June 20, 2023

Implementing SmartCerv in Zambia: Lessons from the roll out of a digital solution for linking women to cervical cancer care

In Zambia, cervical cancer ranks as the most frequent cancer among women of reproductive age. It is also one of the most preventable types of cancer. To reach global elimination targets, cervical cancer screening and treatment services have rapidly expanded across the country; however, the program encountered challenges in maintaining a comprehensive central repository for program data.

An electronic data management system, called SmartCerv was developed and deployed in 2019 in select healthcare facilities to replace paper-based data reporting. The system can be installed on a computer, smartphone, or tablet, allows for offline data collection, and collects patient-level information related to cervical cancer screening and care.

Approximately, one year after rolling out SmartCerv an evaluation was conducted to assess how the system was working. Even though most healthcare workers liked using the system and said it was easy to use, there were some important challenges reported by users like lack of internet data bundles to upload entries, insufficient equipment (tablets) and training, and the inability to enter key patient information into the system. As a result, the system was rarely used as a standalone cervical cancer reporting tool.

Coming out of the evaluation were key recommendations focused on addressing immediate barriers to use in the select sites where SmartCerv was used as well as recommendations for long-term planning. The recommendations for long-term use included developing strategies to position and operationalize SmartCerv as the only data management tool for cervical cancer in Zambia, careful plans for rolling out the system at new sites, and a suggestion to consider integrating SmartCerv within client-centric data systems.

Since the launch of SmartCerv, the system is still unevenly implemented and continues to face many of the challenges identified above. These gaps in the scale up of the SmartCerv system have resulted in a shift in focus to discussions around using a system already in use for routine data management in Zambia’s HIV program.  The assessment empowered the Ministry of Health and partners to identify critical lessons for implementing digital health data management systems in Zambia. In addition, it offers a template for any country looking to advance electronic data collection in their health system. The challenges highlight the need to align these innovative digital health management systems with existing national health information management systems so that data collected is accessible to a wider audience for use in policy decisions.

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This work has been made possible with funding support from Unitaid.

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