[liberationtech] HCT project in South Africa using DHIS2 & OpenXdata (as "Capture")

[Yosem Companys]

From: Dagmar Timler <diggitydugs at gmail.com>

Hi, my name is Dagmar Timler and I am part of a team at *Cell-Life 
<http://www.cell-life.org/>* in South Africa.

It's my pleasure to tell you today about a project initiated by the South 
African National Department of Health.

*Background*

The *South African National Department of Health <http://www.doh.gov.za/>*(NDOH) identified that mobile technology could play an important role in 
improving both the speed and the quality of data for informed decision 
making and improved service delivery in the Public health sector. The 
Department Tendered for a supplier to design and implement a Mobile 
Monitoring and Reporting System for the HIV Counseling and Testing and 
Antiretroviral Treatment data collection programs, the Ward-Based Primary 
Health Care Workers Community Outreach Teams mobile support initiative and 
other rapid data submission programmes as may be required.

Through funding from the Department of International Development, under the 
SARRAH Programme a consortium of *HISP <http://www.hisp.org/>* and *Cell-Life 
<http://www.cell-life.org/>* were appointed to implement the Project, and 
used the *OpenXdata <http://www.openxdata.org/>* software (under the brand 
name “Capture”) and the DHIS2 to implement the Mobile Monitoring and 
Reporting System.

*Pilot Phase*

The pilot phase included all nine provinces in South Africa, selecting one 
pilot district per province.

This meant, that the project pilot consisted of 937 users and facilities (1 
user per facility). The project pilot phase launched in May 2012 and ran 
successfully until July 2013. The pilot phase started with the reporting 
data on HIV Testing And Counselling (HCT) which included the number of 
persons pre-test counseled and also tested for HIV, and also 
Anti-retroviral Treatment (ART) which collects information on people 
started and remaining on ART.

The initial data elements collected reports on the HIV Counselling and 
Testing (HCT) programme of the NDOH. The success of the pilot phase was 
such, that the program is now being implemented in all 52 districts with 
more than 4000 facilities reporting their HCT and ART data monthly via 
mobile phones.

*Technology*

HISP-SA and Cell-Life presented a solution that responds to NDOH 
requirements by integrating OpenXdata (under the brand name “Capture”) and *DHIS2 
<http://dhis2.org/>*.

OpenXdata (under the brand name “Capture”) is used as the Mobile component 
for data collection, which enables users to capture, validate their data at 
the time of capturing and upload data to the DHIS2

DHIS2 is used to store the data submitted via the mobile component and 
provides flexible analysis and reporting tools in the form of dashboards on 
user’s desktop - where the page contents are automatically updated from the 
database – and is fully integrated with reporting tools (iReports, Jasper) 
and third party analysis tools - Excel Pivot tables and GIS .

This solution will provide facility managers, sub district managers, 
district managers, provincial mangers and NDOH with instant access of the 
data collected at facility level and allows it to respond quickly and 
effectively should it be required.

The technical solution consisted of the following elements:

   - 
   
   OpenXdata (under the brand name “Capture”): Mobile data collection 
   - 
   
   DHIS2: web based central database
   - 
   
   APN: Access Point Name with 10 Gig monthly data
   - 
   
   Data SIM Cards: Vodacom SIM cards linked only to the APN
   - 
   
   Server: Hosting Capture and DHIS
   - 
   
   Cell-Phones: Nokia 5230
   - 
   
   Please Call Me line (PCM): Used to send the download link to the users.
   - 
   
   Implementation – set-up (distributing 1000 phones)
   
Each user was given a Cellphone, SIM card, username and password. The 
Cellphones were issued by the National Department of Health and the SIM 
cards are paid for by the National Department of Health. SIM cards were 
configured to link only to the APN and would not have any access to the 
internet or make and receive voice calls in order to control costs and 
limit abuse.

Users send a Please Call Me (PCM) on receiving their phones, that triggers 
a response SMS directing them to download the mobile phone application 
which sits on the server and only accessible via the APN.

A PCM is free service provided by South African mobile networks which sends 
an SMS to a specified number requesting the sender is called back. The PCM 
was used as it would have been logistically challenging setting up each 
phone and then having them distributed to the users, and since it was 
unknown when the users would be receiving the phones, an SMS sent too early 
could be deleted without being read.

*Implementation*

Users were instructed by the NDOH to submit the required data on a monthly 
basis. Once data is submitted from the mobile phone to the openXdata server 
(under the brand name “Capture”) the data is automatically exported to 
DHIS2 in an XML format. The form data elements are linked using DHIS 
specific bindings.

Managers can then access the data and generate the required reports in 
DHIS2 via the web interface.

*Training*

The method used in training users on the application was a train the 
trainers model. 20 master trainers were selected per district and were 
responsible for cascading the training sessions to the rest of the district.

Each user was provided a comprehensive user guide detailing every step of 
the process, which mainly included screen shots and explanations on what 
was required.

*Progress to-date*

On the whole the feedback from users has continually been very positive. 
Users like the simple interface and the ease with which data can be 
inputted and submitted.

It is vital that there is “buy-in” to the solution to ensure that it is 
accepted and used as specified. This should be incorporated into training 
sessions to overcome any potential user resistance to change.

To-date, over 900 facilities have been trained and the project team is in 
the process of planning the roll-out of the balance of approximately 3200 
mobiles required to complete the project. Funding is provided jointly by 
the National Ministry of Health plus DFID who are assisting in the early 
phases.

The Project Pilot evaluation report together with the project close out 
report was extremely positive resulting in the recommendation to commence 
with the full roll-out to the remaining 43 districts.
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