RapidPro in Nutrition Surveillance for Emergency – The Mozambique experience

Launched: October 2016


By Nelson Rodriguez, Innovation Specialist, UNICEF Mozambique

Background:

Due to the “El Niño” phenomenon Mozambique, along with other countries in the region, has been affected by one of the worst drought periods in the recent past. It is estimated that approximately 1.5 million people might be living without the necessary food security levels and thus they face substantial difficulties to access adequate nutrition. As always, the most vulnerable to these shocks are children under 5 and pregnant or lactating women.

In Mozambique nutritional screening of children is performed in outpatient and inpatient care in Health facilities and since 2016 by mobile brigades that perform community outreach activities. The data generated at these 3 entry point is of paramount importance to effectively respond to the impact of the drought. Statistics generated by the health facilities and the mobile brigades are collected at the District Health Office and sent monthly to the Provincial level for compiling. The Provincial level then aggregates all data from the Districts in order to share with the Ministry of Health. All this process is done in paper forms, which decreases the timeliness of information transfer. It is not unusual to have monthly reports taking one month or more to arrive to the central level.

Proposed solution:

UNICEF has been working since August with the Ministry of Health of Mozambique to pilot a monitoring system for to allow faster data collection and dissemination among different levels. This monitoring system will only be implemented in 30 selected districts that have been identified as being more affected by the drought and where children are more likely to be suffering from food insecurity.

A weekly monitoring survey will be created to complement the current monthly reporting system. The weekly monitoring system is a short version of the monthly report data containing a total of 13 indicators divided in 3 major areas (Attached is Annex A: Questionnaire):

  1. Enrolments: enrolments of children into Nutrition program
  2. Exits: exits of children from Nutrition program due to being cured, died, defaulted etc
  3. Stocks: the numbers indicating current malnutrition treatment related stock at districts

Three data collection channels were setup using RapidPro which were SMS, Surveyor App and Interactive Voice Response.

For the time being the Interactive Voice Response System has not been used, but the SMS and Surveyor app have been made available and training sessions have been delivered to MoH staff in the target districts.

In addition, an experimental link has been made to “TransferTo” platform to allow for airtime transfer to participants, in order to address issues related to lack of phone credit by the users. Since the system is still in early stages reversed billing was not considered an option and “TransferTo” seemed like a feasible solution.

Results & conclusions so far:

- RapidPro is a valid solution to have a quick start. The initial setup of the system took less than 2 weeks after decision to use RapidPro (note: the office already had a contract setup with Nyaruka);

- RapidPro is not very user friendly in the exports of raw data and require staff time in order to clean and prepare the data for analysis;

- User reporting rate has been low (approximately 25%), mostly due to lack of understanding of the importance of the system and a low engagement by the Ministry of Health in requesting the data from lower levels;

Update - June 2017

- User reporting rate was initially low (approximately 25%), however weekly user reporting rate jumped to 90%, once Ministry of Health officially requested the data from lower admin levels and once certain personalization was added to the service (customized messages, reminders, credit transfer at the end of report to offset user costs);

- Interactive voice response was launched, but due to technical difficulties it is not widely used by users;

- “TransferTo”used to further incentivise submission of reports 

Next steps:

- Conduct refresher training to districts, co-facilitated by central level MoH Officials to raise the profile of the activity

- Add e-mail feedback loops to Provinces and Central MoH, so it is known in real time who has submitted the Weekly nutrition data

- Train MoH in RapidPro platform management for increased ownership and potential transfer of the system