Overview

The National Malaria Control Program (NMCP) transitioned to a digital system for their bed net distribution campaign in 2022/2023, moving away from their previous paper-based method. However, the team faced numerous issues with the new tool, such as synchronisation errors, data quality issues, inadequate visualization and analysis of geolocation data, and ineffective bednet tracking during the campaign.

To address these challenges, NMCP partnered with eGov to develop DIGIT HCM, a Digital public infrastructure. This collaborative effort resulted in the creation of an open-source digital public infrastructure (DPI) with interoperability and scalability. Customised as Salama (implying health in Swahili), the aim was to mitigate the above challenges and support multiple campaigns efficiently.

Salama and LLIN

Salama was rolled out as part of the Long Lasting Insecticidal Nets (LLIN) campaign for the periodic distribution of bednets in the Tete and Gaza provinces.

The main players involved in the campaigns in Tete and Gaza are listed below:

1. National Malaria Control Program, Mozambique: Provided overall strategic direction for the campaign, part of the Ministry of Health (MISAU).

2. DIS (Information System Directorate): Provided support during the requirements discussion and the implementation of the campaigns, part of MISAU.

3. DTIC (Information Technology and Communication Directorate): Technical team that was trained and helped manage technical training and issues during the campaign, part of MISAU.

4. World Vision: Implementation Partner for the BedNet campaign in Tete and Gaza.

5. Bill and Melinda Gates Foundation: Funder of the DIGIT HCM platform.

6. The Global Fund: Funds campaign implementation across Africa.

The other partners include PNCM, World Vision, the Foundation for Community Development (FDC), Food for The Hungry Association (FHA), Aid for Develop.

Besides the different players mentioned above, a core group called Nucleo Duro, consisting of members from all groups was formed to lead all decision-making aspects of campaign implementation and digitisation.

Lessons learned from the Tete implementation spurred enhancements in Gaza, and underscored the flexibility of Salama. NMCP successfully conducted campaigns with reduced eGov assistance and effectively addressed many campaign-related issues. During the campaign, NMCP noted that the platform was user-friendly for registrars, and the dashboard's clear presentation negated the need to work on different formats in M&E meetings. Notable improvements in the Gaza campaign encompassed enhanced real-time syncing efficiency, prompt access to team performance reports, and a significant decrease in incomplete records.

Key Takeaways from Salama Implementation

The NMCP highlighted the points listed below as things that went well while implementing DIGIT HCM (SALAMA):

• Automatic synchronisation in areas with internet connectivity: The Salama application has enabled automatic synchronisation in intervals of 5 minutes, which resulted in near real-time data synchronisation in areas with internet connectivity. This was observed during the campaign in Gaza.

• Ability to check teams' progress against daily targets: In the application, there is a progress bar that each team can use to verify their progress when compared to the target. This feature was appreciated by NMCP as it gave the local monitors the ability to check the targets and motivate the teams to achieve at least the daily target.

• Automatic collection of GPS data on each Household registered: The collection of GPS coordinates for a household is done in the background of the application. Whenever a household is registered, the registrar does not have to click any button to initiate the capture of geo coordinates. This made the user experience for registrators better and was in turn well received by NMCP.

• Dashboard was flexible, interactive, and user-friendly: The dashboard was used in the daily review meetings as the main monitoring and evaluation tool and saved time as it was not necessary to develop a PowerPoint presentation for those meetings.

• Automatic calculation of the bednets to be delivered: The application was able to recommend the number of bednets to be delivered to a household based on the number of members, which removed the cognitive effort of the registrar to calculate these numbers by themselves.

• Indication of duplications at the end of the day: The custom reports generated at the end of the day indicated duplications of registration and delivery, It further provided details of duplicate households created by the same registrar and the ones duplicated by different registrars.

• Application easy to learn: During the training, it was noticed that it took less time for the trainees to understand the application and flows. Thus, the training was more practical and focused on simulation-based learning rather than on training the users on how to use the applications.

Throughout the campaign, numerous training sessions were conducted to enhance the capacity of NMCP in managing and utilising Salama, with additional capacity-building activities scheduled for post-campaign implementation. Key recommendations include linking credentials to performance, enhancing microplan estimates, improving warehouse manager training, addressing bed net scanning issues, and shifting the focus to monitoring and correcting supervision results.

In summary, the successful digitalization of Tete and Gaza using Salama facilitated accomplishing essential campaign objectives. While recognising areas for improvement, the standardised data format enabled thorough analysis across campaigns, ensuring ongoing enhancement in effectiveness and efficiency.

Following is the list of customisations enabled for the campaign in Mozambique:

• Allow registration without searching.

• Removed a few location and address-related fields from the registration page.

• Removed the option to edit household and individual details

• Removed the unique identifier field on the registration page.

• Removed the facility to add household members and keep only the head of family details during registration.

• Changed registration and delivery into a one-click flow to avoid partial registration.

• Whenever there was a difference between received bednets and bednets to be delivered on the delivery tab, the comment field was mandatory.

• Removed a few fields from the stock management feature and made a few fields non-mandatory.

• Added a few more fields in the stock management such as license plate number, driver name

• Removed the stock lost and stock damaged from the inventory management module

• Custom reports were built as per Mozambique’s requirements.

• Dashboard KPIs were added and updated as per Mozambique’s requirements.

• Built a conditional checklist.

• Changes in the validation for the stock management page.

• Changed numbering format on legends on dashboards; Followed the European system: 4,00,000 must be shown as 400,000 (introduced comma after every 3 digits from the right).

• Validation for the mobile number was changed to 11 digits for Mozambique.

• To stop accidental logout, added logic to not log out if there was no internet.

• In the inventory module, validation limits the vehicle license number to 9 digits.

• Showed warehouse name instead of warehouse code in the drop-down in the stock management screen.

• Mobile number was made editable for self-raised complaints in the complaints module.

Health campaigns, critical for disease control in the global south, face challenges such as limited resources, outdated tools, and a lack of real-time data. In Mozambique, where malaria is endemic, 95% of the population is affected, with 617,000 malaria-related deaths reported in 2021 underscoring the urgency to revolutionize the existing health campaign framework. Hence, we felt the need for a product to address these issues and our first exemplar was in Mozambique.

The Ministério da Saúde ((MISAU) or the Ministry of Health Mozambique in partnership with eGov recognised the need to use infrastructure-first thinking to reimagine how health campaigns were managed, run, and could be sustained over years, not just for malaria, but for many other diseases.

Mozambique reimagined health campaigns using a platform approach, with DIGIT Health Campaign Management (HCM). DIGIT HCM worked closely with various departments within NMCP, as well as other partners to build state capacity, provide technical assistance, and contribute to digital transformation.

DIGIT HCM, customised and branded as Salama for Mozambique, was rolled out as part of the Long Lasting Insecticidal Nets (LLIN) campaign. In 2023, Mozambique used DIGIT HCM to manage the distribution of malaria bednets across Tete and Gaza provinces. Click on the links below to learn more:

• LLIN Overview

• Customisation

• Rollout

Overview

The National Malaria Programme in Mozambique used the DIGIT HCM app, which they called Salama, to manage the bednets distribution campaign, covering a population of 3,117,551 in Tete province, and 1,586,866 in Gaza province.

Tete province: Located at the center of the country with an area of 98,417 square km, the campaign covered 14 districts out of 15, between August 28, 2023, to September 2, 2023, leaving out the capital, Tete City.

Gaza province: Located in the south of the country, it was the last province to conduct the campaign, with an area of area of 75,709 square km, the campaign covered 13 districts out of 14, leaving out the capital of the province, Xai-Xai city. The campaign was implemented as one block from November 21 to 26, 2023.

Key Features Introduced During Each Campaign

Block 1 of the Tete campaign was conducted using Salama, which was developed in collaboration with Nucleo Duro, and validated in two user acceptance testing (UAT) sessions. After this, there were improvements implemented in the product based on the challenges faced and also the feedback received from the NMCP during and after each campaign implementation. In the table below is the list of features and improvements released in each version.

Capacity-Building Activities Undertaken

During the implementation of Salama, several capacity-building activities, to provide NMCP with the competencies to manage and implement the activities without the support of the eGov team, were undertaken.

Before the Tete campaign, a Master Training, with the topics indicated in the table below, was conducted:

Individual trainings were provided DIS, DTIC, and M&E experts on the Complaints module, HRMS, and dashboard after the Master ToT.

After the Master Training, people who received the training went on to do the cascade training for people from the central level, who trained people at the province level, who trained people at the district level, and they finally trained the frontline workers.

Along with this a Technical Training was conducted to the NMCP focal points on the following topics:

During the Tete Campaign, several on-the-job refresher training to the NMCP focal points were provided as indicated in the table below:

Before the Gaza campaign, eGov conducted training and shared several guides to enable the team to improve the operation and use of the application. The topics are indicated in the table below:

Moving from block 1 to 2 and from 2 to 3 in the Tete campaign and then to Gaza campaign, we noticed that NMCP focal points have gained more knowledge and experience with DIGIT HCM (Salama). They were able to solve most of the problems in the field and have conducted the training sessions effectively, requiring less support from our team.

Given below is a summary of different activities that were performed by eGov in-person during Tete and Gaza campaigns

Impact

Real-time data from the HCM dashboard was used daily to make decisions, and course correct. The HCM helpdesk was used to track and resolve technical issues during the campaign.

Tete province - The details around the total household, population, and bednet coverage for Tete can be found in the table below:

For Tete, the campaign was divided into 3 blocks:

• Block 1 - Covered 7 districts between August 29 to September 2, 2023.

• Block 2 - Covered 5 districts between September 22 to 26, 2023.

• Block 3 - Covered 2 districts between September 30 to October 4, 2023.

Gaza province - The details around the total household, population, and bednet coverage for Gaza can be found in the table below: