International Rescue Committee (IRC)

Using cell phones to track a community's health in Congo

For Emelda Musabyimana, life changed a few months ago when the International Rescue Committee asked her to play an active role in a health project rolling out in her village. “Maman Emelda” (Mama Emelda), as she is known by her neighbors, has an important duty to perform: record and transmit all births and deaths in the 15 households she is assigned to survey.

The official census in Congo dates from 1984, so data about population numbers and dynamics is sketchy. During the last decade, the IRC conducted groundbreaking mortality surveys in an attempt to quantify the elevated mortality during and after the Congo wars. But surveys cannot be conducted on a regular basis, as they require tremendous amounts of time, money and expertise, so the IRC initiated a new approach: surveillance instead of survey. 

Run with technical support from Columbia University, Jamii, which means ‘community’ in the local Swahili language, is a project that uses a network of local men and women, such as Maman Emelda, to systematically gather information about all births and deaths in a sample 40 villages in North Kivu. 
Jamii was conceived in response to a significant discrepancy noted in 2010: While the number of recorded births matched estimates, the number of reported deaths was a whopping 77 percent below the expected mortality rate. To put it more precisely, only 509 deaths were recorded in North Kivu but 4,032 were estimated for the province.

“This was a striking realization, and it showed the clear need for more precise data,” says Dr. Amadou Bah, the IRC health coordinator in North Kivu. “One of the main goals of our program is to reduce mortality and morbidity, but in the absence of clear figures it is difficult to quantify the real impact of our work.”

According to Dr. Bah, births are far more likely to be recorded than deaths, in part because some births take place in a health center. Infant deaths and deaths due to a violent event are culturally sensitive in Congo and therefore more likely to go undeclared.
 
Jamii attempts to remedy the situation by recruiting locals already active as voluntary health workers to help create a more accurate database. Maman Emelda, for example, had been educating people in her community about good hygiene and vaccinations for over seven years, so she was knowledgeable about her village and readily accepted in people’s homes. The IRC built upon her experience by teaching her new skills to carry out her mission. 
 
Maman Emelda sends a coded text with the data she has collected
After filling in her register, Maman Emelda sends a coded text with the data she has collected to the IRC.
(Photo: Sinziana Demian/IRC)
 
Maman Emelda eagerly responded to the new task, which involves creating a register, making accurate notes of all demographic changes in each family, and then sending a coded text message on a mobile phone around the first of each month to an IRC employee who centralizes all data. Although she is a mother of 10 and continues as a volunteer health worker, she has made the project a priority (despite that she receives no compensation other than use of the phone and a minimal credit for texting). “Jamii is important because it shows us the problems of the community,” she explains. 

So far, Maman Emelda has had no trouble getting information from her fellow villagers. On a recent visit to the mud hut of Jacqueline Ntakondagize, for example, she sat down with her neighbor and chatted a bit before asking for an update about Maman Jacqueline’s household. There were no births or deaths to report, so Maman Emelda marked zeros in her register. 

Congo is only the second country (Sierra Leone is the other) where the IRC has conducted a surveillance using cell phones. Halfway through the project, the reporting rates are 95 percent of estimate rates. One unexpected development: Volunteers who are illiterate have an easier time reporting data using cell phones than paper forms. Cell phones could become a central part of rural health strategies in developing countries, both for collecting data and for faster message dissemination in emergency situations.
 

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