The Ministry of Health of Zanzibar (MoH) has ensured that all residents are served by a Primary Health Care Unit (PHCU) within 5km of their residence. With work and family obligations, however, some residents still find it difficult to visit a health facility for all of their necessary checkups. These delays in seeking care can lead to poor health outcomes. They can be especially risky during periods in life like pregnancy, when timely healthcare is especially important.
Fishermen and boat commuters in Mkokotoni, a community on the north coast of Unguja island in Zanzibar
(Photographer: Kevin Ferguson | © D-tree)
Kidawa is a Community Health Volunteer (CHV) living and working in Paje, one of the many rural fishing communities on the East Coast of Zanzibar. As a CHV, Kidawa visits her neighbors’ homes throughout Paje to bring important, timely health information and care directly to their doorsteps. She provides education to pregnant women and caregivers for children under five, covering topics such as the importance of delivering in a healthcare facility, good nutrition during pregnancy and for growing children, and child developmental milestones. She also screens for danger signs that could indicate the presence of an urgent health issue that must be dealt with at a healthcare facility. If a danger sign is identified, she can educate her neighbors about the risks they may potentially face and encourage them to seek care at a local healthcare facility
CHVs like Kidawa have had tremendous impacts across Zanzibar, including increasing facility delivery rates by 50% when compared to the period prior to their introduction. These successes have led to the MoH to institutionalize CHV services for all Zanzibaris, launching the national-scale Jamii ni Afya program in July 2019. In this program, D-tree International has partnered with the MoH to provide digitally-enabled CHV services to all 1.6 million residents of Zanzibar.
Community Health Volunteer Kidawa conducting a child health visit at a client’s home in her community of Paje
(Photographer: Kevin Ferguson | © D-tree)
Although CHVs working in Zanzibar have had great success in improving health at the community level, the neonatal mortality rate remains stubbornly high at 28 deaths per 1,000 live births. With funding of the Wehubit programme of Enabel , D-tree is working to operationalize modern machine learning techniques to address these challenges. This innovation will enable Kidawa to provide targeted, personalized care to pregnant mothers in her community.
Instead of providing a static bundle of counseling and danger sign screening services to all expectant mothers, with this digital innovation Kidawa will now receive real-time feedback from her mobile app when she registers a new pregnant woman. The system will analyze information collected about the mother such as her age, living situation, and obstetric history and compare it against past mothers served by the program using a machine learning algorithm. If the system finds that the new mother shares key characteristics with past mothers who suffered negative outcomes to their pregnancy, it will alert Kidawa to pay extra attention to her and to share information regarding the risks that she faces. In this way, Kidawa can actually intervene and attempt to address the underlying issues in a high-risk pregnancy before they lead to harm to mother or baby.
CHV training begins in November 2020, and Kidawa will then immediately have the machine-learning-supported decision making on her phone. During the first few months, Kidawa and her fellow CHVs will provide valuable feedback and observations leading to adjustments and improvements of the system.
Kidawa works with the child’s parents during the visit to ensure they are informed regarding all key aspects
of the child’s health (Photographer: Kevin Ferguson | © D-tree)
