Fighting malaria with digital health: How Kenya is transforming its community health sector

Jackline Vugutsa adjusts the red pack securely on her back, its weight a familiar companion. Ahead lies a winding road, etched into the hilly terrain of Banja Ward in Vihiga County, Western Kenya. For 11 years, Jackline has trodden these paths, crossing valleys and villages, guided by a singular purpose: to bring health closer to her people.

As she arrives at the first household of the day, warm greetings are exchanged. Jackline introduces herself as a community health promoter (CHP), a bridge between health facilities and communities. But today, she's equipped with a new, powerful tool—a smartphone and the electronic Community Health Information System (eCHIS), a platform for collecting, analyzing, and reporting data on community health activities and outcomes

With seamless efficiency, Jackline uses the eCHIS to update information about household members. The eCHIS prompts her, ensuring no detail is missed. As she enters data, the system becomes her ally, alerting her to probable malaria cases needing urgent referral to health facilities for confirmation. eCHIS also shares the information with the nearby health facility. When the family arrives at the facility and presents the referral card Jackline provided, their history is waiting—a lifeline to timely malaria treatment.

"The eCHIS system walks me through everything I need to check and ask before I leave the household, thus ensuring complete and comprehensive evaluation of the household."

— Jackline Vugutsa, Community Health Promoter.

Three quarters of Kenya's 51 million people are at risk of malaria, a serious disease that can cause disability and death. However, in the past decade, Kenya has increased the scope of malaria prevention interventions, resulting in significant reductions in morbidity and mortality. For example, the number of children who die before they turn five years old has declined by more than half in Kenya, from 115 out of every 1,000 babies born from 1999 through 2003 to 52 out of every 1,000 babies born from 2010 through 2014. The country has prioritized scaling up malaria case management at the community level in targeted areas.

Despite Kenya's remarkable results in malaria prevention and control, the country still faces challenges in providing high-quality and affordable health care services to all its people, especially in remote and underserved areas. Kenya has responded to this challenge by adopting digital health to enhance its health system and outcomes.

As a pioneer of digital health in East Africa, Kenya has implemented innovative technologies and established supportive policies and laws for its digital health initiatives. However, despite the progress and significant investments already made in digital health, community health still lags in digitalization; many of its reporting systems remain paper based, which makes them prone to errors and inefficiencies.

To address this gap, Kenya launched the Community Health Digitalization Strategy in March 2021. This initiative aims to scale up the use of digital tools and systems by CHPs—such as Jackline in Vihiga County—across the country. The strategy also involves enhancing the implementation and sustainability of eCHIS.

The eCHIS technology helps CHPs provide better health services, especially for malaria prevention and treatment. The government has to date kitted around 95,000 CHPs with a smartphone for eCHIS use across all the 47 counties in Kenya, though not all of them have been trained to use the system.

"With the phone, you can send messages to households before a visit so they can prepare. This saves time and ensures you get all the relevant information, as clients have time to prepare themselves and avail all the required documents."

— Jackline Vugutsa, Community Health Promoter.

"Lastly, with the phone, you can send messages to households whom you're planning to visit so that they prepare themselves accordingly. This saves time and ensures you get all the relevant information, as clients have time to prepare themselves and avail all the required documents," says Jackline.

To support Kenya's digital community health efforts, the US President's Malaria Initiative (PMI), the United States Agency for International Development (USAID), and the Bill & Melinda Gates Foundation partnered with Digital Square, a global initiative led by PATH that supports digital health innovations and collaborations. PMI and Digital Square conducted a comprehensive assessment of the community digital ecosystem in Kenya, as well as in 26 other partner countries, to understand the needs, challenges, and opportunities for digital community health. Based on the assessment results and recommendations, PMI and Digital Square are working with the USAID mission in Kenya, the Ministry of Health, and other stakeholders to implement and scale up eCHIS and other digital tools for malaria management by CHPs.

A key activity of the Digital Square partnership is the collaboration with the government of Vihiga County, which started in 2022. The goal of this collaboration is to improve community malaria health services in Vihiga County by using eCHIS for data and intervention accountability. The partnership provides support for the implementation of eCHIS in terms of infrastructure (including mobile phones, tablets, and data bundles) and capacity strengthening (training, supervision, and feedback) for CHPs and health managers. The partnership also monitors and evaluates the impact of eCHIS on malaria indicators, such as case detection, testing, treatment, and referral.

The partnership between PMI and Digital Square has had a positive impact on both the health strategy and malaria response of Kenya's digital community. By using eCHIS and other digital tools, CHPs like Jackline are improving the quality and timeliness of data collection and reporting, which is informing decision-making and resource allocation. Moreover, eCHIS is interoperable with other digital health systems in Kenya; that is, it can securely exchange data so that health workers and managers at all levels of the health system have access to the appropriate level of data.

This capacity to communicate with other systems has enhanced the delivery and coordination of malaria interventions—including diagnosis, treatment, prevention, and surveillance—at the community level. As a result, the partnership is strengthening the health system and improving the health outcomes of Kenyans, especially those who are underserved by the health system and hard to reach.

Jackline is one of the many champions who are using eCHIS to combat malaria and enhance health in their communities. She is among the 95,000 CHPs that the government of Kenya has empowered with smartphones and digital tools, thanks to political goodwill and the Afya Nyumbani pledge to achieve health for all.

Johnstone Odemba is a Community Health Assistant in the Givogi Community Unit in Vihiga, Kenya.
Photo: PATH/Denise Akun.

"Now that all households details are in the system, I can interact directly with the household and see when the CHP visited and what they did."

— Johnstone Odemba, Community Health Assistant, Givogi Community Unit.

"In addition, I am able to send one message at once to all my CHPs from the system instead of sending them individual SMSs. Lastly, the system has made monthly reporting to DHIS2 very easy for me, as I can quickly download summarized data of all work done by the CHPs in my community unit," adds Johnstone.

With the support of PMI through USAID at the PATH Kenya office, Digital Square is proud of how its expertise and experience in digital health innovation supported implementation of and advocacy for the committed partnership advancing Kenya's digital community health strategy and malaria response.

Project stakeholders are determined to continue contributing to the achievement of Kenya's health goals and the global health agenda and to demonstrate how digital health can accelerate the attainment of universal health coverage for all Kenyans.

Written by

Dominic Mutai, Margaret Mwakala, and Carolyne Njuguna

Website

This article was originally published by PATH on 24 APRIL 2024.