Layer Erica, Slim Salim, Mussa Issa, Al-Mafazy Abdul-Wahid, Besana Giulia V R, Msellem Mwinyi, Fulcher Isabel, Hornung Heiko, Lampariello Riccardo
D-tree International, Norwell, MA, United States.
Ministry of Health, Zanzibar, United Republic of Tanzania.
JMIR Med Inform. 2023 Oct 9;11:e48097. doi: 10.2196/48097.
While high-quality primary health care services can meet 80%-90% of health needs over a person's lifetime, this potential is severely hindered in many low-resource countries by a constrained health care system. There is a growing consensus that effectively designed, resourced, and managed community health worker programs are a critical component of a well-functioning primary health system, and digital technology is recognized as an important enabler of health systems transformation.
In this implementation report, we describe the design and rollout of Zanzibar's national, digitally enabled community health program-Jamii ni Afya.
Since 2010, D-tree International has partnered with the Ministry of Health Zanzibar to pilot and generate evidence for a digitally enabled community health program, which was formally adopted and scaled nationally by the government in 2018. Community health workers use a mobile app that guides service delivery and data collection for home-based health services, resulting in comprehensive service delivery, access to real-time data, efficient management of resources, and continuous quality improvement.
The Zanzibar government has documented increases in the delivery of health facilities among pregnant women and reductions in stunting among children younger than 5 years since the community health program has scaled. Key success factors included starting with the health challenge and local context rather than the technology, usage of data for decision-making, and extensive collaboration with local and global partners and funders. Lessons learned include the significant time it takes to scale and institutionalize a digital health systems innovation due to the time to generate evidence, change opinions, and build capacity.
Jamii ni Afya represents one of the world's first examples of a nationally scaled digitally enabled community health program. This implementation report outlines key successes and lessons learned, which may have applicability to other governments and partners working to sustainably strengthen primary health systems.
虽然高质量的初级卫生保健服务能够满足一个人一生中80%-90%的健康需求，但在许多资源匮乏的国家，这一潜力因卫生保健系统的限制而受到严重阻碍。越来越多的人达成共识，即设计有效、资源充足且管理良好的社区卫生工作者项目是运作良好的初级卫生系统的关键组成部分，数字技术被认为是卫生系统转型的重要推动因素。
在本实施报告中，我们描述了桑给巴尔全国性的、数字化支持的社区卫生项目——Jamii ni Afya的设计与推广。
自2010年以来，D-tree国际组织与桑给巴尔卫生部合作，对一个数字化支持的社区卫生项目进行试点并积累证据，该项目于2018年被政府正式采纳并在全国推广。社区卫生工作者使用一款移动应用程序，该程序指导家庭卫生服务的提供和数据收集，从而实现全面的服务提供、实时数据获取、资源的高效管理以及持续的质量改进。
自社区卫生项目推广以来，桑给巴尔政府记录到孕妇获得卫生设施服务的情况有所增加，5岁以下儿童发育迟缓的情况有所减少。关键成功因素包括从健康挑战和当地实际情况出发而非从技术出发、利用数据进行决策，以及与当地和全球合作伙伴及资助者进行广泛合作。吸取的经验教训包括，由于需要时间来积累证据、改变观念和建设能力，扩大数字卫生系统创新规模并使其制度化需要很长时间。
Jamii ni Afya是世界上首批在全国范围内推广的数字化支持社区卫生项目之一。本实施报告概述了关键的成功经验和吸取的教训，这些经验教训可能适用于其他致力于可持续加强初级卫生系统的政府和合作伙伴。
