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Overview & Approach

"In a full, diverse and rich empirical world, we need to determine what basic data to collect about a community in a systematic and on-going way. Our criteria for selecting what to collect are based on its purpose and the value the information would have for health care service provision and health outcomes," is the view of Professor Tessa Marcus from the Department of Family Medicine at the University of Pretoria (UP).

Mezzanine partnered with UP in 2014 to be the official providers of the health and clinical content of the AitaHealth application. We have monthly AitaHealth Data Governance meetings, between Mezzanine, UP and stakeholders from our different client implementations, to analyse the data, listen to feedback from end-users and then suggest new improvements to the content, workflow and reports available in the application.

 A Tshwane CHW screens the health of an individual at home.

A Tshwane CHW screens the health of an individual at home.

"Our starting point is that data should provide essential information that would enable Ward Based Outreach Teams (WBOTs) to provide community oriented primary care services to defined communities. The first need was to identify the people who usually live in a geographical locality by household and individual and their domestic circumstances. In order to determine the services that WBOTs could or should provide, it also is necessary to consider information collection in terms of (i) our  conceptual approach (Community Oriented Primary Care); (ii) the programmatic context (health priorities); (iii) scientific evidence supporting engagement with these priorities (effectiveness of interventions); (iv) the mandate of health care professional led CHW teams (legal framework); (v) human resource availability and capability (number, level and quality of services); and (vi) financial resources (availability, scale and sustainability of services).

The second need was to ensure that the data support the organization of ongoing services and follow-up visits. This requires specific protocols that outline the rules for decision support. Creating useful data management tools that specify actions is a complex process.  On the one hand there is the problem of over specification that may undermine discretionary thinking and decision-making and may waste valuable service time to satisfy administrative needs of hyper-complex systems. On the other hand, under-specification may lead to loss of valuable, time-saving support built around reliable follow-up and referral services.

The third need is for data to be collected for monitoring and evaluation. This is necessary to ensure that ward based team services work and are effective at the local level. Equally, they need to be adequately aligned to larger information systems, such as the DHIS.

Fourthly, data must be able to generate new knowledge about the health of individuals, families and communities. Research in the context of COPC, should simultaneously support improved practice and enhance understanding without overwhelming the primary purpose of service delivery. Informationally, therefore, there is a need to strike a balance between the scope and nature of discovery and that of service delivery." - Professor Tessa Marcus, UP Family Medicine.

 
In essence, the role and success of the programme and its role players is to promote community health, to educate the community, to focus on disease prevention and early detection of risk and illnesses, to refer those who are ill to the appropriate health care facilities, to follow up, and to ensure continuity.
— Nomonde Bam, from the University of Pretoria, who have been part of the AtiaHealth content design team since the application went live on 20 August 2014.
 

AitaHealth – Application Workflow

Ward Based Outreach Teams, consisting of Team Leaders and Community Health Workers (CHWs), use a customized mobile application to capture the registration and assessment details of the households they visit on a daily basis.

During the household registration the head of the household is interviewed to identify any household risks. A broad household “Triage Assessment” is also conducted to determine if any household members require assistance with key health issues.

All the data from the assessment is captured using the mobile application. In-application validation of data ensures that data is captured accurately. Built in skip logic also assists the CHWs to ask the correct questions to the relevant household members, based on the individual’s demographics. The household members with risks are “flagged” after completing the household assessment and health screening. The CHW can then schedule a follow-up visit on a future date for the specific household. Follow-up visits are managed and tracked using a “Task Management” feature – empowering CHWs to manage their own workload and also giving their Team Leaders visibility on their visit schedule.

The details of the assessments are immediately available for Team Leaders and Managers to review using a web reporting interface. Aggregated data, trend graphs and spatial information can be viewed on National, Provincial, District, Team and individual level.

 

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AitaHealth Triage questions
 

Adoption Success

AitaHealth is currently live in 3 provinces in South Africa where more than 2000 CHWs are actively using it. They have collectively registered more than 315 000 households,  894 000 individuals and scheduled & completed more than 120 000 follow-up visits for at-risk individuals.

 Example of the web portal home page available to all managers on their different access levels.

Example of the web portal home page available to all managers on their different access levels.

 

AitaHealth - Community Health Care application