Using Data on Traditional Medicine to Help Trace HIV/AIDS Outcomes

Background

In Côte d’Ivoire, it is estimated that 80% of the population uses traditional medicine, especially in rural areas. A 2014 study by the University Research Co, LLC (UR) on the factors influencing the USAID Health Care Improvement (HCI) showed that a higher percentage of patients using traditional medicine were experienced “Interruption in Treatment (IIT)” 12 months after treatment, meaning that their prognoses are more difficult to track and monitor.

The National Program for the Promotion of Traditional Medicine (PNPMT) is a program of the Ministry of Health and Public Hygiene (MSHP) of Côte d’Ivoire, similar to the National Program for the fight against AIDS (PNLS). Managed by doctors, pharmacists, anthropologists and other government officials, the PNPMT is responsible for ensuring the proper functioning of traditional medicine activities. It also ensures that practitioners are aware of compliance with Law No. 2015-536 of July 20 2015, on allowances regarding the practice of traditional medicine and pharmacology in Côte d’Ivoire.

Problem

Côte d’Ivoire’s traditional medicine centers (Centres de Médecine Traditionnelle, CMT) have a similar function to the First Contact Health Establishments (Etablissement Sanitaires de Premier Contact, ESPC) and are required to deliver monthly reports on the services they provide (such as the number of visits, number of patients by illness, and drugs prescribed). However, a 2014-2018 PNPMT activity report shows that of the 390 CMTs authorized by the government, only 2% on average actually submitted their required monthly reports.

Because so little data is reported, the poor quality of the limited data available complicates analysis for decision-making and more specifically limits the traceability of patients who request services. This may explain the lack of data on traditional medicine in the National Health Information System (Système National de l’Information Sanitaire, SNIS). According to Dr. Kroa Ehoulé, Director of PNPMT, “a major challenge for conventional medicine practitioners remains that ‘IIT’ patients are mostly traced back in their communities at CMTs and prayer camps. However, there is no effective data management system that enables data on traditional medicine to be included in the SNIS. If a method of collecting traditional medicine data did exist, it would confirm this state of affairs and enable the necessary adjustments to align modern and traditional medicine data.”

Solution

Through the DCDJ Data Fellowship, Dongo was placed at PNPMT to help the organization identify and address its data management issues. Dongo proposed a solution that aimed to integrate traditional medicine data into SNIS, by developing and implementing a tool for collecting, compiling, and analyzing reliable traditional medicine data, and automating report production. Moreover, to ensure the success of the proposed solution, Dongo also prioritized supporting the CMTs in owning the tool themselves – by welcoming it into their work, integrating it into their processes, and educating and training traditional medicine practitioners to use it.

Process

Dongo conducted an initial needs analysis to inform his implementation plan. Based on this, he developed a tool called OCAR.CMT (Data Collection, Analysis, and Reporting Tool for CMTs) in the Visual Basic programming language, which was installed in CMTs that had the equipment, computers, and staff to collect data electronically. Practitioners now have their own management system for traditional medicine data, the same way that the Ministry of Health and Public Hygiene (MSHP) has the District Health Information Software (DHIS2) health system software.

During the tool’s pilot phase, PNPMT and DCDJ organized workshops in which 64 participants, including PNPMT staff, SNIS users, and traditional medicine practitioners built awareness of data culture and the use of OCAR.CMT. In addition, during a meeting of the West African Health Organization (WAHO), Dongo trained 42 practitioners and experts in traditional medicine from 15 ECOWAS member countries on the use of the OCAR.CMT tool.

Results and Impact

Since Dongo established OCAR.CMT, 7 pilot sites have regularly been using the tool for both patient management and monthly production of reports. OCAR.CMT has enabled the registration of 665 new patients (51% women and 49% men) that had previously been untraceable, including 17 HIV-positive individuals (76% women and 24% men). Additionally, one of PEPFAR’s main challenges in the fight against HIV/AIDS has long been the difficulty of reaching men – and initial data reported in the system shows that a large portion of men visit CMTs rather than modern medicine treatment facilities. OCAR.CMT has the potential to help PEPFAR better target its interventions to meet men’s needs.

The adoption of OCAR.CMT by 8,500 CMT practitioners provides a clinical database of traditional medicine patients, including people living with HIV. There will also be additional validation workshops with the DIIS, integration of validation findings, and continued technical and capacity building support for the CMTs required in the future. Moving forward, the tool will also help meet PEPFAR’s objective of improving traceability of positive patients, to carry out awareness-raising, and encourage ‘IIT’ patients to return to the treatment circuit.

Following Dongo’s efforts, and thanks to the leadership of PMPNT’s Director Dr. Ehoulé, PNPMT is committed to mobilizing financial resources to extend the project across the country. In February 2020, notice of the tool was sent to all members of WAHO, which pioneered the first application used by the CMT to collect data. WAHO countries already acknowledge the limitations of their existing software to collect the “full picture” of health data, and expressed the need to expand the OCAR.CMT tool.