AitaHealth: When Technology and People Join Hands
“Reaching the 150 000 mark in the number of households registered in the Tshwane District’s community health care programme certainly is inspiring. These registrations were done by Community Health Workers (CHWs) in their role to promote and support primary health care in their communities. This milestone had been achieved in record time using AitaHealth, a locally developed mobile phone based product that we use to capture and manage the data of our primary health care programme. ”
Ms Nomonde Bam, a senior lecturer at the University of Pretoria’s Department of Family Medicine, gets excited when she explains her personal role and the university’s partnership with the Department of Health and other organisations to establish and maintain a proactive approach to primary health care.
Through their pioneering efforts, they’ve managed to significantly change the health care landscape in the communities serviced by the City of Tshwane and the district office in the Gauteng province. This community-oriented primary care programme (COPC), uses Ward Based Outreach Teams to render services to individuals and families at household level. The outreach teams are composed of professional or enrolled nurses and Community Health Workers.
The programme serves to make health services more accessible to individuals and families in their households. It improves health outcomes by empowering individuals, families and communities to take responsibility for their own health through health seeking behaviours and lifestyle modification. The role of the team is to provide basic healthcare services at household level, focusing primarily on disease prevention, early detection of diseases as well as health and social risks, and health promotion and education. The programme focuses on four main areas namely Maternal and Child Health (MCH), HIV, AIDS, TB, non-communicable chronic diseases as well as violence and injuries. These areas contribute the most to the burden of disease in South Africa.
This programme in Tshwane relies mainly on AitaHealth, a customized mobile application used by community health workers to capture and share health-related data about households in the communities. AitaHealth allows health departments and organisations to effectively manage, analyse and act upon the data that the CHWs capture on their mobile devices in the field.
Why this became necessary*
Health sector reforms initiated in South Africa after 1994 adopted a primary health care approach. This had led to the building of a range of new clinics to make health services more accessible, affordable and equitable. However, the pressures of a predominantly hospital-centric health care system, together with emerging epidemics, prevented the successful delivery of quality and comprehensive, integrated primary care to millions of South Africans. Also, little attention was given to community partnerships and multi-sectoral collaboration.
In 2010 the focus shifted towards proactive household- and community-focused interventions. Acknowledging health care as a universal right, the approach encompasses promotion of healthy living, disease prevention, early detection, treatment of illness, community-based disease management and rehabilitation. This led to establishing municipal ward outreach teams, district specialist teams and school health teams.
In Gauteng it resulted in the adoption of Community Oriented Primary Care (COPC) as the province’s approach to re-engineering primary health care. This brought about the creation of health posts at district level, where the University of Pretoria’s Faculty of Health Sciences facilitated the implementation process with the Tshwane District Office of the Gauteng Department of Health and Social Development.
More about COPC
In essence, COPC is grounded in the notion that people’s health is largely determined by their social environment. This means that individual and community level improvements in health cannot be achieved without simultaneously changing the social factors that shape health. COPC can be described as the merger of front line clinical medicine with public health. It addresses individual health needs in a collective family and community context and is rendered by multi-disciplinary teams that work in collaboration with local people.
The Tshwane health post model
COPC in the Tshwane District is designed around health posts. These structures are physically located in the communities and health care practitioners comprising professional nurses and CHWs are based at the health posts. As teams, their responsibility is to interact in a proactive way with every household under their jurisdiction. Their role is to promote health, early prevent or detect risks and disease, support minor treatment, rehabilitation and palliation, and to do this in a way that both develops capacity and shares responsibility for health care between service providers and service users.
Each health post serves between 2000 and 3000 households in a defined geographic area within a municipal ward. Each CHW is assigned around 250 households.
At its core, the health post team comprises an Outreach Team Leader (OTL) and 12 to 18 CHWs, proportionate to the number of households served. The OTL is a professional or enrolled nurse and the CHWs are recruited from the communities surrounding the health posts. This approach enables the team to work from a sound understanding of the local culture and idiom.
How the health posts function
The community-oriented primary care programme begins when the ward based outreach teams familiarise themselves with the organisations that are active in their communities by conducting institutional assessments to determine how existing organisations work and to evaluate the contribution they could make to the health post. Health post teams, furthermore, familiarise themselves with the individuals and families who live in the households they will serve. This involves carrying out household registration and individual structured health status assessments in order to establish individual, household and community baselines. These are used to understand the predominant health issues and to determine priority interventions at all levels. These assessments are ongoing so that new issues can be identified and responded to as they arise in a continuous and repeated way.
The ward based outreach teams capture the household registration and triage assessment data on their mobile phones, using the AitaHealth application. The household’s health assessment data is transmitted in real time to the cloud and can be accessed using a web-based data platform. Using daily electronic reports on all CHW visits and interventions, as well as additional verbal reports from CHWs, the Outreach Team leaders are able to allocate daily tasks and address health and social challenges for each household as they arise. The family files are also confirmed, refined and updated through regular home visits. In addition, data is aggregated for community-level assessments and broad strategic health campaigns. The health post teams are able to use the data to plan and determine interventions to the individuals and family members in the respective households. Reports are shared with the clinic managers and operational managers who provide clinical support to the teams. Together with district managers, the University of Pretoria and other collaborating partners use this data to determine short, medium and longer term interventions. Between September 2014 and June 2015 a total of 40 000 household health status assessments had been carried out, using AitaHealth. This figure increased to an impressive 150 000 by March 2017.
(* The above information had been extracted from an opinion paper by the University of Pretoria: Conceptualizing Community Oriented Primary Care (COPC) – the Tshwane, South Africa, health post model. Copyright: © 2013.)
Back to Ms Bam
“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,” says Bam. “And we certainly are successful!”
She acknowledges AitaHealth’s contribution to their success. “Before introducing AitaHealth as a health service management platform and tool, we had piles of hardcopy data sheets that were impossible to process. With AitaHealth, community data is captured, processed and accessible on various levels in real time. We are now able to manage the community health programme on executive level while, at the same time, understanding the detail relating to specific households.”
Having registered 150 000 households becomes an even greater accomplishment when she points out that, on average, each household consists of at least four family members. “In essence we’ve registered at least 600 000 individual community members in Tshwane’s community health programme” Bam says.
Mezzanine, developers of AitaHealth
Casper Strydom, AitaHealth product owner at Mezzanine, gives perspective on the bigger structure and where Mezzanine as a business fits in.
“We started with the development of AitaHealth as a Community Care product in March 2014. Mezzanine is the product and technology partner, the University of Pretoria: Department of Family Medicine the application content partner, and Vodacom the connectivity partner. Furthermore, data collected in the community health programme is securely stored at Vodacom’s state-of-the-art data centre.”
Apart from Strydom’s executive function in managing AitaHealth within Mezzanine, he’s also hands-on when it comes to supporting AitaHealth in the Tshwane District. He attends the monthly governance meetings with all stakeholders in the project where data and the product’s performance, amongst others, are discussed and evaluated. This, together with other ongoing user feedback, enables him to continuously enhance the product according to the community health programme’s requirements and needs.
He makes it clear that data capturing is merely a small function of AitaHealth. Essentially it is an interactive product that empowers CHWs to deliver preventative care services to communities on a home based level. It supports both administrative and clinical decision making on a real-time basis.
Strydom is more than satisfied with the performance of the product and feels proud about being part of the project. “What we do impacts upon the important work that the CHWs and local government do to improve the livelihood in communities. By helping them to deliver a better service, we’re also helping to improve the circumstances of those who are in need of health and social services. And isn’t helping others what we all should strive for?”
The joy of the trainer
Muzi Raseroka, an experienced CHW and now a research assistant at the University of Pretoria’s Department of Family Health, is responsible for training the CHWs in the use of AitaHealth. This takes place at the university, where possible, or in the respective communities.
He delights in this role as it keeps him in contact with community health projects and, at the same time, it gives him the opportunity to transfer AitaHealth user knowledge to those who are using the product. “It makes me happy to be out there in the community,” he says. “To have an influence on the outcome of the success of our community health projects, for me is a bonus that I’m proud of.”
He points out that having registered 150 000 households in the Tshwane District is more than merely a number. He makes a strong point that this achievement highlights the need to further recognise and acknowledge the role of the CHW as an important member of the health team. “If we have more CHWs in the communities, it will dramatically increase the number of households reached, reduce the burden of disease and improve health outcomes through the AitaHealth service delivery platform,” Raseroka says.
· AitaHealth is also used in the Free State’s Thabo Mofutsanya district, the Gert Sibande district in Mpumalanga and the Umgangandlovo district in KwaZulu-Natal.
More about AitaHealth
How it works
Ward Based Outreach Teams, consisting of Team Leaders and Community Health Workers (CHWs), use AitaHealth to capture the registration and health assessment details of the households they visit directly onto their smartphones. The CHW interviews the head of the household to identify any household health risks. The CHW also conducts a broad household triage assessment to determine if any household members require assistance with key health issues and to allocate health care priorities.
The AitaHealth workflow starts with the registration of the household and all its members. The health worker completes a triage assessment for each household member. Thereafter an overall assessment of the households living environment is done. Based on the outcomes of the triage assessment follow-up visit are scheduled and prioritised based on a predefined clinical decision support process.
In addition to this Mezzanine in partnership with the Family Medicine Department of the University of Pretoria has implemented an Individual Health Assessment module which gives the health worker the option to do a more in-depth health assessment for each household member. The assessment covers the following modules: General health (sensory and performance/activity), lifestyle, child health, oral health, chronic/non-communicable diseases, TB, reproductive health, HIV, cancer, violence, sexual assault, accidents and injury.
Each of these modules assists in building a health risk profile for each household. The questions focus on screening and identifying health issues which provide the health worker with more administrative and clinical decision support throughout the assessment.
· Each phone is associated with a specific CHW. In this way all data captured is linked to the CHW, their Ward and the Health Facility they report to.
· Built-in on the spot data validation checks automatically if the CHW is entering data in the correct format. This ensures record and database integrity.
· Consent for registration and research purposes is captured with an electronic signature.
· The on board GPS captures the location of the household registered.
· The integral skip logic features ensure that CHW’s only capture relevant information based on the demographics of the household.
· The built-in interactive decision support feature empowers CHWs to identify health risks in real time.
· A full task management feature allows CHWs to schedule follow-up visits and track their daily tasks.