Authored by: Philip Ngari, Program Manager, Medic
Responding to community needs in Malawi
Malawi is one of the countries with very high levels of poverty and also high HIV prevalence, with about one million people currently living with HIV. The country also has high under-five (39 per 1000 live births) and neonatal mortality rates (19 per 1,000 live births). These health challenges are difficult to overcome in any setting, but are further amplified in Malawi where quality care is limited to most citizens.
Since 2007, Partners In Health (PIH) in Malawi, known locally as Abwenzi Pa Za Umoyo (APZU), in partnership with the Ministry of Health (MoH) has worked in Neno District to provide integrated health care to the area with a population of around 150,000 residents. The interventions have seen improved outcomes in individuals and families struggling with HIV, pregnancy complications, and TB; compounded by poor infrastructure, sexual and gender based violence, and other devastating crises. In addition to strengthening hospitals and health centers, APZU supports outreach programs through community health workers (CHWs) who visit people in their homes, screen for illnesses, and refer patients to health facilities for treatment. This is a cadre of volunteers working hand in hand with Malawi’s MoH cadre of community health care workers.
Each APZU CHW cares for an average of 20 to 40 households and is supported by a direct supervisor; senior community health workers (SCHW) and facility-based supervisors; site supervisors (SS). The system is designed to be proactive, preventive, accessible, and equitable. This model represents a radical and necessary departure from status quo health systems in Malawi, bringing the services closer to where people live.
Leveraging the CHT to empower health workers and provide continuity of care
Since August 2018, PIH Malawi and Medic have collaboratively developed YendaNafe app, a digital health app for community-based health service provision and coordination powered by the open-source Community Health Toolkit (CHT). An offline-first tool with real time capability, YendaNafe, locally interpreted as “walk with us”, enables faster, better, and more equitable care, in addition to real time data collection and aggregation. Implementation of the YendaNafe app started in July 2019 with 228 CHW’s from two of the 14 catchment sites implementing the CHW program household model in Neno district. The app links PIH’s network of CHWs to primary and secondary clinical teams in Neno District to more effectively screen, provide ongoing care, and refer patients in communities to care in health facilities. The app supports five key areas of functionality: in-app messaging, longitudinal patient profiles, task and schedule management, evidence-based care guides for decision support, and dashboards for performance management and supportive supervision. In concert, these features collectively improve the quality of care through protocol-driven door-to-door home visits. To date, 629 CHWs, 87 SCHWs and 7 SSs from seven of the fourteen catchment sites have been equipped with the YendaNafe app as they support screening, referrals and follow-ups for malnutrition, childhood illnesses, vaccinations, maternal health (family planning, pregnancy, antenatal care and postnatal care), Non-Communicable diseases (NCDs), Tuberculosis (TB), Human Immunodeficiency Virus (HIV) and work toward Universal Health Coverage in their communities. Medic and PIH team are also exploring the interoperability of the Yendanafe App with OpenMRS, to link both facility- and community-based care records to support care retention efforts via electronic-TRACE (Tracking Retention And Client Enrollment).
Making YendaNafe available as a fully open “Integrated CHT App”
As a key partner in health systems strengthening, PIH Malawi is collaborating with Medic to release the full application source code of YendaNafe as first of its kind “Integrated CHT App ”, free for all to access and replicate. This commitment to open sharing of proven best practices, studied workflows, and established integrations developed alongside World Health Organization protocols on care delivery will allow development partners to adapt the app for their own specific needs and innovate upon its strong foundation to support their country’s context-specific interventions – critically reducing the time and financial resources needed to build an app of this maturity from scratch. Partners will also benefit from years of iterative enhancements resulting from numerous user feedback sessions conducted with health workers and programme managers. Putting the full app into the open domain also provides an opportunity for collecting feedback and contributions from implementers on potential areas of improvement and innovation.
As we want to carry Paul Farmers’ ( 1959-2022) legacy and vision, we want to bring the benefits of modern technology and social medicine to all. By releasing this project, we will help support CHW programs across the world, help communities access services even in remote locations and help support the achievement of universal health coverage to all.
Dr. Chiyembekezo Kachimanga, PIH Malawi Chief Medical Officer.
Medic applauds Partners In Health’s shared value of openness and commitment to radical collaboration. This is a critical step in promoting open source technologies as a sustainable approach towards health equity and equality.
Krishna Jafa, Medic CEO
To learn more, visit the recent announcement on the Community Health Toolkit Forum.
- UNAIDS, Malawi country profile (Malawi | UNAIDS)
- Malawi (MWI) – Demographics, Health & Infant Mortality – UNICEF DATA