D-tree is an NGO that develops clinical protocols and mobile applications to improve healthcare in developing countries. They implemented a project in Malawi that equipped health workers with phones containing an app to assess and treat under-5 children per national guidelines. Over 20,000 children have been assessed using the app, which has led to better adherence to guidelines, automated reporting, and improved confidence in health workers' abilities. However, challenges include stockouts, network issues affecting data syncing, and eyesight problems for some health workers. D-tree plans to expand the project and add new features like malaria testing.

1. Presentation by Clement Udedi at Mobile for Development
Conference in Senegal at Cheikh Anta Diop University
Better decisions save lives
Mobile Health Improving Decision Making
Process of Community Based Workers in Hard
to Reach Areas in Malawi

2. D-tree background
An NGO dedicated to improving the quality of
health care available to the world’s poor
Our vision is a world in which every person has
access to high-quality health care

3. Problems we solve
Shortages of doctors and nurses in poor countries
means critical decisions are made by health
workers with limited training which can lead to:
Inconsistency in adhering to clinical protocols
Problems in diagnosis and treatment
Lack of adequate information for care provision

4. What we do
Develop clinical protocols for
health workers in low and middle
income countries
Design software for delivering
protocols on mobile devices
Enable the effective use of
electronic clinical protocols
worldwide

5. 1. Chronic disease
 HIV/AIDS
 Diabetes
 Hypertension
 TB
2. Child health
 IMCI
 Malaria
 Newborn
 HIV/AIDS
 Nutrition
3. Preventive
Care
 Antenatal
 Immunizations
 Care and
support
4. Reproductive
Health
 Family Planning
 Labor &
Delivery
 Newborn
Our work in Tanzania, Malawi, Benin, India and Sri Lanka
Both at facility and community level….

6. Integrated Community Case Management Project
(iCCM)
 Project that equips health surveillance
assistants (HSA) with a phone containing a
community case management application
 Application follows Ministry of Health
community IMCI protocol for assessing and
treating under five children
 Application has 3 components aimed at
strengthening HSA’s ability to deliver effective
and efficient care
 Integrated Community Case Management protocol
 Supervisor application
 cStock

7. What has been done so far
 119 Health Surveillance Assistants and 6
HSA supervisors have been trained
 Supervisor application is used for remote
monitoring of HSA activities and routine
supervision
 Dashboard developed for data analysis
and monitoring of village clinics activities
 Over 20.000 children assessed using the
mobile CCM application

8. Overview of the CCM application
 Registration of child done before any assessment (for
children attending clinic for first time)
 HSA asks caregiver series of questions; based on
responses the application determines illness, treatment
and health education advice for child

9. Sick Child Recording Form

10. Vaccinations Monthly reports
Simple paging between monthsVaccinations due highlighted

11. Counting breaths
lth worker uses phone as timer for respiratory rate
Stopwatch in the application

12. cStock user interface

13. Supervisory Application

14. Zenji Dashboard

15. Lessons learned
 Improved access to information compared to village
clinic register
 Better adherence to stipulated guidelines
 Automatically generated monthly reports
 Easier follow up because of reminders
 Reduced workload of reregistering children
 Improved confidence caregivers in ability HSA
 Respect community because of technological
advancement
 Concern caregivers about increase assessment time
 Competence in using application comes with
practice

16. Implementation challenges
 Stock outs of drugs
 Maintenance application and equipment
 Poor network affecting synchronization data
 Paper vs. mobile phone
 Reporting and supervision
 Eyesight problems

17. Way forward
 Project to be expanded to other areas
 Malaria Rapid Diagnostic Testing
functionality
 Resource mobilization to train more HSAs in
using CCM application
 Identification of sustainability measures
beyond project duration

18. Contact us
Offices in Boston, Tanzania and Malawi
Clement udedi
cudedi@d-tree.org
http://www.d-tree.org
Better Decisions Save Lives