Delivery
How mobile phones can strengthen supportive supervision and improve immunization services
By Mauro Cuna, Antonio Sambo, Kate Brownlow & Ahmed Razzak
Since 2003, approximately a third of Mozambican children aged 12-23 months have not been fully immunized against vaccine-preventable diseases. To help reduce the rate of under immunized children, Acasus has been working to improve leadership, management and coordination within the Expanded Programme for Immunization (EPI) in the country.

Since 2003, approximately one third of Mozambican children aged 12-23 months have not been fully immunized against vaccine-preventable diseases. To help reduce the rate of under immunized children, the government launched new digital supervision tools to help manage service delivery challenges. However, in order to get the system working, the government had to get lots of small details right. In this article, we look at some of the lessons learned.

 

Getting the tech right

 

To avoid a common pitfall, it is important to emphasise the need for simplicity and user-friendliness, and put local managers at the centre of the design process. Their input led to a focus on ensuring that the supervision survey was not too long and time consuming (a barrier to them completing other important durites), was simple to use, even for those with low technical skills, and worked well in areas with poor internet connectivity.

First prototype of FESP, the supervisory application for EPI managers

 

 

Testing and developing a holistic implementation plan

 

The application was first piloted to get feedback from frontline health supervisors. Their feedback enabled many further refinements. The pilot also demonstrated that improvinging supportive supervision would require a combination of different but complementary processes including:

  • Building managers’ skills in the analysis and use of data for decision-making

  • Providing smartphone and data bundles to each district for use in supervision

  • Providing monthly reports to each district and the province as a whole, to be used for performance review in district data meetings

  • Facilitating problem solving sessions through expert guidance to support districts and provinces to analyse and agree actions for improvement

 

Health workers piloting the applicatio

 

Smart reporting of data to enable regular data use

 

There is no one-size-fits-all approach to data sharing. Indeed, data from supervision is shared in different formats to serve different purposes. The main report type is data packs, shared monthly with managers to help track progress and identify areas for potential improvement.

Example of a data pack

 

A second report focuses on key performance indicators requested by managers to support the allocation and deployment of key inputs, such as cold-chain equipment or vaccine replenishment statuses. This is then used to prioritise and plan which health facilities and districts should receive new cold chain equipment.

Finally, live dashboards and on demand heatmaps displaying progress and identifying bottlenecks are regularly made available for key decision makers at National and Provincial levels to ensure regular use of data to drive improvements.

 

Impact

 

Getting the details right enabled the government to drive fast improvements in health services. For instance, there have been dramatic increases in vaccine availability, fridge functionality (essential for vaccine storage) and the number of vaccination sessions being conducted. These in turn are leading to more children receiving life-saving vaccines every month.

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