Mobile enabled last mile solution to health referrals – the case of PSI Familia e-referral service in Tanzania
On Tuesday, 11 July 2017, the mHealth working group went for a field visit hosted by Population Services International (PSI) Tanzania. PSI/Tanzania supports the Ministry of Health and Social Welfare’s objective to raise contraceptive prevalence in Tanzania to at least 60 per cent and to reduce maternal mortality. It does this by increasing access to the Familia range of high quality and affordable family planning products and services.
The mHealth group was able to observe the Familia e-referral mobile application in practice – an innovative application designed to enable Interpersonal Communication Agents (IPCAs), equivalent to community healthcare workers, to track door-to-door visits, register clients and provide referrals for a host of reproductive health services provided by PSI. These services include dispensing or administration of condoms, contraceptive pills, implants, intrauterine devices, and injectable contraceptives. Once a client is registered during a home visit, they are counselled on available services including contraceptive options, side effects and benefits, and effective duration of contraceptive. They are then informed on where they can receive the service they would wish to get, a referral is created on the app, and the client then receives an SMS with a unique voucher number. This electronic voucher is redeemable at their local reproductive health facility for services they are interested in.
The client then visits a health facility when they have an opportunity, and presents the voucher number/SMS to the health service provider, who uses the voucher number to redeem desired services. During the visit to the facility the client is once again counselled on the various contraceptive methods available, and asked to confirm their choice. The health service provider then administers the reproductive health service and captures data on the type of service provided. This enables both the health service provider and the IPCA to track the number of referrals still open, redeemed, and/or services successfully provided.
The role of mobile
The Familia mobile app has become an indispensable tool for IPCAs, as was shared by one IPCA whom we had a chance to interact with. The biggest win for IPCAs is the reduction of the workload arising from the paperwork necessary for tracking and reporting their work. According to the IPCA the mobile app has made work much more efficient by enabling:
- Capture data from households visited – this enables IPCA to capture data in real time, demonstrate effort, and also easily reach out to clients at a later date;
- Manage referrals – the e-referral system enables IPCA to create referrals on the app, which trigger a unique referral number sent to the client via SMS. With this e-referral number, IPCA is able to tell whether clients have visited the facility and redeemed the services, and if not, enable follow up to provide any further assistance; and
- Activity reporting – the mobile application allows IPCA to easily report activities, and performance indicators.
For the service provider (nurse) at the health facility, the mobile application has had similar positive effects. The nurse we spoke to was quick to let us know that the mobile app made her work easier in tracking and reporting the number of clients she had attended to in any given period. She is also able to now see how many referrals have been made, and to anticipate the number of clients she will be attending to, as well as report on her key deliverables and performance indicators.
From a program perspective mobile has enabled efficient data collection, provide key metrics and indicators on a dashboard, and informed key decisions like training and support as well as where to conduct outreach. PSI Tanzania has not only equipped the IPCAs and nurses/service providers with mobile technology to enhance their work, but also provided enhanced training to enable the delivery of high quality reproductive health services.
The Familia e-referral platform could provide increased impact through several enhancements:
- Increase number of tools available on the app to tackle a variety of misconceptions within the communities, as well as demystify the costs of services provided;
- Provide timely reminders directly to clients, or to their respective IPCAs when the client is due for a clinic visit, thus increasing retention, and extending the benefits of services offered; and
- Client education through a series of SMSs to help clients adhere to services, and realise its full benefits.
When all is said and done, and from the testimonials of clients we met, the Familia e-referral system has enabled young women and mothers in Tanzania to effectively select an appropriate reproductive health method, fully understand the pros and cons, and make an informed decision. This is giving them much needed empowerment to plan their families, and provide adequately for them.
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