Partnering with governments to expand reach and impact

Jamii ni Afya (Zanzibar)

Jamii ni Afya is a national community health program which provides home visits by community health volunteers (CHVs) to mothers and their children under age five in Zanzibar. The Ministry of Health, D-Tree – a global health organization with experience integrating digital tools to strengthen health systems – and Medic have collaborated to develop and deploy a digital platform to support CHVs and their supervisors at scale. Each CHV receives a smartphone loaded with an application that provides guidance to a CHV in their interactions with families. A second app associated with the program guides supervisors in carrying out routine observations of CHVs during home visits. Both the CHV and CHV supervisor applications have been created through the Community Health Toolkit which is an open source tool for creating health apps.

By August 2021, the Ministry of Health and D-Tree had scaled the app from an initial pilot to a national program that works with about 2,300 CHVs and reaches more than 1.4 million people across all 11 districts in Zanzibar. A key to success has been the strong partnership between the Ministry of Health and D-Tree, which dates back to 2010. To support this success, secondment exchanges between D-Tree and MOH staff have been a core component to transferring skills and expertise in aspects of program implementation management, technology and data use. Notable accomplishments include the revision of the National Community Health Strategy which is very much aligned to the first Zanzibar Digital Health Strategy, an approved national curriculum for CHV service delivery, trained national trainers and various iterations of the app which incorporate feedback from users and clients to better meet the needs of families.

Data use is becoming an increasingly important part of the program and the teams are working on integrating the community-level monitoring data from the app into the government health information system (DHIS2), thus promoting data-informed decision making at the national and district level. The integration of the two systems will enable Jamii ni Afya to provide population-level data on community health service delivery and information on early childhood risks, outcomes, and programme impact that can be used to inform advocacy and programming.

A key to success has been the strong partnership between the Ministry of Health and D-Tree, which dates back to 2010.

Now that Jamii ni Afya is operating at full national scale, the Government of Zanzibar has committed to full financial, programmatic and technology ownership of the program over the next four years (2023-2026). The Jamii ni Afya transition plan was signed in April 2023, detailing the gradual transfer of the program to the MoH. In the first year of the transition, the MOH has committed to include 25% of the Jamii ni Afya annual operations cost in the national 2023-2024 health budget.

Mobile Academy and Kilkari (India)

In India, the Ministry of Health and Family Welfare (MoHFW) has collaborated closely with ARMMAN – a non-profit focused on mHealth – since 2019 to implement two complementary digital tools to support mothers with young children at scale: Mobile Academy and Kilkari. By working within government systems, the partnership has achieved impressive reach.

Mobile Academy is the largest mobile-based training program for frontline health care workers employed by the government known as Accredited Social Health Activists (ASHA). These ASHA workers focus on mobilizing communities and facilitate access to health services in rural areas. The Mobile Academy tool addresses the lack of ongoing professional development available to these community health workers. Specifically, Mobile Academy consists of pre-recorded modules – ASHA workers dial in to listen to them – designed to promote the knowledge of preventative health behaviors and improve quality of engagement of ASHAs with pregnant and new parents, and their families.

Leveraging government systems has been key to reaching so many health workers. All ASHAs receive immediate access to Mobile Academy once they are registered on the Government’s Reproductive Child Health (RCH) portal. More than 300,000 users across 17 states in India have started the course, and about 75% complete it, a high completion rate for mobile training. One success factor of the tool is how it incentivizes ASHAs to complete the training. Once the ASHA completes all chapters and quizzes, they will get a final score. If this score exceeds a certain threshold, they receive a certificate from the Ministry of Health. This official government recognition has been found to be a motivating factor for an often-undervalued workforce.

Leveraging government systems has been key to reaching so many health workers.

The second, complementary tool is Kilkari, the largest maternal messaging program in the world. Kilkari has reached over 33 million mothers (3.2 million current users). Kilkari targets pregnant and new parents by sharing tips and resources directly to their phones. When a pregnant person is enrolled in the RCH portal by frontline health workers, they receive access to government services including Kilkari. Through this RCH portal, Kilkari and Mobile Academy have been scaled up to cover most states in India.

As a public-private partnership, the government supports telecom costs, while ARMMAN manages the program implementation, building off their previous experience with mHealth tools. The MoHFW also provides inputs on program improvement measures and approves program material (e.g., translation of training content). In the coming years, the MoHFW and ARMMAN plan to expand the reach of Mobile Academy across all 29 states and 7 union territories in India. ARMMAN is also planning to launch more targeted and nuanced multimedia content (e.g., videos, images) to complement the existing audio content.