The Directorate General of Family Planning (DGFP) manages 3,924 Union Health and Family Welfare Centers (UHFWC) all over the country. These are first-level facilities situated in rural areas. The catchment area of such facilities consists of a union, an administrative unit. Maternal and child care, family planning services and general patient care are available in these facilities. There are positions of Sub-Assistant Community Medical Officers (SACMO) and Family Welfare Visitors (FWV). Medical Officers-Maternal and Child Health, based in upazila, is overall responsible for their supervision and management.
Comprehensive digitization is taking place in the DGFP. The DGFP eMIS is an ecosystem of mobile apps and web-based applications. Facilities eRegister is a component of eMIS ecosystem. All activities performed by the SACMOs and FWVs have been digitized. Paper registers used in the facilities have been converted into digital eRegisters. Accordingly, providers serving in these facilities can keep track of their activities entirely using app on a Tablet PC. A module in the facilities system allows treatment of sick children using a Child Register based on integrated management of childhood illness (IMCI).
Providing Care to the sick children in UHFWCs
Human capacity in low- and middle-income countries is limited. Minimal or non-existent diagnostic supports such as radiology and laboratory services complicate the issue. For this reason, many children may be inadequately assessed and treated in first-level facilities where they turn up. In this background, WHO developed IMCI to provide high-quality treatment in a low-resource setting. Structured IMCI case management allows community level providers with training to provide services to the children. The DGFP has introduced an IMCI based Child Register Module in the eMIS Facility Systems.
The DGFP providers can treat children with fever, diarrhea etc. following IMCI protocol and report accordingly with automatic classifications. For the purpose of diagnosis, the providers need to assess illness of the child, classify the illness based on signs, identify treatment, treat the child and provide follow-up care. They may need to refer patients to higher facilities. The selected interventions require the availability and use of some simple medicines like an antibiotic (usually amoxicillin), an antimalarial, oral rehydration solutions (ORS) and zinc tablets. The DGFP follows the guidelines provided by WHO and provides IMCI based child care from the UHFWCs.
The app interface
The DGFP adopted the IMCI guidelines for its community level providers and incorporated in IMCI Register. The eMIS app interface was developed following guidance provided by the DGFP. The screenshots below show how the app guides the providers in managing the children reporting in facilities for treatment:
Personal and geographical identifiers are noted/retrieved.
Physical examinations (weight, temperature, breathing rate, etc.).
Symptoms are recorded using a list with check boxes.
Algorithms help to determine the disease.
Management and administration of drugs.
Counseling, date for follow-up and referral to a higher facility.
Conclusions
In a real-life situation, the skills of the providers may vary even after rigorous training. There are scopes for omissions. More importantly, ability to diagnose may not be the same for all providers. Digital tools address such constraints as standards and protocols are implemented rigorously. Clinical guidelines are accessible to all in a uniform manner. Therefore, it could be said that digitization increases the skills of community level providers which eventually lead to improvement in the health of the population living in their catchment areas.
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