Introduction
Tanzania has made progress in addressing childhood illness and mortality, and registered some major gains. For instance, according to data from UNICEF, deaths of children aged under five years have steadily declined from 62.2 deaths per 1000 live births in 2012 to 40.5 in 2022 (Unicef data1). On the island of Zanzibar, under-five mortality rate is still high, at 47 deaths per 1000 live births. The government uses Community Health Volunteers (CHVs) to conduct health promotion activities that include child health, and to provide very basic curative services and referrals for further services.
Through a project implemented in collaboration with D-tree, a digital technology company, the Ministry of Health in Zanzibar is using Internet of Medical Things (IoMT) devices to enhance the performance of CHVs in managing childhood illnesses, with remarkable results. IoMT is a network of interconnected medical devices and systems that collect, analyse, and transmit health data. It revolutionises healthcare by linking providers to a network of tools that support clinical decision-making in patient care, enabling timely interventions, and personalised treatment.
Implementation
The Ministry of Health in Zanzibar and D-tree implement Jamii ni Afya project, which inter-linked digital devices to support CHVs in managing childhood conditions. The CHV uses a mobile phone app to make decisions care on the care of sick children in the community. The app guides the CHV through all the stages of care, following the established standardized care guidelines on maternal and child health. The CHV can initiate referral for further care, if necessary, directly from the app. The app runs on low-end Android smartphones, with offline functionality to support care decision-making even when out of internet range. The app sends data to a supervisor using a computer, who can access it via a dashboard. This enables the supervisor to provide support if needed, and to follow up on any referrals made to ensure continuous patient care.
The project started as a pilot, first ran in 2011–2012, followed by expansion. By 2021, the project had been scaled up to reach all CHVs on the island. It has also been fully adopted by the Ministry of Health, who now oversee its implementation across Zanzibar.
Policy and Regulatory Framework
The Government of Zanzibar is committed to integrating emerging technologies to improve the quality and reach of health services. The 2021-2025 Zanzibar Digital Health Strategy emphasises the use of digital solutions in health care to enhance access to high-quality health services (Ministry of Health, 20202). Specifically, the strategy recognises the added value of applying health technologies to improve services at community level. Zanzibar is also guided by the national Policy Framework for Artificial Intelligence in Tanzania Health Sector, launched in 2022, to guide the use of technology in the health sector, in line with the country's health goals. The 2023 ICT policy provides the framework for regulation in the application of technology in service, which can cover technologies in health.
Impact
By 2023, 1.5 million people (out of a total population of 1.9 million) had registered in the Jamii ni Afya digital programme, demonstrating strong community acceptance (MOH, 20233). Over 320,000 pregnant women and children younger than 5 years had received health visits from a CHV. Further, nearly all pregnant women and children exhibiting life-threatening danger signs are successfully referred for care at a health facility, which is a significant improvement over the normal referral route. The government documented increased numbers of deliveries in health facilities and reductions in stunting among children younger than 5 years (Layer E, S. Slim et al, 20234). In addition, the linked supervision has led to improvement in the CHVs’ performance, ensuring that households can receive the care they need, when they need it.
Lessons Learnt
Embracing digital technology has enabled Zanzibar to enhance the performance of its CHVs to contribute to positive health outcomes in their communities. Leadership and ownership by the Government has helped the programme to achieve near full population coverage in a short time. Other African countries seeking to leverage IoMT technologies to improve population health should consider:
- Investing in digital infrastructure and the internet, including supporting the market for low-cost smart devices.
- Promoting the capacity of all levels of healthcare professionals in using IoMT technologies to deliver quality health services.
- Entrenching support and adoption of emerging technologies programmes in policy, and strategic health priorities.
- Encouraging local innovation and development of IoMT solutions tailored to their healthcare needs.
- Embracing partnerships with other agencies, who can support and pilot innovations at their cost, in collaboration with the government.
Conclusion
D-tree’s Jamii ni Afya shows how mHealth applications can support community health workers in managing community health including childhood illnesses. The widespread use of smart phones and Bluetooth and WiFi-linked devices in Africa presents new opportunities and means for countries in the region to extend health services to their people. These technologies can bridge healthcare gaps, improve outcomes, and build more resilient healthcare systems tailored to the diverse needs of African populations.