How Government Ownership Helps Digital Health Programs Scale

Every day, Safia Khamis, a Public Health Nurse on the Council Health Management Team (CHMT) in Zanzibar’s Kusini District, logs onto her laptop to monitor vaccination coverage, danger sign referral completion and facility delivery rates in her district. This data is updated continuously from services provided by community health volunteers (CHVs) equipped with mobile phones through the government’s Jamii ni Afya program.


Based on the dashboard, Safia has an easy view of the health system’s performance in her district. She can identify which communities and catchment areas have lower levels of referral completion rates or other indicators of health seeking behavior and get in touch with CHV supervisors to help them address these challenges.


Health managers like Safia understand firsthand how challenging it can be to administer a health system. Her team is 1 of 11 CHMTs across Zanzibar that are each responsible for overseeing and managing all of the healthcare services provided in their district, including coordinating community health programs and supporting primary healthcare facilities.


In the past, CHMTs lacked clear guidance and tools to go about their work. They struggled to oversee competing community health programs that were led by different partner organizations and often focused on a specific set of services. This fragmentation contributed to variations in how CHVs were recruited, trained and supported, and made it difficult for CHMTs to ensure the quality of the community programs and services that clients received. Furthermore, since program and service data were kept in paper records, it was nearly impossible for the CHMTs to take prompt action in response to changing community needs.


This changed after Zanzibar’s Ministry of Health launched Jamii ni Afya as the unified national community health program that consolidates all previously separate community health worker programs and provides cohesion and clarity for CHMTs and other health system supervisors.


The Ministry of Health and D-tree worked side-by-side to engage CHMTs, community members, and clients directly in the design of Jamii ni Afya, and when the Ministry revised the National Community Health Strategy, CHMTs were designated to oversee the program’s CHVs in their districts with the support of the program’s digital system.


Engaging CHMTs from the very beginning and formalizing their mandate in national policy generated a strong surge of support that helped Jamii ni Afya rollout nationwide. With CHMTs helping create and shape plans to fit their communities’ needs, they were well positioned to lead community outreach and CHV recruitment, training and supervision. This government ownership at the district level not only enabled Jamii ni Afya to scale-up, but also is a key to the program’s long-term sustainability because CHMTs now have experience managing every stage of the program.


Jamii ni Afya connects every household in Zanzibar to a dedicated CHV who is trained and equipped with a mobile app that guides them in providing high-quality services tailored to a client's unique health needs. The mobile app collects data during every visit and is integrated with the government's national reporting systems so health managers have data available in real-time.


And this benefit is not lost on Safia, who says:

Safia Khamis, a District Public Health Nurse in Zanzibar’s Kusini District.
Safia Khamis

"One of the big differences with Jamii ni Afya is that you get information directly from communities, which helps you take action quickly. With quality data in our possession, the program is helping improve health by increasing facility utilization."

With Jamii ni Afya operating nationwide, every CHMT now has data directly from their communities so they can act quickly to improve health outcomes. As the Government of Zanzibar’s partner since 2011, D-tree is proud to celebrate the program’s achievements and the government’s commitment to universal health coverage. Their leadership has been essential in taking Jamii ni Afya to national scale and we look forward to our continued partnership as the government takes on full management of the program as part of their health system in the years to come.

This is the second post in a series highlighting Jamii ni Afya, one of the world’s first digital community health programs to reach full national scale. Learn more about Jamii ni Afya’s journey to connect every community in Zanzibar to essential health services.