In the Village Clinic , the HSA deals with infant and child health according to guidelines laid down by the government scheme "iCCM" - Integrated Community Case Management.
iCCM is a package of child survival interventions designed to address infant mortality, primarily in hard-to-reach areas, in all 28 districts of Malawi.
It includes the following interventions:
- For diarrhoea, treatment with zinc and oral rehydration salts
- For malaria, treatment with artemisinin combination therapy
- For pneumonia, treatment with antibiotics
- Treatment of red eye (or conjunctivitis)
- Diagnosis of neonatal sepsis and referral with an initial antibiotic dose
As part of iCCM, HSAs are trained to use a job aid called the Sick Child Recording Form.
This is a form whose directives embody some of the decision logic required for correct diagnosis and treatment.
In other words, the Sick Child Reporting Form is a care protocol.
In D-tree, when we see such a care protocol, we think of software running on a mobile device rather than a form or a flow chart.
So we set out to transform the Sick Child Reporting Form into something interactive, something easier, and something more supportive. We initially produced and deployed a "CCM App" for this purpose.
It has since developed into a comprehensive integrated Village Clinic App covering child health, maternal health and family planning.
This digital health solution is deployed to over 1,000 of the 11,000 Village Clinics of in Malawi.
One major advantage of an interactive app from a quality of care point of view, is the inexorability of its logic. Simply: it reduces the likelihood of error.
But it helps the HSAs in other ways too, such as ..
- calculations: of correct medicine doses, relative to the patient's age
- timing and counting: measuring respiratory rate requires timing and counting, two things software can do accurately, leaving the HSA to focus on observing breaths
- reminding: support for the steps in the process of applying an mRDT (Rapid Diagnostic Tests for malaria)
- stock management: support for sending drug stock messages via SMS to the central government drug logistics system (C-Stock)
- reporting: an HSA using the app does not need to compile a monthly statistical report - it is automatically there in the digital health system and can be viewed by the HSA, supervisors and managers.
Rapid diagnostic tests for malaria are a recent introduction to the iCCM syllabus. The process of applying such a test can be complicated.
The app supports the HSA to execute this process correctly, step-by-step, every time.