A mobile patient feedback platform for primary care facilities in Tanzania

Afya Pamoja is a mobile patient feedback service to support responsive and accountable decision making within the public healthcare system in Tanzania. With FID support, the team will test the solution focusing on maternal, newborn and early childhood healthcare and then observe and assess the impacts of the service in prevision for scale.

Context

In Tanzania, public primary healthcare facilities provide essential healthcare services to 51 million people. Women and children are particularly reliant on these services for antenatal and early childhood care. These facilities also serve low-income and rural communities who rely on public facilities for their healthcare needs. However, these primary healthcare facilities face a range of difficulties in their mission to provide qualitative services  to the targeted populations.

While the Development Vision 2025 formulated by the Tanzanian government stands that there is a need “to adopt strategies to build integrity by promoting accountability and transparency”, there are still inadequate patient feedback channels within Tanzanian primary healthcare facilities. Insufficient patient feedback reduces the ability of healthcare workers and public healthcare managers to understand the real-time needs and challenges of patients on a local level.

Innovation

In partnership with the Ministry of Health of Tanzania (MoH) and UNICEF as technology implementing partner, Afya Pamoja has developed a free SMS survey on the services received at a healthcare facility accessible through a phone. Once submitted, the feedback is analyzed and provided to healthcare workers and government officials in the form of simple alerts, dashboards and quality reports.

The project aims to conduct a pilot of Afya Pamoja focusing on maternal, new born and early childhood healthcare in 150 facilities, to monitor and test client adoption of the service as well as understand how healthcare workers and officials interact with the service.

The intervention is based on both learnings from existing evidence, and a demand from the government of Tanzania:

Rigorous academic research:

• A randomized controlled trial (RCT): “Building Resilient Health Systems: Experimental Evidence from Sierra Leone and The 2014 Ebola Outbreak” (Christensen and al., 2021), finding that of over 250-health clinics in Sierra Leone patient feedback services reduced under-5 mortality by 38% and;
• A randomized controlled trial (RCT): “Brokering Collaboration: Involving Officials in Community Scorecard Programs” (Kosack and al., 2021) suggesting that accountability programs involving officials are more effective than those that rely on social accountability alone;
• Mobile patient feedback system is a key part of the country’s digital health strategy (Ministry of Health 2019).

Expected results

The pilot activities are expected to drive change in:

• Increasing trust in services, leading to increased service utilization. Evidence from similar services suggests that this can increase utilization by 20% (Gullo and al., 2017).
• Increasing service availability. Evidence from similar services suggests that it can increase availability of essential medicines by 41% (Blake and al., 2016).

At the pilot scale, Afya Pamoja is expected to save approximately 434 under-5 lives per annum.

Ultimately, the innovation is expected to drive improvements in healthcare outcomes by enhancing patient engagement.