Zambian Centre for Applied Health Research and Development Limited, Lusaka, Zambia.
Center for Global Health and Development and Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
Glob Health Sci Pract. 2017 Sep 28;5(3):486-494. doi: 10.9745/GHSP-D-16-00275. Print 2017 Sep 27.
Effective community health management information systems (C-HMIS) are important in low-resource countries that rely heavily on community-based health care providers. Zambia currently lacks a functioning C-HMIS to provide real-time, community-based health information from community health workers (CHWs) to health center staff and higher levels of the health system.
We developed a C-HMIS mobile platform for use by CHWs providing integrated community case management (iCCM) services and their supervisors to address challenges of frequent stock-outs and inadequate supportive supervision of iCCM-trained CHWs. The platform used simple feature mobile phones on which were loaded the District Health Information System version 2 (DHIS2) software and Java 2 platform micro edition (J2ME) aggregation and tracker applications. This project was implemented in Chipata and Chadiza districts, which supported previous mHealth programs and had cellular coverage from all 3 major network carriers in Zambia. A total of 40 CHWs and 20 CHW supervisors received mobile phones with data bundles and training in the mobile application, after which they implemented the program over a period of 5.5 months, from February to mid-July 2016. CHWs used the mobile phones to submit data on iCCM cases seen, managed, and referred, as well as iCCM medical and diagnostic supplies received and dispensed. Using their mobile phones, the supervisors tracked CHWs' reported cases with medicine consumption, sent CHWs feedback on their referrals, and received SMS reminders to set up mentorship sessions.
CHWs were able to use the mobile application to send weekly reports to health center supervisors on disease caseloads and medical commodities consumed, to make drug and supply requisitions, and to send pre-referral notices to health centers. Health center staff used the mobile system to provide feedback to CHWs on the case outcomes of referred patients and to receive automated monthly SMS reminders to invite CHWs to the facility for mentorship. District- and central-level staff were able to access community-level health data in real time using passwords.
C-HMIS, using simple feature phones, was feasible and viable for the provision of real-time community-based health information to all levels of the health care system in Zambia, but smartphones, laptops, or desktop computers are needed to perform data analysis and visualization. Ongoing technical support is needed to address the hardware and software challenges CHWs face in their day-to-day interaction with the application on their mobile phones.
在严重依赖社区卫生服务提供者的资源匮乏国家，有效的社区卫生管理信息系统（C-HMIS）至关重要。赞比亚目前缺乏一个运作良好的 C-HMIS，无法将社区卫生工作者（CHWs）提供的实时社区卫生信息提供给卫生中心工作人员和卫生系统的更高层。
我们为提供综合社区病例管理（iCCM）服务的 CHWs 及其主管人员开发了一个 C-HMIS 移动平台，以解决 iCCM 培训后的 CHWs 经常出现库存短缺和监督不足的问题。该平台使用了加载了 District Health Information System version 2（DHIS2）软件和 Java 2 platform micro edition（J2ME）聚合和跟踪应用程序的简单功能手机。该项目在 Chipata 和 Chadiza 区实施，这两个区都支持以前的移动医疗项目，并覆盖了赞比亚所有 3 家主要网络运营商的移动信号。在 2016 年 2 月至 7 月中旬的 5.5 个月期间，共有 40 名 CHWs 和 20 名 CHW 主管接受了移动电话和移动应用程序培训，并使用移动电话提交了他们所看到、管理和转诊的 iCCM 病例数据，以及 iCCM 医疗和诊断用品的接收和分发数据。通过移动电话，主管人员跟踪 CHWs 报告的用药情况，并对他们的转诊情况进行反馈，同时还接收短信提醒，以安排辅导会议。
CHWs 能够使用移动应用程序向卫生中心主管人员每周报告疾病负担和消耗的医疗用品数量，提出药品和供应需求，并向卫生中心发送预转诊通知。卫生中心工作人员使用移动系统向 CHWs 提供转诊患者的病例结果反馈，并通过自动每月短信提醒邀请 CHWs 到机构接受辅导。地区和中央级别的工作人员可以使用密码实时访问社区层面的卫生数据。
使用简单功能手机的 C-HMIS 为赞比亚的各级医疗保健系统提供实时社区卫生信息是可行的，但需要使用智能手机、笔记本电脑或台式电脑来进行数据分析和可视化。需要持续的技术支持来解决 CHWs 在日常使用移动电话应用程序时遇到的硬件和软件挑战。
