Pakistan has a population of over 200 million, with only 46,000 doctors tending to it. On average, there’s 1 doctor to cater to 4,348 people.
In Sindh — the second largest province of the country — the health crisis is as prevalent as any other part of the country. With a population of 42 million people, the province faces challenges such as stunted growth, infant mortality and malnutrition in children.
With the country’s healthcare situation, minimal resources and ever growing population in view, the Benazir Bhutto government — under the Prime Minister’s Programme for Family Planning and Primary Care — created the globally recognised Lady Health Worker programme in 1994.
Through the programme, for the first time in Pakistan, essential primary health services were dispensed in urban slums and rural parts of the country.
Lady Health Workers (LHWs) are women recommended for the position by their own communities, they are then trained for 15 months in diagnosing illnesses, pregnancy monitoring, child growth monitoring & family planning counselling: three months in the classroom, followed by 12 months of practical on-the-job training.
However, in the years that followed, it was seen that keeping track of the programme on-ground became exceedingly difficult. Furthermore, the pen-and-paper records maintained by the LHWs were difficult to access and the process of digitalising the data with the DHIS was long and tedious.
That’s where TEXT comes in.
Our model — TIBBI
Created by TEXT, TIBBI is a set of mobile tools that create digital health profiles of citizens in order to assist, improve & track the work of the interdependent network of Lady Health Workers (LHWs) and their Lady Health Supervisors (LHSs).
Digitalisation of citizen’s health profiles has not only increased the LHWs’ efficiency, it has made their life easier by replacing large paper-based record keeping journals with a much lighter mobile device.
On the other hand, TIBBI has made it much easier for the Health Department, Government of Sindh to monitor the citizen's medical data as it is uploaded in real time. New information is added to the profiles upon each visit by the LHW, so the profiles continue to evolve.
The mobile tools also facilitate the government in ensuring transparency & accountability of the health sector in Sindh. With weekly scorecards for each LHW, the department can easily track their performance and take measures to ensure improvement in the areas where they are lacking.
TIBBI in action
Currently operating in one district of Sindh, TIBBI has 50,324 citizens registered to its network. The app, in real time, updates the detailed medical appointment data — such as the height and weight of infants and the medicines prescribed to pregnant women — for each citizen that LHWs visit in their designated area.
From June 2020 to November 2020 — with a three month suspension in LHW activity due to Covid-19 — the app has recorded 24,803 visits that have been conducted by 49 LHWs in the Tando Muhammad Khan district of Sindh. This number grows each day as data of more and more visits conducted is uploaded to the app in real time.
Keeping record of these details through TIBBI has made the health system instantly more transparent and the essence of accountability has improved LHWs’ performance drastically. For example, data from the app shows that almost all LHWs spent more time in each of their appointments in November 2020 — three months after using the app — than they did in September 2020, when they initially started using the app.
TIBBI helps in better on-ground provision of health services through detailed question-based conversation flows, which lead to improved diagnostic abilities. LHWs, for example, step by step conversation flows in place regarding family planning and diagnosis of child illnesses. These decision trees enable them to relay information and identify illnesses with ease and accuracy.
The app allows for live synchronisation between LHWs and LHSs and with time links with FWWs, Vaccinators, FLCFs & DHOs will also be added to the system.
TIBBI also helps in keeping track of the medical supplies provided to on-ground personnel. This allows the Health Department to monitor the exact amount equipment, medicines and family planning tools provided to the LHWs and see where these supplies are being used and how quickly.
What does the Sindh Government think of TIBBI?
“I think TIBBI is of extreme importance, through the app we are able to monitor and evaluate various members of Sindh’s health system.
Since supervised monitoring is difficult physically, TIBBI has enabled us to keep tabs on our on-ground workforce.
The app has made it possible for the ministry to establish a direct link with all the different stakeholders in the system, even the ultimate consumer of our health facilities. Through the app we are able to better our system of complaint redressal and we hope that use of the app will result in better performance on the medical officials’ part.
Overall, I believe the app is an excellent idea. It helps us keep tabs on workers remote areas of districts where it was harder to reach in person.
We are very grateful to TEXT for creating TIBBI and securing funding from the Gates Foundation. The health department is hopeful for highly favourable results from the use of the TIBBI app.”
Dr Azra Pechuho, Sindh Minister for Health and Welfare
What's next?
With TIBBI in use in Sindh’s Tando Muhammad Khan district, we have seen tangible improvements in the way the on-ground healthcare network operates. TEXT believes it is now time to take the initiative to the next level and with the help of the Sindh Government, scale the operation up to even more districts and eventually the whole province.
In fact, why stop at one province or even Pakistan?
TIBBI can be used to change the way basic healthcare works in other countries that struggle with healthcare problems similar to ours, such as malnutrition, lack of family planning awareness and lack of neonatal care.
The mobile tools can transform the way basic healthcare is provided at the grass root level and eventually lead the way in the elimination of global health crises such as stunting in children, high rates of infant mortality and malnutrition.
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