 efforts and marketed to all smartphone users to help them report their symptoms and help the MOH detect and respond to cases in a timely fashion. 

The Ministry of Health of Mozambique is currently facing an urgent problem, which is its ability to be able to locate potential risk areas for COVID-19 transmission and spread. The individual monitor of symptoms will allow the MOH to close this information gap and improve targeted testing and timely health care delivery for those most in need, particularly in low income communities which tend to suffer and die the most from epidemics such as malaria, cholera and TB. The immediate outputs of this project will be: 1) the mobile app for the general population to use and declare their symptoms and; 2) the web app for the MOH to view the information that will allow to identify the areas showing COVID-19 symptoms spread at a higher rate than others to augment testing efforts. The long term outcomes are: 

1. Increased awareness on COVID-19 Symptoms 
2. Reduced stigmatization of persons showing COVID-19 symptoms 
3. Increased COVID-19 testing based on evidence 
4. Improved health care services for COVID-19 patients 

The project aims to affect over 1,000,000 users of the mobile app in the first year. The Ministry of Health has effective mechanisms of communicating amd raising awareness on the existence of new solutions for the well-being of the population. The MOH has free access to national TV channels, radios and newspapers when it comes to informing the population on epidemics in different national languages. The COVID-19 awareness campaign has spread nationwide in 2 months making about 40% (over 10 million people) of the entire population wear masks within the above mentioned period. In this sense, the Ministry can promote the use of the app in a similar period and start affecting the lives of the users the first 3-6 months of implementation of the solution. 

The development and expansion of both solutions to the entire target group will take about 6 months. The subsequent years will be under the responsibility of the Ministry of Health which will be implementing the technology and monitoring COVID-19 risk areas to provide better health care services. 

The main constraint at the moment for the proposed solution is financial and time. These are instruments that need to be developed and implemented quickly as the spread of the pandemic progresses. The COVID-19 pandemic is an emergency and millions of lives can be saved if the necessary measures are taken in a timely manner, therefore the earlier the proposed solution is approved and funded, the better for the Mozambican population and the national health system, which may collapse very soon due to the pandemic. 

The above-mentioned barriers may only be solved with an early approval of the project. 

Project Manager: 7 days 

Business Analyst: 15 days 

Senior Developer: 20 days 

UI/UX designer: 7 days 

Implementer: 3 days 

Solutions Architect: 7 days 

There are several initiatives being presented to the Ministry of Health (MOH) of Mozambique, but many have not been approved to financial implications that may present a burden to the government. However, Jembi has been working with the MOH through the Department of Information systems for over 10 years and has implemented nationally over 20 health information systems projects and trained 2,666 health professionals to use them according to national and international standards, and is thus positioned strategically to provide technological support in the context of the COVID-19. Jembi coordinators and technicians have been invited to join several committees created at the MOH to address the pandemic, including the technology and the communications committees. 

In Mozambique, Jembi partners with PEPFAR/CDC for several health information systems and strategic information project related to HIV prevention, some of these projects include: national mortality registration system, national monitoring and evaluation, electronic patient tracking system, point of care system, civil registration and vital statistics which have all contributed largely to national health statistics and provided information for decision-making and policy-making by health authorities. As of June of 2020, Jembi has trained 2,666 health technicians of the national health system to ensure sustainability and ownership over the above-mentioned systems by the Ministry 

In addition to the Ministry of Health, Jembi has also collaborated with the public sector, including the Ministry Justice, Constitutional and Religious Affairs on reforming the national civil registration and vital statistics system, the Ministry of Gender, Children and Social Affairs on the development and implementation national M&E evaluation for this sector. 

Jembi has also partnered locally with AIHA Twinning Center to expand the specialized computer (SIS-Compact Station) we developed for the national health system and is currently implemented in over 250 sites in Mozambique. 

Jembi partners with PEPFAR clinical partners such as EGPAF, Ariel Foundation, Jhpiego and CCS providing tech solutions to be used by these partners at health facility level. 

We provide technical assistance to our clients with funding from donor organizations who provide us with grants, contracts, consultancies and cooperative agreements. We are a non-profit, therefore we do not make any profit from our interventions. We are an honest broker between donor organizations and public sector institutions for the development and implementation of information systems. We bring value to public institutions such as the Ministry of Health of Mozambique by equipping them with the tools, knowledge and savoir-faire to conduct their activities related to strategic information for decision-making. 

Our financial sustainability is guaranteed through long term and financially sizeable cooperative agreements, grants and contracts with donor organizations. We manage between $2 million-$10 million dollars per year for our several projects with the European Union, United States Government, Italian Agency for International Development and other donors who need local organizations to implement projects in our areas of intervention.