(DECOST)

DECENTRALISED COMMUNITY SERVICES TRACKING

Empowering community health workers

• Convert current paper based system to a electronic system

• Enable referrals and promote effectiveness of the household outreach team

Requirement

• Develop an electronic system that allows for more effective data collection, processing and decision making that is easy to use and support the outreach worker.

Solution

Background of the DeCost System implementation

• The DeCost System mobile solution was deployed and training commenced mid-September 2014. • A total of 13 community health workers were trained, many of whom have never used a tablet before. • The team have been receptive since the very start of the project and have embraced the solution. • The team went through a exercise where they transferred all their existing paper based files to the

electronic system giving them valuable experience in the use of the system. • A large number of households have been registered on the mobile solution and ongoing information is being

collected every time a CHW visit the household. • Data that is collected is pushed up to a online data repository each day, updating the patients electronic

records at the facility • Follow up & back referrals are pulled back into the appointment schedule for the so that the health worker

is always aware of which households need to be visited next.

Integrated DeCost System How does it work?

VEMR Community Outreach System

Offline mobile application for data collection purposes

Application runs on android OS based tablet, compatible

with the google chrome browser

Primary Health Care Facility

Online Web-based repository

Virtual Electronic Medical Record System (VEMR)

Integrates with VEMR through HL7 messaging framework. Processing of referrals and

back-referrals.

Hospital (Phase 2)

We will be pushing data to hospital level once a hospital is identified

This is work in progress and will be incorporated in a phase 2

DeCost System Process flow

DeCost System Process flow

System Functionality: DeCost System DeCost System mobile application • Register new households • Screen patients in households • Add new household members • Open associated adult, maternal and

child related health records • Make referrals to additional health

services and facilities • Receive ‘Back Referrals’ from facility

to OHH

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System Functionality for DeCost System DeCost implemented at facilities • Britstown Clinic, Carnarvon Clinic, Loxton

Clinic, Petrusville Clinic, Richmond Clinic – Pixley Ka Seme District , Northern Cape

• Empathe Clinic – UMzinyathi District, KZN • Masons Clinic – Umgungundlovu, KZN

Functionality • Incoming referrals are processed on the

VEMR and once the patient has been treated by a nurse they are back referred to the community health worker for follow up.

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Perceived Efficiency Gains The CHW’s unanimously agreed that the DeCost system has improved their work. Specifically:

•There is less worry about carrying around growing stacks of paper – one WBOT user said that tablets are safer than paper as they are not mistakenly dropped or left behind;

•It is easier to track the timing of past and future visits on the tablet (can easily see visit dates);

•Referrals to the clinic are easier as they are electronic; and

•The tablets can assist with care (CHW’s use the tablets to take photographs for referral to and further training by the Facility Manager – one case was given during the discussion of a positive effect on patient care just that week ).

Scale up to additional facilities Due to the success at Britstown Cinic, a decision was made to extend the pilot to a further 4 facilities.

The DeCost solution was rolled out to Loxton, Carnarvon, Petrusville & Richmond clinic in October 2015.

The Pixley Ka Seme district is in the process of procuring another 100 tablet computers so that more facilities can be initiated on the system.

The intention is to use a ‘train the trainer’ approach where more experienced homebased care workers, who have had a lot of exposure to the system, show less experienced home based care workers how to use the system.

The idea is to build capacity and ensure that there is a sustainable model for extending the rollout in a cost effective manner using existing resources.

What has been accomplished Activity Richmond Petrusville Loxton Carnarvon Britstown

Number of households registered 752 840 264 252 934

Number of household members

registered

60 1916 18 219 3711

Number of adult health records logged 17 130 7 25 690

Number of MC health records logged 4 34 3 4 625

Number of referrals logged 21 33 15 28 56

Number of back referrals logged 19 12 7 26 41

System Dashboard

The online repository has a built-in dashboard that visually displays 17 DHIS-VEMR

Community Based Outreach System indicators viewed from the main VEMR software.

Impact of mobile app implementation

Improved patient care

• Early identification of serious illnesses,

• Effectively screen & refer household members for treatment of communicable diseases

• Closer monitoring of pregnant women and young children

Cost effectiveness

• Improve the efficiency and coordination of services

• Increased the number of patients processed

• Easy referral of patient to other services

Improved management

• Provide clear instructions to CHW & improved monitoring of number & outcome of the household visited

• Seamless integration with existing VEMR patient management system

Conclusions Effectiveness

The system has built in checks to ensure integrity of data. It is far

superior to a paper-based system in that it allows for much faster

processing times, data retrieval and decision making. It allows the VEMR

Community Based Outreach System team to have a ‘finger on the pulse’

so to speak.

Challenges

Any system is only as good as the data that is being entered, the move

from an existing paper based system to a electronic system is a change

in mind set and can be overwhelming. This can be counteracted by

following a solid change management plan and ensuring comprehensive

implementation support and continued training of the CHW.

Conclusions Scaling up The intention is to roll out the system to additional clinics and then move data up to district level so that they can monitor interventions across the board. The DeCost System will be able to post aggregated data to the DHIS 2 platform to support the accuracy of data captured. The DeCost System is a component of a much larger integrated health management system that can be implemented from hospital, PHC facility and community outreach programmes. VP Health Systems is in the process of adding other parallel programs to strengthen the electronic outreach offering.

Impact The system enables compliance to national norms and standards for patient care and therefor positively impacts on the quality of care patients receive. The integrated DeCost System realised the vision of quality community health care through accountable, effective service delivery and improved management controls. Such a technology driven solution puts the Sustainable Development Goals related to Health Care within reach.

The way forward We will be customising the user interface of all our mobile applications to be more appealing and fun as we are doing with the Impact Monitoring Tool in Mozambique (see slide)

Include a comprehensive School Health Module based on the NHI guidelines for School Health

Add other “innovative” developments we have planned, like our Enterprise Architecture Design, which will incorporate Health, Social and Education

Implement district level repository

Push aggregated WBOT data up to DHIS2 instance, currently waiting for launch of NC DHIS 2 instance

Contact details VP Health Systems Technical Consultant:

Jacques Vosloo Email: jacques.vosloo@vphealth.co.za

Cell: 083-785-4751

VP Health Systems Executive Director:

Warren Lambert Email: warren.lambert@vphealth.co.za

Cell: 078 368 3003

55 Rietfontein Road Claric Place Rivonia Johannesburg