Mass drug administration (MDA) to eliminate trachoma – the world’s leading infectious cause of blindness – requires giving medication once a year to everyone in areas affected by the disease. This year in Zimbabwe that meant ten districts. In all, 1.4 million people needed to be reached. In one week!
With these types of numbers, and given the nature of the disease, which thrives in remote areas, MDA campaigns are an exercise in logistics and sheer willpower. Through the new Accelerate programme, this feat has been achieved, but even with a well-organised system, monitoring campaigns and keeping in touch with drug distributors and supervisors throughout can be a challenge.
Not being able to see where issues are occurring or communicate with the right workers when they need support negatively affects performance. But technology – in various forms – is helping to solve these issues.
Applying lessons learned from previous real-time MDA monitoring, carried out to eliminate other neglected tropical diseases, we built a platform to capture trachoma data. For this we used something called District Health Information Software (DHIS2), an open-source platform that reports, analyses and disseminates data for health programmes and is used by many ministries of health to collect monthly reports, including Zimbabwe.
We worked with Zimbabwe’s Health Information and Surveillance Unit to design a monitoring platform specifically for MDA, define the new reporting processes, and train field teams.
In total, we had 278 distribution teams tasked with bringing treatment to at-risk communities, and targets were set for each one. Each team uploaded data every day so progress could be tracked. Drug use and stock was also followed daily.
mHealth, which stands for ‘mobile health’, involves using phones to collect data and provide training during health projects.About mHealth
It is very demanding to keep up with almost 300 daily data entries from the distribution teams, each of which has a dozen data points, while also trying to coordinate logistics. To ensure we were able to monitor team-by-team throughout the campaign we set up a command centre, staffed by health information officers from the Health Information and Surveillance Unit, plus 10 Ministry of Health interns and staff from Sightsavers.
The team spent the week monitoring data entries for potential errors, low coverage and comments. Using simple mobile phones to make calls, they then communicated any issues to province and district leads, creating an invaluable feedback loop.
WhatsApp is being used increasingly by field teams to keep each other up to speed in a fast and easy way. It’s a perfect fit – an app everyone already has and knows how to use. For this MDA, a WhatsApp group was set up with district, province and national leads as well as representatives from the Health Information and Surveillance Unit, the Ministry of Health and Child Care, and Sightsavers.
This was an incredibly efficient way to share updates, issues and challenges with everyone who needed to be in the know. It also created a team atmosphere, with encouraging messages on our progress shared as the week went by.
Engagement across the programme was extremely high during the campaign, and it was easy to see why. Thanks to the monitoring platform, for the first time national and province-level workers were able to have a view of the whole MDA as it unfolded.
District-level team leaders were able to identify the distribution teams that needed additional support then provide it, which helped to encourage individual teams to reach their target. The command centre ran a tight ship throughout, helping everyone else focus on delivering the campaign.
Once treatment was complete, a data verification process followed. Less than two weeks after the MDA, the programme had a full data set showing 87 per cent of people in target communities had been reached.
This is exciting for two reasons. First, treatment coverage was high. With trachoma MDA, the general goal is to reach between 85 and 90 per cent of people, but meeting this target is often a challenge because of the logistical complexities and visibility issues discussed above. The speed at which the reports were available was also significant. Data collation usually takes months, which can hinder review meetings and activity planning.
Using technology to support data collection, monitoring, supervision and team building, the Zimbabwe programme has helped create a blueprint for how MDA campaigns can be run in a smart and sustainable way, and in a way that allows ministries of health to take the lead in managing their own data.
Because DHIS2 is open source, it requires very little cost to run. Teams in many countries where we work already know the system, making training easier and data use more likely. And unlike other monitoring platforms, where a parallel data flow is created just to monitor MDA data, this process allows a country to monitor the actual reports as they come in.
Through the Accelerate programme, we will be scaling up a DHIS2 platform to use in more countries and for MDAs that target other diseases.
Next up: northern Nigeria to monitor river blindness and lymphatic filariasis with Nigeria’s Federal Ministry of Health. Watch this space.
Sarah is director of digital health and innovation at Sightsavers.
Sightsavers’ Boubacar Morou Dicko shares the obstacles Mali faced on the road to eliminating trachoma, and how the country was able to overcome them.
In 2018, Sightsavers CEO Caroline Harper took to the TED stage to talk about the importance of eliminating trachoma. Since then, 14 million people have been protected from the disease, but further progress hangs in the balance.
Sightsavers’ Edwin Maleko shares the impact of an inclusive eye health programme on communities and eye care services in Singida and Morogoro.