Originally Posted on July 1, 2010 by karibusauri
By Denise Lee & Jaclyn Carlsen
No, not that Hilary Clinton, this was a little boy (yes a boy) living in the Sauri Millennium Village Cluster. Hilary was having a nutritional status screening performed by Richard*, his community health worker. To do this, Richard placed a specially designed flexible ruler around Hilary’s arm and recorded the measurements. This measurement, known as a MUAC (mid-upper arm circumference), serves as an uncomplicated, effective field method for identifying malnourished children under five.
In the past, community health workers (CHWs) in the area were volunteers who provided basic health advice and services. When MVP began operations in Sauri five years ago, a core part of their health strategy was to establish a network of professional CHWs. To do this they provided them with training and a small stipend, and increased their responsibility and accountability. In addition to mass nutrition screenings, CHWs in the cluster also treat malaria and diarrhea in children under 5, monitor pregnancies, sensitize households on water and sanitation, provide advice on family planning and give referrals for pneumonia. For the past 7 months, the CHWs have been utilizing a new mHealth platform, ChildCount+, which uses SMS messages to monitor pregnant mothers and track nutrition readings, malaria, and other illnesses in children under 5.
Going around with a CHW was eye-opening. It’s one thing to read about nutrition screenings and the use of mobile phones for health monitoring, but quite another to see it in action. Four times a year the CHWs perform the mass nutrition screening, going from household to household measuring the MUAC of all children under 5. On the day I trailed him, Richard visited a total of seven households in Nyaminia. After measuring the children, he texted the results of the screening to the central ChildCount+ database that records all the personalized health data the 108 CHWs send in.
A major benefit of ChildCount+ is that it provides immediate feedback to the CHWs, guiding their action. For instance, if any of the children we monitored had had a MUAC below 115mm, Richard would have received a message to refer them to the clinic for treatment of Severe Acute Malnutrition. Hilary’s MUAC did not indicate undernutrition, but it had dropped from 210mm to 168mm prompting Richard to inquire about Hilary’s health and eating habits. After Hilary’s mother mentioned he had been sick recently, Richard explained the importance of seeking medical attention in such cases and ensuring a nutritious diet.
A CHW performs a nutrition screening using a MUAC
Similar feedback is provided for malaria cases. In one home, after texting in the results of a positive rapid malaria diagnostic test and the estimated weight of the child, the system sent back a text message of the appropriate dosage of Coartem the child should take. Although an experienced CHW may know these prescriptions by heart, each of these texts acts as a check of diagnosis and prescription, and the ChildCount+ system processes the information in a database that makes monitoring faster and easier.
There is great value in mobile systems such as the one used by the CHWs in Sauri. Beyond providing immediate feedback, this type of system can reinforce the learning of newer CHWs, increase accountability by quantitatively measuring the actions of CHWs, improve tracking of health and disease patterns in a community, inform resource allocations, and with proper monitoring and evaluation tools, assist in measuring the effectiveness of interventions.
Although the use of ChildCount+ in the field has been impressive, our time with the CHWs emphasized the point that an information system is only as good as its people and its tools. Although none of the children monitored were severely malnourished, there were some who were clearly not receiving all the necessary micronutrients. Others, such as Hilary, were not yet in the danger zone, but were in danger of having their conditions worsen if not given proper medical care. These cases could only be recognized and acted upon by a trained health worker, like Richard, who is familiar with the people he works with and has resources at his disposal. Richard himself had some critiques of the ChildCount+ and CHW systems. The texting of medical information takes time and errors do occur. As the CHW system has become more professionalized, responsibilities have expanded and many feel that the pay, a stipend provided by MVP, is far from adequate. Even though there are challenges, CHWs have seen improvement in the nutrition status of the children in the region, and attribute these changes to MVP interventions such as door-to-door health screenings, nutrition training, and immediate clinic referrals for emergency and supplementary feeding.
A CHW using the ChildCount+ system to register a new person.
*names changed
This piece was originally two posts on http://karibusauri.wordpress.com/ and was also posted on www.summerinsauri.wordpress.com. We thank the authors for their permission to combine the two posts and cross-post on ChildCount.org.
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