Mobile Health & Clinical Mentorship for Safe Antibiotic Stewardship - "MOCA Project"

Photo credit: L Cobuccio

The MOCA Project aims to tackle antimicrobial resistance (AMR) by reducing the overuse of antibiotics in healthcare settings in Zanzibar. Implemented by Ifakara Health Institute, key partners of the project include the Ministry of Health, Zanzibar (MOHZ), the Zanzibar Food and Drug Agency, and D-Tree. The project seeks to introduce Digital Clinical Decision Support Algorithms (CDSAs)—tools that guide healthcare providers to make appropriate diagnoses and treatment during primary care consultations.

Problem Addressed
Antimicrobial resistance (AMR), primarily driven by the overuse and inappropriate prescription of antibiotics, is a growing global health concern. In Tanzania, 60–80% of antibiotic prescriptions are estimated to be unnecessary, accelerating bacterial resistance and making treatments less effective. Globally, AMR caused 1.3 million deaths in 2019, surpassing deaths from HIV and malaria combined.

Proposed Solution
To address this crisis, MOCA introduces Digital Clinical Decision Support Algorithms (CDSAs)—tools that guide healthcare providers through the consultation process, prompting the appropriate symptoms, signs, and tests to evaluate. Based on the guideline/evidence based algorithms, the CDSA proposes an appropriate diagnosis and treatment.  

Gaps Identified
Existing CDSAs are primarily for children; adult-focused CDSAs have not been evaluated through cluster-randomized trials. There is poor uptake and integration of digital health tools due to a lack of user-centered design and ongoing mentorship. Ministries of health and stakeholders require strong evidence of effectiveness before investing in such tools.

MOCA Project Goals
To reduce unnecessary antibiotic use and enhance the quality of care for acutely ill adults in primary healthcare settings, MOCA Project's objective is to develop and implement an evidence-based digital CDSA and supportive antibiotic stewardship mentorship, collaboratively with partners in Zanzibar based on the new WHO IMPACT guidelines, Tanzanian/Zanzibarian guidelines and local experts.

The project also seeks to evaluate the impact of this digital CDSA and supportive interventions on reducing antibiotic prescription in 26 health facilities across Zanzibar, covering 9,000 patients as part of a cluster-randomized trial.

By leveraging digital health tools and promoting responsible antibiotic use, MOCA aims to curb AMR and enhance patient care in Zanzibar, setting a new standard for antibiotic stewardship in the region.