The USAID-funded Madagascar Community-Based Integrated Health Project (CBIHP), known locally as MAHEFA, is a five-year program (2011-2016) implemented by JSI that provides basic, quality health care to isolated populations in six of Madagascar’s most remote regions. In October 2013, the project launched an SMS-based data management system to track stock status of essential medicines and health supplies; stocks are recorded and sent via SMS by community health workers. The results of this #mHealth #logistics innovation were presented at the Digital Health Conference (#D4Africa), held in Malawi, May 13th, 2015.

1. SMS for Community Logistics Management
Introduction
The USAID-funded Madagascar Community-Based Integrated Health Project (CBIHP), known locally as MAHEFA, is a five-year program (2011-2016) implemented by JSI Research & Training
Institute, Inc. that provides basic, quality health care to isolated populations in six of Madagascar’s most remote regions. MAHEFA’s overall objective is to increase use of proven, community-
based interventions and essential products for maternal, newborn and child health (MNCH); family planning and reproductive health (FP/RH); water, hygiene and sanitation; malaria prevention and
treatment; nutrition, and community integrated management of childhood illness (c-IMCI) among underserved populations.
After the Ministry of Health (MOH) developed the National Policy on Community Health (NCHP) in 2009, MAHEFA was the first program to operationalize it, by aiming to increase demand for and
availability of quality services and products, and to improve community health workers’ (CHW) service provision skills. Now at the program mid-point, MAHEFA advances the MOH’s policy by
engaging communities and increasing population coverage of basic health services through the champion commune approach, or Kaominina Mendrika Salama Miabo (KMSm), whereby communi-
ty actors are supported to take over health management to increase community participation and accelerate behavior change. More than 6,000 CHWs in MAHEFA areas are trained, equipped,
and supervised to provide integrated services for 3.4 million people (16% of the population).
Target areas include extremely isolated communities, many of which did not have community-level health services available or development assistance until MAHEFA started. Clients often must
travel 25 km or more to reach the nearest health center. Challenges such as cyclones, flooding, and insecurity due to local bandits are common and can impact accessibility. To address these and
other challenges, core services are complemented by innovative approaches that support community members to work together to achieve better health outcomes.
JSI is the lead implementing organization working with two main partners: The Manoff Group and Transaid. In addition, JSI is working with and through 15 Malagasy NGO grantees, private sector
groups, social marketing organizations, and community partners.
This poster is made possible by the generous support of the American people through the United States Agency for Internati onal Development (USAID).
The contents are the responsibility of MCHIP and JSI Research & Training Insti tute, Inc and do not necessarily refl ect the views of USAID or the United States Government.
Box 1. Summary of the results of the stock management system by SMS evaluation
Strengths of the system
1.CHWs appreciate receiving phones - good motivator
2.TAs and CHWs are already making use of the phones to coordinate their supervision visits, monthly
meeting appointments, and transmit some information about stock availability informally
3.CHWs believe that the program is worthwhile, would like to use it
4.TAs like the potential for real time information on what is happening with their CHWs
5.CHWs report that in some cases, just sending in the messages has reminded them to resupply
Areas needing improvement:
1.Challenges related to the design of the system
2.End users not clearly identified
3.Too many products
4.Too many data points
5.Duplicate work considering hard copy forms
Challenges related to the use of mobile technology
1.Data entry (message codes; need to first fill out an additional paper SMS guide form; lack of constraints/
validation during data entry; lack of specificity in error messages; only sending in one or two out of the five mes-
sages; high cost of resending messages many times)
2.System output messages (CHWs usually didn‟t receive these messages; PAs didn‟t send in data to populate
them; messages not clear)
3.Dashboard and data visibility (No visibility into PSI/PAs‟ data though it was being used by the system; lack of
visibility into the exact messages received and sent by the system; data collection system is different than a logis-
tics management information system; rigidity of the platform to respond to specific requests)
4.Hardware (CHWs not comfortable with manipulating cell phones - less than 50% (maybe as low as 20%) had
personal phones before this SMS pilot - Airtel network is not always available; electricity/charging of phone bat-
teries is unreliable or expensive)
The JSI/MAHEFA Revised Sms System
MAHEFA SMS for CHVs: is a mobile-phone based logistics management information system, used by
CHWs to report logistics data and manage resupply from the commune level for twelve key tracer com-
modities :
The logistics management information system project goals are based:
1. to reduce the cost of collecting data and generating meaningful reports,
2. to significantly reduce the time taken to collect data and generate reports, charts and maps,
3. to increase the frequency and accuracy of reporting
4. to improve on the visibility of the available stock leading to a reduction in the number of stock
outs
5. to reduce the cost and time taken to generate accurate forecasts To deploy and support a sys-
tem that is proven to operate well in similar environments
6. to deploy a system that is financially sustainable
Description :
The project is piloted in two districts: MANDRITSARA and AMBANJA involving 375 CWs, 22 TAs, 34 CSBs and 2 MIs
JSI’s mHealth Center and MAHEFA is working with Greenmash to implement this project on Greenmash’s system
named “MANGO”.
Mango has a growing suite of modules and applications making it an ideal platform for the MAHEFA data collec-
tion and reporting requirements beyond stock management.
The system will use these functions to deliver 5 SMS surveys as follows:
 An SMS survey to capture stock on hand for Community Health Volunteers.
 An SMS survey to capture stock on hand for PA (Supply Point).
 An SMS survey to capture stock on hand for Health Center (“Centre de santé de base”).
 An SMS survey to capture stock purchases by Community Health Volunteers.
 An SMS survey to capture stock-outs for Community Health Volunteers.
Background :
In October 2013, a data management system to track the location and movement of CHWs‟ stock of health products was operationalized in two pilot districts (Mandritsara, Sofia Region and Ambanja,
DIANA Region). On the one hand, this system uses mobile phones to transmit information on CHWs‟ stock status to a centralized system that conveys this information to the supply points or PAs (“points
d’approvisionnement”) assigned to the CHWs. The PAs, in turn, are able to inform the CHWs of the health products available at their level. This is meant to reduce stock-outs and the risks involved in
transferring the monthly stock reports of CHWs located in remote areas from their NGOs‟ regional office to MAHEFA‟s M&E team. This was intended to help avoid the situation in which CHWs travel long
distances to their PAs only to return empty handed as the health products they were seeking were unavailable. However, in February 2014, it was noted that the system did not bring about its expected
results. Furthermore, after analyzing the options for improving the system, MAHEFA decided to shut it down in March 2014 and conduct with a JSI mHealth expert to review the pilot system and give ap-
propriate recommendations for a new system. The main results of this review are highlighted in the box 1. Based on its recommendations, a new design of the system has emerged.
1.Oral contraceptive
2.Injectable contraceptive
3.ORS/ZINC
4.Water treatment (Sûr’eau)
5.ACT Child
6.ACT Infant
7.RDT
8.Cotrim /Amoxicilling 120
9.Cotrim /Amoxicilling 240
10.Cotrim /Amoxicilling 480
11.Misoprostol
12.Chlorhexidine
Products that are managed through this system are :
1. Current response summary
2. Stock Level Chart
3. Historical Level Report
4. Stock Out Graph
5. Response Chart
6. Response Maps
7. Monthly quantity dispensed
8. Average Monthly Consumption
The following reports are available in this mango installation: