TY  - JOUR
AU  - Layer, Erica
AU  - Slim, Salim
AU  - Mussa, Issa
AU  - Al-Mafazy, Abdul-Wahid
AU  - Besana, Giulia V R
AU  - Msellem, Mwinyi
AU  - Fulcher, Isabel
AU  - Hornung, Heiko
AU  - Lampariello, Riccardo
PY  - 2023
DA  - 2023/10/9
TI  - The Journey of Zanzibar’s Digitally Enabled Community Health Program to National Scale: Implementation Report
JO  - JMIR Med Inform
SP  - e48097
VL  - 11
KW  - Zanzibar
KW  - digital health
KW  - community health
KW  - health systems strengthening
KW  - maternal health
KW  - child health
KW  - data for decision-making
KW  - implementation science
KW  - health systems
KW  - healthcare infrastructure
KW  - health care
KW  - implementation report
AB  - Background: While high-quality primary health care services can meet 80%-90% of health needs over a person’s lifetime, this potential is severely hindered in many low-resource countries by a constrained health care system. There is a growing consensus that effectively designed, resourced, and managed community health worker programs are a critical component of a well-functioning primary health system, and digital technology is recognized as an important enabler of health systems transformation. Objective: In this implementation report, we describe the design and rollout of Zanzibar’s national, digitally enabled community health program–Jamii ni Afya. Methods: Since 2010, D-tree International has partnered with the Ministry of Health Zanzibar to pilot and generate evidence for a digitally enabled community health program, which was formally adopted and scaled nationally by the government in 2018. Community health workers use a mobile app that guides service delivery and data collection for home-based health services, resulting in comprehensive service delivery, access to real-time data, efficient management of resources, and continuous quality improvement. Results: The Zanzibar government has documented increases in the delivery of health facilities among pregnant women and reductions in stunting among children younger than 5 years since the community health program has scaled. Key success factors included starting with the health challenge and local context rather than the technology, usage of data for decision-making, and extensive collaboration with local and global partners and funders. Lessons learned include the significant time it takes to scale and institutionalize a digital health systems innovation due to the time to generate evidence, change opinions, and build capacity. Conclusions: Jamii ni Afya represents one of the world’s first examples of a nationally scaled digitally enabled community health program. This implementation report outlines key successes and lessons learned, which may have applicability to other governments and partners working to sustainably strengthen primary health systems. 
SN  - 2291-9694
UR  - https://medinform.jmir.org/2023/1/e48097
UR  - https://doi.org/10.2196/48097
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37812488
DO  - 10.2196/48097
ID  - info:doi/10.2196/48097
ER  -