USAID IHP: Assisting the supervision of integrated Community Care Management sites in DRC
About the author
Sacha Hinz joined Bluesquare in 2019 as project manager to support Monitoring & Evaluation projects as well as Health System Strengthening projects mostly in DRC. With a background in Public Health and work experience in West Africa, she seeks to harmonise as much as possible the digital tools developed with the realities of the field.
In Congolese villages too small for clinics and health facilities, people seek care at integrated community care management sites (iCCMs). These are run by community health workers. Services may include sharing information to improve healthy behaviors, distributing oral rehydration solutions for diarrhea, and referring more serious issues to a health facility.
In June 2021, the USAID Integrated Health Program (USAID IHP) surveyed its nine target provinces. It found that 54% of respondents cited community health workers as their most frequent source for health information.
Yet, iCCMs were historically not included in monitoring and data collection for the DRC health system. Head nurses were functionally the only people with any insight into iCCMs, including cases treated and supplies needed. This can lead to shortages in the supply of basic medicines (such as paracetamol, antimalarial treatments and contraception) but also miss key public health information such as the number of cases received in the iCCM with respiratory symptoms, malaria-related symptoms, diarrhea symptoms and malnutrition. Constant monitoring of these situations makes it possible to better direct the necessary assistance to deal with these health issues that are relatively easy to treat with the right equipment.
Starting point, put community care management sites on the map
In order to include iCCMs within monitoring, the DRC Ministry of Health (MoH) was running into several issues:
- iCCMs were not precisely mapped via satellite, a process known as geolocation
- iCCM sites are supervised by head nurses at the nearest health facilities, but their monthly reports were unstandardized and completed on paper, never entered digitally into any national database or reported directly to the Ministry of Health.
In October 2020, USAID IHP introduced a solution to address this blind spot. While supporting the MoH to supplement their health facility registry, Bluesquare, as technical partner in the USAID IHP consortium had the honor of developing a mobile data collection app for health facilities to input their geographic location. This app was then adapted for iCCMs—and expanded to monitor available stocks of drugs and health commodities and track patient traffic. The app standardizes monthly supervision forms and provides data on indicators tracked across all levels of the health system.
“Managing this data was tedious. But with the arrival of this app, the mapping of iCCMs is done electronically. We have the GPS coordinates of these sites and even their photos. Essential iCCM supervision data is now coming back faster than before because it it immediately available on the server.”
Dr. Albert Kadjunga, Kinshasa-based manager at the Ministry of Health
Map new structures and start monthly supervision
Since December 2020, USAID IHP-trained trainers at the central level have in turn trained provincial staff to use the app in all nine provinces, and training is ongoing for head nurses at facilities in health zones. The number of geolocated iCCMs has nearly tripled, from 889 in 2019 to 2,321 in October 2021. In less than a year, head nurses have submitted 2,151 monthly supervision forms for iCCMs. New data arrives every week.
To expand the iCCM app for use nationwide, the MOH has asked for USAID IHP’s support to develop a platform that syncs app information about community care sites with the country’s health management information system. Integrating this information will enable decision-makers to better allocate resources and target interventions.