Mobile Technology for Community Health

{Photo Credit: Samy Rakotoniaina}Lynda Razafiharilalao, a Malagasy community health volunteer, shows various modules of the mHealth app to a fellow volunteer.Photo Credit: Samy Rakotoniaina

In rural areas of Madagascar, community health volunteers (CHVs) are instrumental in improving maternal and child health services. Their activities include raising awareness on healthy behaviors, child growth monitoring, family planning counseling and services, and treatment of simple illnesses, such as pneumonia, diarrhea, and malaria. As CHVs are part of Madagascar’s health system, their activity reports feed into the national health information system.

CHVs collect and report health service data through paper-based forms and logs. This data is aggregated through the health system and used by the Ministry of Public Health to inform health policy programmatic strategies, health planning, and other decision-making.

"The whole package of paper registers weighs at least 10kg, and I have to walk to the health center with all these documents in my bag on a monthly basis,” explains Lynda Razafiharilalao, a CHV from central Madagascar. “To be honest, it's a heavy task, both intellectually and physically.”

To help ease this burden, improve reporting accuracy and timeliness, and improve the health care and counselling that CHVs provide, the Ministry of Public Health developed a mobile health (mHealth) initiative with the support the USAID Mikolo Project. Implemented by MSH, the project increases access to and availability of community-based primary health care, especially for women of reproductive age, children under age five, and infants living in remote areas in Madagascar.

In a pilot program in two regions of Madagascar, between April and September 2017, CHVs used a tailored smartphone application that guided them through the case management and counseling process, and instantly recorded activity data.

Lynda is among 50 pilot users of the mobile application (app). She monitors the weight of 75 children under five each week in the village of Ambohidava, which is a two-hour walk from the nearest health center. With her new smartphone, she directly records activity data on the mHealth application. The head of the health center can supervise her activities from a distance in real time, which significantly improves the quality of the health services Lynda is then able to provide.

"Lynda Razafiharilalao is one of the most active community health volunteers in this commune. She mastered the technology in no time, and, as the smartphone also eases communication between us, we have been able to ensure that referred cases actually come to the health center," explains Dr. Lalatiana Rakotoarivony.

Although the limited battery life of her smartphone poses challenges, Lynda says the mHealth initiative has significantly improved her work as a CHV. She feels more confident about the services she offers to the local population and more efficient in data reporting. Among CHVs in the mHealth pilot, 88.5 percent to 94 percent reported monthly health service data on time, compared to 46 percent to 75 percent among CHVs using the paper system.

The Ministry of Public Health and the USAID Mikolo Project are continuing to scale up the mHealth program to reach an additional 550 users in four regions of Madagascar.