Building one of the world’s largest data surveillance platforms
Chief Singani of Zambia’s southern province displays the tablet that he uses to check up on his chiefdom’s sanitation progress.
Leveraging a massive network of community volunteers, Akros works with the Zambian government and UNICEF to manage one of the world’s largest data surveillance platforms. The platform, designed and scaled for monitoring sanitation uptake in rural villages, relies on a network of over 3,600 community champions (CCs), environmental health technicians (EHTs), and other government representatives at the district level to report on sanitation uptake from ~ 21,000 villages across Zambia using mobile devices. The sanitation platform, which includes information on community and school led total sanitation and facial and environmental cleanliness for trachoma elimination is the largest surveillance platform in Zambia. However, Akros also supports similar community data collection systems in Zambia for malaria, education and land tenure. The systems, although different in content, all funnel data up from the community level into national level DHIS2 databases using similar technology. Many of the community volunteers use their mobile phone to collect data for more than one of the systems, reporting on multiple issues simultaneously such as latrine standards and mosquito net usage in their communities.
How does this work?
Across all sectors, it begins with a feature phone, a simple Nokia model mobile device. In their respective sectors, volunteers visit the households in their specific catchment area and survey specific indicators such as hand washing stations, proper number of mosquito nets per household member and latrine covers. They then input this information into the mobile phone DHIS2 platform for that month. With consistent data input, the software then allows anyone with a username, password and Internet access the ability to see up-to-date data on malaria, sanitation and trachoma statistics for different districts and provinces in Zambia. In community-led total sanitation (CLTS) alone, more than 1,300 village-level Community Champions (CCs) provide monthly reports to DHIS2 from over 13,500 villages.
DHIS 2 is a flexible, web-based open-source information system with visualization features centered around a dashboard for users and includes GIS, charts and pivot table functionality. This low-tech and sustainable mobile to web data collection approach allows for a readily available information system that paints an up-to-date picture of public health in Zambia.
These are Zambian people working under Zambian leaders working towards improving Zambian communities.
Statistically, especially in a country with limited resources and health staffing, the increase in volunteers reporting has decreased the burden on already understaffed health facilities. In malaria surveillance, for example, by training CHWs posted within their communities to test and treat for malaria, malaria management has expanded from 260 health facilities to a total of more than 1,800 health facilities and CHW posts. Consequently, outpatient burden on health facilities has also seen a decrease of 8.5% as the additional CHW workforce are now in the community providing malaria testing and treatment.
The machine behind this massive data surveillance platform is the network of personally invested and engaged Zambian volunteers. It is more than data collection; it is a concentrated effort in improving their communities. Akros’ programs strive to work with governments to enable, empower, and encourage these volunteers to do their jobs in all of these areas by minimizing reporting burden, providing cross-sectorial supervision and support, and giving them feedback to make their value tangible, guide micro-planning, and encourage best practices.
Here are some of those best practices.
Engaging Communities, Local Leaders and Government Entities
Akros works with Zambian community volunteers. We consult with traditional leaders, chiefs and chieftenesses, and partner with UNICEF Zambia, the Ministry of Local Government and Housing, the Ministry of Health and the Ministry of Education. The success of Akros programs and surveillance relies on engaging these highly respected and powerful community and government members.
Because of Akros’ engagement with Zambian national and local leaders, data surveillance participants have a sense of ownership in their work. These are Zambian people working under Zambian leaders working towards improving Zambian communities.
Appropriate & User-Friendly Technology
The technology used in reporting is both accessible and appropriate for the setting of the work being done. What use would an innovative system be if nobody could easily access it? The choice of simple, affordable and easy-to operate mobile devices is especially important in this context.
Feedback loops empower communities and impact local decision-making. As volunteers add data to the system, government leaders and stakeholders can efficiently allocate resources to the regions most in need. In addition, it is important to also get the data back down to communities, especially visually. This is done through chief reports, where chief tablets are updated with a “scorecard” of their villages. This awareness, especially useful in sanitation monitoring, creates a healthy competition between chiefdoms as chiefs work to make their villages “open defecation free” before other chiefdoms.
Both intrinsically and extrinsically, there must be incentives for the valuable volunteers that make this surveillance possible. Akros respects community health workers time by limiting the size of their catchment areas and ensuring they are not overstretched. The feature phones Akros provide volunteers also receive a monthly “talk time” payment for on-time reports, so that reporting does not drain volunteers personal phone credits.
The power of pride in this work is a welcome element of incentive. These EHTS, CCs, and CHWs are revered in their communities. They understand the importance of what they do and the importance it has on the landscape of public health in Zambia.
About Alexis Barnes
Alexis Barnes is a communications and advocacy Global Health Corps fellow at Akros. Previously a NYC-based journalist, she has interests in development, sanitation issues and human rights.