The effect of training of CHWs in enhancing data collection and reporting
It is important to note that before starting using mobile phones as a data collection and reporting tool, CHWs were engaged in training on how to use mobile phones as a tool to support data collection and reporting on LF morbidities. This section presents their experiences and perceived benefits of training prior to starting using mobile phones, perceptions on the feasibility, effectiveness and perceived challenges of using phone-based text messages in data collection and reporting LF morbidities.
It was almost unanimously conceded by KIs and majority of participants of the FGD sessions that the training helped the beneficiaries reduce errors in data collection and reporting hence enriched decision making at higher levels of the NTDCP. This was done by improving all aspects of care for the cases, including safety, cleanliness, communication and adherence. In fact, many further admitted that the training conducted helped CHWs, and those in the NTD control program to effectively and efficiently full fill their responsibilities and better on understanding procedures the patients should be doing to manage their conditions. CHWs themselves reported that training improved their approaches to communicate with communities and followed required steps especially when managing LE cases at community level. NTDCP officials reported on their perspective that through training CHWs were able to track and identify individuals with morbidities due to LF. As such, there was an increased number of patients reported at national level. Therefore, training has increased effectiveness in reporting and managing of LF Cases:
“I can say the training was beneficial to us CHWs and to our patients. Prior to training CHWs, LF patients used to hide in their homes or farms. But after we have been trained and used our knowledge to sensitize and educate our patients on how to manage their conditions and where to get treatment, they have changed and became receptive of the service offered by us and now they are coming out public” (FGD, Mandawa)
Additionally, it was conceded by majority of FGD participants that stigma-reducing messages through sensitization and health education given to community has made some patients accept their conditions and start seeking medical services something which was initially seen as unusual practice in the past.
Effectiveness and feasibility of using mobile-based LF morbidity surveillance system.
Apart from discarding the need for them to carry manual registers during field visits, CHWs perceived a greater level of efficiency in routine reporting and record keeping especially when mobile phones were used albeit in tandem with manual registers. Generally, the use of mobile phones was perceived to be relevant and thus feasible for the day-to-day activities of CHWs. Further perception amongst CHWs is that the mobile phone-based text messages enabled a more direct channel of communication with senior health staff at the district and national NTDCP level concerning LF morbidity cases.
… “I think it is relevant and acceptable because it has simplified the reporting work, it is faster than paper-based reporting and the good thing these days almost everybody in the community has a mobile phone…” (Female FGD participant, Mandawa).
“Communication is everything. The world has been reduced to a village because people communicate easily, so is the case with our situation” (FGD, Female, Somanga)
Compared to paper-based data collection and reporting the mobile phone- based system was perceived to be more effective.
“When reporting using papers, sometimes papers can get lost or torn especially when it is raining but with mobile phones it is easy and comfortable….” (Female FGD participant, Kilwa Masoko)
According to the respondents from both FGDs, the mobile phone technology has the potential to enhance community engagement through encouraging and simplifying the exchange of information between lower and higher levels of health program. Among the mostly cited advantages that were mentioned are real-time reporting of LF morbidity cases and enhanced CHWs-patient interactions. Respondents viewed the technology to be simple, fast and effective.
…. “By using the Phone-based text messages for LF morbidity surveillance, an instant message of the information required is received and what is most important is the availability of stable network” (Male FGD participant, Mandawa).
Another participant had to say
… “It is easy to use the menu in mobile phone because it is similar in fastness and familiar to one used for sending money and it only needs signals for mobile phone company to send text messages” (CDD Miteja).
It was learnt from both FGDs and KIIs that mobile phones are instrumental in facilitating referrals of the identified patients to available health care services for morbidity management and remotely providing health education. The observation below further illustrates:
... “Mobile phones have narrowed the communication gap between the CHWs and LF clients on the one hand, and between CHWs and health providers on the other. Generally, CHWs had a perception that their effectiveness in case identification, referrals and provision of health education for morbidity management for LF patients has increased as a result of using mobile phone technology”. (Male FGD participant/CHWs, Tingi).
Another participant responded that
… “My experience with mobile phones, especially after being trained to use it for data collection and reporting has, to a large extent, made my job easier and I can reach and connect clients to health services faster than before. I can remotely provide health education to the people I serve in the community and I can monitor progress of their conditions even without coming into direct physical contact with them”. (Female FGD participant CHWs, Miteja)
Perceived impact of using mobile phones-based text messages on performance of CHWs
The use of mobile phone-based text messages was said to enhance LF morbidity cases’ follow up by CHWs. That is, the ability to track patients and their information and transmit them to national NTDCP level was enhanced and thus leading to improved performance. Generally, Many CHWs viewed the use of mobile phone-based text messages in monitoring and reporting cases as very crucial in improving the performance of health care staff. Through monitoring and reporting cases, staffs are able to notice the trend of LF morbidity cases in their respective communities.
“The phone helps in bringing patients information faster, and it helps knowing how many new patients we have at the community. And after receiving patient information we handle it promptly and effectively it will help to control and reduce LF disease” (NTDCP officer, Miteja).
Using mobile phone technology was further perceived as an effective tool for reaching many patients in a short time regardless of how remote and sparsely located they are.
… “The mobile phone-based data collection and reporting system by CHWs helped in easy of reaching more LF patients. Getting LF patient without using this system is a huge undertaking because as I mentioned earlier, LF is a common disease that someone develops and stays with it all his/her life in hard-to-reach areas. We have, through campaign, sensitized communities to view this as a common disease which can be managed in health facilities. But by using text messaging system they can report the disease through CHWs by using mobile phones without having national teams or facility staffs of LF coordinators to go looking for them. So, using phones is a great innovation in not only dealing with the existing LF morbidities but also in registering new cases” (NTDCP officer, Kilwa district council).
“It will help. For example, new cases or even old cases the CHW will be aware of the trend, whether according to the services he/she provides patients are decreasing or vice versa, all these will be in the reporting trend” (NTDCP officer, Kilwa district council).
The use of mobile phones among CHWs was perceived by majority of FGD participants to be associated with increased access to health care services and coverage of population. Health education provided by CHWs has brought up patients who would otherwise hide in their homes as a result of stigma or misconceptions about the disease and all its manifestations.
… “using mobile phones has helped us to easily identify LF morbidity patients and understand different stages of the disease progression. We do not end at identifying and staging the patients but we also refer them to the health facilities for further action.” (Male FGD participant, Mandawa)
Perceived contribution of CHWs in reduction of LF morbidity and transmission of disease
Positive perceptions by community members were demonstrated towards CHWs as having an important contribution in tracking LF morbidity cases for them to access MMDP services provided jointly by NTDCP and partners. Additionally, CHWs are involved in MDA activities at community level that contributes to reduction of transmission of the disease. Therefore, their role in As such, affected people thought that by CHWs involved also in distributing ivermectin to a community, a job often done by CHWs, contributes to curtailing disease transmission within their localities. One discussant put it:
“In my opinion because they give us drugs (Ivermectin through MDA) and insist that we should use bed nets consistently, that is the contribution of CHWs in transmission control” (FGD, Adult Male, Tingi)
Another discussant observed that since CHWs started using mobile phones, there has been noticeable improvement in the management of their conditions. This was attributed to the ease of communication and reporting.
“I think when they (CHWs) report our situation to higher authorities in time, those people respond immediately and we get attention accordingly” (FGD adult Female, Tingi)
Perceived challenges experienced during case identification and reporting using mobile phone-based text messages
The experienced challenges can be understood from three interrelated perspectives, namely; those of the LF patients, CHWs, and of district and national program officials. Note that, the critical challenges are those perceived by CHWs who are the primary users of the digital technology in data collection and reporting of the LF morbidity cases as described here.
Despite popular perceptions by CHWs on the advantages of using mobile phones in data capturing and reporting, concerns were also raised regarding associated challenges related to using mobile phone technology. The frequently cited challenge by the majority of KIIs and FGD participants was the mobile phone’s network instability especially in very remote areas.
…. “One of the challenges which is not within our reach is network connection breakdown. Although this is not so frequent but it happens some time when you are submitting a report to the program officers at the national level; you may think it has gone but it takes time to reach the destination or sometimes it is not delivered altogether” (FGD male Participant, Miteja)
It was further revealed that electricity was also critical for the smooth functioning of mobile phones. For mobile phones that need to be regularly charged, power black-out was frequently mentioned by the majority of FGD participants as a challenge they face in using mobile phones for data capturing and reporting.
… “Not every village has a stable electricity supply and network coverage. Hence if that happens, CHWs may not be able to send the information to recipients until the systems stabilizes, this becomes a critical set back. Issues mostly experienced are calls not received, the system not returning responses, phones not charged and poor communication system. All these experiences make the text messaging system some of the times to be counterproductive”. (FGD male Participant, Mandawa)
…. “Unreliability of electricity is quite challenging in our contexts. Sometimes one is forced to wait for 8 to 12 hours’ power black-out before power normalizes again. So, this makes it difficult to collect patients’ data and report them timely to the required authorities (FGD Female participant, Kinyonga)
It was further learnt that the challenges that affect the LF clients and CHWs at the community level have a spill over effects on the operations of facility health staff at the primary health care level, district NTDCP program officials and finally affect the amount and quality of data captured at the national LF data repository. Accordingly, one informant revealed this:
… “The NTDCP implements its activities using a cascaded bottom-up approach. Many operations are implemented from the bottom by CHWS in close collaboration with the local community leaders, in-charges of primary health care facilities and community members. From there, information is sent to the district level and in these days with the help of mobile phones, information can as well be sent directly to the national program level. The national level provides program/policy guidance, Standard operating procedures (SOPs), capacity building and M&E. So, definitely all the challenges that affect operations at the lower level will definitely affect the data that is captured at the national level”. (NTDCP officer, Kilwa district council).