From left to right, former and current Akros GHC Fellows Aimee Edmondo, Aaron Mwamulimba, Nguza Yikona, Bethany Joy Larkin, Phillip Siwila, Musonda Chikwanda
On November 16, current and former Akros GHC fellows shared their experiences and fielded questions from hopeful GHC candidates. Each year, GHC a diverse group of young leaders with a vested interest in health equity joins GHC to complete a 13-month fellowship with partner organizations in five countries: Malawi, Rwanda, Uganda, Zambia, and the U.S.
Below is a full recording of the webinar in case you missed it!
I’ve realized that, in Zambia, almost everything is done in groups. I’ve arrived at a village called Ngandu Jakalasi expecting a short sit-down interview with a certain Mr. Mwiinga, but am instead greeted by every adult in the village, beginning to spread out on blankets and on logs. “Yes, everything in groups,” laughs my companion, Akros Surveillance Officer Anne Mutunda. “It’s the way we do transparency!” she muses, though I think she’s actually quite serious.
When my subject arrives I am at first a bit confused because my preparation notes say the man is 70. Instead the man I meet is spry-looking, wearing a trim gray goatee, a mischievous grin and a red bucket hat. After we exchange greetings and have a seat on opposing logs, ingeniously supported about a foot and a half above the ground by separate, y-shaped logs, I ask him about this apparent age discrepancy. “I am 70!” he tells me, “though I feel younger than that. Look, I can even run!” he says as he springs back up from his log and gives a demonstrative lap around the collected audience who clap and laugh in approval.
Elijah Charles Mwiinga, 70, sits with his neighbors to discuss bringing the message of CLTS to his community.
He attributes much of this energy to his having been a teacher for 20 years, first in Zambia’s Western Province and then in its Southern Province. When Mr. Mwiinga was a boy, his uncle was a teacher, and he envied the man, who he saw as getting to spend enjoyable days with the children of his class, having fun while passing down knowledge. So go into teaching he did, and successfully, rising through the ranks of teacher and head teacher and, eventually, school principal. He says his job was difficult at first – the schools at times had no materials. As the years went on, the job got easier as he knew more of what to expect.
In 1990 he retired from teaching and decided to return home. He had grown up in the village and he wanted to return. “I was brought up as the son of a farmer so I decided to come back and farm,” he said. “We depend on the farms. We grow what we eat.” He now grows cabbage, tomatoes, onions, rape, and sometimes carrots. Though he had begun his new “retired” life as a farmer, Charles was still a connector of people – he maintained his teacher’s proclivity for explaining things in ways people could understand. (He has been given the nickname “The Professor” in his community as a result.) It was likely for this reason that the Environmental Health Technician (EHT) for his community chose him to attend a workshop in Mazabuka when the first training for Community Champions began. “I didn’t know exactly what it was but I went,” he said.
Charles was there introduced to the idea of villages working toward becoming open defecation free (ODF), an idea brought about by the community-led total sanitation principals (CLTS) developed by UNICEF and introduced at the community level by trainings led by Akros. The ODF movement encourages communities to construct and begin using latrine toilets rather than defecating in “the bush” or in the open where flies and animals can get to the waste and spread it around the community on their feet, contaminating food and potentially causing sickness and disease.
Mr. Mwiinga checks some of the latrine construction numbers from the past month.
“We were used to open defecation,” said Mr. Mwiinga. “It was challenging for the instructors to convince even us of the need for change.”
Some of the innovative toilet adaptations in Charles Mwiinga’s community include features like this toilet paper roll holder.
But Charles and his fellow Community Champions (CC) were eventually convinced of the importance of this movement, and began sharing the message with their communities. “Being a CC was challenging, but rewarding,” he said. “We were going from place to place trying to convince people that open defecation was a thing of the past, that they should have shame and disgust at it. I remember one of the first times we held a meeting and triggered at a nearby village. Some people, upon seeing the link between the feces and the food carried by the flies would even vomit! These things, these feces, are not meant to be with us. After that most people realized how important it is to have a toilet.”
He has seen swift change in his community as he continues to share with them the importance of using toilets. In a village of 19 households, where just a few years ago there were virtually no toilets, 15 now use toilets, with plans for more to be built. He said that, interestingly, one of the drivers of toilet construction in his area are children, who are becoming accustomed to using toilets at school. “These children say, ‘we don’t just go in the open at school why should we do it here?’” said Mr. Mwiinga.
The uptick in toilet use, from Mr. Mwiinga’s perspective, seems to be doing more than reducing the chances of stepping in something unpleasant on your walk from place to place. He said that in 2012, coughs and water-borne diseases were rampant, but that when you go to clinics now, diarrhea is down and diseases brought by flies are down.
The tippy tap system has made it easier for toilet users at the community level to wash their hands regularly.
Charles has also led the construction of tippy taps in the areas he oversees – easy to build and upkeep devices that allow someone to wash their hands after using the toilet. “It is almost like a game for the children,” he says. “I put five liters in the tippy tap in the morning and by the evening it’s gone! ‘Grandfather, let me go to the toilet,’ they say. It’s because they want to wash their hands with the tip tap!”
Mr. Mwiinga sees himself as a lifelong civil servant. “I thought I should continue to improve the lives of my people,” he said. “Growing up, we didn’t know why we were sick so often. We thought maybe we didn’t eat properly, or perhaps we ate too much. Now we know more of the reasons. I really want my people to change from the old system of life to the modern system. I want the toilets to improve even from the state they’re in now.”
About Andy Prinsen
Andy Prinsen is Communications Lead for Akros. He has a masters degree in public affairs and a bachelors in journalism, both from Indiana University. He specializes in visual communication and photography.
We strive to be consistently on the cutting edge of the development and technology sector. And the cutting edge does not form without a stalwart commitment to research and a collecting of best practices. We are excited to have been mentioned in several recent pieces of independent research as having implemented technologies and systems that are furthering development work around the world.
Mobile Solutions for Malaria Elimination Surveillance Systems: A Roadmap
The first is in a report titled “Mobile Solutions for Malaria Elimination Surveillance Systems: A Roadmap” funded by the Gates Foundation and carried out by Vital Wave. The study was done to “develop key recommendations regarding appropriate, scalable strategies to promote further innovation and coordination among technology partners” and to “Develop specific recommendations for a coherent and effective Foundation strategy for strengthening data collection systems and associated platforms.” Our mSpray system was featured as a highlight of the geolocation category for the way it increases the efficiency and effectiveness of indoor residual spraying (IRS) campaigns (page 48 of the report).
In its conclusions and recommendations, the report points out that “many of the key elements needed to improve the development and implementation of robust mobile tools for malaria surveillance already exist.” It also says that coordination among malaria program implementers will be key to success and will help keep current the list of necessary features within these digital tools.
Improving Data Quality in Mobile Community-Based Health Information Systems–Guidelines for Design and Implementation
Another report, titled “Improving Data Quality in Mobile Community-Based Health Information Systems–Guidelines for Design and Implementation” carried out by Measure Evaluation focuses on the most localized levels of data collection, namely the areas where community-based health workers (CHWs) collect and submit data and often provide services as an extension of the health system at large. Akros is featured when the report speaks to performance-based incentives established for health workers and their supervisors (page 26). In our community-based surveillance of malaria program, CHWs were incentivized with mobile phone airtime, helping the program maintain strong reporting rates and therefore better data from which to make decisions.
DHIS2 Community Health Information System Guidelines
In a third report, titled “DHIS2 Community Health Information System Guidelines” by the Health Data Collaborative, Akros and the University of Oslo collaborated on a DHIS2-based information system for Water and sanitation that was featured for its focus on transition to the Zambian government, its unique moible-to-web application, and its use of automated feedback loops (page 164).
What do you feel when the Star Wars end credits roll? If you’re like me, it’s an abrupt mental shift from awestruck fantasy back to real life, a reminder the movie only got made when thousands of real people collaborated towards a singular vision. If you’re nerdy enough to dive into “behind the scenes” extras, all the grunt work needed to make a blockbuster franchise looks… well… less exciting. Of course, once you discover how a film was made, you begin to appreciate its artistry on a whole other level.
I had the same feeling as I absorbed two weeks of conferencing in India with digital development and global health practitioners from around the world on behalf of Akros. At the Information and Communication Technology for Development (ICT4D) conference in Hyderabad, we joined global experts to share our practical experiences in applying new technologies across a wide spectrum of development and humanitarian programs. Akros also participated in the Health Data Collaborative’s community health experts’ consultation in Goa, The workshop convened academics, government officials, and implementers from eight countries to craft technical guidelines on digitizing mobile health data from community health workers, the volunteers who deliver critical services in the most remote regions of Africa and Asia.
From theorizing on the broad meaning of the “Data Revolution” down to nitty-gritty tech requirements of community information systems, the overarching theme of both events was mainstreaming technology into day-to-day operations of development programs. That means moving past the futuristic “gee wiz” stage of exploring what’s possible with ICT4D, towards setting practical expectations and realistic national strategies. This is very familiar territory for us at Akros, where we have a developed for applying practical informatics systems for a variety of complex development challenges, ranging from malaria prevention to education management.
Some of the tips shared at the ICT4D Conference might seem obvious in theory, but can be surprisingly rare in practice, especially in public health. For example, before you start an new system to collect community level health data, you ought to know what kind of data already exist, and ask real people how these data are used. This tactic was exemplified by Cooper/Smith, which presented a robust landscape analysis of HIV data in Malawi under the Kuunika – Data for Action! project. Their focus groups with stakeholders found over 3,527 unique data elements across five systems, informing 335 unique decisions. Detailed assessments like these will not only increase the use of routine health data for decision-making, but might catalyze new innovations to send data where its most needed. Ona presented on the tablet-basedmSpray tool, deployed by Akros in Zambia, which gives managers of Indoor Residual Spray teams the localized geographic information they need to manage local spray operations. Mangologic and e-Registries also presented on two adaptive tools for health professionals to bridge individual-level patient records with population-level health management systems— two solutions which only arose from assessing what tools already exist, and finding their design inappropriate for the complex user needs. Read More
Over the past few months, two photos by Akros Communications Lead Andy Prinsen have been selected as winner and honorable mention in their respective photography competitions. The first was the “Picturing inclusive CLTS photo competition” sponsored by the CLTS Knowledge Hub, and Prinsen’s photo titled “School Sanitation: Equal and Proud” was selected as one of three winners.
Female students from Maunga School in Zambia’s Southern Province stand in front of one of the school’s new improved latrines. When the girls were menstruating, they would often stay home for lack of sanitation facilities at school. Now, with funds from UNICEF, the girls’ latrines are built with a privacy enclosure and a specially built water-channeling floor so they can wash properly before returning to class. Through sanitation tracking done by Akros, the school has seen a significant decrease in the young women missing school for days at a time.
The CLTS Knowledge Hub is a collection of news and information on the Community-Led Total Sanitation Movement and is a great resource for professionals working in the field or those interested in learning about CLTS.
Another of Prinsen’s photos was selected as the honorable mention for the category of mHealth and Communications Technology in the 12th annual Photoshare contest.
An Akros surveillance officer sits with Community Champions from Nyimba, Zambia, to map the villages they serve. In this innovative mapping process, the surveillance officer uses Google Earth’s satellite imagery to navigate these community members’ villages “like a bird in the sky.” Most community champions have never seen satellite imagery before, but they know their communities so well that the mapping process works amazingly well. This is the first time decision makers at the national level will have detailed location data on these villages, allowing them to make more informed decisions and reach villages in times of emergency.
Photoshare is a service of the Knowledge for Health (K4Health) project, based at Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (CCP). Photographers submit images to Photoshare for free, public use by nonprofits and for educational purposes. Photoshare is a leading source for public health and development communication, focused on demonstrating the value and impact of photography in global health efforts to improve health and save lives.
To achieve malaria elimination, an understanding of neighboring country malaria situations is critical for the prevention of introduction of parasites. Malaria parasites don’t stop at country borders, so effective elimination strategies shouldn’t either. That is why the Elimination 8 (E8), in its strategy on cross-border collaboration, identified Akros to support the development of the E8 Regional Surveillance Database System (ERSD) for the eight member states constituting the E8: Botswana, Namibia, South Africa, Swaziland, Angola, Mozambique, Zambia, and Zimbabwe. This innovative approach is a means to level the playing field and conduct malaria surveillance at a regional scale.
Figure 1. Cross-border incidence* in districts in Zambia, Mozambique, and Zimbabwe: Having access to several countries in one database allows these kinds of visualizations, which may highlight transmission patterns that occur between countries, which in turn supports decisions to invest in control methods in border areas. *All data shown is used purely for illustrative purposes and do not reflect current or historic epidemiological status of countries. Current data can be accessed in the database itself by those granted authority.
Malaria is hardly an emerging disease, and though the interventions of preventing, treating, and monitoring malaria are somewhat standardized, each country has slight permutations of their approach to doing so. Indicators may differ slightly, investment in one prevention method versus another likely differs too, and policies surrounding implementation certainly are not identical. Read More
CLTS has been shown to be an effective method to combat malnutrition and stunting in children under five. In this study, a mobile-to-web platform increased the uptake of CLTS even further, allowing for greater community feedback, a reduced cost per new user of sanitation, and increased data transparency.
Akros, in partnership with Zambia’s Ministry of Local Government and Housing (MLGH) and UNICEF, layered a unique mobile-to-web application over traditional CLTS delivery methods, resulting in an innovative service delivery and monitoring system dubbed “CLTS M2W.”
CLTS M2W uses mobile phones, automated data feedback loops, and engagement of traditional leaders to provide communities with the ability to clearly see their progress towards sanitation goals. CLTS M2W paved the way for unprecedented CLTS uptake in Zambia, facilitating the creation of over 1,500,000 new users of sanitation in 18 months. In short, CLTS creates the demand, and CLTS M2W creates the critical transparency necessary to drive sustained behavior change.
GAVI is an international organization – a global Vaccine Alliance – bringing together public and private sectors with the shared goal of creating equal access to new and underused vaccines for children living in the world’s poorest countries. It is backed in part by the Bill and Melinda Gates Foundation.
GAVI held its first INFUSE workshop (Innovation for Uptake, Scale and Equity in immunization) in Geneva. Around 60 organizations and companies applied to the program, and 18 of these projects were selected for a final round of vetting in front of a panel with representatives from the organizations and companies like the World Health Organization (WHO) and UNICEF. At the end of the workshop, the panel selected seven “pacesetter” organizations who will work with GAVI to scale up their ideas and projects and bring them to new countries.
We are excited to announce that Akros has been selected as one of these seven pacesetter organizations for a concept that follows in-line with our approach of gathering village level information to inform decision making. The approach takes existing monitoring tools in the country, like stock monitoring and commodities tracking, and merges them into a single vaccine-tracking database using a platform called DHIS2. In the database, Rural Health Clinics (RHCs) log immunizations delivered using simple feature phones. Parents of children due for their next immunization receive SMS appointment reminders along with a list of clinics that have the vaccine in stock. The RHC also receives a list of patients in the area who are due for follow-up vaccination appointments.
“Vaccine coverage has made big leaps, but until we reach the last mile of care, we won’t see disease elimination,” said Akros Portfolio Lead, Laurie Markle. “We are excited what this partnership could mean for reaching the ‘fifth child,’ not just in Zambia but around the globe.”
Akros is proud to be working with Sightsavers, an organization working in more than 30 countries to eliminate avoidable blindness and support people with visual impairments to live independently. Recently, we spent a day with Chipo, a young girl living in rural Zambia. Both Chipo’s great grandmother and great-great-grandmother are blind as the result of an infection called trachoma. Their disability would make life more difficult anywhere in the world, but especially so in the setting where their family lives. Chipo must work extra hard every day to care for her elders, often times at the expense of her studies.
Sightsavers has featured Chipo’s story, created in partnership with Akros, at their Exposure site. Click here to read the story, and stay a while to browse the other powerful pieces demonstrating the difference that can be made for those with blindness – and in the prevention of blindness – around the world.
For a longer version of Chipo’s story, click below to download the PDF.
Andy Prinsen is Communications Lead for Akros. He has a masters degree in public affairs and a bachelors in journalism, both from Indiana University. He specializes in visual communication and photography.
About two years ago, Zambia’s Ministry of General Education (MoGE) approached us with an idea: let’s build a more routine, faster method for capturing key school indicators. At that point, the Ministry was collecting a 27-page annual census and using the data to make nearly every key decision like procurement of school supplies, investments in infrastructure, and distribution of teachers. The data was outdated by the time it was received and the Ministry needed a method of responding to student needs more than once per year. Shortages in teachers, textbooks and toilets require a more timely response than an annual survey allows.
And so began the work of setting up Zambia’s first mobile-to-web Education Management Information System (EMIS). Though education was a new sector for Akros, we knew what it takes to build out a national system and began applying those principles:
(1) Keep your eyes on sustainability
I remember walking out of our initial stakeholder meetings with a list of over 40 data elements in hand. We knew this was too many. Sending data, though inexpensive, adds up when you grow to scale and sending too much data creates reporter fatigue. It took us a few months of asking key questions, like “when are you making decisions?” and “What do you need to know in order to make them?” to get the list of data elements down to 11. With only 11 questions, we’re monitoring student and teacher attendance, school-feeding program activity, grant distributions, access to sanitation and menstrual hygiene management, and test scores in literacy and numeracy.