GROUND-ZERO

We seek to address the challenge of Health status reporting using diarrhea & fevers as primary indicators of a myriad of diseases, occurring in low-income and rural settings that go unchecked and reak havoc.

A major concern for Kenya’s Ministry of Health and Sanitation is the management of diarrhea, the 3rd most
common cause of mortality/morbidity in-country; with a case fatality of up to 21%. The ministry conducted a
survey in Nov-2006 through the Division of Child & Adolescent Health which revealed gaps in diarrhea
disease management, where only 55% of the children with diarrhea were correctly assessed.

In view of the scale of the problem within the Kenyan setting, the national survey by the Kenyan Ministry of Public Health and Sanitation revealed that diarrhea is the fourth most common illness seen in health facilities in Kenya and accounts for one in five of all hospital admissions. It is the overall fourth most common cause of death among children under five years of age in Kenya with a case fatality of up to 21%.

Globally, the World Health Organization (WHO) estimates that 1.87 million people die every year due to diarrhea-causing diseases (including cholera). 90% are children under 5 years and most of these deaths are in developing
countries.

Our choice of tracking Diarrhoea/Fevers is because it's associated with not only viral and bacterial infections but also with the rising burden of neglected tropical diseases such as adverse jiggers infestations, schistosomiasis, & other helminthic infections, which need to be integrated into regular health systems in order to scale up interventions for control/eradication. Previous studies have tried to establish rapid approaches for self-reporting of diseases by answering questionnaires which in all truth can be costly, time-consuming, and is often not real-time, with correct answers often misinterpreted.

Under-reporting of diarrheal/fever events in homes, to Front line Workers & local clinics alike, poses a niche hold for our innovation to create a stop-gap tool that provides reliable mitigation & feedback platform through a rapid treatment/Dynamic-reporting response algorithm; while measuring the improvement of primary health care performance at the grassroots level.

REFERENCES:

- Management of diarrheal diseases among children under five years: International journal of Community Medicine and Public Health Njeru PM et al. Int J Community Med Public Health. 2017 Aug;4(8):2762-2766http://www.ijcmph.com

- Health sector strategic and investment plan (khssp)july 2013-june 2017

- Kenya-strategy-for-community-health-2014

- IMCI Health Facility Survey, Division of Child and Adolescent Health, Ministry of Public Health andSanitation, Kenya, 2006.

- WHO, Water sanitation and hygiene links to health, water sanitation and health journal 2008.

- Policy Guidelines on Control and Management of Diarrhea Diseases

- UNICEF/WHO, Diarrhea: Why children are still dying and what can be done , 2009, p.31

Ground-Zero as an innovation implements a mobile phone platform system that gathers daily diarrhea/fever occurrence information at the household level& relays it to Front line workers (who in our case are community health workers - CHW), for intervention.

“Cohesion©”, is the brand name of our homegrown mobile phone application that runs on any simple Android-based Smartphone & integrates seamlessly with a portable biometric scanner provided by our working partners Simprints™. Utilizing the two tools, we are able to collect and collate, at the household-level, real-time health status using the following initial metrics:

•  Daily loose stool events (W.H.O guided algorithm calculates loose stool events to flag diarrhea cases)
• Fever checks (Verified by Community health workers)
• Anomalous Health-related events  / For instance malaria occurrences in a homestead

The system works using the Kenya Essential Package of Health (KEPH) stratification policy, with a particular interest in Pregnant women/infants & children under 5.

COHESION uses minimal data transmission meaning it can work at the lowest form of mobile internet speeds like edge and has full offline functionality for moments or days of internet downtime.

Its architecture and usage incorporate inclusive human-centered design derived from our continual consultative workaround which involves having our primary users frequently present challenge roundtables to help us better understand what works and what needs change or additions that are practical and allow prompt rollout updates.

We are unique in being able to roll out a biometric-based platform of this kind allowing precision identification of beneficiaries/users which means our error margins are pretty low in identification and recall of patient/follow-up record entries..... We have also worked on an API that we hope allows us to run trials into district/clinic level data entry points for cross-platform integration with the national health system effectively giving us leverage to influence household-level primary health care provision  / Front line worker effective activation.

Both Healthcare givers (Community clinic / Community Health workers) & participating Homesteads are the primary interactive users. Using COHESION - Homes report on a daily basis, while each field-based community health worker receives collated reporting from roughly 20-30 homesteads (50-150 people). The reports activate a health worker by prioritizing which homes to visit on a daily basis based on need and urgency, with flagged diarrhea cases being attended to by having Oral Rehydration Solutions (ORS) delivered to the afflicted homes by front-line workers and provided by the local clinic. Non-responsive cases picked by the platform are Forwarded upstream to the local reference clinic as referrals.

Currently in Kenya Community Units (C.U) have been formed as the primary entry point for healthcare provision. C.U’s face the challenge of accessing household-level information for efficient and effective targeting
of interventions or performance reviews/enhancements. There is a perceived burden of data collation. Our innovation will address this gap effectively.

The population whose lives we are working to directly and meaningfully improve are from the Village of Usoma (Kisumu County, Kenya) and Keveye Village (Vihiga County, Kenya) 

Usoma people dwell by the shoreline of lake Victoria and are hard hit by water-borne diseases as are Keveye village dwellers whose rivers can pose dents into their health outcomes due to the same predicament of water-borne disease challenges 

They are currently underserved in terms of their health service provision towards the burden of every potential water-borne disease outbreak.

COHESION as a health intervention and services provision App will upscale progress against diarrhea/malaria/fever, with diarrhea being the third-leading cause of death of children under five years, especially for the poor/marginalized. The tool becomes a powerful tool in the hands of a community health worker to execute interventions at the household level as an extension of community units.

These household levels are the lowest entry point possible and would be vital for intervention for the poor and marginalized households.

With poor infrastructure, many of the people who desperately need health services do not reach health facilities,from where regular surveillance and monitoring data is obtained. This leaves them out of the surveillance, and consequently, policies formulated may not be sensitive to their needs. One of the greatest challenges is therefore ensuring that available health interventions are sensitive to these “unreachable” populations, who most need them. Many simple, affordable, and effective disease control measures have had only a limited impact on the burden of disease due to their inadequate distribution in poor and remote communities, creating an urgent need for more effective strategies to improve access. The idea of health care systems in which the community itself participates has gained a global momentum, but there is a real need for effective and integrated delivery strategies for community-based interventions

Community Health Support has had the privilege of being in the front lines of WASH programs, and community-directed interventions in many of our programs. Our familiarity with communities endear themselves to is ever so present. We are poised to engage this community in a very enabling manner and can ensure a great impact on their long-term life by bringing this innovation to life and making it sustainable.

We equally have great partnerships relevant to our bringing in such an innovation:

- WASH programs with United Nations University / University of Waterloo
- Queen's outreach program for various behavioral change programs
- TOMS / USA for jiggers and shoe-giving program
- SIMPRINTS (Cambriddge) , Bio-metrics partnership, and ongoing programs among others

One seeming challenge would be the extent to which total reporting by household members can be verified & the possibility of unreported cases. Some of this verification may be obtained from Community Health Workers, but there are bound to be cases that will not be reported.

The reporting period will be short & therefore larger conclusions will be difficult to infer. Chance Slow uptake by the community due to resistance to technology and its nuances or fear of it could also pose a challenge.  Financial leverage for social capital and training within the community will potentially help us open a flood gate for uptake by homes, frontline workers, and clinics alike

Our innovation will allow Real-time real-world observation of select groups such as pregnant women/infants and children under-five and their predisposition to diarrhea.

This would also be realized through live geographic occurrences that can be visualized, quantified, and shared with local health facilities and Community health workers for immediate intervention.

Kenya's advent into mobile phone technology has been quite the leap and as such every household has likely access to a phone and knows how to use one. Our provision of a smartphone & necessary application will be a plus allowing us to train households further & empowering them. 

We would also significantly reduce cases of self-medication & the misuse of antibiotics that has led to higher cases of drug resistance. This rapid form of household-level intervention and feedback will be life-saving for infants
and children under 5 years who depend greatly on their overburdened mothers as witnessed in LMICs

This concept empowers and allows a community health worker; and by extension, the Community Unit to have the ability to effect behavioral change, conduct good practice in their health engagement with
households, deliver new mandates as is required by their work plans, issue early warnings based on data collected, greatly eases their workload and access to information and more accurate reporting to the health clinics. It allows precisely targeted intervention

The most viable move to up- Scale the platform would be to integrate with local clinics. Providing clinics with the digital capacity to have real-time data from the Frontline worker which can guide them on reconciling referrals from

the household level. 

We would also work towards having bio-metrics and ultra-mobile computing to allow Accurate identification of households that use the Community unit clinic. with a follow-up Blockchain verification for service delivery and mobile money service payment and FLW remuneration model.

The next step would be to integrate the National District Health Information System (DHIS) through the clinic. We would trade our custom API to have service providers integrate with our platform to make it workable and versatile

During the 24 months of the implementation, we anticipate that 24% of the compounds will have improved sanitation and water provision services measurable at the onset of the scaling program.

Measurables include:

Weekly Diarrhea events/fever Counts / Malari testing  / User interaction / Downstream Clinical Notices and advice / Amber alert for clinic guidance to mobilize FLW users for emergency community events / Full circle Referrals / Stockouts of urgent home-based dispensable medication like ORS

Preventive Messaging to homes will also be included like use of nets and de-worming

The mean age of the participants would be roughly 19.2years(2 months to 80 years). The proportional distribution of participants, according to the
Kenya Expanded Programme for Health would be roughly 0.93% pregnant women and infants, 20.80%early childhood, 20.70% late childhood, 29.04%teenage, 25.54.8% adults, and 2.99% elderly. 

Application handlers will have different levels of education, ranging from those who had never been to school, to those who will have completed high school. The level of education should not be an impediment to reporting
once the phone handler has received training.

We would expect 3 years and counting that diarrhea/malaria cases will have dipped greatly and be able to heavily impact and reduce diarrhea-based morbidity, especially amongst infants and children under five.
We also expect a greater uptake of the mobile phone technology by another community home that will have heard of the impact from the initial inception. This would be shared systematically by a visual print guide utilizing mobile marketing to neighborly communities & metrically measures for new subscriptions

This would increase our reach and give greater coverage and more impact. The community health worker will have properly acclimatized and have the capacity to train fellow CHW thus accelerating the ability of the system to serve more and hopeful also be able to capture more indicators such as fevers and suspected malaria cases now that they are equipped for testing

Our innovation will allow Real-time real-world observation of select groups such as pregnant women/infants and children under-five and their predisposition to diarrhea. this would also be realized through live geographic occurrences that can be visualized, quantified and shared with local health facilities and community health workers for immediate intervention.

Kenya's advent into mobile phone technology has been quite the leap and as such every household has likely access to a phone and know how to use one. Our provision of a smartphone & necessary application will be a plus allowing us to train households further & empowering them. We would also
significantly reduce cases of self-medication & the misuse of antibiotics that has led to higher cases of drug resistance. This rapid form of house hold level intervention and feedback will be life-saving for infants and children under 5 years who depend greatly on their overburdened mothers as witnessed in LMICs

Community engagement is a key pillar of this innovation that drives information gathering, our familiarity with the community will allow us to bring them in an associative way so as to agree on the modalities of rolling out and engaging them to realize its benefits.

We also have a prepared working methodology to help train them to effectively use the tool & control diarrhea in their community. Moreover, the Use of Community health workers allows direct integration with existing methods.

We Rely on an android based App hosting its back-end data platform on Google Firebase, The coding and workflow are dynamic and homegrown.  We have an integrated Biometric Api build that integrates Simprints Portable robust Finger printing identification precision for beneficiary registration and recall that is highly encrypted with total identity protection, A live working web-based dashboard shareable with Stakeholders and partners. 

With adequate financing, we are currently integrating and working on a blockchain-based proof of service for a payment system geared towards the Front line workers incorporating OTP verification and possible mobile money payout and payments for goods/services under the health sustainability approach.

Both front-line workers and home-based nominated app handlers per household make the backbone of data collection and interactive users.

This concept empowers and allows a community health worker; and by extension, the Community Unit to have the ability to effect behavioral change, conduct good practice in their health engagement with
households, deliver new mandates as required by their work plans, issue early warnings based on data collected, greatly ease their workload and access to information, and more accurate reporting to the
health clinics. 

It allows precisely targeted intervention assisted by identifying the Home App handler, to whom all diarrhea cases would be reported with special attention to the children.

- Each phone handler is provided with a training workshop facilitated by a medical doctor, a representative
from the Ministry of Health, 2 Community Health Workers & Program personnel.
- Phone handlers will be trained on how to use the app to report diarrhea
- Provide general health information on diarrhea & when to refer severe cases of diarrhea/fever/malaria to the nearest
health facility or Community Health Worker.
- Training on how to mix oral rehydration solution, check temperatures using home thermometers, and dispense fever relieving medication and told to pass on this information to other members of
their compounds.

As we mentioned the overburdened Kenyan mothers are the default home managers and are subject to the possibility of not responding adequately or in time to assist their young ones when they are suspected to be unwell. 

Their position has them engaged in a multitude of commitments; to allow them to eke out a living and sustain their families. 

By focusing on them being our enumerators, they are able to monitor their families using this innovation. Hence, better assessment and intervention towards their families, lowering the burden of illness or moralities that would trouble them even more.

Our key customers and beneficiaries fall into 3 tiers:
Household users / FrontLine workers / Community level Clinics and their Respective Supervising DHIS (District level Health Information System / Reporting District Hospital)

For social enterprise sustainability purposes, we have set up a health nutrition agro-enterprise model through our respective homes using clusters of women groups thus making it pa out as an Integrated business model blending Low-income client / Service subsidization but also supported by the COHESION app backbone and whose nutrition activities overlap with the health programs thus creating as a funding mechanism and to expand/enhance the mission of the Ground Zero program. This incorporates a high-value honey production model whose profits allow necessary returns if the model holds and the financing is well executed. It shows great long-term promise.

Further to this products or services we would be providing field-based integrative real-time reporting tools for upstream data collation and downstream service and health provision feedback and guidance between homes and frontline workers/clinics

The app once-in service will incorporate a subscription service for all 3 parties to achieve some financial and sustainable viability including integrating private partners for medical products/services, product advertisement, and educational content moving forward.

Health care seeking has been for ages in this part of the world - been seen as a preserve of the able one in society and more fortunate. By proving home-based medical services and preventative practice, grassroots-level homes can improve their health-seeking habits and greatly impact their family's economic and health outcomes

Besides further grants application, we now are selling health-geared products or services in particular honey and apiary management services to raise investment capital, so we do hope to expand the model for every cluster of community units we work with to help give some financial leverage and freedom for the system to pay for support services remuneration for Front line workers as a form of a community health scheme.

grants that we have received include Our seed/pilot has originally been funded through Grand Challenges Canada. 

Honey-based Bee products & Services have recently provided revenue for the program we have generated and has helped finance our back-end engine growth for COHESION.