Digitalized Community-data for Planning (DCfP)

According to Tanzania Demographic Survey, the under-5 mortality rate was 67 deaths per 1,000 live births in 2015/16, attributed to high neonatal deaths taking place age 0-6 days. Whereas, the maternal mortality ratio was 556 per 100,000 live births. Nearly half of the pregnant women attending 4 ANC services, often rate bookings, two third delivering at the health facilities. The majority of deaths, underfive children and pregnant-related deaths could be prevented, through community-based interventions aimed at health-seeking activities.

The demographic surveys, service user statistics such as District Health Information System (DHIS) and more recently, the government added Government Hospital Health Information System (GOTHOMIS) for Local government authorities’ health facilities, are not only expensive but take long intervals to analyse and use for planning 

The robust DHIS and GOTHOMIS collect the data from the users of the health facilities and not from the communities, hence likely to leave out vital information from the people that may not have access to the facilities. The information gaps are (1) the timing (2) health facility data rather than community-based information.

Existing collection systems for planning is usually not collected in real-time, it takes time to aggregate, analyse and report. Some, such as demographic surveys, are outdated at the time-released, besides, they do not reflect the local context. As such, the Council Comprehensive Health Plans are dependent on facility-based information and surveys, hence don't represent the true picture of the state of health - morbidity and mortality, for prompt responses

Digitalized Community-data for Planning (DCfP) will regularly collect information, in real-time, as the event occurs in the community using lay volunteers, and a simple data collection mobile phone platform to gather the data

Digitalized Community-data for Planning (DCfP) will use a mobile phone application, adapted from the open-access Open Data Kit, uploaded to the mobile phones. The CHWs will collect two types of data using the application (1) complete a max 5 items form available on an affordable and easy-to-use mobile phone (2) record their voice, narrating a state of event(s) in the community.  The application shall be able to store the information offline, using the last mile solution (LMS).  The report shall be transmitted to a central point upon reaching the internet point, biweekly.

The data collected will include the under-five children's information on morbidity and mortality and utilisation of antenatal services and maternal mortality.  The under-five data will consist of the health facility sought by the parents or guardians, as the time it takes from the onset of the symptoms to the presentation to the health facility.  We intend to track three main symptoms: fever, diarrhoea and difficulty breathing, as proxy for 3 commonest underfive children diseases.  The CHWs will report the history of these diseases from the mothers, which could vary from not taking a child to health facilities to taking hours or days to do so. 

Tracking and reporting the utilisation of ANC services, the CHW shall visit the pregnant woman’s household and find out at what gestation age she started attending the ANC services.  The purpose is to determine the proportion of women accessing ANC services, preferably the first booking taking place 12 weeks after the conception, as a proxy indicator for scaling up access to making pregnancy and delivery safe

The government coordinator at the ward level will aggregate the data from the number of villages and present the same to the ward development committee (WDC). The WDCs will present the information to the council for inclusion in the Comprehensive Council Health Development Plan for planning. IN a similar reverse manner the community shall be given feedback

Sengerema district council is a rural council and it is one of the eight districts of Mwanza region in Tanzania. The council has a population of about 640,000 whereby 90% of the population are in rural areas, and the majority of the residents are engaged in small-scale farming and fishing. Administratively, the district is subdivided into 26 wards, 71 villages, 21 Streets and 419 hamlets. 

The district has a total of 49 health facilities which include one district hospital (Designated District Hospital), five health centres and 41 government-owned dispensaries, one private dispensary. The health facilities are unevenly distributed, as the majority are along the main trunk roads. Several islands have no health facilities at all.   

Although the national average antenatal booking is reported to be 19 weeks, the local data are very unreliable. A higher proportion of facility-based deliveries by pregnant women has been reported in recent years, however, there is reported evidence that a significant proportion of pregnant women do not visit the ANC clinic at all; hence missing vital screening and preventive measures

Digitalized Community-data for Planning (DCfP) will provide the essential data and bridge the gap of information needed for planning, in particular, information from the most rural and under-served communities, including the islands in Lake Victoria, the majority of the communities are without a health facility

In turn, the Sengerema district council would be able to devise annual comprehensive health plans, including allocation of the resources to the community-based interventions that are informed by the data generated from the community the council serves

Dr. Severin Kabakama (MD, MPH) has over 20 years of experience in humanitarian and public health sectors in Tanzania, Zambia, Haiti, Sudan, South Sudan and Mozambique. He has researched on Routine Data Quality at the local government. Focusing on public health and health systems research. He's an Honorary Lecturer in Community Medicine, at the School of Public Health, Catholic University of Health and Allied Sciences. He will a team leader and also responsible for the coordination of the Digitalized Community-data for Planning (DCfP) project and liaison with the local government authorities

Dr. Domenica Morona (MSc, MPH, PhD) is an Associate Professor of Parasitology, Director of Research and Innovations, Dean, School of Public Health of the Catholic University of Health and Allied Sciences. She has over 30 years of experience in the LMIC countries, Africa in particular. Has worked extensively with community disease prevention programs, and authored extensively on primary health issues. She will be responsible for leading the Digitalized Community-data for Planning (DCfP) performance against the target  

Dr. Humphrey D. Mazigo (Ph.D,Cert. M & E) is an Associate Professor & Department Chair, at the Department of Medical Parasitology and Entomology, School of Medicine, Catholic University of Health and Allied Sciences.  He has worked and published extensively on schistosomiasis transmission, prevention and other public health-related matters. He will be responsible for validation and training of the CHWs and Coordinators on the gathering of the data and aggregations of information 

Mr. Oswald Mpelasoka (BSc EHS, MPH): Has over 10 years of experience in public health services and health systems in Tanzania. He has worked with local and central government authorities in implementing and evaluating performance of primary health care services.

Dr. Saumu Kumbisaga (MD, MPH Candidate). She has 10 years in clinical practice, and three years as Sengerema District Medical Officer. She is in charge of health services and programs, both curative, preventive and promotive. She has will be coordinating the routine activities of the CHWs and ensuring the data collected is integrated with the Wards Development and the Council Comprehensive Health Plans

100 Community Health Workers

40 Ward Development Officers 

Many institutions have worked with CHWs in the area. However, for a lack of financial resources, and job satisfaction among the CHWs, their programs were not sustainable. Digitalized Community-data for Planning (DCfP) project seeks a start-up grant from the Challenge to introduce state-of-the-art technology that would improve the recognition and integration of the community data the council plans, at all levels. 

The digitalized community-based data collection model shall offer an opportunity to collect and utilize the data and information never used before in Tanzania, for Comprehensive Council Health Plan. Councils may find the system very useful to compile the information for planning in real-time. The systems will be available for use by the local and international non-governmental organizations, much more so those working with vertical programs such as HIV/AIDS, TB, and Malaria. Besides, the systems could be used in other cross-cutting sectors such as gender, water and sanitation 

During the first Digitalized Community-data for Planning (DCfP) project, the first ward would be able to integrate Ward Development Plan. After five years, the Sengerema would be able to use the DCfP for Comprehensive Council Health Planning (CCHP). Using the community-based data, the CCHP will be informed about the community's needs. Providing feedback to the community practices and healthy behavior hence improved under-five children and maternal outcome; such as reduced mortality

1. Number of CHWs trained in Digitalized Community-data for Planning (DCfP) project
2. Number of villages collecting under-fives and maternal morbidity and mortality data 
3. Digitalized Community-data for Planning (DCfP) piloting completed in one year 
4. One ward with at least 10 villages rolling the DCfP integration in the ward development plan 
5. Improved reporting of under-five children cases of diarrhoea, fever and difficulty in breathing 
6. Improved reporting of under-five children with an illness seeking health care within 24 hours of symptoms onset 
7. Improved reported antenatal care services booking within 12 weeks after conception 
8. Improved reported number of under-five children deaths 
9. Improved reported number of maternal deaths 

The DCfP project theory of change is to ensure community data collection is integrated in the villages, ward, up to the district level. The process would ensure that data collection for planning is sustainable through the local government planning process, which in Tanzania, ideally, should start from the grassroots level. Usually, the Local government commits funds collected from own revenues and allocations from the central government. The DCfP will ensure that the allocation is informed by the data collected from the communities.

The ultimate outcome is ensuring the data is integrated into the Council Comprehensive Health Plan (CCHP), the community practices are improved and the community based interventions are scale up, through the feedback provided. The ultimate goals are reduction of the under-five children and maternal mortality.

The DCfP will provide cheap mobile phones will data and internet capabilities. Each phone will be loaded with open-source mobile data collection platform, 5 item form, simpler to be completed by the 100 CHWs. The form will send to the Ward Development Officer for consolidation. The CHWs could also record themselves regarding the incident that took place in the community such as maternal deaths. 

In hard to reach areas and places without internet, last mile principle shall be used; work offline, save the form and transmit as soon as the internet become accessible

DCfP is negotiating with a mobile phone provider for a corporate package at a reasonable monthly subscription, tentatively 6 US$ per months per CHWs. The mobile phone may cost from 80 - 100 US$ each. 

The district had 200 Community Health Workers registered to work in the district, 100 of them are actively involved in preventive activities for Malaria, HIV and ANC; the majority are given monetary incentives by vertical projects such as HIV, which are donor funded. 

The DCfP team is very diverse; professionals, non-professionals, various ethnicity, political groups and community members are fully participating. At the leadership level composes of the teaching, not teaching staff, systems developers, public health professionals and leaders of the district health services. Moving to the implementation levels, there shall be community participation in selection of the CHWs to collect the data from the communities. Most of the CHWs are women at 3:1 female vs male ratio. At the ward level, so as the Council level, the planning process is very participatory. Technicians, Councilors, Religious Leaders and Influential persons participates in the planning process. 

The data will be collected from the villages by their own community resource persons, using affordable technologies - mobile phone applications. The cost of the mobile phone is estimated at US$ 80 - 100 each, and the air time to be provided is 6 US$ per CHW per month. DCfP is negotiating with mobile phone providers to access subsidized tariffs.  The data collected shall be used to inform the council planning, from the village to the ward, up to the council level. The resources shall be allocated according to the maternal and under-five children priority areas. Besides, the community shall receive periodic feedback about the data, the funds allocated to the villages and community-based interventions.

The councils and other partners would be interested in investing in the data collection for planning as a sustainable planning mechanism. The CHW's costs could be easily integrated into the council's plans using their own resources, as the council find the data collection mechanism useful. Other donors, vertical programs such as HIV and Malaria will be interested as they would find the DCfP useful for planning

Already 100 out of the 200 CHWs are already being used by the ICAP (a partner engaged in HIV/AIDS) in the district for community mobilization. It is anticipated more partners, including the council shall join in to ensure the participation of more CHWs, in maternal and under-five morbidity and mortality preventive activities, in particular