How digital health is helping Zanzibar to achieve UHC

In August 2021, the Zanzibar Ministry of Health (MOH), in partnership with D-tree International, celebrated a significant milestone as Jamii ni Afya—the government’s digitally-enabled community health programme—reached full scale

 

 

Jamii ni Afya leverages government guidelines and global best practices to walk community health volunteers (CHVs) through each step of delivering high-quality, standardised services in maternal and child health; nutrition; water, sanitation and hygiene and early childhood development using digital tools. The data generated from these interactions is used to strengthen the health system by improving CHV supervision, personalising health services to
client’s needs, and supporting programmatic and policy decision-making at community, district and national levels.

 

This is an important moment for the field of global health, as Zanzibar is among the world’s first examples of a government-led digital community health programme achieving full scale. By ensuring all of its 1.6 million citizens have access to a digitally-equipped CHV at their doorsteps, Zanzibar is closer to universal health coverage than ever before.

 

Jamii ni Afya’s comprehensive digital system connects communities, health facilities, and the health system to transform how care is delivered. 2,300 CHVs are equipped with digital tools that guide them in providing care, automate data collection, and digitally link referred clients to primary health facilities. As a patient’s care needs change, CHVs receive tailored guidance to follow up and provide the most appropriate and personalised care possible. For supervisors and decision-makers, Jamii ni Afya provides valuable data, visualised on dashboards, to
monitor and improve performance of the health system. Because data is aggregated from across the system, the MOH has a real-time understanding of community health in Zanzibar for the first time.

 

Although the programme is still in its early stages, Jamii ni Afya is already making an impact:

 

● More than 1 million people (out of 1.6 million) have been registered in the programme, demonstrating strong community acceptance and buy-in.

 

● 86 per cent of pregnant women in the programme are delivering in a health facility with a skilled birth attendant—a 28 per cent increase over the national average and one of the strongest predictors of positive maternal and newborn outcomes.

 

● Over 95 per cent of women and children who exhibit a life-threatening danger sign successfully receive care at a health facility, more than triple the rate of typical referral completion.

 

● Due to the strong digital monitoring and supervision system, more than 75 per cent of CHVs consistently meet performance targets to deliver quality, timely home-based visits to their neighbours, ensuring that everyone receives the care they need, when they need it.

 

At the policy level, the government has taken important steps to ensure long-term ownership and financing of the programme into the future. To formalise the use of digital tools within the primary health system, the government revised its National Community Health Strategy (2019-2025) to recognise digitally-enabled CHVs as part of the government’s health system and to reaffirm the MOH’s vision of an inclusive community health system for all Zanzibaris. While this alone is a tangible demonstration of the government’s commitment to Jamii ni Afya, embedding the programme in the strategy also makes it eligible to receive direct government funding from the Ministry of Finance and from multilateral donors.

 

“We are extremely proud that the Jamii ni Afya programme is now serving every community and ensuring that every Zanzibari can access high-quality health care. This represents an important milestone in our long-term partnership with D-tree, and a meaningful step toward achieving universal health coverage.

 

With Jamii ni Afya, we are creating a foundation for transforming Zanzibar’s primary health system. The Ministry is committed to leading Jamii ni Afya into the future and to continue increasing demand for health services, improving the quality of care provided, and actively involving communities in the health system.”

 

– Dr. Abdullah S. Ali, Director General, Zanzibar Ministry of Health

 

The Zanzibar government has also shown strong commitment to strengthening the enabling environment for digital health. In 2020, the government developed their first National Digital Health Strategy (2020-2025) and corresponding Digital Health Investment Roadmap, outlining plans for a coordinated digital health ecosystem. Jamii ni Afya is also integrated into Zanzibar’s health management information system (DHIS-2), positioning the
government to use this vast data set in resource planning and decision-making.

 

There is a tremendous opportunity to employ Jamii ni Afya as the foundation to transform Zanzibar’s health system. From health insurance to client registries that enable seamless care from the community to facilities; having comprehensive individual client health records, made possible by Jamii ni Afya, will be catalytic in strengthening Zanzibar’s health system and advancing its goals for universal health coverage.

 

For further information, please contact Erica Layer, D-tree International elayer@d-tree.org