Join us for the July session of the Kano Tech meetup. This month’s session will focus on Geographic Information Systems. If you would like to find out more about GIS and learning how mapping can transform all sectors of society, don't miss this edition!
eHA and Afrolynk teamed up with Unicorn Workspaces to host a meetup that brought together the community of innovators that makes Berlin, Germany a hub for technology-driven social impact.
Approximately fifty attendees listened to talks related to different aspects of leveraging technology for social impact before getting to know one another during a networking session.
The speakers were Moses Acquah, the founder of Afrolynk; Sabine Claassen, a Senior UI/UX Designer at eHealth Africa; Dr. Seth Kofi Abrokwa from the Robert Koch Institute; and Vanessa von Frankenberg, a senior venture developer and project manager at Digital Health Factory.
See photos from the event below.
Masud Abdullahi is the face of eHealth Africa at the Katsina Emergency Operations Center (EOC).
As office manager, Masud makes sure that our polio eradication partners, who utilize the EOC have access to all amenities including steady electricity and internet connectivity at all times so that Routine Immunization reports and data from Supplementary Immunization Activities (SIAs) can be promptly reviewed and acted upon.
He has been the Office Manager at the Katsina EOC for three and a half years now but insists that every day feels like the first day that he resumed. He is still in awe of the time and efforts that go into polio eradication and surveillance. In addition to managing his eight-person team, he supervises how the assets and supplies that are deployed to the EOC are used. He represents eHA at meetings, builds and maintains relationships with external stakeholders and serves as eHA’s liaison person in Katsina state.
Masud’s driving force is to never be the weak link in any organization or team. This mindset has helped him evolve from being just a boss to a leader who leads by example. He is especially proud of his team and in his eyes, his greatest achievement is that he is able to lead and build the capacity of his high-performing team so that they can support the organization's objectives and initiatives.
Despite his quiet exterior, he is very adventurous and curious about other places and cultures. He satisfies this curiosity by traveling and watching movies.
Schistosomiasis (Snail fever) is one of twenty communicable diseases classified by the World Health Organization as Neglected Tropical Diseases. The disease has dire health and economic consequences including disability, infertility, stunting in children and death.
Its close link with poor hygiene and sanitation, make its burden higher in poor, rural communities. Schistosomiasis is contracted when people are exposed to water infested by parasitic worms called Schistosomes. According to the World Health Organization, over 250 million people worldwide are affected by this disease and 90% of them live in Africa.
This public health impact drove Emory University Masters students, Angela Udongwo and Chibuzor Babalola, to partner with eHealth Africa’s Kano Lab to conduct a two-month research study in Kano State Nigeria. In this interview, they share the inspiration behind the study and their expectations for the research.
Why Schistosomiasis? What inspired this project?
We were inspired to conduct this study because of the public health impact of schistosomiasis. Nigeria is one of the Schistosomiasis-endemic countries and in fact, has the highest number of cases worldwide. Kano state is one of the five states with the highest burden of the disease in Nigeria. There is a need for more cost-effective, accurate and sensitive field applicable diagnostics to achieve the goal of eliminating the disease.
What's the purpose of this research study?
The purpose of this research is to compare the sensitivities and specifities of three diagnostic methods—polymerase chain reaction (PCR), loop-mediated isothermal amplification (LAMP) and microscopy—for detecting Schistosoma haematobium (urinary blood fluke). The research will examine the appropriateness of these methods for field diagnosis in low-resource settings and for detecting both acute and chronic schistosomiasis. We are also administering questionnaires to assess the communities' knowledge, attitudes, and perceptions about schistosomiasis.
How did you end up doing this in Kano at eHealth Africa?
eHealth Africa was accepting interns from Emory University for summer research and having introduced my research idea to one of the co-founders at a previous event in my school, I applied. eHealth Africa is providing us with the lab space and equipment to conduct this research. Our project activities are supervised by the Lab team here in Kano and we are truly blessed to have this opportunity.
Their project is supervised by eHealth Africa’s Lab coordinator, Tolulope Oginni
What do you hope to accomplish at the end of the study?
The end goal of this study is to develop a device that is capable of detecting schistosomiasis among people with a low burden of infection. We intend to use the results of this research as preliminary data for future research and grant-funded projects. In the long term, we also hope that it will provide evidence to influence the improvement of policies on field diagnosis of schistosomiasis.
By Sahr Ngaujah and Nelson Clemens
According to WHO, Sierra Leone is the first country in the Africa region to fully transform its national disease surveillance system from a paper-based system to a web-based electronic platform. This is due to the introduction of the electronic Integrated Disease Surveillance and Response solution.
Sierra Leone was one of the hardest-hit countries during the 2014 EVD outbreak in West Africa. The country’s poor disease surveillance infrastructure highlighted the need for a robust disease surveillance mechanism. Introducing an electronic method for disease surveillance reporting became one identified remedy for improving disease surveillance in a country that was still trying to catch up with the rest of the world in terms of digital technology.
Paper-based health data recording and reporting from across Sierra Leone’s 1300 health facilities became increasingly inadequate and inaccurate and was also characterized by late reporting, incomplete district-level reports, multiple data entry errors, and difficulty storing and retrieving data.
With an expertise in health informatics, eHealth Africa (eHA) designed the electronic Integrated Disease Surveillance and Response (eIDSR) solution and has been implementing the solution in collaboration with Sierra Leone’s Ministry of Health and Sanitation (MoHS), the U.S. Centers for Disease Control and Prevention (CDC), the World Health Organization, Focus 1000, and GIZ since 2016, with the objective to enhance disease prevention and control through the digital capture and submission of data on epidemiologically-important diseases. The eIDSR project was funded by the CDC.
eHA customized an open source health information tool from DHIS2 for the purpose-built digital data collection and reporting. The eIDSR tool is integrated into the national health system through its compatibility with the health information systemDHIS2, which is used in over 45 countries, especially those with vulnerable health systems like Sierra Leone. eHA developed the web form and custom mobile application, piloted both, and created a Short Message Service (SMS) submission solution for health workers to submit their weekly surveillance reports in locations where internet access is weak.
As of June 2019, 2758 health care workers at the health facility and district level were trained by eHA on the use of eIDSR across Sierra Leone. These health care workers now monitor 26 disease categories digitally. Digitizing health-related data has yielded positive outcomes in Sierra Leone. eHA has supported the rollout of eIDSR to all 14 administrative districts in Sierra Leone and a ceremony was held on June 6th in Tonkolili district, with participants from the MoHS and other implementing partners, to celebrate the milestone achieved.
The eIDSR system has also enhanced:
Reduced data entry errors
Reporting completeness, timeliness, and efficiency
Reducing data entry error
Optimal data management and quality are crucial to the delivery of high-quality healthcare services. Accurate data is essential to informed decision making and appropriate public health action. In the past, when health care workers submitted their reports, there was no opportunity for their superiors to perform data quality assurance. This sometimes resulted in erroneous data being sent to the national level, reducing the quality of data used for disease surveillance in Sierra Leone. With eIDSR, digital data is now managed in an efficient manner at District and National levels and made available to all relevant parties in the quickest way possible.
Reporting completeness, timeliness, and efficiency
The eIDSR tool was created to improve the speed of the flow of information within health systems. Through the electronic Integrated Disease Surveillance Response (eIDSR) solution, disease prevention, and control is enhanced through timely electronic capture and submission of data on epidemiologically-important diseases as data can now be submitted, reviewed and acted upon near real-time.
Disease surveillance plays an important role in disease prevention, control and elimination.
eHA continues to work with its partners to ensure eIDSR is sustainable in Sierra Leone.
By Tope Falodun and Emerald Awa-Agwu
Functional disease surveillance systems provide data that can be analyzed to yield insight for planning, project execution, monitoring, and evaluation of public health interventions. For a priority disease like Polio, surveillance systems are important because they monitor the burden of the disease and alert health systems of any increase in the occurrence of the disease in any location of implementation, ahead of time.
A key element that is often missing in disease surveillance systems is intersectoral action. In the past, the responsibility of finding, investigating, reporting and monitoring AFP cases rested solely on the disease surveillance officers (DSOs). This resulted in incomplete data because the DSOs could not cover every single community, and also manual errors as DSOs had to enter reports using paper-based tools. Recognizing this, eHealth Africa (eHA) partnered with the World Health Organization (WHO), Novel-T, the Bill & Melinda Gates Foundation (BMGF) and the Ministries of Health in eight countries including Chad and Niger to develop the Auto- Visual AFP Detection and Reporting (AVADAR) system for improving AFP case identification and reporting. The goal of the project was to support health systems in polio-endemic and high-risk countries to find, report and investigate AFP cases using available, context-appropriate resources, in this case, community members.
By partnering with local communities and enlisting members to serve as informants and investigators, some of the pressure on disease surveillance officers who performed all three functions of finding, investigating, reporting and monitoring suspected AFP cases were relieved. In addition, AVADAR infused digital data management and reporting innovations through the mobile application. With this, community informants report cases of suspected AFP via the AVADAR mobile application. The investigators receive alerts of these reports on their mobile devices, locate the cases, investigate and collect stool samples for further laboratory tests in cases of true AFPs.
In 2017, AVADAR was launched in 6 pilot districts in Chad and three pilot districts in Niger. By 2018, the project expanded to an additional three districts in both Chad and Niger. In total, eHA trained 849 and 509 community informants in Chad and Niger respectively. eHA also supported the training of 177 investigators by the WHO in Chad and 178 investigators in Niger. Within these periods, eHA supervised the activities of the informants, investigators, and technical officers, and also resolved technical issues relating to the mobile application, telecommunication, and network access on Android phones.
After almost three years of supporting the health systems in Chad and Niger through AVADAR, it was evident that the model worked. eHA successfully handed over the continuation of the project in the pilot districts to the Ministries of Health and the World Health Organization in Chad and Niger. A total of 109 first and second line technical support officers in the two countries, were trained to continue to handle and resolve any technical issues that may arise.
At eHA, we support health systems to effectively monitor and eradicate communicable diseases like polio by developing and supporting the development of creative surveillance methods and innovative data management solutions.
By ZIllah Waminaje
In Africa, 50% to 90% of children who have sickle cell die before their fifth birthday1. To improve their chances of survival, health systems must integrate Newborn Screening (NBS) for Sickle Cell Disease (SCD) with comprehensive treatment and management plans.
For almost five decades, newborn screening for SCD has been conducted using conventional procedures such as electrophoretic techniques, isoelectric focusing (IEF), high-performance liquid chromatography (HPLC) and DNA analysis, which require specialized laboratories with stable electricity, long sample processing times, expensive equipment and reagents, and highly skilled personnel. These methods, while ideal and feasible for developed countries, are inappropriate for low-resource settings like sub-Saharan Africa where 70% of SCD sufferers reside.
Sickle SCAN is an innovative, cost-effective point-of-care (POC) device that has been developed by Biomedics Inc. to address the challenges of SCD diagnostics in low-resource settings. It is a simple rapid point-of-care test kit that can detect the presence of Hemoglobin A, S, and C and yield results within 5 minutes using blood from a heel/ finger prick or vein. In addition to newborn screening, the Sickle SCAN device can be used for premarital/preconception genetic counseling, blood donor screening, and general screening.
Several features make the Sickle SCAN ideal for low-resource settings and large-scale mass screening programs. The first is that it does not require specialized technical knowledge to administer or read the test results. Anyone can be trained to use the device. The device does not require any special equipment or electricity and thus, eliminates the time, resources and logistics needed to transport samples to a laboratory. Finally, the short result turnaround time allows for the prompt identification of SC-positive babies so that early treatment can commence and survival rates can improve.
Since December 2018, eHealth Africa has partnered with Sickle Cell Well Africa Foundation (SCWAF), Pro-Health International and the Presidential Committee on the North- East Initiative (PCNI) to hold Sickle Cell awareness and testing outreaches in Adamawa, Bauchi, and Gombe states. Over 1000 people in all three states were screened using Sickle SCAN rapid diagnostic test kits. Patients who tested positive for sickle cell disease were immediately given routine medication and referred to sickle cell clinics.
Since healthcare in many African countries is community-based, rapid POC test kits like the Sickle SCAN can be easily integrated into existing health programs like routine immunization at primary health care centers or health insurance schemes to facilitate universal screening and ensure sustainability. This will ensure that relevant data on SCD births, morbidity and mortality rates and long term outcomes are captured.
eHealth Africa continues to work with partners to address health inequalities by ensuring equal access to quality and effective diagnostic tools to achieve universal health coverage.
Last year, eHealth Africa’s CornBot Application was one of the finalists for the Fall Army Worm Tech Prize. The application received the Frontier Innovation Award for its ease of use and human-centric design. CornBot also received $50,000 in prize money. Six months later, CornBot’s, Chinedu Anarado and Cornelius Adewale share their progress and how they are using the prize money to expand CornBot so that the solution addresses more challenges in nutrition and food security.
Why did you develop CornBot?
One of eHA’s focus areas is Nutrition and Food Security Systems. Our goal with this program is to provide nutrition stakeholders at all levels of the value chain, with technological tools and data so that vulnerable populations in West Africa can have access to nutritious food.
When USAID called for innovations to address Fall Armyworm (FAW), a major pest that destroys various crops worth $2.4bn – $6bn annually, predisposing communities to food insecurity, we knew we had to respond. We partnered with the Washington State University (WSU) to design and build CornBot, a mobile application, that interacts with farmers in their local dialect and guides them through the process of detecting, preventing and treating FAW infestation on their farms. The application is synced to a dashboard to enable us and other stakeholders to easily aggregate data on FAW infestation and make informed decisions.
What scenario mapped the transition from CornBot to FMT?
After we received the Frontier Innovation Award and the prize money, we started thinking about what we could do to expand CornBot. During the field testing phase as well as during other field research carried out by WSU, we realized that smallholder farmers needed more than just a pest detection tool—they needed a platform where they could exchange and receive guidance and knowledge to increase their productivity. We then decided to invest the prize money in building a platform where farmers can gain additional information to enable them to yield as much as possible from their farms, in line with the Good Agricultural Practices (GAP) put forward by the Food and Agriculture Organization (FAO). So, CornBot went from an idea that helps in combating farm pests, to a platform for providing guidance on farming practices as a whole. For now, we call it the Farm Management Tool.
What do you hope to accomplish with the Farm Management Tool?
Overall, we want to improve the quality of livelihood among smallholder farmers and strengthen the resilience of communities against food insecurity. We know that by making small changes in their farming processes and decisions, and by adopting good agricultural practices, farmers can increase the crop yield from the same plot of land. They just do not know how to. Many of these farmers have been doing things the same way for years without ever knowing why. Our goal is to arm them with relevant information and ensure that they can produce more crops. If we can achieve this, it will be a huge success and it means that our solution is viable.
What first steps have you taken?
We are currently working to build a mobile application. However, we held a workshop with 40 smallholder farmers in April to glean baseline data about their current agricultural practices, their level of knowledge, and current challenges, and to introduce them to our project and the concept of good agricultural practices. They have agreed to work with us for the pilot scheme and testing, as well as map out portions of their farmlands to test our concepts. We have also commenced field operations such as soil sample testing to understand the existing soil composition and what kinds of fertilizers will be needed.
The idea is to “hand-hold” the farmers throughout the planting season and see if there are significant differences from their previous outputs.
We are very excited about this platform and the possibilities that it presents for addressing food insecurity in communities across West Africa.
Meet Mohamed Sulaiman Kamara, a die-hard Arsenal fan and the Chief Accountant in our Sierra Leone office!
Mohamed joined eHealth Africa (eHA) as a Project Accountant in 2017 and was promoted to this current position after consistent hard work and excellent performance. Mohamed has always worked closely with his team to ensure that they are working towards their team goals and the organization’s overall goals.
Mohamed’s role is a challenging but exciting one, he and his team primarily support all projects by ensuring their accounting and finance processes and procedures are in line with best practices. He ensures the books are closed on a monthly basis in compliance with regulatory standards and makes sure that all the i’s are dotted and t’s crossed for audits. Mohammed also guides and mentors the project accountants, he provides technical support to them when needed and ensures his team remains high performing.
For him, the most rewarding part of his job is the challenges. These challenges help him think critically and innovatively to come up with solutions. Mohammed also enjoys working with diverse teams that include partners and stakeholders, they ensure that no two days are the same at eHA.
In addition to his love and passion for Accounting and Arsenal, Mohammed loves reading motivational books and listening to business news.
eHealth Africa is a team of people from diverse cultures, educational backgrounds, and experiences, united by the desire to build stronger health systems across Africa.
One of our values at eHealth Africa is ownership—we work hard to become embedded in the fabric of the communities which we work in and we invest our time, ideas and resources to ensure that the quality of life in those communities is improved.
This week, our staff in Kano and Abuja hosted an Iftar celebration for members of neighboring communities. Iftar breaks the daylong fast that Muslims must observe during the month of Ramadan. eHA staff came together to distribute food packs and clothes to over 500 people in Kano and 200 people in Abuja. Our aim was to give back to the communities that we live and work in.
Here are pictures from the event in Kano. Ramadan Kareem!
My name is Juliana Jacob and I am a Helpdesk associate with the IT Engineering and Operations team. I studied Mass Communication at Kogi State University and I am currently studying to earn my Masters in Public Relations at Bayero University, Kano. Up until January 2018 when I became an intern with the Helpdesk/ Network Operating Center at eHealth Africa, all I could think about was pursuing a career that would put me in the limelight and make me a household name.
Everything changed during my National Youth Service year in 2016. I worked at the Nassarawa Broadcasting Service (NBS) as a Radio/TV presenter but I had the opportunity to participate in a project as a data collector/ enumerator. I visited settlements in very remote and hard-to-reach locations and saw first-hand the deplorable state of health care in those communities. Many health facilities were dilapidated and had no vaccines or medicines. I decided there and then that I had to play my own part to improve healthcare for the people in such communities.
Someone told me about an eHealth Africa internship placement. I was immediately interested because eHA was a NGO and I knew it would give me the opportunity to touch lives in some way. I am not sure what I expected but when I found out that I would be placed with the Helpdesk/ Network Operating Center, I was worried. I didn’t see any similarities between my background in Mass Communications or my prior experience as an on-air person and working in Information Technology (IT). I had very little knowledge about IT or what it entailed, prior to this internship. My only experience with IT was a course that I took as an undergraduate student.
My time as an intern was the most challenging experience of my adult life but it was also the most enlightening. The Helpdesk is perhaps the busiest unit in the entire organization because it supports the delivery of all the projects in some capacity. We make sure that every team member has all the digital tools that they need to deliver their results. The helpdesk also functions as a customer call center and provides support, information, and solutions to eHA staff and partners. Working at the helpdesk helped me to internalize and exhibit the eHA values especially innovative problem-solving. In no time, I found that I had gained valuable skills such as interpersonal communications, and time and task management.
I have become familiar with IT terms and concepts—that I never thought I would encounter. I have fallen in love with IT and what is so amazing that I did not have an IT or tech background. Everything I know about IT and network operations, I learned from my team at eHealth Africa. Not only were they patient with me, but they also recommended several courses and seminars for my own personal development.
At first, I didn’t think that I could really be of any help to the communities with poor healthcare if I was not on the field or if I was not in the medical profession but my internship with the Helpdesk proved to me that everyone can do something to improve the quality of healthcare for vulnerable populations or communities. At eHealth Africa, everyone brings their strengths to the table and contributes their quota to achieve our mission and vision. We have staff who are not medical doctors or nurses but contribute to the improvement of health service delivery through their expertise in software development, logistics, construction or communications.
In February 2018, I became a full-time staff at eHA. One of the things I love most about eHealth Africa is that it focuses on applied knowledge rather than theoretical knowledge. To a large extent, what matters is getting the job done and not what you studied in school. This is why an intern with a Mass Communications background can become a full-time staff in one of the most technical fields in the organization.
My internship experience helped me to discover what I truly want to do career-wise. Even though my masters is in Public Relations, I have decided to pursue a career in IT. I am currently taking several online courses to attain some certifications in Information and Communications Technology (ICT). There are so many intersections between PR and ICT and I cannot wait to explore them.
I am truly grateful to my team and to eHA for this opportunity. If you are looking for an organization with bright, progressive people who are passionate about transforming health systems in Africa, eHA is definitely the place for you.
Meet Gift Ogbaje, our “Director of First Impressions”. She is a security associate/ receptionist with the Operations unit at our Kano office in Nigeria.
She joined eHealth Africa 2 years ago. Gift’s primary responsibility is visitor management and she is the first person that our visitors meet when they walk through our doors. Gift takes this responsibility very seriously and has made a conscious effort to improve her interpersonal skills so that guests can feel welcome.
At eHA, our strongest asset is our people. Gift embodies our values here at eHA and has shown a remarkable aptitude for innovative problem solving by creating unique and workable solutions to problems within her team. One of her major successes was her simple solution to the traffic during on-site events with external participants. In place of the cumbersome process of generating and printing individual visitors tags, Gift created tags for the training which she could print ahead of time; as well as a register where each participant could enter their details. Her solution reduced the traffic by over 85% and made work much faster.
We are proud to have Gift as part of our team, if you’re ever visiting our office in Kano, be sure to say a warm hello.
By Emerald Awa- Agwu and Olayinka Orefunwa
Thomas* has just received some feedback from donors to suggest that his organization may need to refund some of the funding it received. The donors feel that there is insufficient evidence to demonstrate that the project achieved its outcomes and overall objectives.
Thomas managed a three-year nutrition project, which aimed to combat malnutrition in children under the age of 5 by training local women and caregivers to produce nutritious meals for children from 6 months to 5 years using indigenous, locally available foods. He and his team conducted several activities including producing recipe manuals, organizing food demonstration classes, developing communication materials, and educating women on nutrition and hygiene issues.
Thomas believed that the project had achieved great results. Malnutrition rates had dropped and mothers in the community had a better knowledge of how to create nutritious, balanced meals with local foods in order to support the optimal growth and development of their children. He simply could not understand why the donors could not understand this. After a lot of back-and-forth conversations, the donors asked to see the Monitoring & Evaluation Framework for the project. Thomas and his team had never created one.
What is Monitoring & Evaluation?
Over the last decade, monitoring and evaluation (M&E) processes have become an important source of knowledge management and organizational learning in the development sector. Monitoring and Evaluation (M&E) are processes that help project managers like Thomas as well as donors and relevant partners to assess the performance of a project or organization. Monitoring is a systematic, continuous and long-term process of gathering information about a project’s progress towards its set objectives. Evaluation helps to determine if the project has, in fact, achieved its goals and delivered the expected outputs as planned.
Why is Monitoring & Evaluation Important?
As we saw from the case study, neglecting M &E can have dire consequences. It is important to factor it in from the inception of the project. Best practices in programming and project management suggest that an equivalent of 5% - 15% of the overall project budget should be allocated to M &E. Here are a few reasons why organizations and project managers should have a strong M & E framework in place.
1. M & E is relevant for donors to assess the quality of project implementation. In the development sector, an M &E framework is required by donors for them to gauge how reliable an organization is as a partner, before considering them for future collaborations and opportunities.
2. Together, M&E help to keep track of how efficiently projects are implemented (with regards to using resources and inputs) or how effective the programs are. This is extremely valuable for project managers like Thomas because it helps them ensure that donor funds are being used judiciously to get the best value for money.
3. M&E is also important for identifying challenges and gaps so that changes can be made as needed.
4. It allows teams to learn from each other’s experiences, and to build on expertise and knowledge.
At eHealth Africa, M & E is led by our Monitoring, Evaluation, and Research (MER) team and is built into projects from the inception to close out. The MER team supports project managers across the organization to develop solid M & E frameworks that guide project delivery according to laid down standard operating procedures. Apart from their internal quality assurance functions within projects, our MER team supports eHA’s efforts to contribute to public health research.
The team provides research services to organizations including universities and implementing partners to conduct qualitative and quantitative studies on a wide range of areas. In addition, eHA’s MER team provides third-party monitoring services for humanitarian organizations so that they can have a true picture of the quality and impact of their interventions. Recently, our MER team provided technical leadership in a baseline data survey for the Clinton Health Access Initiative (CHAI). The survey aimed to gather data relating to perceptions and practices relating to sexual and reproductive health among males and females of reproductive age in Kaduna, Katsina and Kano states. Over the course of three years, CHAI will support the state governments of Kaduna, Kano, and Katsina to increase contraceptive prevalence rates and utilization of reproductive health services, which should lead to reduced rates of unintended pregnancies and unsafe abortions. The increased use of family planning, in addition to sustained gains in the provision of quality emergency obstetric services, should lead to a further reduction in the number of maternal deaths in the same time period.
To effectively achieve this goal, a clear understanding of current levels of knowledge on reproductive health was required. First, as a baseline against which program outcomes can be measured at the end of the project, but more importantly, as a basis for which strategies for program intervention can be designed and delivered. eHealth Africa trained the data collectors to use Android-based digital applications such as ODK to collect data across 70 LGAs and supervised the data collection process.
Overall, to avoid scenarios like the one in our case study, organizations need to recognize Monitoring and Evaluation as a necessary component to ensure the quality of their project execution and the accuracy of their outcomes. M&E ensures visibility and accountability as donors, implementing partners and relevant stakeholders will have adequate information about successes, challenges and even changes made in the course of the project.
Meet Abdulai Dumbuya, Senior Network Administrator, in our Sierra Leone office.
Abdulai has been part of the eHealth Africa (eHA) team for approximately 4 years. He is a team lead and go-to person for issues relating to networking, troubleshooting, systems backups, the configuration of network application systems, maintenance and administration of Wide Area Network (WAN) technologies and the execution of network disaster recovery plan.
He also the deputy to the ICT Manager and performs administrative duties for the ICT team, including assisting with the preparation of annual ICT budget and procurement for the department.
One of Abdulai’s biggest contributions to eHA is reducing the operational cost of the 117 Call Center by over 50%. He achieved this by moving the 117 call center ICT infrastructure from an external provider to the Emergency Operations Center (EOC), under the Ministry of Health and Sanitation (MoHS).
We are glad to have Abdulai on our team!
By Joshua Ozugbakun & Emerald Awa-Agwu
In July 2016, after over two years of being polio-free, two wild poliovirus cases were discovered in Borno State, Nigeria. This launched fresh efforts to strengthen the four pillars of polio eradication including Routine Immunization (RI), Supplementary immunization activities (SIAs) (including national Immunization Plus Days (IPDs)), Surveillance and targeted mop-up campaigns.
Partners, both local and international, collaborated with the Nigerian government at state and national level, through various interventions and projects to increase the coverage and effectiveness of IPDs and mop-up campaigns in order to increase herd immunity and stop polio transmission, especially in high-risk states like Adamawa, Borno and Yobe states. These interventions were coordinated by the State Emergency Routine Immunization Coordination Centers (SERICCs). Each SERICC is led by individual state governments and help to improve information sharing, joint programming of public health emergency management activities (planning, implementation, monitoring, and evaluation) with partners. The National Emergency Routine Immunization Coordination Center (NERICC) is responsible for strategy development and oversees the activities of all the SERICCs. With this coordination mechanism in place, the menace of polio is being tackled collaboratively and Nigeria is well underway to being declared ‘Polio Free’, a major milestone in its vaccine-preventable disease management efforts.
A major takeaway for Nigerian polio eradication stakeholders after years of battling polio is the need for data collection, management and storage systems to be upgraded. As the need to halt poliovirus transmission increased, it became increasingly obvious that paper-based data management systems were incapable of providing decision makers with the reliable, actionable data which they needed for effective programming. eHealth Africa responded to this challenge by supporting states across Nigeria to develop comprehensive, digital maps using our expertise in Geographic Information Systems (GIS). The accuracy of these maps improves the microplanning process and guarantees a greater coverage of settlements during campaigns.
In addition, through our Vaccinator Tracking Systems (VTS) project, GIS-encoded Android phones are used to record and store passive tracks of vaccinators as they conduct their house-to-house visits; allowing decision-makers to have an accurate picture of the settlements that have been covered during IPDS and mop-up campaigns. This data can easily be accessed through dashboards for a more detailed analysis and breakdown of coverage information.
Supporting polio emergency response activities also highlighted the need for the Nigerian health system to move from an emphasis on SIAs and campaigns to strengthening the RI and disease surveillance systems. Sound routine immunization and disease surveillance systems are necessary to sustain the herd immunity built through polio campaigns.
In Kano state, the LoMIS Stock solution helps the State Primary Health Care Management Board to ensure that the vaccine supply chain is maintained. Health workers at the facility level use the LoMIS Stock application to send reports on a variety of vaccine stock indicators including vaccine utilization, vaccine potency, stock levels, wastage rates, and cold chain equipment status. Supervisors access the reports through the LoMIS Stock dashboard and are able to respond appropriately. This ensures that the RI system is maintained and that health facilities are never out of stock.
In the past, Acute Flaccid Paralysis (AFP) surveillance in health systems across Africa was passive. This meant that disease surveillance and notification officers (DSNOs) only reported or investigated suspected AFP cases that were presented at the health facility. According to the U.S Centers for Disease Control and Prevention (CDC)1, over 72% of polio cases are asymptomatic and as such, will not present at the health facility. In addition, DSNOs are unable to visit every single community to actively search for AFP cases due to logistics and security challenges. Relying on data from passive AFP surveillance causes programs to be designed based on data that excludes the asymptomatic polio cases. Auto-Visual AFP Detection and Reporting (AVADAR) reduces the burden on the DSNOs by enlisting members of the community to actively find AFP cases and report using a mobile application on a weekly basis; thus, providing accurate real-time surveillance data that can be used for program planning and implementation.
An often overlooked factor that promoted the transmission of the poliovirus was the rejection of the polio vaccine by mothers and households due to various myths and socio-cultural barriers. By engaging traditional and religious leaders as ambassadors of vaccination, more mothers and households are accepting the polio virus.
The central lesson in Nigeria’s journey so far towards polio eradication is the importance of collaboration and engagement at all levels including communities. eHealth Africa is proud to be supporting governments and health systems across Africa to respond to the polio emergency.
By Samura Bangura
I am Samura Bangura, a Financial Services graduate from the Institute of Public Administration and Management (IPAM), University of Sierra Leone. I am currently completing a diploma course in Supply Chain Management. I joined the eHA team in January 2019. eHealth Africa is a go-to place for a wonderful internship experience. I will tell you why:
1. At eHealth Africa, I am gaining the requisite skills and experience to begin my career
I joined eHA, believing the opportunity would help me reach my career goals and sharpen my skill set. I do not regret joining the team. I have always wanted to serve in an organization that would give me the experience I need to begin my career. At eHA, I am able to put into practice what I had learned during my four years at the University and learn new skills.
2. eHealth Africa is a technology-driven organization
I remember thinking that the procurement unit had so many tasks and processes that I was not conversant with, and was worried that I wouldn’t be able to master them. One of the first things that struck me about eHA was the use of technology to make working more efficient. Technology aids almost all processes, including the signing of documents. I was like; “wow! this is great’’. There was so much to learn. I learned how to use different apps and platforms for financial management, document storage, and even task management.
3. Opportunity for learning and growth
At eHA, I have learned so much in a short time. Now, I know how to execute a procurement process, from bid evaluation to processing vendor payments. I also learned how to do administrative tasks for the procurement department, including organizing procurement committee meetings! All this, within just a few months of starting my internship with eHA. I love the fact that eHealth Africa provides opportunities for everyone to learn and grow in their career and in any other areas of interest. One of my biggest takeaways from eHA is to deliver every task with utmost diligence. The experiences and knowledge that I have gained will be mine for the rest of my life. I am very grateful to eHA.
4. Staff are welcoming and eager to help
I love working at eHealth Africa! My colleagues ae very welcoming and eager to help. By the third day of my internship, I quickly realized that there was no need to worry because my supervisor is very inspiring, hardworking and patient with me. She trained me one on one, for a week, so that I would be accustomed to how things are done in the procurement unit. She encouraged me to ask questions and to seek clarification whenever I was unsure of something.
5. Interns are truly part of the team
It’s true, no one treats me differently, even though I am an intern. We are included in all aspects of the organization and our work is just as invaluable as any other team members’. There’s no sense of “real staff” vs. “interns”, we are all one team. For example, the procurement team in Sierra Leone was commended for being the Team of the Quarter, during an employee event on 29th of March 2019, marking the end of the first quarter.
Are you interested in applying for an internship with eHA? Click here to see the list of open internships and apply now.
By Ayodele Adeyemo & Hawa Kombian
The Cholera Threat
According to the World Health Organization (WHO), cholera (an infectious disease which causes acute watery diarrhea) remains a global threat to public health with an annual average of 82,000 deaths. In Nigeria, the cholera burden has been an average of 10,000 cases annually with over 70% of the cases coming from Bauchi, Yobe, and Zamfara states.
Following the review and recent publication of WHO guidelines on cholera control, the Nigeria Centre for Disease Control (NCDC) has begun the implementation of innovative approaches to tackle cholera via:
Strengthening disease surveillance for early detection and quick response through innovative use of technology and data.
Improving coordination for technical support, resource mobilization, and partnership.
Adopting a multi-sectoral approach to meet the 2030 cholera elimination by working with the environment and Water and Sanitary Hygiene sectors to ensure that communities have good water and sanitary facilities which will prevent further outbreaks
The Digital Health Advantage
What does an innovative model for cholera prevention and control look like?
In 1854, John Snow mapped out the cholera deaths during an outbreak and observed that they all occurred within short distances and were clustered around the Broad Street pump. He went ahead to carry out statistical tests to illustrate the connection between the source of water and the cholera cases.
In synergistic partnership, NCDC and eHealth Africa (eHA) used advanced geographic information systems (GIS) technologies to build on John Snow’s ideas of mapping. eHA uses data-driven solutions and tools to improve community health, with specific expertise in the design, development, validation, and deployment of predictive models for diseases like cholera.
GIS allow experts to explore different aspects of a geographical point. The identification of patterns can drive insights and enable health stakeholders to make informed decisions about how to best plan public health interventions. Due to computational and technological advancement, GIS has been used in public health for epidemiology, resource planning, and surveillance among others.
NCDC and eHA were able to utilize GIS capabilities to enhance the data management within the NCDC National Incident Coordination Centre (ICC). The ICC serves as a the emergency operations center for coordinating disease outbreaks at the national level.
eHA’s GIS and Data Analytics team works with the NCDC to map cholera hotspots (areas where cholera persists) across Nigeria’s Local Government Areas (LGAs). At the start of the outbreak, hotspot analysis helps determine where to vaccinate and what quantity of vaccines are required per LGA. This exercise ensures the effectiveness of the oral cholera vaccine immunization campaigns which are rolled out to stop the spread of disease.
In planning, data from 2012-17 displays the spread of cholera outbreaks and also shows the relative risks of the various LGAs which have reported an outbreak during the five year period.
We layered the 2018 outbreak data with the historical hotspot analysis to identify specific trends and possible overlaps. The result of the hotspot analysis identified 83 LGAs as hotspots, with 87% reporting at least one case with over 70% of the burden from Bauchi, Kano, and Zamfara states. The LGAs identified as hotspots have enabled the government to make informed decisions about where to request vaccines to ensure that the most vulnerable areas are supported.
We continue to collaborate with the NCDC to strengthen cholera surveillance in Nigeria. The partnership ensures that data management and analysis expertise contribute to faster response and informed decision making before, during and after outbreaks.
This work was done in collaboration with the following partners:
Yennan Sebastian- NCDC
Adesola Ogunleye - NCDC
Heloise Lucaccioni - UNICEF
Helen Adamu - UMB
Kobi Ampah- WHO Geneva
By Emerald Awa- Agwu
Good health is crucial for developing economies and reducing poverty. Governments and decision-makers need to strengthen health systems so that people can get the healthcare and services that they need to maintain and improve their health, and stay productive. However, improving access to health services is incomplete if people plunge further into poverty because of the cost of health care. WHO estimates that over 800 million people spend at least 10% of their household budget on health care which is indicative of catastrophic health expenditure (CHE). CHE can mean that households have to cut down on or forfeit necessities such as food and clothing, education for their children or even sell household goods.
One of the targets of Sustainable Development Goal 3—Ensure healthy lives and promote wellbeing for all at all ages— is to achieve universal health coverage by 2030. Therefore, achieving UHC has become a major goal for health system reforms in many countries, especially in Africa.
Through our projects and solutions, eHealth Africa supports countries across Africa to strengthen the six pillars of universal health coverage.
1. Health Financing for Universal Health Coverage
WHO recommends that no less than 15% of national budgets should be allocated to health. We believe that accurate and up to date data, can ensure that available health funds are better allocated. In Nigeria, we worked with several partners to map and collect geospatial data through the Geo-Referenced Infrastructure and Demographic Data for Development (GRID3) program. Data relating to over 22 points of interest categories including health facilities, was collected across 25 states and the Federal Capital Territory in Nigeria. This data helps decision-makers to distribute resources and plan interventions that target the people who need it most.
2. Essential Medicines and Health products
Countries decide what medicines and health commodities are essential based on the illnesses suffered by the majority or significant sections of their population. They must also ensure that quality, safe and effective medicines, vaccines, diagnostics, and other medical devices are readily available and affordable.
When essential medicines and health products are procured, it is important to maintain proper records and to ensure that health facilities do not run out of stock. eHealth Africa created Logistics Management Information System (LoMIS), a suite of mobile and web applications, LoMIS Stock and LoMIS Deliver that address challenges in the supply of essential medicines and health products such as vaccines and drugs. In Kano State, health workers at the facility level use the LoMIS Stock mobile application to send weekly reports on the vaccine stock levels, essential drug stock levels and the status of cold chain equipment. Supervisors can view the reports in near real-time through the LoMIS Stock Dashboard and plan deliveries of medicines and health products to prevent stockouts of vaccines and essential drugs, using LoMIS Deliver. LoMIS Deliver reduces errors by automating the process of ledger entry to capture the number of vaccines on-hand at the facility and the quantity delivered.
3. Health systems governance
Health system governance according to the WHO is governance undertaken with the aim of protecting and promoting the health of the people. It involves ensuring that a strategic policy framework exists and providing oversight to ensure its implementation. Relevant policies, regulations, and laws must be put in place to ensure accountability across the health system as a whole (public and private health sector actors alike). Effective health systems governance can only be achieved with the collaboration of stakeholders and partners who will support the government by providing reliable information to inform policy formulation and amendments. Over the years, we have worked with several partners to provide this support.
4. Health workforce
The attainment of UHC is dependent on the availability, accessibility, acceptability, and quality of health workers1. They must not only be equitably distributed and accessible by the population, but they must also possess the required knowledge and skills to deliver quality health care that marries contextual appropriateness with best practices.
Recognizing this, eHA supports the Kano State Primary Health Care Management Board (KSPHCMB) to improve health service delivery by providing health workers in Kano State with access to texts, audio courses, and training modules through an eLearning solution. Through the eLearning web and mobile-enabled platform, health workers can gain useful skills and knowledge on a wide range of topics. Read about the pilot of the eLearning solution here.
In Sierra Leone, we work with the Ministry of Health and Sanitation (MoHS), U.S. Centers for Disease Control and Prevention (CDC) and the African Field Epidemiology Network (AFENET) to implement the Field Epidemiology Training Program (FETP). Through FETP, public health workers at the district and national level gain knowledge about important epidemiological principles and are equipped with skills in case/ outbreak investigations, data analysis, and surveillance. This positions Sierra Leone to meet the Global Health Security Agenda target of having 1 epidemiologist per 200,000 population. In addition, we support Sierra Leone’s MoHS to build additional capacity in frontline Community Health Officers (CHOs), who are based at the Chiefdom level through the management and leadership training program. CHOs are often the first point of contact for primary care for the local population and the MLTP program equips them to provide better health services and improve health outcomes at their facilities.
5. Health Statistics and Information Systems
In line with our strategy, we create tools and solutions that help health systems across Africa to curate and exchange data and information for informed decision making and future planning. The Electronic Integrated Disease Surveillance and Response (eIDSR) solution has been used in Sierra Leone and Liberia to transform data collection, reporting, analysis, and storage for a more efficient response and surveillance of priority diseases. Its integration with DHIS2, a health information system used in over 45 countries, makes it easy for health system decision makers to visualize data and gain insight into the state of public health. Read more about our other solutions Aether and VaxTrac. In addition, we also support the Nigeria Center for Disease Control and Prevention (NCDC) by creation and maintenance of a data portal which serves as a repository for all datasets that are relevant to detecting, responding and preventing disease outbreaks in Nigeria.
6. Service delivery and safety
The Service delivery and safety pillar encompasses a large spectrum of issues including patient safety and risk management, quality systems and control, Infection prevention and control, and innovations in service delivery. With our experience working to respond to polio and ebola virus emergencies across Africa, we support health systems to mount prevention and control programs at the national and facility level. We are also committed to creating new technologies and solutions that can help health providers to develop better models of healthcare. We also construct health facilities ranging from clinics to laboratory and diagnostic facilities that utilize state of the art technology to correctly diagnose diseases such as Sickle Cell Disease, Meningitis, and Malaria.
Our Sokoto Meningitis Lab has been at the forefront of meningitis testing and surveillance in Northern Nigeria, offering reliable and prompt diagnoses to support the prevention of future outbreaks.
eHealth Africa continues to work with governments, communities and health workers so that everyone can obtain the quality health care, in a prompt manner and from health workers and facilities within their communities, thus achieving universal health coverage.
Meet Muhammed-Naziru Halliru, a State Coordinator with our program delivery team!
Naziru is involved in planning, organizing and delivering activities to ensure that the objectives of the Geo-Referenced Infrastructure and Demographic Data for Development (GRID3) project are achieved. Following the mapping of the 36 states of Nigeria, he coordinated stakeholder engagement at the state level to garner government support for the use and application of geospatial data for better economic planning, resource distribution and decision making across a variety of sectors including health, education, agriculture, housing, and transport.
In addition to this, he supports capacity building activities for data managers at the State Ministry of Health, State Primary Health Care Management Board and the Health Management Information System department to equip them to manage, analyze and use the data stored on the GRID3 portal.
Although he has been with eHealth Africa for only a year, Naziru has made very significant contributions to his team and project. Under his supervision, the GRID3 project mapped 10 states across three geopolitical zones: North Central, North East, and North West and collected geospatial data on 19 point of interest categories. This data has been instrumental in improving the impact and effectiveness of polio eradication efforts in these states.
Naziru credits eHA with his new exposure and familiarity with technological tools which have enabled him to achieve his work goals more efficiently. eHA, according to him, has improved his communication and stakeholder engagement skills, which he believes will be invaluable to him in the long run.
The first-documented most widespread and deadly outbreak of the Ebola Virus Disease (EVD) in West Africa devastated three countries: Guinea, Liberia, and Sierra Leone. The outbreak started in May 2014 and by November 2014, during the height of the outbreak, Sierra Leone recorded over 500 new cases of Ebola a week. By October 2015, a total of 8,704 EVD cases had been diagnosed, and 3,589 people had died of Ebola in Sierra Leone.
This disease caught the country’s Ministry of Health and Sanitation (MoHS) by surprise. The outbreak could not be effectively managed because the country did not have the requisite capacity (structure and staff) and systems -Standard Operating Procedures (SOPs), policies and plans, to effectively manage and mitigate the risks posed by the disease.
Ebola’s destruction on the peoples of Sierra Leone and the absence of appropriate structures to deal with future outbreaks, prompted the establishment of Public Health National Emergency Operations Center (PHNEOC) in June 2015, as a coordination structure charged with the responsibility of providing public health emergency preparedness leadership, scientific and technical situational awareness and advice at a national level.
As Sierra Leoneans reflect on the atrocities of Ebola and other emergencies, this question becomes inevitable: Is Sierra Leone better prepared to address any future public health emergencies?
To better prepare for future outbreaks, the U.S. Centers for Disease Control and Prevention (CDC), in collaboration with the Ministry of Health and Sanitation and eHealth Africa, conducted successful trainings for health workers and other stakeholders on Public Health Emergency Management, Risk Communication,Threat and Hazard Identification and Risk Assessment (THIRA), Incident Management Systems and Public Health Operations and Management. These training sessions were done in Bo, Bombali districts and Western Area Urban with the involvement of health workers, district councillors, the national security agency and members of the agricultural sector. These trainings are geared towards improving the PHNEOC’s capacity to better prepare for health-related emergencies.
The PHNEOC/MoHS as beneficiaries have acquired increased knowledge on the method of approach in risk mitigation, analysis, preparedness, response, and recovery. For instance, EOC Focal Persons have been trained in all districts in Sierra Leone to decentralize command and control approach which has provided the necessary pace, efficiency, and structure for response efforts and foster real-time reporting and bridged the gap in communication from the districts EOC’s to the national EOC. eHA, with support from CDC, has embarked on introducing tools that seek to improve the coordination strategy of the PHNEOC such as the Virtual Emergency Operations Center (EOC) communication platform tool. eHA has partnered with MoHS with support from CDC to train about 200 PHNEOC/MoHS staff on various public health emergency topics such as tabletop simulation exercises on Cholera and Lassa Fever; Executive Management training and Virtual EOC training.
Sahr Amara Moiba, District Surveillance Officer and EOC focal person in Kono district, is one of the 200 beneficiaries of the EMP training.
In 2018, there was a Measles outbreak in Pujehun and Kambia district. The EOC focal persons in these districts sent in a daily situational report to the national EOC which was presented to partners during the daily briefing meetings held at the EOC.
As part of the effort to strengthen the PHNEOC preparedness and response capacity, and also improve on the country’s Joint External Evaluation scores, eHA in collaboration with MoHS with support from CDC, developed SOPs for public health response. These SOPs will help improve on the response strategy of the PHNEOC in a coordinated way.