Written by THINKMD, June 11, 2020

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In 2011, American student Lonnie Hackett traveled to Zambia to conduct research on HIV/AIDS testing for adolescents. At the time, the country was transitioning out of its emergency phase as testing and treatment rapidly became more accessible, but many Zambians still weren’t taking advantage of these services.

After several months of fact-finding and analysis, Hackett and colleagues realized that HIV was only one of many serious health problems afflicting Zambian school-aged children. To delve deeper into the problem and a possible solution, the team spent a significant amount of time in schools, working with teachers, students, community members, and health professionals.

Interestingly, the search for answers to their initial question uncovered another disturbing truth: school-age children in Zambia were often succumbing to highly-treatable illnesses because of a failure to seek treatment, and, compounding the problem, most children’s health programs were focusing only on pre-school-aged children

“We realized that since this age group is not accessing health care, but 90% of kids are enrolled in school in Zambia, why not move the access point from clinics, which seem distant and foreign, to schools, where we have a captive audience,” said Hackett.

Healthy Learners was born of this idea. The organization’s initial challenge was to adapt the existing community health model to a new, school-based approach by training teachers as a new legion of community health workers, linking local schools to medical facilities. What resulted was a robust network of school administrators, health professionals and parents, who are for the first time effectively addressing the health issues of school-aged children.

Shortly after its founding in 2014, Healthy Learners partnered with faculty from the Harvard T.H. Chan School of Public Health to determine whether this program could, and should, be scaled. The results published in May 2019 showed that students at Healthy Learners (HL) schools were about 40 percent less likely to be sick than their peers elsewhere in Lusaka, and that the improvement in access was much greater than anticipated. These exciting results were the catalyst to scaling the program. They also attracted the attention of Zambia’s Ministries of Health and Education, which were soon eager to implement the new health model in government schools across the country.

But expansion presented this small, young organization with logistical challenges: how could HL improve health care capacity, maintain quality of care, and develop critical data-driven solutions while effectively managing and monitoring a growing number of health care workers and students? The trained teachers had limited diagnostic skills and training, they were able to do only minimal data collection, and there was no efficient system for centralizing data. Scaling would require financially sustainable solutions to these problems.

In mid-2018, in order to meet this substantial challenge, HL partnered with THINKMD, a Burlington-based diagnostic technology company whose mission is to increase data-driven health care capacity and quality by developing next generation digital mobile health (mHealth) and data-driven solution platforms. HL founder/President Lonnie Hackett and THINKMD co-founder/President Barry Finette M.D./Ph.D. met as fellows of the Mulago Foundation, which identifies and funds high-impact organizations fighting global poverty. After discussing their respective projects, Barry proposed the development of a school-aged-specific health platform that could transform school-based healthcare delivery in an underserved demographic by providing critical diagnostic assistance and streamlining data collection, visualization, and analysis.

THINKMD began developing a clinical assessment and decision-support technology for school-aged children aged five to 18, the first such diagnostic tool specifically designed for this age group. Instead of a paper checklist, THINKMD’s diagnostic mHealth platform now guides teachers through the process of assessing children and adolescents for key clinical conditions and diseases and responding to different scenarios. The platform includes 40 unique assessments, triage procedures, and instructions/monitoring for follow-up care. In its first year, HL has implemented THINKMD technology in its 45 partner schools, trained over 300 School Health Workers (SHW’s) and increased the number of students being served by the HL program from 60,000 to more than 110,000.

Furthermore, the quality of screening is now being standardized. For each assessment of a student by an SHW, THINKMD’s system automatically collects dozens and dozens of data points. HL can now track in real time the performance of SHW’s, how many students are being screened, their health status, and whether and how a teacher has followed up with a sick child.

According to THINKMD data analyst, Ezra Mount-Finette, the benefits of this proprietary system go beyond monitoring and treating health conditions in school-age children. “The data collected has the potential to create sweeping advancements in Zambia’s ability to monitor potential outbreaks of serious and life-threatening diseases, such as tuberculosis, dengue, and measles,” said Mount-Finette. Zambia’s Ministry of Health is equally enthusiastic; HL is collecting a treasure trove of epidemiological data, which will eventually be useful to track health trends and potential outbreaks nationwide.

Hackett sees even broader application. “One of our funders who does a lot of work in international health believes we may soon have assembled the largest database on school children’s health in the region,” said Hackett, “That observation is pretty dramatic, especially given the relatively brief time we’ve been doing this.”

As a result of the close collaboration with Zambia’s Ministries of Health and Education, HL has become an essential support system for a government program. “Teachers are not serving Healthy Learners; rather we are here to support them. This framing is subtle, but powerful,” said Hackett.

With Lonnie Hackett’s vision, the Zambian Ministries of Health and Education’s cooperative efforts and strong desire to help its citizens, and THINKMD’s innovative technology, Zambia is serving as a model for other African nations as well as developing countries across the globe. As higher percentages of school-aged children gain access to healthcare, not only do morbidity and mortality decrease but literacy and graduation rates are positively impacted, all of which bodes well for Zambia’s future. Equally exciting is the potential these tools provide for identifying and curbing such life-threatening outbreaks as ebola, polio, typhus, dengue, measles, and other serious diseases that threaten the planet.

“School-aged children are often a forgotten population in the global health arena, in particular in low and middle-income countries with limited resources and healthcare capacity,” said Barry Finette, THINKMD founder. “One of the goals of THINKMD is to develop health technology that can provide quality health care capacity building solutions that allow for financially-sustainable scaling. Our partnership with HL is demonstrating this is possible.”

Hackett’s goal is to scale to all public schools in the capital city of Lusaka reaching a total of 250,000 children within two years, extending services to twice that number or half a million by 2024. “Ultimately, the Ministries and Healthy Learners see this as a national program, enabling Zambia to serve as a model for implementation of similar programs by other nations.”

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