Equipping Mobile clinic with Health informatics to end HIV

Many African countries that keep on having a lower standard of wealth services and technology, as well, are not managing to handle this situation, this hinders them to provide the required medical care services to their citizens. Burundi as part of our case study, it experiences this as well due to insufficient resources and less advanced technology. Burundi is located in east-central Africa, south of the Equator. The health system in Burundi is structured around three levels: central level, intermediate level, and the peripheral level. They have the mission of defining, leading health policy, carrying out monitoring and evaluation, leading research, training and regulation in order improve accessibility of healthcare services across Burundi. To improve accessibility of health services, Service Yezu Mwiza (SYM) has established Mobile clinic whose purpose is to reach out the rural community with a package of medical and psychosocial services within the community.

Though the Mobile Clinic strategy served around 4000 people in Burundi, there is a still a big number of underserved people such as those infected and affected due to HIV. This is because, the mobile clinic cannot reach out each person’s home due to improper load. Furthermore, the high poverty rates in Burundi also affect in delivering medical care services. For example, it is undoubtedly problematic to people affected and infected by VIH to go out of their homes to look for medical services due to lacking transport facilitations. As low-income country, health system in Burundi is more centralized. Health centers and hospitals are more accessible in urban area rather than in rural. This provides hindrances to accessibility of health care services by underserved groups of people from rural areas.

Some threats in communication between clinicians and patient Due to less advanced technology is still challenge. This means, people infected and affected due to HIV have no way of setting up an appointment with doctor due to lack of mobile phone, Laptop-machine, tablets. One of the most gaps SYM has identified is that the people infected and affected due to HIV have a high detectable viral load because, they do not follow the treatment carefully by maintaining an undetectable viral load and it therefore exposes them to new infectious diseases as result of poor communication with clinicians via technology.

For making Mobile clinic strategy more efficacy and impactful, SYM has established the peer educators, in each zone of its interventions to play role of linking the long-distance patient with clinicians. They have tasks of communicating, sensitizing, advocating, and offering non-medical services to vulnerable people. Although they have task of communicating the difficulties of patient to clinicians, when it comes to a medical consultation, they face the problem concerning the lack of reporting tool to set up an appointment with Doctor, as well as the lack of enough proficiency of using technology related tools. In brief, solution intends to address: lack of informatics tools and lack of enough proficiency of using technology related tools for both clinicians and peer educators.

Equipping Mobile clinic with Health informatics is our solution that can improve the accessibility and quality of health services for underserved people infected affected due to HIV, displaced people, women and children, older adults, and LGBTQ+ individuals. This is about, firstly, establishing Mobile Clinic strategy with aims of offering prevention, care, and support services within the community. The Mobile Clinic team must travel long miles to reach out to the underserved people’ home with a package of care services. The team performing the mobile clinic consists of a doctor, a nurse, a psychologist, and a health mediator, and medical staff. Secondly, establish the peer educators, in each underserved community, whose role is to link the long-distance patient with clinicians by using the technology of KOBOCOLLECT. Besides, they have tasks of communicating, informing, educating, sensitizing, advocating, and offering non-medical services to vulnerable people.

Thirdly, to provide the informatics tools such as mobile phone, laptop, tablets to clinicians and peer educators, and install within them smart medical devices such as KOBOCOLLECT that allows clinicians to automatically access to data reported by peer educators/ community workers. In this regard, both clinicians (doctors or nurses) and peer educators/community workers have to be trained on the use of these smart medical device (KOBOCOLLECT).

How can the technology of smart medical devices (KOBOCOLLECT) improve accessibility and quality of health services for underserved groups in fragile contexts around the world, especially in Burundi? In the main, each Mobile clinic doctor or nurse/ clinician must have KOBOCOLLECT/ smart medical devices in his/her mobile phone or laptop, tablets or in other informatics tool, as well as the peer educators/ community workers. The KOBOCOLLECT is an app often used in medical services to enter data from patient data, and used to deliver therapy via visual or physical consultation. As solution, the data base of KOBOCOLLECT has to be well programmed with option icon: online portal systems, electronic medical records, data collection devices such as vital signs monitor records of patient, personal data devices and email telephone number, automated chat, video and photo device option, device configuration report. This means, the data base has to show application icon where a peer educators/community workers fill patient date such as patient’s location, patient’s profile, patient’s life situation. In case a community worker fills in the application icon the patient’s life situation whether illness case or set an appointment with clinician, this has to automatically notify the clinicians (doctor or nurse).Once the clinicians get the notification of any patient’s record or illness cases, the Mobile Clinic team has to travel to reach out to that person’s home with a package of care services. In brief, this is our solution that, to equip the Mobile clinic with Health informatics, can help us to HIV disease through the provision of free accessibility and good quality of health services as well as enable continuity of care and well-being for underserved people infected affected due to HIV, other displaced people, women and children, older adults, and LGBTQ+ individuals.

Through Mobile Clinic, our organization (SYM) currently serves around 1200 persons living with HIV/AIDS, 3000 orphans and other vulnerable children in Bujumbura rural area and in the suburbs of Bujumbura city. Our organization provides free health services to underserved population due to the poverty and poor living conditions. The fact that there is still a big number of underserved people infected and affected due to HIV, is due to low number of organizations that perform Mobile Clinic strategy equipped with health informatics to facilitate pre and post-test counseling and access to voluntary, confidential, and anonymous HIV testing among all people in general and groups at high risk of HIV transmission including sex workers, prisoners, young people students, marginalized communities, and LGBTQ+ individuals.

However, through the solution of equipping Mobile clinic with Health informatics, the marginalized communities and groups at high risk of HIV transmission will access free and quality of health services. Their lives will be meaningfully improved through delivery of the information, education, and communication necessary for behavior change related to HIV /AIDS/STI, PMTCT and reproductive health. With this solution, the psychosocial and medical care including ARV treatment and related services will be provided as well as the required support

Since 2010, Service Yezu Mwiza (SYM) started Mobile Clinic in order to offer prevention, care, and support services within the community. The Mobile Clinic team which consists of a doctor, a nurse, a psychologist, a health mediator, and medical staff have for long traveled to reach out to the underserved community in need with a package of care services. A vehicle equipped to transport appropriate drugs and qualified personnel leaves the SYM headquarters two or three times a week to go to remote places in the province of Bujumbura rural area to care for people infected and affected due to HIV residing there. With the mobile clinic, 192 home medical visit or more are carried out every year, allowing the regular monitoring of more than 850 PLHIV enrolled in our active file and the maintenance of an undetectable viral load for more than 95% of this population.

with support of health mediator whose role is to link the patient’s need with medical care services, our organization has contributed to the promotion of the integral health with a preferential option for the most needy by putting forward three priority areas, namely: prevention to contribute to the reduction of new HIV/STI/TB infections; medical and psychosocial care to accompany patients to adhere to treatment and live positively with the disease; promotion of socio-economic empowerment in communities by encouraging vulnerable women to initiate income-generating activities in order to improve their standard of living.

Moreover, with support of peer educators/community workers and psychosocial care service, our team annually provide 51 therapeutic education sessions reaching 1,285 beneficiaries, 16 sessions to strengthen treatment compliance for 44 beneficiaries with a detectable viral load, 14 nutritional education sessions for 316 beneficiaries including women on Prevention of Mother-to-Child Transmission of HIV program, guardian families of OVC, vulnerable widowed women, bedridden beneficiaries from the most distant communes.

As team of different background, we have one doctor, one nurse, one psychologist, two social workers who well trained on use of KOBOCOLLECT (smart medical devices). Though they are all trained, there is still a challenge lack of enough proficiency of using  technology related tools(KOBOCOLLECT). For peer educators/community workers, our organization is looking for support so that we can buy them the appropriate tools such as tablets, mobile smart phones, and train them on usage of different smart medical devices. By means of equipping Mobile clinic with Health informatics, both Mobile clinic team and peer educators are right people to deliver this solution with aim of improving accessibility and quality of health services for underserved groups in fragile contexts especially in Burundi (such as refugees and other displaced people, women and children, older adults, and LGBTQ+ individuals)

Our solution serves around 4,000 vulnerable people so far, but if our solution is well supported, we can serve more than 100,000 vulnerable people across Burundi and our solution might be implemented in other country with health fragile background. 

We are applying to Solve to fund opportunity which, via collaboration, can help us to accomplish our mission that of promoting integral health through a global management of both chronic and infectious diseases, and promotion of reproductive health for vulnerable people in Burundi. Our solution is at a growth stage of development, and we are looking for opportunity, through partnership and collaboration, to overcome/address the problem of inaccessibility and poor quality of health services for underserved groups. Solve is our best opportunity of connecting us with partners who can help us to advance our solutions through monetary and/or non-monetary support. Accordingly, our organization needs various support: financial support, advisory and fellowship support (coaching, training, monitoring). We hope that through Solve opportunity, our dream of improving accessibility and quality of health services for underserved groups will be realized.  

The solution of equipping Mobile clinic with health informatics to end HIV is innovative and has significant impacts on health system, especially in low-income country such as Burundi. As part of the global project of USAID to end HIV/AIDS by 2030 and thus achieving an HIV-free generation, Service Yezu Mwiza started Mobile clinic as strategy of offering prevention, care, and support services within the community by reaching out to the marginalized communities and groups at high risk of HIV transmission with package of care services (drugs and ARVs treatment). This approach is more innovative because, even those who are bedridden beneficiaries from the most distant communes are served. 

Figure: mobile clinic carried out home visits to bedridden and vulnerable beneficiaries, who are no longer able to arrive at health center.

Our solution is innovative because, it applies the psychosocial approach by considering people infected and affected due to HIV in their context of the combined impact of psychological factors and their social environment on their physical and mental health and ability to function. This solution is innovative as it is based on Individual Care Plan (ICP). With the technology of KOBOCOLLECT, our Mobile Clinic team provide health service based on every beneficiaries’ primary problem to be worked. By the contribution of peer educator in linking beneficiaries’ problems via KOBOCOLLECT technology, it allows the doctor to better communicate with the patient. When there is a need for primary medical care, the doctor sees where the patient is, and then visits him/her at home. We usually know that the patient comes to the doctor for treatment, but our solution is to reach out patients in their home with package of medical services by the contribution of peer educators/ community workers via KOBOCOLLECT technology. So, it is innovative and has positive impacts in health system to improve accessibility and quality of health services and enable continuity of care, particularly around primary health, complex or chronic diseases, and mental health and well-being.

Our transformational impact goals on people’s lives for the next year and the next five years are as follows:

• Promotion of community screening by involving peer educators/ community workers (indexed screening and use of self-testing);
• Bedridden beneficiaries from the most distant community will be reached out with free quality health care services;
• The marginalized communities and groups at high risk of HIV transmission (such as refugees and other displaced people, women and children, older adults, and LGBTQ+ individuals), will access free and quality of health services such as pre-exposure prophylaxis, access to ARV drugs and related services.
• The extension of HIV testing services targeted children, women on Prevention of Mother-to-Child Transmission of HIV program and free access to Pre-natal consultation service within the distant communities;
• The initiation of the income-generating activities for marginalized people and people at high risk of HIV transmission. 

The indicators that are using to measure UN Sustainable Development our solution addresses are:

By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases

Indicator 1: Number of new HIV infections per 1,000 uninfected population, by sex, age and key populations.

By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes

Indicator 1: Proportion of women of reproductive age (aged 15-49 years) who have their need for family planning satisfied with modern methods

Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all

Indicator 1: Coverage of essential health services

Impact (general objective):

Equipping Mobile clinic with Health informatics to end HIV

Outcome (specific objectives):

1.      Connect Mobile Clinicians (doctors, nurses) KOBOCOLLECT databases with peer educators/community workers’ personal mobile app to access beneficiaries’ daily life situation;

2.      Reach out the underserved people infected and affected due to due HIV from distant location with a package of care services;

3.      Promotion and provision of free access and good quality of Health services to underserved population from rural area, and the care for people infected by HIV/AIDS and chronic pathologies.

4.      Facilitate pre and post-test counseling and access to voluntary, confidential, and anonymous HIV testing among all people in general and groups at high risk of HIV transmission including sex workers, LGBTQ+ individuals, prisoners, young people students and marginalized communities.

5.      Provide psychosocial and medical care including ARV treatment and related services as well as the required support.

6.      Provide support to vulnerable children orphans so that they have access to care and support.

7.      Provide care and support to people suffering from chronic pathologies.

Output (result intended):

Equipping the Mobile Clinic with Health informatics is associated to extensive results. The most significant positive result is improved and accessible service, accompany and care of vulnerable population infected by HIV/AIDS and other diseases in the rural area. Besides, by implanting a free clinic in a rural area, time and distance spent to travel from distant location to reach to health centers considerably be reduced.  In addition, peripheral and remote areas which are hardly accessed will be reached out. SYM beneficiaries will also be facilitated and encouraged to refer to our service. Moreover, they will be an increase and improved space to deliver health services. Likewise, there will be improved systems and programs run by our organization’s services. As Mobile Clinic will be equipped with health informatics, there will be an improved communication of health data between our clinicians and patients, as well as other health district clinicians. The availability of o Mobile clinic equipped with health informatics will improve health and welfare, and will motivate health providers, such as nurses and doctors to better serve beneficiaries specially those infected by HIV/AIDS, people living with skin infections such as leprosy, people living with cardio-vascular diseases and chronic diseases. 

Our technology uses software and SMS technology  by utilizing online portal systems, electronic medical records, data collection devices such as vital sign monitor, personal data devices, email and telephone number, to solve a problem of inaccessibility and quality of health services, within the community, faced by the underserved people infected affected due to HIV, other displaced people, women and children, older adults, and LGBTQ+ individuals, facing community.

SYM Clinic affirm the principle of equality and equity of genders, in keeping with the 2030 Agenda for Sustainable Development Goals. SYM implements this pledge via processes of recruitment of personnel that support both women and men, as well people of different sexual orientations, people of different tribes or races and background, equal chances opportunities.   

Through value of Compassion, Collaboration, Transparency, Innovation, Option for the poor, Excellency, our organization provides prevention care and psychosocial support services to the community by promoting integral health through a global management of both chronic and infectious diseases, and promotion of reproductive health for vulnerable people, in order to have a flourishing people enjoying physical, mental, psychological and spiritual well-being at all levels of Burundian society.

As non profit organization, we plan do not plan to bring money form this solution, but we plan to help the vulnerable people by requesting funds to equip Mobile Clinic with health informatics so that we continue promoting of free Health services to underserved population, and the care for people infected by HIV/AIDS and chronic pathologies and improve accessibility and quality of health services for underserved groups in fragile contexts around the world (such as refugees and other displaced people, women and children, older adults, and LGBTQ+ individuals).

We received 48,000 $ to buy a car for Mobile Clinic