The introduction of the RapidPro tool is a giant step forward as for improved monitoring and evaluation as users can build, test and fine-tune scalable mobile-based applications. UNICEF has a greater opportunity and responsibility to maximize the potential benefits and support quality standards in reporting while preventing the possible disadvantages of potential fractioning, duplication and over-burdening of reporting tasks caused by the proliferation of new applications and methods.
Introduction of innovation projects
New adaptable plug and play services simplify launching of innovation projects. At the same time many UNICEF offices and government counterparts have had a risk averse behaviour to adopt technological solutions. To get a foot in the door, innovation projects often followed opportunistic paths. In many cases, we have not been able to capitalize fully on the existing opportunities. In most developing countries, coordination issues are evident for innovation. Tech projects often fall under the lead of an innovation wing of the Ministry of Telecommunications. Production of nutrition, WASH and health data should naturally integrate into national information management systems. Governments have committed to use products such as DHIS2 but are still adapting the generic products into locally relevant tools. In a few countries, such as Uganda and Rwanda, government leaders assumed the coordination role to define and coordinate the innovations agenda. In these cases, the government has directly addressed the problems of proliferation of projects, duplication of efforts and demands of excessive reporting burdens.
The 1000 days – Critical time-period for UNICEF supported interventions for children
The new opportunities for improved services on many different projects, platforms, target audiences and objectives could greatly benefit from an overall coordination framework. As proposed by the innovations section, the UNICEF supported projects building on the strengths of community health workers and the national health system would be buttressed by a 1000 days program structure. Through the global leadership and coordination for nutrition in the Scaling-Up Nutrition (SUN) initiative, UNICEF has lead efforts to introduce mobile tools to ensure the availability and utilization of essential interventions in the 1000 days between a woman’s pregnancy and her child’s second birthday.
UNICEF wants to strengthen community and health system services delivery by providing mobile services for support across the entire continuum-of-care throughout the 1000 days time period. An effective coordination umbrella can help to ensure that critical child survival and development interventions are available and supportive actions for those services are maintained. Opportunities for support include:
- Implementation of antenatal care (Iron supplementation, Tetanus Toxoid vaccinations, danger signs)
- Maternal and neonatal survival packages (EMOC)
- Birth registration
- Nutrition Package (MNPs, IYCF, VAS/Deworming, Management of SAM)
- Expanded program for immunization
- Community based management of pneumonia, diarrhea and malaria
- Water, sanitation and hygiene services promoted through health centers and workers
- Stocks management, human resources management
- Training, testing and motivation/incentives of health service personnel.
This coordination framework should also be inclusive to help support other partners providing:
- Emergency obstetric care (recognizing and tackling the 3 delays)
- Reduction of maternal mortality (Rx for post-partum hemorrhage)
- Access to contraception / family planning services
The communications (C4D) aspects for community based and health system service delivery are needed within the coordination umbrella to ensure messaging for improved demand for services is provided and repeated at the correct times, places and media channels. With the new innovations tools, there are greater opportunities to have more qualitative information with UReport and specific triangulated quantitative data through standardized program reporting tools.
With a coordination framework and generic tools for adaption in countries, it will be easier to develop monitoring and evaluation systems in a streamlined fashion. Emphasis is needed to ensure that the monitoring tool can work in areas with limited information availability and in regions with more robust reporting. The reporting tools should be based on national, regional and global protocols. Coordination should provide support both within and across program sections and the coordination work must be in conjunction with all counterparts and strategies in countries (for example with national mHealth policy). The coordination support also needs to provide clear guidelines on how to maintain privacy and anonymity of children and their families while ensuring that all collected data are protected from general release or misuse.
In countries with the highest rates of infant and maternal mortality, there are often barriers to actually using data for decision-making. National HMIS tools are are often incomplete, inconsistent, or a year out of date. Significant needs are evident not only structures for data collection but also the development of analysis skills and use of results for programmatic guidance. In these cases, the automation of programmatic management support is critical.
The bottleneck analysis framework is a well-defined tool easily grasped by most supervision staff, but sustainability of this analytical thinking is often a problem. Feedback mechanisms to respond to the identified constraints must be developed and supported. The innovations tools can support the regular collection of supply, demand, human resources and enabling environments but targeted messages to support the correct responses and regular reminders are needed to make the assessment, analysis and action cycle function.
Harmonization of data collected
Under the coordination structure, efforts to harmonize the collection of indicators are also needed. Significant efforts have been made by the global and regional offices through the NutriDash reporting tool and harmonization of management of SAM protocols across countries with high burdens of acute malnutrition. Other efforts such as those of David Brown UNICEF to improve reporting on coverage of vaccination rates have made progress. Still many mixed methods of reporting remain. There are needs to standardize reporting both within and across countries. With the introduction of new reporting forms and tools, we have the opportunity to make important improvements while improving the frequency and validity of data.
Equitable delivery of services
UNICEF and partners have demonstrated that integrating mobile technologies into health systems can help to identify problems of time, distance and coordination in the delivery of health services. The emergency responses for Polio and Ebola have contributed enormously to improving maps of areas where populations were typically underserved by health, nutrition and WASH services. Using and contributing to open-source mapping services provides opportunities to better link community health services to the formal health system and to directly target and interact with even the most isolated or often neglected beneficiaries.
To build this coordination framework, we will need three key inputs: country level facilitators of innovation projects, national coordinators to use innovations to improve monitoring and evaluation and global guidance for the design of tools and promotion best practices for implementation of the 1000 days programs.
A maintained supported platform of mHealth / mNutrition applications under the larger 1000 days coordination umbrella and active global support will decrease barriers to use technology for programming implementation, reduce duplication and costs, and promote replicability, accountability and commitment to improved service delivery.