Innovation in Mobile Reporting: Community Health Worker Reports Land Tenure Claims with DHIS2

`Brian O'Donnell December 18, 2015
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I think mobile tools are fantastic, especially when they empower individuals to quickly report important community events. Does your neighborhood latrine require an urgent upgrade? DHIS2 monitors community-led sanitation programs which have brought over a million Zambians new access to adequate hygiene. Is your local health clinic running low on malaria medicine or rapid diagnostic tests? Akros has a DHIS2 app for that too.

These “mHealth” tools help communities navigate through crisis and transition, all while reinforcing each community member’s rights to lead healthy lives. I emphasize rights here because it’s ultimately these multiplicative, integrated rights (like access to care and access to clean water) which provide the foundation for sustainable development. If mHealth tools exclusively focus on health, they risk ignoring these other types of rights. For example, in rural Zambia, people also have the right to live and work on their family land. But where are the mobile tools to protect traditional rights to land ownership?

Juvensio Banda, chairperson of the Village Land Committee (VLC) in Kalichero, Eastern Province.

Juvensio Banda, chairperson of the Village Land Committee (VLC) in Kalichero, Eastern Province.

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How Zambia is Tackling Malaria

`Alexis Barnes December 11, 2015
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Click here to view original publication in Africa Times.

Five-year-old Melanie lives on the outskirts of Lusaka, Zambia’s capital city in Chainda compound, a settlement that is less than one square kilometer (.24 square mile) yet houses approximately 26,000 people. She spends her days running around the maze of dirt roads and alleyways, playing with the dozen siblings and neighbor children near her brick and mud home.

In late July she tested positive for malaria at Chainda Clinic, her small body exhibiting some of the most common symptoms, fever and chills, of a disease that affects approximately four million and kills 8,000 Zambians annually, according to UNICEF. More than 50 percent of those killed by the disease are children under the age of five.

Her positive malaria test immediately set off a chain of events. A Reactive Case Detection team, including a nurse, environmental health technologist and community health worker, dispatched to Melanie’s neighborhood. Within 90 minutes, the team tested family members and the nearest neighbors. The GPS locations of the homes and the test findings were then entered into a tablet- painting an on the ground real time picture of malaria statistics in that neighborhood of Lusaka.

Chainda Clinic is a part of a community led surveillance initiative, called Step D, taking hold in selected parts of Zambia. The Zambia Ministry of Health and the National Malaria Control Center (NMCC) in partnership with organization, Akros, are working to create five malaria-free zones by 2015, as proposed in the Zambia National Malaria Strategic Plan (2011-2016).

The first of its kind on the African continent, the community health worker malaria surveillance network mixes community mobilization and simple technology to tackle malaria in Zambia.

“In the past we used paper-based forms to collect data from the field and would send them to National Malaria Control Centre physically,” said Mwila Sianankange, an environmental health technologist (EHT) at Chainda Clinic. “This would take a much longer reporting time period.”

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Akros Contributes to mHealth Journal

`Alexis Barnes November 12, 2015
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Akros contributed to a recent USAID journal on mHealth use throughout Africa. The fourth volume compendium, produced by the African Strategies for Health Project for USAID, documented Akros’ work in malaria community surveillance for elimination, community-led total sanitation mobile surveillance and mSpray.

The article discussed how we partnered with the Zambian government to design a comprehensive WASH surveillance system using basic Nokia feature phones that works to target the 50 percent of Zambians that are without access to adequate sanitation.

Just like in our WASH work, the malaria community surveillance for elimination program we helped create uses a system where community health workers and mobile phones combined with the District Health Information System (DHIS) platform to create a sustainable solution to low access and areas of need.
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Zambia Systems for Better Health consortium created

`Andy Prinsen November 9, 2015
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USAID has awarded a new consortium a $54 million contract for a five year health systems strengthening project. Akros will be one member of the consortium led by Abt Associates that also includes the American College of Nurse-Midwives, the Broadreach Institute for Training and Education, Imperial Health Sciences, Initiatives, Inc., and Save the Children. Over the next five years, the consortium will collaborate with the Ministry of Health at all levels to strengthen the systems that underpin the delivery of high quality health services and increase the utilization of high impact health interventions at district and community levels.

The health systems strengthening strategies include an emphasis on five major program areas:

1. HIV – strengthening of systems that underpin the delivery of high impact HIV prevention, care and treatment services in high prevalence districts;

2. Family Planning – information and services to promote the delay, spacing and limiting births;

3. Nutrition –interventions at community level in Eastern Province aimed at reducing chronic malnutrition;

4. Maternal and Newborn Health – strengthening demand and services for safe delivery and newborn care; and

5. Child Survival – including Integrated Management of Childhood Illnesses (IMCI) and Expanded Program of Immunization (EPI).

This program builds on the success achieved by the Zambia Integrated Systems Strengthening Program (ZISSP) that was implemented from 2010 to 2014.

Health Worker Continues Commitment to Malaria Elimination Despite Injury

`Alexis Barnes September 24, 2015
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When Cairo Situlo learned of a new surveillance system that mobilizes community members and data, he sprung into action volunteering his time tracking down sources of malaria cases. He volunteers in the Southern Province Zambian city of Zimba to fight malaria in his community.

Mr. Situlo's x-ray, showing his orthopedic surgery.

Mr. Situlo’s x-ray, showing his orthopedic surgery.

When a health facility or post receives a malaria-infected patient, it alerts community health workers (CHWs) near the patient’s household. The CHWs then open a case investigation- testing surrounding households and giving treatment where applicable.

Committed community health workers like Cairo are vital to the system and their work has increased access to care in rural areas of Zambia, stopping transmission of the disease. Nowhere was Mr. Situlo’s commitment more evident than following his accident in late 2014.

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How to Harvest the Health Data Revolution

`Brian O'Donnell September 16, 2015
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Data is the last great hope for African development, heralded by leaders from the AU to the UN as the new currency of performance and accountability. Smoother data sharing might make chaotic traffic more streamlined, hold leaders accountable for public funds, or even help epidemiologists predict the path of ebola. The universal link between quality data and quality healthcare is particularly instructive. In developed countries like the United States, for example, sharing electronic health records will be fundamental for broadening access to care.

But if African healthcare professionals don’t believe the hype, the skeptic in me can’t blame them. Faced with the complexities of healthcare in developing countries, “open data” seems a reductive and naïve option. Doctors already go to school for eight to ten years, and besides, reporting to cloud-based databases through feature phone technology could distract them from their day jobs. And why on earth would they want to risk sharing patients’ sensitive data anyway?
To answer these questions on public health data, let’s hear some experts on food security:
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Chainda Clinic Contributes in the Creation of Malaria Free Zones Using Tablets

`Maswabi Precious Matantilo August 20, 2015
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The Zambia Ministry of Health and The National Malaria Control Center in partnership with Akros have been conducting Community Malaria Surveillance in selected parts of Zambia including Lusaka where the malaria prevalence rate is low. This is in an attempt to eliminate malaria as stipulated in the Zambia National Malaria Strategic Plan (2011-2016) that calls for the creation of five malaria-free zones by 2015.

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Real-Time Monitoring of Rural Sanitation at Scale in Zambia Using Mobile-to-Web Technologies

`Andy Prinsen August 3, 2015
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Akros has been working with UNICEF and the Government of the Republic of Zambia to support Zambia’s goal of being “Open Defecation Free” by 2020. This recent WASH Field Note, released by UNICEF, details some of the progress achieved thus far, along with lessons learned along the way. Click here to read the full note.

Here are some excerpts:

“The M2W system was developed in 2013 for monitoring rural sanitation and hygiene by UNICEF and its technical partner Akros, under the lead of the Ministry of Local Government and Housing of Zambia. The system utilizes the Short Message Service (SMS) text delivery system found on most basic mobile phones and is coded using the open source District Health Information Software 2 (DHIS2). This is a free, open-source software originally designed for health applications, but is currently being used in 40 countries under various sectors, from water management to agriculture and forestry.”

“Over the past year, the system has been put in place in 29 out of 92 rural districts which are now submitting monthly reports through 1,564 Community Volunteers and 210 Environmental Health Technicians; over 1,500 phones and tablets are now operational and being utilized by the trained counterparts. This covers a total
population of 2,383,704 from 13,805 villages. In addition, 32 Chiefdoms have been trained in using the monitoring tools. Within the areas covered by M2W, the programme aims to achieve 1,520,661 new users of improved sanitation and to raise the practice of handwashing with soap or ash from 8.6% to 47%.”

Click here to read the full note.

Crowdfunding for Zambia’s Healthy Schools

`Andy Prinsen July 28, 2015
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We’re excited to announce a new undertaking that we’re calling “Zambia’s Healthy Schools.” It’s a crowdfunding campaign that will allow our partnership with the Government of the Republic of Zambia to raise the standards of sanitation and hygiene at schools right here in Zambia.


Click here to learn more


Every year of education improves a person’s health and quality of life. This is a universal fact, as true in rural Africa where every year of education means less child and maternal mortality as it is in metropolitan Washington, DC where every year of education means fewer deaths. One of the big barriers to keeping kids in school in rural Africa is a lack of sanitation facilities and no access to clean water. When girls hit puberty they miss one week every month because there is no safe place at school for them to address their needs. Also the lack of toilets at schools means kids can get sick even when they’re at school. Throughout rural Zambia, schools are simply not healthy nor safe.

But what if we turned this around? What if students could go to school, have a safe place to address their sanitation needs and learn the best practices of sanitation, about germs and proper washing? What if they could learn about the importance of using a latrine, and then take that knowledge back to their families, spreading the news far and wide? We would see kids stay in school. We would see healthier students. We would see healthier communities. And as a result, we would help increase the quality of life for Zambians everywhere.

How will we do it? Click here to visit our crowdfunding page and learn more. We would love to have you join us in this effort!

Montana State University Students visit Zambia for Community Health Course

`Maswabi Precious Matantilo July 9, 2015
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Akros recently hosted 14 undergraduate Montana State University (MSU) students in Zambia from May 14 to June 11, 2015. The students were enrolled in a course titled “Zambia: Community and Family Health,” taught by Professor Wendy Bianchini Morrison of the Health and Human Development department at MSU.

“I approached Akros management a year and a half ago with the idea for this course,” said Morrison. “I wanted to bring MSU students to Zambia to expose them to international community health work. Akros management was very open to the idea and expressed interest in collaborating on the course.” She reported that Akros was appealing because it is an established organization in Zambia that has strong relationships with the government, local ministries and communities across the country, and implements public health initiatives that use data and research to increase the efficacy of their interventions.

Student Stories

The three stories below were written by students from Montana State University during their time in Zambia.

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