The story of Jamii ni Afya: 3 keys to successful sustainable digital health

This blog is part of a series. Following our brand refresh, we want to invite readers to better understand our approach and work. Read the other pieces:

• Redefining and reconfirming what we do
  
• Saving lives in Tanzania with the digital tools for tomorrow
• Using data to drive health impact in Tanzania
• What’s the most important ingredient of a successful a design process?

Omar Abdalla, D-tree Technical Advisor for Government Integration and Strategy in Zanzibar, writes about our collaboration with the Ministry of Health in Zanzibar bringing the digital community health program, Jamii ni Afya to national scale, and what he believes are central to the long-term sustainability for this program and similar digital health initiatives elsewhere. 

Zanzibar has long been a champion of Universal Health Coverage (UHC) and recognized the need to strengthen its community health system to reach this goal. Previously, the community health system was characterized by multiple projects and lacked coordination, not bringing impact to scale. Community health providers worked for different programs and often visited households in silos, providing one specific service such as HIV treatment, malaria treatment or family planning services. Many of the projects came to an end after 1-3 years, leaving gaps in the services provided to citizens and households confused by the many visits from different health care providers.

Improved coordination for increased health impact

In 2015, D-tree implemented Uzazi Salama to provide digitally enabled reproductive and child health services in 10 of 11 districts in Zanzibar.

“Data from Uzazi Salama, which was also the very first digital community health program in Zanzibar, showed that over 86% of the pregnant women who enrolled in the program delivered their babies in a health facility – compared to the national average of 68 %.”

Health targets related to reproductive and child health services such as facility delivery, antenatal and postnatal care services utilization and maternal and child mortality improved significantly. Data from Uzazi Salama, which was also the very first digital community health program in Zanzibar, showed that over 86% of the pregnant women who enrolled in the program delivered their babies in a health facility – compared to the national average of 66%. For the first time, we were seeing real impact. The Ministry of Health trusted our efforts had contributed to this positive change and started developing a Community Health Strategy in 2018. With our support, the Ministry updated the strategy to include a clear role and commitment to Community Health Volunteers (CHVs) and developed its first Digital Health Strategy, calling for a unified, integrated community health program to cover every household in Zanzibar.

Out of this policy environment, Jamii ni Afya (meaning “community is health” in Swahili), kicked off. Jamii ni Afya is a comprehensive, government-led, digital community health program connecting families, community health volunteers and the health system to ensure everyone has access to essential health services. It achieved full national scale last year by bringing digitally enabled healthcare to every household in Zanzibar, making it one of the first examples of a government-led, digital community health system achieving national scale anywhere in the world. Since 2019, we have proudly been driving, in collaboration with the Government of Zanzibar, the design and implementation of digital solutions for improved community health in Zanzibar.

“Since 2019, we have proudly been driving, in collaboration with the Government of Zanzibar, the design and implementation of digital solutions for improved community health in Zanzibar.”

Sustainable digital health transformation in practice

We are currently focused on supporting the Ministry of Health to ensure the sustainability of Jamii ni Afya. For us at D-Tree, this means that the Ministry of Health will fully own the program and be in the driver’s seat for all programmatic, operational and technical aspects, with D-tree continuing to support as needed. To get there, we are at the early stages of putting together a transition plan and ensuring the Ministry has the capacity and knowledge required not only to keep the digital system updated but also to make modifications as needed.

We believe that what has been, and continues to be, central to the success of the program and sustainable digital health transformation are:

1. A sustainability roadmap for operations and finance

Key for long-term success is to put in place a sustainability roadmap for operations and finance. Following an inclusive and participatory approach, we are working to channel donor investment for the creation of the digital health strategy and create a sustainable finance strategy to ultimately establish a roadmap that aligns donors and partners to work toward the government vision. 

2. Capacity transfer between the Ministry of Health and D-tree

Since the onset of the program, we recognized the need of building the necessary skills for the government to be able to take full ownership of Jamii ni Afya. The Ministry of Health and District Health Management Teams raised awareness in communities, recruited and trained CHVs and supervisors as well as managed the impact of the program. 

The Ministry seconded staff to D-tree, making them heavily involved in all aspects from design to planning, technology development and implementation and D-tree seconded a staff member and a long-term Senior Digital Health Advisor who joined the Ministry to supplement their teams and coordinate Jamii ni Afya.

3. A supportive policy environment

Finally, an important ingredient to the success was the supportive policy environment in which the program has been implemented. The role of the CHVs in Jamii ni Afya is incredibly important and should not be underestimated. With the development of the Community Health Strategy, their roles and responsibilities were clearly defined, which ultimately provided the opportunity for the program’s institutionalization.

The points above may not be a surprise or seem unique on their own, but together they contribute to an environment where digital health solutions can be institutionalized and sustainable.

The global perspective & future

Jamii ni Afya is one of the first digital health programs in the world to reach national scale and as a Zanzabari, I’m really proud to be part of this unique program. Not until we make digital health innovations become part of countries’ health systems, will they be sustainable, efficient and effective. 

The Zanzibar Digital Health Strategy was developed in 2021 and continues to foster the institutionalization of digital health in the country. I believe that digital health actors have a lot to learn from the success of Jamii ni Afya, especially on how to work closely with governments and partners to develop policies, systems and leadership so that innovations can reach scale and advance UHC. 

Apart from the transfer of ownership of Jamii ni Afya, I hope to see a link between Jamii ni Afya with its focus on the community level, with the facility levels. If this ambition would be realized, it would improve the connection between two crucial levels of health providers in Zanzibar and we could improve the access to and quality of care further. 

Thanks to our funders Fondation Botnar, USAID, Gates Foundation, UNICEF, McGovern Foundation, and James Percy Foundation and our partner, the Government of Zanzibar, for making Jamii ni Afya possible and contributing to sustainable digital health systems in Zanzibar!