Masvingo PM- Diabetes and Hypertension

There is a growing number of Diabetes and Hypertension patients in rural and urban Masvingo province. Key challenges in the town and province at large include essential drug provision, accessible treatment, disease control, health education, and also maternal and child health care. There has also been a lack of comprehensive vision and purpose of data collection and/or availability of poor and impractical data. Performance measurement is usually randomly taken largely motivated by either an ongoing government program or to inform independent project funders as such, performance measurement in both urban and rural Masvingo largely remains a dream.

The proposed solution includes:

1. Electronic Medical record keeping at health centres which track a patient’s history. All healthcare centres should have access to the record systems and patient health cards (which are largely manual) should have information that should be entered into electronic records once patients visit a healthcare centre.

2. Health education campaign to communities starting at individual to families /homes and schools- Patients also require training on the importance of providing a true account of themselves as patients or a true account of their relatives who are patients.  

3. Health education would be complemented by a simple phone application (and usable on non-smartphones in light of power challenges in the country). The application would feed into the integrated provincial electronic health platform.

4. Provision of BP machine and glucometer to patients. One of the biggest challenges is that critical tools to measure effectiveness are out of reach for many as well, travelling to medical centres is a challenge on its own due to related costs. There is therefore no way of knowing a patient's progress even in the case of death. Provision of requisite resources would enable data collection and update to computerised systems, and further, by the number of equipment made accessible, that is a measure by itself.

5. Accountability measures to ensure accurate service provision and performance measurement.  During the Covid-19 period numerous cases were omitted due to poor accountability through both lack of follow-up on patients and health education to dispel much mis/disinformation in communities hence a traceable inefficient use of resources. Proposed accountability strategies (informed by the lived experiences during Covid-19 case management) include having an independent entity manage resources (including health workers).

1. Health education in schools and communities- More time is dedicated to education. Most patients and caregivers rely on public institutions which, being overwhelmed, are unable to provide adequate education to consulting patients. The patients themselves would often be in a hurried state to travel back to their homes therefore outreach services imply taking services where it is most required.

2. Mobile Application- patients can receive an SOS service through data updated on the mobile application. Challenges of accessibility to medical centers hinder necessary medical visits hence a way of remote monitoring and measuring will be of crucial help.

The team is comprised of:

• Dr. Thomas Nyasha (Male)- a medical doctor who has over ten years hands-on experience serving in both private and public hospitals and is in touch with areas of most need. 
• Mr. Adam Mkushi- A social worker with extensive experience in social protection and challenges in medical service provision and patient accessibility in the province.     
• Mrs. Tendai Ganduri- a social researcher with experience in writing policy briefs and convening meetings with government officials and respective stakeholders for intervention programs.
• Doctor Nyasha and Tendai are locals of Masvingo and have an appreciation of the landscape at various levels from social, economic, and political dimensions. 

We have witnessed firsthand challenges in service provision and data collection for improved services. We have an appreciation of the socio-economic and political challenges to programs' implementation and are in a position to mediate and assist as locals and professionals even in ways, external funders may not be able to do (in terms of interaction with health workers and community). The biggest driver of success in any project in our country rests on a motivated team, accountability and funds. We will implement the project in collaboration with a government institution whilst accountability sorely rests with the team. We have an advantage of not being an NGO as under the prevailing conditions, funds may have to be administered through the government which would hinder project flow such as deisgn and implementation of low costs records systems and relevant mobile application. 

1. We work with both individuals, communities, and existing government health service providers. The combination of an academic approach, social protection interests, and qualified professionals has proven to work in many circumstances. The method relies on services, key persons, and technical integration and that is a critical component of the approach.

1. stakeholder meetings between government officials and service providers in the health industry
2. health education across selected locations
3. health workers' training sessions
4. distribute bp machines and glucometers to patients
5. develop a mobile application for patients
6. develop low cost and easily manageable electronic records systems 
7. implement the record system across selected health centers in the province

1. reduced episodes of critical health conditions
2. improved food basket because of savings on medication
3. improved physical fitness
4. reduced to no need for visits to a medical center
5. formulation of health peer groups and conducting of meetings in communities

1. Fearless living, which is an improved feeling of well-being and outlook on life. Diabetes and Hypertension are somewhat labeled as death sentences because being largely viewed as chronic the then anticipated financial burden of medical attention and treatment scares many before it even starts. The project will empower patients and their families on how to manage the disease and improve lifestyles to the extent of suppressing the illness. Families are relieved of stress and having machines to assess conditions on a daily basis brings a feeling of being in control.
2. measurement of improvement by authorities helps detect trends of what and where challenges in health care remain probing for further investigation of the matter. 

Mobile application

Electronic records system

Patient self-help methods through health education

1. Local and community health workers- a collection of data on patients (and medical condition assessments) within communities. Per diems will be paid at health workers' rates of US$50/day
2. systems programmer- agreed project contract rates guided by prevailing tarrifs.
3. mobile application programmer- agreed project contract rates guided by prevailing tarrifs.

1. We will always be guided by the ethos of research and medical practice to ensure free, fair and non-partisan implementation of the project
2. We will work with individuals based on merit through professional positioning and service to the project. 
3. We seek to include every patient within the target range therefore it will be non-discriminatory. 
4. we will rely on the knowledge of area headmen who have knowledge of their respective constituencies which removes any biases

1. Health Centers (Clinics and Hospitals)- These will be provided with electronic health systems integrated with a mobile application which will make data storage, retrieval and performance measurement computational hence easy and convenient to use. Follow-up on patients is non-existent as the current system (mostly in public institutions which serve the majority) is largely manual. Patients visit health centers with their medical cards and information is updated on the card.
2. Health condition Mobile application- this will benefit both health centers and patients. It will lessen work in data capturing at health centers and help data convergence from respective patients.
3. BP machine and glucometer - these are largely inaccessible to patients due to costs and priority as most of the affected already live below the poverty datum line. 

This grant will be the initial propeller of the project, afterward low project maintenance is required and can be sustained through a combination of the government's budget for health and volunteers (towards electronic records, mobile app maintenance, and replacement/procurement of BP machines and glucometers).

Through JF Kapnek Trust Adam has managed grants from Oxford Policy Management UK & UNICEF Zimbabwe, SAFE Project, National Team Lead – Disability - Child Protection and Safeguarding (UNICEF) ranging between US$30 000-US$200 000. He will be the team's leader in the grant management aspect.