ZIDISolution design, testing and national scale-up of an enterprise healthmanagement systemGathering reliable, retrievable and timely informationon service delivery and other key indicators is animportant step in improving health outcomes. MobileHealth Management Information Systems (HMIS) canhelp with this process. Additionally, the private sectorcan play a key role in the design, development andtesting of such systems, especially when it is not heldto the scope and scale-related constraints that comewith grant-funded projects.ZiDi is an innovative cloud-based enterprise healthmanagement system developed by MicroClinicTechnology, Ltd., a Nairobi HMIS company. ZiDi’srobust, easy-to-use and integrated design has primed itfor large scale use in the public and private sectors. Totest the system, a pilot of the ZiDi was undertaken inKisumu County in September 2012. The successful 12-month pilot led to ZiDi’s approval for use in publichealth facilities by the Government of Kenya.Implementation date: September 2012About ZiDiZiDi is a cloud-based software service that iscurrently optimized for use in dispensaries, healthcenters and out-patient departments. It allows healthworkers to record and access patient data at any timewith web-enabled devices, preferably tablets. Regardlessof connectivity, a health worker can enter a patient’sdemographic information, health parameters, symptoms,tests, diagnosis and prescribed drugs when offline.ZiDi automatically uploads the data to the cloud onceconnectivity is reestablished. ZiDi also assists healthworkers to adhere to clinical protocols, tracksprocedures and services performed, lab tests orderedand results in a manner that facilitates supportivesupervision, monitoring and evaluation of the quality ofcare offered. Drug inventory and facility revenues andexpenses are also tracked. Patients who default on visitscan be easily identified and contacted via outboundtargeted or generic text messages. Data archived inZiDi can be easily retrieved and exported as an Excelfile for offline analytics. Auto-generated serviceutilization, financial and inventory reports facilitatedecision-making by the health workers and districtmanagement teams. Through tracking the productivity ofhealth workers, it enables the MOH, in collaborationwith the county governments, to correlate resourceallocation with productivity in a health facility.ZiDi is also interoperable with multiple existinginformation systems. Service utilization data areexportable into a District Health Information System(DHIS2). Consumption data on all essential medicinesand medical supplies are exportable into the KenyaMedical Supplies Authority’s (KEMSA) logisticmanagement information systems. Lastly, data from themaster facility list can be uploaded into ZiDi toupdate facility profiles.Evaluation and ResultsZiDi has been successfully piloted in dispensaries andhealth centers in Kisumu County. Frequent andconsistent feedback from health workers and districthealth management teams has been incorporated intoZiDi to improve the system. More than 95% ofreports generated in ZiDi matched those housed inthe facility. Fifteen health workers are currently usingZiDi and have fully adopted the system within theirpractice. Patients also report enhanced service deliveryand quality of care at the pilot sites. ZiDi has alsoeliminated the need for health workers in the pilot sitesto manually quantify and forecast their 90-day supplies.Instead, this information is readily available from ZiDi.The system also allows the Kenya Medical SuppliesAuthority (KEMSA) to monitor consumption, rationaluse and stock levels in real-time. Benefits such asimproved health worker efficiency, enhanceddecentralized decision-making, and improved clinicaldecision-making are invaluable attributes of ZiDi. It isalso easy to adopt and use.Lessons LearnedIt is important to incorporate end user feedbackinto the design of mHealth technology.Government entities should be active partnersthroughout the entire development and pilotingprocess.30 mHEALTH COMPENDIUM | VOLUME 3
DATA COLLECTIONPlan ahead for various scenarios to better anticipateadverse situations that may impact scale up of theproduct and program.When thinking about sustainability, keep in mind therole of different stakeholders, including those inheadquarters and those in the field.While open source systems are often preferred, it isimportant to note any limitations they may haveregarding integrated needs of the health systems.ConclusionZiDi’s offers an integrated approach to data collectionthat ensures health workers have constant access topatient data even in remote rural health settings, andprovides access to real-time monitoring of diseasetrends and inventory, thereby, preventing drug stockouts.Designed to streamline reporting, it accords theMOH and other health officials access to up-to-date,web-based reports in real time, serving as a valuableresource for future decision-making and supportivesupervision. By incorporating accountability into ruralhealthcare, it provides the necessary foundation toimprove health outcomes in Kenya.--------------------------------------------------------Geographic Coverage: KenyaImplementation Partners: Government of Kenya |Kenya Medical Supplies Authority | MicroClinicTechnologies | OGRA Foundation | Microsoft 4 Africa |Yahclick – SimbaNet, Kenya | Samsung/SafaricomFunder: Public-private partnership between private equitypartners and Government of KenyaContact Information:MicroClinic Technology: H. Moka Lantum, MD. PhD,SM, Managing Partner (+1585 820 6403, +254715459584,moka.lantum@microclinictech.coml)Kenya Medical Supplies Authority: Dr. John Munyu,MBS, Chief Executive Officer (+254(20)3922000, +254719033000, john.munyu@kemsa.co.ke)References:1. Com World Series. Find out more about ZiDi, the mHealthapplication winner of the Top App award at East Africa Com2013. 11 July 2013. Web.2. ZiDi -- An Enterprise Management System for Rural HealthCenters by MicroClinic Technologies. 3 October 2012. Video.mHEALTH COMPENDIUM | VOLUME 3 31
Change language