Written by: Nelson Rodrigues

I was sent on a mission to Cabo Delgado Province in the north-eastern area of Mozambique (bordering Tanzania) to understand the progress that has been made by UNICEF’s community-based health interventions.

During my visit to the Metuge district, the rainy season had started and road access beyond the capital city of Pemba was difficult. Muddy roads transform short distances into slow, lengthy routes that deny people access to adequate healthcare. To support remote communities in receiving timely medical assistance, the Ministry of Health established the ‘Agentes Polivalentes Elementares’ programme. This project includes deploying approximately 3,700 community health workers, or APES as they are commonly known, throughout Mozambique.

Alongside this project, UNICEF in partnership with Malaria Consortium implemented a mHealth programme, called upSCALE – designed to improve the quality of care given by APES to their patients. Each APES is also equipped with a mobile device with pre-installed software. This device has the ability to manage consultation workflows and has the functionality to store patient history files – providing APES knowledge about a patient’s medical conditions and provide appropriate treatment.

Belafonte explains an Agente Polivalente Elementar / APES how to use the upSCALE application © UNICEF Mozambique/ Nelson Rodrigues/ 2017

Yet developing innovative and sustainable solutions within communities require more than just integrating technology. It’s also about having people who are resourceful, creative, and adaptive to change – something that Belafonte Jaime manifested, when I met him during this trip.

Belafonte Jaime works in Metuge District Health Department where he coordinates the activities of 19 community health workers. Since the upSCALE project started, Belafonte has been learning how to manage mobile applications and how to troubleshoot and resolve issues on mobile devices. He believes that through upskilling, he is better equip to help improve the existing community-based healthcare systems and in effect can benefit more children and families in his district.

Carrying two mobile phones, Belafonte shares “In our last monthly meeting two APES informed me that their devices were not working properly,” Belafonte told me. “I decided to try to solve the situation. One of the phones was missing an application shortcut, so I had to re-install it. As for the other phone, I think it’s a hardware problem because I can’t turn it on!”

Deploying the upSCALE programme in his district has made him understand how to better contribute and expand his work – that is through finding more ways on how to improve systems of services and generate faster, more reliable statistics.

To do so, he needed to have as many devices operational. Without receiving any training or instructions, Belafonte learnt how to manage mobile devices, and how to troubleshoot them remotely or through direct support.

An Agente Polivalente Elementar (APE) practicing the registration of a patient in the upSCALE application © UNICEF Mozambique/ Nelson Rodrigues/ 2017

Belafonte also created a peer support network amongst the community health workers in his district. He identified which APES handled the mobile application with ease and designating them as focal points to provide support to other community health workers.

But why would Belafonte go through all this additional work if it had not been requested of him?

He explained, It’s extremely hard to reach the communities, especially in the rainy season. The best solution is to have a good first line of response in the community. These devices and applications help the community to be able to deliver such a response. For me, it generates data and statistics so I know what is happening in communities. Can you imagine how many silent cases there would be if I didn’t have the statistics?

It also has a positive impact in the consultation procedures as the APES are reminded of which questions to ask and what exact prescriptions to provide to children. And while the increase in the quality of the procedure is the most important, in the future we might even get to have maps so I’ll be able to pinpoint exactly which households have specific issues!”

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