The Story
In Zimbabwe, HIV remains a pressing public health issue. One of the most effective preventive measures has been Voluntary Medical Male Circumcision (VMMC), which reduces HIV acquisition risk by up to 60%. Yet with millions of procedures carried out, the burden of follow-up care on nurses and clinics became overwhelming. Each patient was required to return for multiple post-surgery visits, even when most healed without complications.
For young men, this often meant missing school, paying transport fees, and spending hours in clinic queues. For nurses, it meant processing long lines of healthy patients while struggling to prioritize the few with real complications. The inefficiency was unsustainable
The Challenge
The Ministry of Health and Child Care (MoHCC), with I-TECH and ZAZIC, needed a system to reduce unnecessary follow-ups while preserving safety. Past digital interventions had been fragmented, and there were fears that patients might slip through the cracks if follow-up was relaxed. The challenge was to create a scalable, low-cost solution that reassured patients, supported nurses, and maintained quality of care.
The Turning Point
The turning point came when the team asked a simple question: “What if patients only came back if they needed to?” By leveraging two-way texting (2wT), patients could report symptoms daily via SMS. Nurses would triage remotely and only call patients in if adverse symptoms were flagged. This shifted follow-up from a blanket requirement to a personalized safety net, reducing clinic burden while empowering patients in their recovery.
The Execution
The design journey followed the Discover → Define → Ideate → Prototype → Test → Iterate & Learn cycle. Fieldwork in Chitungwiza, Norton, Monera, and Harare revealed major challenges namely: paper-based errors, overwhelmed nurses performing up to 120 circumcisions daily, and poor patient follow-up.
From this, three personas emerged: the site nurse, the 2wT nurse, and the patient. Their needs shaped the solution: remote triage, reassurance during recovery, and culturally relevant communication for low-literacy users.
Ideation sessions mapped SMS workflows using simple “Yes/No” responses for symptoms like pain or bleeding. Nurses envisioned dashboards flagging high-risk cases and tracking referrals.
The prototype automated SMS triage, supported decision-making, and integrated into clinic reports. Testing refined message tone and timing. Iterations added motivational texts and escalation alerts, transforming 2wT into a reliable digital companion that strengthened patient safety, follow-up, and nurse efficiency.
The Evidence
Pilot results showed significant reductions in unnecessary clinic visits without compromising safety. Adverse events were detected and referred early, while patients appreciated the convenience of home-based follow-up. Nurses reported lighter workloads and greater ability to focus on complex cases.
The Result
Human impact: Men recovering at home avoided long, costly trips. Many reported feeling “looked after” despite not returning to the clinic. Nurses expressed relief at managing fewer but more urgent cases, improving their work-life balance.
Systemic transformation: 2wT proved that digital triage could uphold clinical safety while reducing healthcare burden. It has since informed policy discussions about scaling SMS-based follow-up models across HIV and surgical care in Zimbabwe, marking a shift towards smarter, patient-centered digital health ecosystems.