Strengthening the community health information system contributes to the reduction of infant mortality – Burundi

With funds from the Rockefeller Foundation, Burundi has set up the iCOHS (intelligent community health system) project to improve the quality of data in the health system in general and the community health information system in particular.

Odette Kwizera

Makebuko, Gitega/Burundi. Béatrice Niyonzima, 38, is a community health worker on Mwaro-Mivuvu hill in Makebuko commune. She is one of 277 community health workers in the health district of Kibuye whose work contributes to the reduction of maternal and neonatal deaths, through two complementary approaches, implemented with the support of UNICEF and its partners.

The first “kiramama” approach, which is based on the RapideSMS system, consists of using mobile phones to transmit information during the follow-up of pregnant women in the “1000 days” window. This involves, among other things, monitoring the progress of pregnancies and births, identifying and reporting situations where the lives of sick mothers and children are in danger, and relaying important information that can help promote a change in behavior.

The second approach, called iCCM (Integrated Community Case Management), consists of taking charge, at home, of the pathologies considered to be the main causes of death in children under five, namely malaria, diarrhea and pneumonia. . This approach also includes screening for malnutrition and referral for treatment. If necessary, community health workers refer severe cases to appropriate health facilities for appropriate management.

”When I learn that a woman in my village is pregnant, I first ask her to go to the nearest health center for consultation. If she has already done so, I ask her to bring me her card so that I can register it in kiramama by sending an SMS from my phone; then I start to follow the evolution of her pregnancy with the support of kiramama, who sends us reminders as each mother and child approaches the visits, reminding her, among other things, of her appointments for the prenatal consultation until at childbirth. After birth, I also follow the evolution of the newborn, making sure that the vaccination schedule is respected,” says Béatrice Niyonzima, very confident.

Béatrice Niyonzima also treats children under five, who suffer from malaria, diarrhea and pneumonia, in addition to screening for malnutrition. ”We know how to handle each of these cases. We also know when to refer high-risk cases to the health center for prompt and effective treatment. Many recover without having to go to the health center,” explains Béatrice.

The services of Béatrice and other community health workers make life easier for many families in the commune of Makebuko.

Signoline Ndihokubwayo, 28, mother of a 2-year-old child and 7 months pregnant, is one of the lucky ones. She has had their support since her first pregnancy. ”Given the context in which we live here, some women, overwhelmed by agricultural and domestic work, easily forget to go see a doctor and the consequences are often harmful. I know a mother who had an abortion following a complication of which she was not aware because she had never consulted a doctor, out of ignorance,” says Signoline.

Modelas Iradukunda, on the other hand, is a mother from Mwaro-Mavuvu hill whose child’s life was saved thanks to the home care offered by Beatrice, who treated him, successively for malaria and diarrhoea. ”It’s really an advantage to be able to access home care because sometimes it’s hard to get to health facilities in time, which are not always close. My child is cured without me having to go to the health center in Makebuko,” she says happily.

The positive results generated by the Kiramama and iCCM approaches are already being felt at the Makebuko health center. Laetitia Kubwimana, head of the health center, mentions in particular the increase in the number of women who keep appointments for prenatal consultations as recommended, or to have their children vaccinated, but also the decrease in the number of home births.

”Before the Kiramama project, our health center only received about 5 women per month for early prenatal consultation; today we receive more than 50 women per month,” confirms Laetitia Kubwimana, head of the Makebuko health center. She is also pleased with the reduction in the number of children who come to consult for illnesses such as diarrhoea, malaria and pneumonia thanks to the iCCM approach: “The general danger signs are no longer observed in our health center” , she said proudly .

Community health workers are supervised and coordinated by the health centers, to which they regularly share their reports for analysis. With the support of UNICEF, at least 1,357 community health workers, 56% of whom are women, have seen their capacities strengthened in the collection and communication of health information relating to the implementation of community-based interventions.

“The Kiramama and iCCM approaches have made it possible to significantly reduce maternal and infant mortality in the health district of Kibuye”, also said Dr. Magorwa Jean Bosco, Chief Medical Officer of the health district of Kibuye. It refers to data from the DHIS2 Platform of the Ministry of Public Health and the Fight against AIDS; a platform that centralizes data collected from the community level to the hospital level.

“Thanks to the iCCM approach, almost 100% of children cared for by these community health workers in Kibuye district are cured; the majority of them consult within 24 hours of the first signs. And with the kiramama or RapidSMS approach, it becomes easier for health centers to save the lives of pregnant women who show danger signs such as bleeding, early uterine contractions, or ruptured membranes (… ) Community health workers send text messages directly to the health center, which, if necessary, dispatches an ambulance in a timely manner“, explains Dr. Magorwa Jean Bosco, chief medical officer of the health district of Kibuye.

In an effort to strengthen the data quality of the health system in general and the community health information system, in particular the establishment and strengthening of intelligent systems for monitoring maternal and child health, the iCCM approach, and the quality of DHIS2 data at the community level, Burundi has been implementing a project called iCOHS (intelligent community health system) for 3 years; funded by the Rockefeller Foundation, to highlight some of the best practices and strategies in digital health.

In collaboration with Mediabox, its implementing partner, UNICEF has developed a digital application that aims to improve the quality and speed of reporting. The app is designed for community health workers and health professionals to provide data directly to the DHIS2 platform, using tablets, phones or smartphones. UNICEF and the Ministry of Health have also developed a roadmap for the interoperability of existing systems such as DHIS2, the RapidPro-based community information system (iCCM and Kiramama application) in UNICEF target areas. .

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