Advancing Public Healthcare with Digital Innovations: Lessons from Insights Learning Forum 2024

by Moshood Isah

In recent times, the focus of conversations in digital health forums has increasingly centered around optimizing and integrating existing solutions to enhance surveillance, preparedness, and impact. This is not unconnected to the fact that the world and especially the African region has endured a series of public health emergencies and disease outbreaks which required urgent responses.

The World Health Organization also echoed that the 21st century health challenges like the pandemic have further accelerated the use of digital health interventions, including hotlines, online assistance, mobile phone applications and many more. These innovations have shown potential in reducing the interruption of Non Communicable Diseases (NCDs) and mental health services, making it necessary to continue scaling up digital health technology.

Health stakeholders have consistently taken intentional steps to stimulate ideas and expand advocacy to improve the impact of these solutions, especially when it comes to disease surveillance. One such conversation is the Insights Learning Forum (ILF 2024) hosted by eHealth Africa with the theme; “Digital Transformation in public Health practice: Innovations and Impact”. 

Deputy Director of Partnerships and Programs Dr. David Akpan

Reflecting on the theme of this event, the Deputy Director of Partnerships and Programs Dr. David Akpan raised critical questions on the perceived values and the role of stakeholders in ensuring digital innovation to thrive in public health. He also raised concerns around the investment being made to promote digital innovation and the impact criteria investors are focusing on. He emphasized, “we want to do this  because we want to make that grandmother and other persons in the rural community have access to quality healthcare. It's what they call equitable access that removes all barriers”. To achieve this, “you need to do the human-centered design approach, which takes the people into consideration when you're developing any form of innovation”, he stated. Thus he called for the need to document diverse salients points and outcomes from  various digital health forums for the purpose of effective advocacy. 

eHealth Africa’s Director of Partnerships and Programs  Ota Akhigbe

Speaking during the event, eHealth Africa’s Director of Partnerships and Programs  Ota Akhigbe said, the event is beyond a conversation on digital innovations but  a platform to advocate for a unified approach to digital transformation, emphasizing the importance of integrity in data usage.  She revealed that,  “The ILF serves as an advocacy tool to raise awareness and engage government agencies, ensuring that these innovations receive the necessary support and funding”. According to Ota, this collaborative approach between the private sector and government agencies is vital for the successful implementation of digital health solutions. 

She lauded the positive body language of Government at all levels to support and advance digital innovation in primary healthcare. This, according to her, is why the Insights Learning Forum is an opportunity for the stakeholders to communicate their needs and expectations to government representatives, ensuring that policies are aligned with the sector’s evolving needs.

Track Sessions at the IFLF 2024

Speaking on why it's vital for the government to continuously support digital innovations in health sector, Incident Manager, Polio Emergency Operation Center in Katsina state Dr Kabir Sulaiman said,  It is very important for us to know that, we need to embrace this era of digital technology that is currently transforming the paper based routine to electronic database. According to the Incident Manager, “Digital innovations will support the strengthening of health systems because some of these digital tools are currently being used in Nigeria.” For instance, “the Surveillance Outbreak Response and Analysis System (SORMAS), which was deployed to the state for reporting priority diseases, has brought about transformation in terms of real-time data and decision-making. So, when you look at the importance, you know there is a lot that we are going to benefit from this technology,” he reiterated.

Through a diverse array of plenary sessions, panel discussions, and track sessions, the Insights Learning  Forum 2024, empowered individuals, groups, and organizations to harness digital technologies to address emerging challenges and drive positive change in public health systems in Africa.

Uniting Against Circulating Variant Poliovirus: Traditional Leaders Lead the Way

eHealth Africa representatives addressing Traditional Leaders in Wammako LGA of Sokoto state

by Moshood Isah

A visit to Sokoto State, Nigeria’s historical Caliphate, is always an intriguing experience, despite the often challenging weather. The city's rich history complements the profound respect held for its traditional and religious institutions, which are similarly revered across Northern Nigeria. These esteemed leaders have consistently played pivotal roles in public health initiatives.

According to the World Health Organisation, the strategic partnership with traditional leaders in Northern Nigeria since 2009 has been instrumental in eradicating the wild poliovirus in the country. Professor Oyewale Tomori, Chairman of the Expert Review Committee on Polio Eradication, emphasized that overlooking these influential community figures would have been a colossal error.

A cross-section of traditional leaders during a one-day engagement of frontline traditional leaders on Polio vaccination in Sokoto state.

While these institutions were crucial in eliminating wild poliovirus in 2020, the emergence of the Circulating Variant Poliovirus demands a redoubled effort. To combat this new threat, traditional institutions across Northern Nigeria are being strategically deployed. Supported by the Bill and Melinda Gates Foundation (BMGF), eHealth Africa is collaborating with the Sultan Foundation for Peace and Development and other partners to engage these leaders in polio campaign activities.

Haruna Yusuf Aliyu, Senior Program Officer at the Sultan Foundation for Peace and Development, highlighted the significant role of traditional leaders in a sensitization workshop held in Wammako Local Government Area. He revealed that many are spearheading vaccination campaigns directly from their palaces, which has significantly reduced vaccine hesitancy and boosted uptake.

“You can see traditional leaders going house to house, supervising vaccination teams and resolving cases of non-compliance while providing guidance to the teams to make sure that all households are actually identified, enumerated,  then eligible children in those houses are vaccinated”, he said.

Through ongoing sensitization workshops, traditional leaders are equipped with the knowledge and tools to effectively communicate the importance of vaccination to their communities. Despite security challenges in some areas, Yusuf emphasized the organization’s commitment to working closely with community groups and traditional leaders to reach all children with essential vaccines.

Fatimah Howeidy, eHealth Africa’s Project Manager, expressed pride in supporting the Sultan Foundation and other partners to reduce vaccine hesitancy through the involvement of traditional leaders. The initiative has successfully bridged knowledge gaps and dispelled myths surrounding polio vaccination, particularly in underserved communities.

“It's so inspiring seeing traditional leaders in Sokoto state turn out in their numbers to participate in the polio campaign activities” she said.  We are indeed excited that this intervention remains a  platform to remind traditional leaders of the need to intensify the campaign to eradicate the Circulating Variant Poliovirus (cVPV2)”, she said.  

The Engagement of Traditional Institutions (ETI) project aims to strengthen advocacy by traditional leaders, increase community ownership of polio eradication efforts, and reduce vaccine hesitancy in high-risk Northern states. There are plans to expand the initiative to Southern Nigeria.

eHealth Africa’s Digital Innovation Takes Center Stage at the Africa Digital Health Summit (ADHS)

by Moshood Isah

eHealth Africa’s Executive Director, Atef Fawaz (Second from right) receiving a partnership award alongside other partners at the ADHS

eHealth Africa’s Digital Innovation Takes Center Stage at the Africa Digital Health Summit (ADHS)

Nigeria and indeed the African region have continued to endure a series of public health emergencies, with the most recent being the cholera outbreak affecting more than 21 states. These and other issues necessitate engagement that brings stakeholders together to improve disease surveillance and response. One such engagement held recently was the Africa Digital Health Summit (ADHS). The summit is a platform for innovators, academics, entrepreneurs, researchers, regulators, policymakers, and development partners to share knowledge and experience in digital health across Africa.

The 2024 edition of the summit, with the theme "Digital Transformation of Health Systems: What, Why, and How?", featured industry experts from around the world. In the presence of the Honorable Minister of State for Health and Social Welfare, Dr. Tunji Alausa, and the Commissioner of Health in Lagos State, Prof. Akin Abayomi, eHealth Africa, and other organizations displayed crucial digital health solutions currently being used to address public health emergencies.

eHealth Africa leading panel session at the 4th ADHS

During the summit, eHealth Africa hosted a panel session where it discussed a series of digital innovations and how instrumental these solutions have been in public health and disease surveillance. The session, moderated by David Akpan, Deputy Director of Programs and Partnerships, featured Andrew Karlyn, a board member at eHealth Africa; Dr. Emmanuel Agogo, Director of Pandemic Threats at the Foundation for Innovative New Diagnostics (FIND); Dr. Monique Aaron Foster, Deputy Director of Programs at the Sierra Leone Division of Global Health Protection, Global Health Centers for Disease Control and Prevention; Dr. Ubong Okon, Deputy Director of Programs and Impact at eHealth Africa; and Motunrayo Bello, Chief Executive Officer of Womenovate.

In the words of Atef Fawaz, the Executive Director of eHealth Africa, after the session, "Digital innovation is the future of health and the world in general. If we want to avoid the next pandemic, we must build on existing digital solutions. Technology has helped in responding to health emergencies in the past, and it will help in the future."

Another key highlight of the event was the technical session moderated by Kazeem Balogun, Program Manager at eHealth Africa, which featured the demonstration of Electronic Integrated Disease Surveillance and Response (eIDSR). As revealed by Deputy Director of Global Health Informatics and ICT Operations, Abdulhamid Yahaya, the eIDSR is an optimized system created to improve the flow of information within health systems. This allows accurate and early detection of disease outbreaks right from the communities to the highest level of intervention. According to Abdulhamid, “This is an opportunity to reignite and energize stakeholders to drive the utilization of the eIDSR solution to improve early detection of disease outbreaks in our communities.”

The demo session was preceded by a technical session on leveraging digital innovation to strengthen early warning systems for early detection of outbreaks using an ecosystem approach, led by Dr. Emmanuel Agogo. He explained the importance of effective data flow during disease surveillance and how it helps in developing early warning systems from the communities to health facilities, state, and national levels.

While commending the insightful presentations, the Director of Programs and Partnerships at eHealth Africa, Ota Akhigbe, emphasized the need to consider all stakeholders playing an active role in promoting the early detection of disease outbreaks. She said the public sector is crucial in providing population data, while the private sector leverages its capabilities to develop innovative solutions and the academia contributes research to bring out learning points.

To reecho the words of Dr. Tunji Alausa, "Digital health innovation is no longer a luxury but a necessity." Thus, conversations like this should remain at the forefront of national discourse.

The conversation around digital health and the innovative use of digital technology in advancing public health cannot be overstated. In furtherance of this conversation, eHealth Africa is delighted to announce the second edition of the Insights Learning Forum, an annual event dedicated to advancing digital health in public health practice. The 2024 edition of this high-level forum will be held on July 31st, 2024, at the Transcorp Hilton, Abuja with the theme "Digital Innovations in Public Health Practice: Innovations and Impact."

Click here to learn more and register to attend.

eHealth Africa is Assessing Life Cycle of Insecticide-treated Mosquito Nets in Bauchi Communities

by Moshood Isah

eHealth Africa is Assessing Life Cycle of Insecticide-treated Mosquito Nets  in Bauchi Communities

Do you sleep under or inside insecticide-treated mosquito nets? It's an interesting question, right?. While both words are often used interchangeably, it's important to use the specific term "sleeping under" to ensure mosquito nets are used effectively for optimal impacts. 

When it comes to preventing or reducing malaria transmission, especially in high-risk regions like Africa,  the most effective method is arguably the consistent use of long-lasting insecticidal nets (LLINs) for sleeping. The World Health Organisation has constantly recommended this intervention as malaria remains a significant public health problem. 

Despite this, research reveals that underserved communities are less likely to purchase LLINs due to economic constraints. This may explain the frequent free distribution of mosquito nets in these  communities. One such free distribution campaign was conducted in Bauchi State, Nigeria last year. 

Led by the Against Malaria Foundation in partnership with the state Government, over 3 million insecticide-treated mosquito nets were distributed  to more than one million households across Bauchi state.

To assess the availability, effective use, and impact on malaria transmission of the distributed nets, eHealth Africa, in partnership with strategic stakeholders in the state, deployed a comprehensive Post-Distribution Monitoring (PDM) strategy.

During the entry meeting with the Bauchi State Agency for the Control of HIV/AIDS, Tuberculosis, Leprosy and Malaria (BACATMA), project manager Toju Ogele said that eHealth Africa will deploy over 100 data collectors and supervisors to visit about 20,000 households across the state. 

Data collectors and Supervisors after conclusion of training on Post Distribution Monitoring of Mosquito net

The households were randomly selected to prevent any bias in the Post Distribution Monitoring (PDM) process. “While data collectors conduct house-to-house surveys using electronic devices to ensure accuracy in the data collection process”, he said. 

The process which had already begun in the state capital, also involved roving supervisors who conducted spot checks and provided oversight. "The primary objective of the PDM intervention is to confirm net presence, assess their effective use, and determine their current condition across households," he said. 

“We recognize the important role of community gatekeepers, such as traditional and religious leaders, for intervention of this nature. Therefore, we conducted advocacy visits to different levels of leadership at the local government level to secure their support for the project”, he added.  Importantly, the team also deployed local guides familiar with the communities to ensure a smooth data collection process. 

In his remark, Sulaiman Danladi, Deputy Director of the State Malaria Alleviation Programme, commended the community-based approach to the intervention and pledged his support for an objective PDM outcome. He reiterated that “since 2009, the state has distributed Long Lasting Insecticide Treated Nets (LLINs)  every four years. It is an ethical standard to conduct follow-up to assess  the availability, hanging rates, and maintenance of the nets”. 

According to him, this is done to ensure the nets are being effectively utilized for the overall protection of the entire Bauchi State population, especially under-5 children and pregnant women, against malaria. 

During the first phase of the Post Distribution Monitoring, a community leader in Bauchi metropolis, Mallam Ya’u Adamu praised the process saying the PDM helps identify gaps experienced during the initial net distribution process. He explained that “some of the ad-hoc staff deployed to identify households and collect information for net distribution purposes are not necessarily familiar with the communities they are deployed to."

eHA Completes the training of 25 Supervisors for Post Distribution Monitoring in Bauchi

This undoubtedly impacted  access to mosquito nets in the community.  He, therefore,  called on partners to always involve community leaders in the identification of households and distribution of insecticide-treated nets. 

Community Health Workers, Patients Get Boost in Battle Against Non-Communicable Diseases

by Moshood Isah

Nana Abdullahi, a Community Health Extension Worker residing in Nasarawa Local Government of Kano State has just completed a 3-day comprehensive training on effective screening, diagnosis and management of Non-Communicable Diseases.  The training  built the capacity of 24 Community Healthcare workers in both the Federal Capital Territory (FCT), Abuja, and Kano state, Nigeria on adopting the World Health Organisation (WHO) Package of Essential Non-Communicable Diseases Intervention (N-PEN) in Nigeria. 

Nana, a health extension worker for some years now, has encountered a mix of experiences with her patients.  The most heart-wrenching is that after screening and providing them with medication, many of these patients lack the financial resources to consistently purchase the necessary medications. This often leads to a decline in their health, complications and potentially culminating in death. 

“We used to have issues with the patients due to lack of   drug compliance because they complain of financial challenges and without the medications you cannot manage hypertension”, she said. 

According to Nana, “there is a patient whose Blood Pressure (BP) keeps rising despite the drugs I prescribed for her. Unfortunately, after visiting her a couple of times, she confessed that she could not afford to buy the drugs”.  Faced with this situation, Nana felt compelled to purchase the medication herself to save the patient's life.

While the training exposed Nana to a more effective way of screening, communicating and administering medications to patients, Nana is even more excited that this intervention by eHealth Africa will be providing free medication for her clients. She said, “we are glad that this project (Digitizing for Impact, Improving Access to Integrated Services for NCDs in Nigeria) by eHealth Africa  will be giving our patients free medications so that will help them with compliance with their medications”. 

“I have upgraded from my previous knowledge on how to screen and prescribe medications. We will now use the national protocol for treating diabetic and hypertensive patients”, said Nana. . 

Beyond Primary Healthcare facilities, the intervention also collaborates with REACH clinics (Reaching Everyone with Accessible Community Healthcare) located in selected communities. Dr Adawiya Mahmud Ila, a Product Quality Assurance Coordinator at the EHA’s REACH Clinics in Kano has been supporting free medical outreach programs in Kano while also managing the community health extension workers. She identified challenges faced by healthcare workers, including determining when to introduce new antihypertensive medications, reduce existing medications, or wean patients off them entirely.

“We have been properly trained on how to identify and screen for hypertension and diabetes and how to counsel patients”, she said.  After this training, Dr Adawiya expects improvement in the way hypertension and other Non-Communicable Diseases are being treated and managed. 

“My expectation from the Community Health Extension Workers is to treat hypertensive and diabetic patients the right way and not make the mistakes of inadequately reducing or increasing medications”  She is also optimistic that the training will lead to proper management and better follow up with patients. 

Non-Communicable Diseases (NCD) like Diabetes, Cancer, Hypertension and heart disease are considered among the most deadly diseases globally. According to UNICEF, it is estimated that one in five deaths among adolescents are caused by NCDs.  Similarly, the disparities in access to healthcare services contribute to the ineffective diagnosis and management of NCDs. 

Digitizing for Impact; Improving Access to Integrated Services for NCDs in Nigeria, is a brainchild of eHealth Africa currently being piloted in the FCT, Abuja, and Kano communities. This intervention is a household-based and integrated approach especially for underserved communities to improve the coverage of appropriate NCD services.  

The N-PEN intervention basically identified the primary health care system or facility as the most effective and cost-effective means of getting a lot of people to treat common NCDs like Hypertension and Diabetes. This is because Primary healthcare services are the closest to the poor and vulnerable and they could easily walk in and access the services. 

Advancing Public Health: Niger State Set to Inaugurate State-of-the-Art Emergency Operations Center

by Favour Oriaku

Following the successful commissioning of the Emergency Operations Centers (EOCs) in Kebbi and Zamfara states earlier this year, the spotlight now shines on Niger State as they prepare to inaugurate their own EOC, marking the 11th such facility constructed and overseen by eHealth Africa across Nigeria. 

 The inclusion of Niger State in this initiative can be traced to the state being one of the critical regions in Nigeria's fight against the circulating variant of the polio virus and other vaccine-preventable diseases. Aligned with the objectives of the Global Polio Eradication Initiative (GPEI) and its partners, this new EOC aims to enhance coordination and response strategies for Niger State.

Upon its completion, health stakeholders anticipate a state-of-the-art infrastructure that will streamline the planning and execution of public health interventions in Niger State. Through data-driven decision-making processes, the EOC promises to yield improved outcomes, benefiting not only the citizens of Niger State but also its neighboring regions.

During a recent site inspection, discussions with key figures including Eyitayo Samuel, the supervisory site manager, Dr. Abdullahi Usman Imam, Permanent Secretary of the Niger State Ministry of Public Health Care (NSMPHC), and Dr. Samuel Jiya, Director of Disease Control and Immunization at NSMPHC, shed light on the construction progress, and future collaboration prospects.

Eyitayo Samuel, the supervisory site manager, shared insights into the construction progress, affirming the dedication to quality and functionality. He stated, "The progress of the work reflects meticulous planning and execution, indicating a facility that is poised to meet its objectives effectively."

Dr. Ibrahim Ahmed Dangana, the Honourable Commissioner for Primary Health Care Development in Niger State, along with Dr. Abdullahi Usman Imam, Permanent Secretary of NSMPHC, Dr. Samuel Jiya, Director of Disease Control and Immunization, and other essential stakeholders, conducting a site inspection of the ongoing construction of the Niger State Emergency Operation Center.

Dr. Abdullahi Usman Imam commended the meticulous planning evident in the design phase of the EOC, foreseeing its potential to significantly enhance primary healthcare services in Niger State. He affirmed the government's commitment to maintaining the facility at world-class standards, allocating resources for its upkeep and even planning to establish a Data Center to complement its activities. Dr. Abdullahi Usman Imam remarked, "Looking at the progress of the work, it is obvious that a lot of planning has gone into the design phase, as It is already looking like a world class facility that would serve the purpose for which it is being built thereby making very significant impact on Primary Health care services in Niger state."

He further stated, "The government of Niger state will ensure that a budget is set aside to ensure that the facility is maintained to world class standard. The government of Niger state has already set aside in its budget for this year to establish a Data center, this will complement the activities of the EOC."

Dr. Samuel Jiya emphasized the EOC's role in fortifying the state's immunization campaigns, likening them to strategic warfare where planning and execution are paramount. With the EOC as the central hub for coordination, he expressed confidence in the state's ability to combat prevailing diseases effectively. Dr. Samuel Jiya stated, “The campaigns are like a war situation whereby a lot of planning and strategizing goes into play, and this EOC as well equipped would be the hub of that planning and strategizing, ensuring that we efficiently fight the existing variant of polio and other vaccine-preventable diseases, and kick them out of the state.”

The construction and management of the Niger State EOC by eHealth Africa, with support from The Bill and Melinda Gates Foundation and Aliko Dangote Foundation, exemplify the potential for impactful achievements when communities, leaders, and partners unite for public health initiatives.

Empowering Communities Through Data: Saleh Umar Vulegbo’s Story with eHealth Africa’s EMID App

Group photo of eHealth Africa's training team, the National Primary Health Care Development Agency (NPHCDA) training team, and Health Workers from Lapal Local Government Area  following the EMID cascade training in NIger State.

By Tijesu Ojumu

In the heart of Lapai Local Government Area in Niger State, Nigeria, Saleh Umar Vulegbo stands as a beacon of hope and efficiency. Working as a data recorder at the Bow Comprehensive Primary Health Center, Saleh's dedication to his community is evident in every entry he makes and every record he keeps. His journey, intertwined with the Electronic Management of Immunization Data (EMID) by the National Primary Healthcare Development Agency (NPHCDA) and optimized by eHealth Africa with funding from the Global Alliance for Vaccines and Immunization (GAVI), is a testament to the power of technology and training in transforming lives and communities.

Saleh’s introduction to data recording and immunization came early in his career. “The first time I started hearing about data recording and immunization was when I began my work,” he recalls. “Without recording, it means you haven’t done anything because the record speaks on behalf of any assignment you did in your facility or local government.” This realization fueled his passion for data accuracy and reliability, ensuring that every immunization was documented meticulously.

The turning point in Saleh’s career came with the introduction of the EMID app. Before this innovation, data recording was a laborious task, relying on pen and paper. The transition to electronic data management was revolutionary. “The day I was introduced to the system, inputting and outputting data electronically, was memorable. Before then, everything was done with pen and paper. Now, things have turned to electronics,” he reflects.

The EMID app not only simplified data recording but also enhanced accuracy and traceability. “With EMID, you input biodata, scan a QR code, and take a personal picture to identify the person. It’s much more efficient than the old pen-and-paper method. It’s easier to identify and locate individuals now,” Saleh explains. This technological leap meant that immunization records were no longer confined to dusty registers but were accessible and verifiable in real time.

eHealth Africa’s role in this transformation cannot be overstated. After optimizing the EMID native app, eHealth Africa conducted comprehensive training, ensuring that health workers across Nigeria’s 36 states, 774 local government areas, and the Federal Capital Territory, Abuja, were proficient in using the EMID app. The training program equipped data recorders like Saleh with the skills needed to navigate the digital landscape. For Saleh, this training was more than just skill acquisition; it was empowerment. “The world is moving from hard copy to digital. Anything you do now is being watched globally. You must come out boldly and be transparent in your work,” he emphasizes.

Saleh’s mentor, an experienced Monitoring and Evaluation (M&E) officer, played a significant role in shaping his career. “He coached me since I was a child, teaching me the importance of monitoring and evaluation through proper reporting,” Saleh says. This mentorship, combined with eHealth Africa’s training, positioned Saleh as a crucial player in his community’s health system.

Saleh Umar Vulegbo, data recorder at the Bow Comprehensive Primary Health Center, Lapal LGA, Niger State.

Saleh’s impact extends beyond data recording. His dedication ensures that immunization programs run smoothly, with accurate data guiding every step. His work serves as a foundation for decision-making, policy formulation, and resource allocation. By maintaining precise records, Saleh helps safeguard his community against preventable diseases, contributing to a healthier future.

eHealth Africa’s optimized EMID app has revolutionized the way immunization data is managed, making the process seamless and efficient. Their commitment to training and empowering health workers like Saleh has had a ripple effect, enhancing healthcare delivery across Nigeria. Saleh’s story is a shining example of how technology, when coupled with proper training and dedication, can transform lives and communities.

In the words of Saleh, “In this global world, anything you do now is being watched. Inputting data into systems means everyone can see what you’re doing in real time, and it ensures accountability and accuracy.” His story is a reminder that behind every data point is a human story, a commitment to excellence, and a desire to make a difference.

Through Saleh’s eyes, we see the profound impact of eHealth Africa’s efforts both in optimizing the EMID app and in disseminating training to empower healthcare workers to use the app. Their work not only streamlines processes but also inspires individuals to rise above challenges, making meaningful contributions to their communities. As we celebrate these achievements, we are reminded that the heart of innovation lies in the people who bring it to life.

OutREACH: eHealth Africa, Clinic Collaborate to Tackle Non-Communicable Diseases

by Moshood Isah

Hypertension is a major public health problem in Nigeria, with prevalence of 37.5%. This means that nearly 4 out of 10 Nigerian adults have hypertension. Similarly the prevalence of diabetes is increasing worldwide, and Nigeria is no exception; an estimated 7% of adults in Nigeria have diabetes, making it among the most common cardiovascular diseases in the country.

Unfortunately,  lack of access to quality and affordable hypertension and diabetes services in rural communities and primary health care is a major concern. This is largely due to  disparity in access to quality healthcare, especially between rural and urban areas in Nigeria as a result of  economic, social, geographic, and health workforce factors. For instance, the secondary health facilities where the few drugs are, with the facility for testing and the medical professionals are far from the rural communities, making access difficult. This is exacerbated by the high cost of medications, making it difficult for some clients to afford the treatment they need, resulting in low treatment outcomes.

Thus, adapting and digitizing  the World Health Organisation Package of Essential Noncommunicable (PEN) disease interventions for primary health care, eHealth Africa is collaborating with the EHA Clinic Reaching Everyone with Accessible Community Healthcare (REACH) program to reach out to marginalized communities with healthcare interventions. This, according to the Project Manager Lucy Okoye, is aimed at improving access to quality care and affordable services for persons with hypertension and diabetes and others at risk. 

She said, “Social mobilization activities will increase rural communities' knowledge of hypertension and diabetes”, saying  the identification of risk factors and the signs of hypertension and diabetes will likely result in the adoption of a preventive healthy lifestyle and prompt seeking of treatment. Another potential impact of the intervention according to her is to reduce the prevalence of hypertension and diabetes and improve the health and well-being of the target communities, helping people to live longer and lead healthier lives. 

In February, eHealth Africa supported the free medical outreach conducted in the Kuje community of the Federal Capital Territory and Gyadi-Gyadi community of Kano state. According to Adawiya, Mahmud Ila, Product and Quality Assurance Coordinator at the EHA REACH clinic said the outreach is an opportunity to reach the people accessible and  to provide free healthcare within the community. 

“We are having an outreach where we see hypertension and diabetic patients,we measure the blood pressure and fasten blood sugar.”  If there is a need for us to give hypertensive and glycine medication we give them which is going to be free for 6 months”, she said.

She said, the economic realities in developing countries like Nigeria limits citizens especially the older generation from accessing good medical care.  She said, “You know how the economy is in Nigeria; economically it's hard for them to go to the hospital so we are just trying to make an impact in the community”.

Speaking on community acceptance and mobilization strategy for the outreach, Adawiya said, the partners leveraged on its Community Health Extension Workers (CHEW) to discuss the impact of the intervention  with traditional leaders and community influencers. 

Community Feedback

Zainab Abdullahi is  a resident of Kasuwan Dare area of Gyadi-Gyadi community of Kano state. She heard of the REACH Clinic Outreach through community influencers. “Now they checked our BP,Blood sugar level and from here we will proceed to see the doctor”, she said. 

Zainab lauded the outreach initiative saying the community is receptive to ideas like this. “the hospital environment is clean and welcoming and this is why you can see close to 100 people coming for this outreach”.  “If they can spread their tentacles and establish  this kind of hospital in all areas, we will be happy so that everyone will visit the nearest hospital rather than going far from home to access healthcare”, she said.  There is also a need to have additional doctors to attend to a growing number of patients in a bid to reduce waiting time, she said.

Ahmed Salisu Musa has spent 45 years in the community.  He expressed his excitement saying the outreach has brought good healthcare delivery to his doorstep. “They took my blood samples, gave me some medications and I was told, I am not diabetic”, he said

He said, “as a community leader myself, I am glad to  have witnessed what is happening and will pull  in more people to come and get checked.” Musa called for increased mobilization of citizens and more importantly expansion of the intervention to reach other communities.

Empowering Nigeria’s Healthcare System with EMID App Training

Group photo of eHealth Africa's training team, the National Primary Health Care Development Agency (NPHCDA) training team, State Train the Trainers representatives, and other stakeholders following the EMID cascade training in Ebonyi State.

by Favour Oriaku

Since March 2022, eHealth Africa (eHA) has been instrumental in enhancing the capabilities of the Electronic Management of Immunization Data (EMID) System in Nigeria. This project, funded by the Global Alliance for Vaccines and Immunization (GAVI), is in partnership with the National Primary Healthcare Development Agency (NPHCDA). The goal is to streamline immunization data management at Primary Healthcare Centers (PHCs) across the country, improving vaccination scheduling, real-time data entry, and the overall process of data collation, analysis, and validation.

Dayo Akinleye, a technical Project Manager at eHealth Africa and a member of the EMID project implementation team, shared insights on the progress  made. "The EMID app has been optimized significantly ," he said. "We've introduced several new features, such as the integration of a dedicated Routine Immunization (RI) module, liveness detection, geo-fencing, Frequently Asked Questions (FAQ), real-time help desk support, and overall enhancements to the app's user-friendliness."

Following these improvements, eHealth Africa and NPHCDA, with support from Data-Fi, initiated a comprehensive training for health workers across Nigeria's 36 states, 774 local government areas, and the Federal Capital Territory, Abuja. The series of trainings, recently conducted in several states including Kogi, Nassarawa, and Ebonyi states, were meant  to familiarize healthcare professionals with the updated EMID native app.

James Gambo, a Data Processing Officer with NPHCDA and a member of the training team, emphasized the app's evolution and the significance of the training. "Originally designed for COVID-19 vaccination data, the EMID app now includes a module for routine immunization. It eliminates paper-based records, allowing immediate data access at the NPHCDA headquarters. We're conducting nation-wide training to ensure all users are proficient with the app," he explained. The training strategy involves National Training of Trainers (NTOT), who go on to lead the training at the State level. The State Training of  Trainers (STOT) comprises LGA EMID Focal persons and the State EMID teams. After the STOT, the LGA EMID Focal Persons  then go on to train the recorders at the LGA levels with oversight from both eHealth Africa and NPHCDA/State teams. The hands-on training has received positive feedback, and we've observed participants adeptly navigating the app during the training.

Christopher Nwodom, the Ebonyi State Immunization Officer (SIO), also shared his thoughts. "The EMID native app has revolutionized immunization data collection. It's not just about moving away from paper; it's also about ensuring data accuracy. This training will undoubtedly enhance the skills of EMID focal persons in recording and uploading data in real time," he remarked.

Nwonu Victor Onyedikachi, an EMID recorder who underwent the training, expressed his enthusiasm for the new app. "I find the new EMID native app incredibly user-friendly, efficient, and responsive. The added features have made my experience even more enjoyable," he stated.

Once the training phase is completed, an official launch and deployment date for the new EMID native app will be announced. This marks a significant milestone in the collaborative efforts of GAVI, NPHCDA, and eHealth Africa to enhance health data collection, recording, synchronization, and storage in Nigeria.

Nasarawa SPHCDB set to Sustain Vaccination Progress with User-Friendly EMID Mobile App

by Moshood Isah

The race to  ensure accessibility to  COVID-19 Vaccine and  intensive campaigns to promote the uptake of the vaccines led to its routinization especially in developing countries.   To further ensure the successful implementation of its COVID-19 vaccine deployment plan and address existing challenges of data management, Nigeria developed the Electronic Management of Immunization Data (EMID) system in 2021. By the end of the year,  the National Primary Health Care Development Agency (NPHCDA) revealed that Nasarawa state, located in North Central part of Nigeria has again overtaken other states in the COVID-19 mass vaccination campaign in Nigeria.

However, recent experience has also revealed that manual data collection remains vulnerable to damage or manipulation. Digital solutions remain mostly more recommended as it enables more accurate data capturing and better storage process.  However, the potential challenges that could hamper the progress of development and utilization of digital solutions for management of immunization data are likely technical glitches and capacity limitations of health officials, especially in underserved communities. 

 To Address these challenges, eHealth Africa in partnership with National Primary Health Care Development Agency supported by GAVI developed an optimized version of the EMID mobile application, incorporating routine immunization to further standardize and harmonize data collection and storage. Thus, eHA successfully completed the training of healthcare personnel across the country, in the use of the EMID Native App.

Speaking during the training session for healthcare personnel and immunization recorders across over 300 Primary Health facilities in Nasarawa state, key stakeholders highlighted how the optimum utilization of the EMID application will sustain vaccination progress in the state.

LGA EMID Focal Persons in Nasarawa state after a Training of Trainers on optimised EMID application

Abubakar Alilu Awei, State Primary Healthcare Development Board, (SPHCDB) Immunization Officer (SIO) said the presence of EMID Focal persons at the LGAs ensuring that all recorders upload information of clients on the national server was indeed instrumental in the state progress during the COVID 19 vaccination.  He said, “You may recall that Nasarawa state emerged as the overall best performing state in Nigeria in terms of COVID-19 vaccination and also the best performing state in the North central zone. This may not be unconnected to the good use of our EMID application that we adopted during the COVID 19 vaccination.”

Awei further lauded the incorporation of routine immunization into the application saying, the training is timely as it  will enable the state to have  data on the server to enable adequate tracking of client information. He said, “with the optimized EMID app,  at a glance we can  check on the client that has been vaccinated with the first antigens. So when they come back to the health facilities for the next antigen it's just for the recorder at the health facility to go to the server and update the current antigens that they have received”. It reinforces the prospects for effective management of immunization data.

In a similar vein, Beatrice Samuel, NPHCDA, Zonal technical officer,  Nasarawa state said, “one of the things we really enjoyed is that we could see the accessibility, the user friendly and not much challenge”. While describing the optimization of the EMID app as a milestone for the agency and eHealth Africa, she called for its sustainability. 

“I  want to believe that the excitement we have now would not just go away. It should be something that will not give us challenges when we go to the field.  There should be a sustainable native app for us to enjoy more and more”.

Immunization Recorder in Doma LGA of Nasarawa State

In his words, Ahmed Ibrahim, EMID State Focal Person for Nasarawa State lauded eHealth Africa for leading the optimization of the application saying, “ our recorders at the health facility will now know the value and importance of keeping record”. He said the application guarantees the safety of data in its electronic form saying,  “even if the facility is burnt you can still go to the database and search for the record of any person”, he concluded. 

Celebrating the Handovers of EOCs in Zamfara and Kebbi States

Kazeem Balogun, Senior Programs Manager at eHealth Africa, and Dr. Muyi Aina, Executive Director of the National Primary Health Care Development Agency (NPHCDA), during the handover ceremony for the Zamfara State Emergency Operations Center.

by Favour Oriaku

In the ongoing battle to eradicate the polio type 2 virus, Kebbi and Zamfara states, alongside six others - Borno, Katsina, Kaduna, Niger, Sokoto, and Yobe - have been identified as critical regions in Nigeria's fight against this debilitating disease. These states, collectively referred to as the Axis of Intractable Transmission (AIT), face unique challenges due to areas that are difficult for vaccination teams to access. To bolster the efforts of the Global Polio Eradication Initiative (GPEI) and its partners, the establishment of additional Polio Emergency Operation Centers in Kebbi and Zamfara States became essential. This strategic move aims to accelerate the journey towards the complete eradication of polio in Nigeria and the wider African continent.

January 2024 marked a pivotal period in Nigeria's public health sector with the official handovers of Emergency Operations Centers (EOCs) in both Zamfara and Kebbi States. Held on the 29th and 31st of January respectively, these events signified major advancements in healthcare systems in these regions.

Governor Dauda Lawal, Executive Governor of Zamfara State, cuts the ribbon at the handover ceremony of the Zamfara State Emergency Operations Center.

Zamfara State's EOC Handover

The transfer of the EOC to the state government in Zamfara on January 29th was a celebration of partnership, progress, and a vision for a healthier future. The day included visits to Governor Dauda Lawal and HRH Alh. Ibrahim Muhammad Bello Sarkin Katsinan Gusau, the Emir of Gusau, followed by the official handover ceremony.

This event saw participation from state officials, traditional leaders, and representatives from various organizations. Dr. Muyi Aina, the Executive Director of NPHCDA, stressed the governor's vital role in upkeeping the EOC. In response, Governor Lawal expressed, "I am deeply grateful to all our partners and pledge to ensure the EOC's effective management for the benefit of Zamfara's residents."

Kazeem Balogun, Senior Programs Manager, and Abubakar Shehu, Programs Manager at eHealth Africa, during the courtesy visit to the palace of Alhaji Sama'ila Muhammad Mera, the Emir of Argungu.

Kebbi State's EOC Handover

On January 31st, Kebbi State echoed this progress with its EOC handover in Birnin Kebbi. The day began with a visit to the Emir of Argungu, Alhaji Sama'ila Muhammad Mera. The Emir, emphasizing his commitment to health, said, "80% of the conversation we have around the palace is geared towards health and wellbeing, as I have been a health practitioner for a very long time." He also facilitated a tour of the Argungu war museum for the delegation.

The handover ceremony was attended by state health officials and representatives from supporting organizations. Governor Abubakar Atiku Bagudu, represented by Alhaji Safiyanu Garba Bena, Head of Service, received the EOC keys and new trucks donated by Unicef. Relaying the governor's message, Bena stated, “We deeply appreciate our partners' efforts in supporting Kebbi's health and wellbeing. We assure you of our commitment to not only using this facility effectively but also ensuring its proper maintenance.”

Muyi Aina, handing over the facility, emphasized the need for collaboration. "For this to work, there needs to be a conscious effort towards the judicious use of the facility," he advised. He also called for the swift appointment of an Incident Manager to manage the EOC.

A Testament to Partnership and Progress

The establishment of EOCs in Zamfara and Kebbi, built and managed by eHealth Africa with support from The Bill and Melinda Gates Foundation, Aliko Dangote Foundation symbolizes a renewed commitment to public health. The handover represents more than just new buildings; they are a collective resolve to improve healthcare in both states. Additionally, the events were utilized to hand over maps derived from micro planning and tracking by eHealth Africa. These maps are intended for the state's use in health and other social development planning, providing valuable resources for more effective and targeted initiatives.

As these EOCs commence operations, they stand as testaments to the power of partnership and dedication to improving health outcomes. The handovers in Zamfara and Kebbi are vivid examples of the remarkable achievements possible when communities, leaders, and partners unite for public health.

Optimised EMID Mobile App Aids Immunization Data Collection, Storage in Kogi

By Tijesu Ojumu

In March 2021, Nigeria rolled out a COVID-19 Vaccine national campaign. Just as with every other campaign effort, it was met with initial scepticism and hesitation. While some states were able to quickly accept and adopt the vaccine, some other states were hesitant. A prime example of this was the Kogi state government.

This hesitancy may have contributed to the state’s delay in kicking off the vaccination campaign for the virus. As a matter of fact, the State was the last to commence vaccination of its citizens; one month after the national roll out.  Having kicked off its own vaccination campaign, the race to catch up with the rest of the country became daunting with the state ranking amongst the lowest in terms of progress made with vaccine uptake.

Interventions have been made by leaders in the health sector to not just ensure vaccine accessibility but also advocacy for stakeholders to encourage vaccine uptake across the state.  One of the most recent interventions is the optimization of the Electronic Management of Immunization Data (EMID) application by eHealth Africa for the National Primary Health Care Development Agency (NPHCDA) supported by GAVI. 

The EMID Application is a tool used for real-time data collection, including offline data. It was developed for the Nigerian terrain in which most health facilities are in areas with little or no internet connectivity and deployed for the collation of COVID-19 data across the 36+1 states. However, in line with the development roadmap of the EMID application, it has now been expanded to include Routine Immunisation services (Electronic Immunization Registry) Primary Health Care (PHC) services, and Polio Supplemental Immunizations Activities (PSIAs)/Non-Polio Supplemental Immunization (NPSIAs) campaigns. 

In view of these optimization efforts, eHealth Africa implemented a week-long State Training of Trainers (STOT) & step-down training in Kogi State on the use of the EMID mobile application.   

The aim of the training of trainers was to build the knowledge and skills of the 21 Local Immunisation Officers (LIO) in the use of the updated EMID mobile application and to provide further training and capacity-building activities to about 500 other data recorders and EMID focal persons at the individual local government areas (LGA) level. The EMID app would be used for effective real-time facility-level data collection and daily health services data transmission.

The Project Manager of Kogi State Emergency Routine Immunisation Coordination Center (SERICC), Mrs. Garba Khadijat, while speaking at the training said: “The introduction of this application will afford Kogi State efficient immunization data coverage, reporting and reduce the gaps experienced due to manual data recording” 

The training was instructor-led, It was delivered through lectures, use of visual aids, and engaged the participants through individual activities, role play, video and slide presentations, simulations, and do-it-yourself tasks.

In his own words, Mr Salami Oni, the EMID focal person at Okehi LGA, said 'I am very impressed with the training we were given at the state level and confident enough to step it down at the LGA. He added that any immunization work done without proper reporting is void.

Through supportive supervision, the eHealth Africa team ensured a correct assessment of the learning progress: pre-training and post-training tests were administered during the beginning and end of the training, containing both open-ended and multiple-choice questions. This accounted for an average improvement in observable knowledge and skills.

During and after the training, all participants expressed their enthusiasm to learn and commitment to explore the application further to strengthen their knowledge of its usage. This would make them efficient in data collection and reporting.

ehealth Africa Commits to promoting early detection of Vaccine Derived Polio Virus through Lab Support

by Moshood Isah

Nigeria may have been declared a polio free nation but the Variant Poliovirus Type 2 strain transmission still lingers. Nigeria reported 168 cases in 2022. This  has made further interventions crucial particularly  around early detection. The growing cases in a  number of African countries require a focused effort to strengthen polio laboratories that can effectively help the affected countries to quickly confirm cVDPV2 cases and launch outbreak responses, including the introduction of novel OPV2.  

In 2018, the World Health Organisation (WHO) introduced a Global Polio Surveillance Action Plan (GPSAP 2018-2020) to support endemic, outbreak, and high-risk countries in evaluating and increasing the sensitivity of their surveillance systems against Polio. The plan also initiated supplemental strategies that may help in closing gaps in detecting polioviruses, including strategies for immunodeficiency-associated vaccine-derived polioviruses (iVDPVs) while also strengthening coordination across surveillance field teams to foster a more effective programme and document zero cases worldwide. 

The new Global Polio Surveillance Action Plan (GPSAP) for 2022-2024. also focuses on increasing the speed of poliovirus detection, improving surveillance quality at the subnational level, fostering the integration of polio surveillance with surveillance for other epidemic-prone vaccine preventable diseases (VPDs), and mainstreaming gender equality in surveillance activities and programming as a key enabling factor.

To achieve parts of the Global Polio Surveillance Action Plan (GPSAP) 2022-2024, ehealth Africa worked with World Health Organisation (WHO)  supported by the Bill and Melinda Gates Foundation (BMGF) to  renovate and upgrade the   Sequencing Laboratory in the Virology department, University College Hospital (UCH) Ibadan, Oyo State. The laboratory was commissioned by Kazadi Walter, Country Representative and Head of Mission; World Health Organisation to Nigeria. This is part of the effort to improve surveillance, rapid detection and response against the spread of Vaccine Derived Polio Virus and other vaccine preventable diseases.  

Speaking during the official commissioning of the Laboratory, Dr. Kazadi Walter reiterated the commitment of WHO towards eradicating polio virus through the provision of facilities and rendering of technical support to Nigeria’s health care. He stated that WHO in collaboration with the government established the Global Polio Laboratory Network of which 16 are currently in Africa, with two located in Nigeria; Ibadan and Maiduguri. According to Walter, the primary objective is to work with WHO in the African Region (AFRO) to equip the global polio laboratory network labs for robust and rapid sample analysis for polio and to provide support in equipping these labs with sequencing capabilities.

Prof. Kayode Adebowale, the university vice chancellor, commended the initiative saying “this laboratory will not only provide vital information for the eradication of polio but also contribute to our university infrastructure, helping us to fulfill our vision and mission in addressing social needs.” The VC said: “The department has played a crucial role in Nigeria’s polio eradication programmes by contributing significantly to the country’s achievements of being declared wild polio-free in 2021.

Speaking on the role of eHealth Africa in the support for Laboratory Supplies across selected countries in Africa, the Project Manager, Tolulope Oginni said, to ensure optimum utility of the laboratory supplies, eHealth Africa leverages previous and current experience in setting up and managing Emergency Operation Centers to strengthen the staff capacity at the Laboratories in operating the installed equipment.

“These interventions  for  the support for laboratory supply and installation with consumables currently ongoing in at least 12 African countries are expected to improve the labs functionality for faster outbreak detection”, he said. With the support of other stakeholders in the region, this intervention will support labs in the African region that are targeted for expansion of sequencing capacity, support to improve existing sequencing capacity, or labs that require support for virus isolation and identification. This intervention has a huge opportunity to explore collaboration with WHO and other global stakeholders to transform the laboratory infrastructure in Africa into world class facilities which in turn will significantly strengthen their capacity and preparedness for disease outbreaks.

World Tuberculosis Day: Investing in diagnosis to save lives

By Juliana Jacob

Tuberculosis (TB) is one of the world’s most significant causes of mortality, and it is also the first from a single infectious agent. 1.7 million people died from tuberculosis (TB) in 2016, with Africa accounting for over 25% of the total deaths. Tuberculosis is not incurable, but timely diagnosis is necessary to get proper treatment. However, lack of access to health facilities that provide diagnostic and treatment services is an obstacle for people in low-resource settings.

Why is TB diagnosis a challenge in Sub-Saharan Africa? Here are some facts you need to know about diagnosing and treating TB in Africa.

1. Ten million lives were saved in the African Region between 2000 and 2014 through TB diagnosis and treatment. When suspected patients of TB receive timely and accurate diagnoses, they are empowered to seek treatment which increases their chances of curing non-drug-resistant strains of TB.

2. Nigeria accounted for about 12% of the enormous gap between the number of new cases reported (7.0 million) and the estimated 10.0 million (9.0–11.1 million) incident cases in 2018. This gap was due to underreporting of detected cases and underdiagnosis.

3. In 2017, 10 million patients fell ill with tuberculosis; 36% were undiagnosed or detected and not reported. In many countries across Africa, the number goes higher. In Tanzania, it is as high as 55%.

4. Funding for TB diagnosis and treatment has doubled since 2006 but still falls far short of what is needed. When the funds required are not available, there will be a significant reduction in the number of people diagnosed with TB.

Diagnosis of TB remains a challenge in developing countries, and innovative interventions can help bridge the gap in TB diagnosis and treatment. One of such interventions is  Health Telematics Infrastructure (HTI). eHealth Africa worked with the Charité University of Medicine to design HTI, a digital solution to improve, analyze, and evaluate the diagnosis and treatment of TB and HIV. We implemented HTI in St. Francis Referral Hospital (SFRH), Ifakara Health Institute (IHI) in Ifakara, and Kilombero District (central Tanzania). 

HTI is an SMS-based solution that allows patients to get their TB and HIV test results faster through text messages. Before the implementation of HTI, patients would travel long distances to Ifakara to get tested and return at a later date to get their results. Many patients did not return to Ifakara to collect their results due to the cost of transportation and other factors. Without their diagnoses, patients did not seek treatment and potentially infected more people.

Some benefits of the HTI system include; accurate and timely diagnosis of suspected patients of tuberculosis, patients having access to cutting-edge diagnostic methods, and a treatment process that is structured and monitored to ensure that patients follow through with their entire treatment process. 

The system sends reminders to patients to inform them about the next step in their treatment plan. This method of getting test results via SMS saves time. It removes barriers to TB treatment clinics that were previously inaccessible to the people of these communities due to long distances. We gathered information from patients using a tablet and open-source software ‘open data kit (ODK) collect.’ We used Aether and Gather to analyze the data from the ODK collect app. As a security measure, we also installed data protection so that we can retrieve data in the event of a loss. We have successfully routed 79.9% of SMS correctly to the patients.

To end tuberculosis, we must coordinate and implement approaches that will help us scale the hurdles associated with TB diagnosis, especially in low-income countries and communities. Communicating test results to patients on time and effective communication on TB diagnosis will decrease the number of people who die from the disease because they better understand their condition and can start appropriate treatment regimens. 

The centrality of data in outbreak detection and response: the Data for Action intervention in Kano and Kebbi states

By Chinedu Anarado and Tope Falodun

The world is recovering from the disruptions and losses caused by COVID-19. Nigeria was heavily affected and worked hard to manage the fallout from the outbreak. Using quality data and information was central to these efforts. Daily, the Nigeria Centre for Disease Control (NCDC) published data on those infected and the attendant mortalities. It harvested information from various sources as it worked to control the outbreak. But what if Nigeria had access to quality data at all levels on disease outbreaks? Could it have done better with the COVID-19 outbreak, despite its global dimensions? Perhaps it will have enough information to plan outbreak response and keep people safe.

One of the critical challenges confronting public health management officials is access to quality data to identify, prepare, and respond promptly to potential public health events. This challenge manifests in data illiteracy among relevant officials, inability to aggregate and analyze data, and leveraging analyzed information to take action. There are also data quality issues and the political will to act on the information.  

Participants reviewing data during the Disease Identification USSD training session in Kebbi State

There are many challenges that prevent the regular use of data In Nigeria’s public health sector. For instance, data sources are stored in silos, especially at the generation points. There is no upward information flow where decision-makers can understand what is happening and prepare a response strategy for such an outbreak. For instance, the NCDC has set up Public Health Emergency Operation Centers (PHEOCs) in 23 states. But they are not staffed with the right personnel and tools to analyze information, detect and flag disease outbreaks early enough. They are also not integrated in a manner that gives the NCDC some visibility into what is happening, allowing for easy monitoring and timely response. There aren't enough skills at the generation and perhaps usage points at the local level to clean up, analyze and interpret the data at the primary source.  

Fortunately, eHealth Africa is implementing the Data for Action project to address these issues. The Data for Action effort is a component of the Subnational Emergency Preparedness and Response Capacity Building (SERCB) program, an initiative of the NCDC. The SERCB effort provides an overall emergency preparedness capacity at the state level. Its Data for Action component provides data and information for prompt response action that underpins emergency preparedness. Resolve to Save Lives (RTSL) funds this intervention, which involves delivering solutions for the benefit of the NCDC and state-based Public Health Emergency Operations Center (PHEOCs). Successfully implementing Data for Action will provide data that will support an early warning system, allowing stakeholders to detect and respond to potential disease outbreaks before they assume challenging proportions. The states will also have the critical capacity and resources to sustain the use of data for decision making at the local and sub-national levels. 

eHA has conceived an early warning system that should involve the aggregation and analysis of data. This will cause periodic reporting of identified diseases from the ward unit up to the state level, with a mechanism that shows the reported disease and the frequency of occurrence. It should also define what level of spread and actions to be taken if an outbreak is imminent. 

To arrive at these solutions, we implemented a bottleneck assessment in Kano and Kebbi states that helped us identify the critical challenges preventing the seamless flow of data from the various ward units right up to the state and the center. eHA’s findings from the assessment were addressed by investing in creating data products, building the capacity of disease surveillance and notification officers on data clean up, analysis and presentation. We also trained community informants on disease identification to help improve the sensitivity of surveillance systems. If they can accurately identify diseases, we can report more and ensure that relevant public health actors do not miss potential outbreaks. 

eHA also provided infrastructure and equipment support to ensure the conducive functioning of the PHEOCs. For instance, we operationalized a power generating set in Kano and provided a six-month diesel supply and internet connectivity to support data analysis. In Kebbi state, we provided additional equipment to support communication and visualization, including projectors and screens, public address systems, internet connectivity, air conditioners and water dispensers. Kebbi PHEOC, still at its nascent stage, requires these pieces of equipment to improve their work, and we are glad they are being put to good use.  

In the coming days, we will implement additional training on data use and ensure beneficiaries can produce data products or reports that give insights on the prevalence rate of six priority infections. These include Cholera, COVID-19, Lassa Fever, Measles, Meningitis and Yellow Fever. These diseases are the most prevalent in Kano and Kebbi states. Hence, tracking them will help reduce the prevalence of these outbreaks and the safety of Children. We will back up this effort with periodic supportive supervision to ensure that valuable data is available to ensure decision-makers keep their citizens safe and prevent more disease outbreaks.

Building Local Capacity and Infrastructure for Disease Surveillance in Africa

By Chinedu Anarado

Nigeria is the only country in Africa where polio is still endemic, however, the continent is still at risk of polio returning due to low immunity levels and weak surveillance systems.  Since 2016, the AVADAR project has been implemented in 8 countries across West and Central Africa to improve the quality and sensitivity of Acute Flaccid Paralysis (AFP) surveillance by health workers and key informants within health facilities and local communities, using mobile phones and an SMS based software application. eHealth Africa trained a total of 7,847 community informants to identify and report suspected cases of AFP, which is the defining symptom of Polio.

The AVADAR mobile application

The project increased the rate of AFP detection and reporting and put the implementing countries in a better position to meet the World Health Organization’s targets for AFP surveillance. In the Democratic Republic of Congo (DRC), for example, a total of 499 true AFP cases have been reported by community informants through AVADAR, a significant improvement over traditional paper-based surveillance systems which yielded 38 cases in the same period.

The Challenge

Our goal was to model a system that would enable health systems in the implementing countries to find, report and investigate AFP cases, and that would be sustainable in the long run. It became imperative for the health systems in these countries to take ownership of and lead the implementation and expansion of the AVADAR model, and possibly replicate it for the surveillance, reporting, and investigation of other diseases of public health concern. However, without the requisite skills, most countries will fail at effectively managing the system including reporting and managing the investigation of cases, and tracking and resolving technical issues.

The Strategy

Relying on our experience with the execution of AVADAR, where some informants were groomed to take on more roles on the project, we worked with the WHO to identify champion informants who had distinguished themselves through their timeliness on the system and technical aptitude with the AVADAR devices. Some of these informants were trained to serve as investigators—who track and review reported AFP cases to confirm if they are true or not—or as technical officers, who resolve technical issues and ensure that their fellow informants are able to continue reporting suspected AFP cases.

The technical officers were grouped into two categories: first-level and second-level technical support officers. The first-level technical officers serve as the first point of contact when an informant has technical challenges with his/her device. When they are unable to resolve these issues, they escalate the challenge to the second-level technical support officers, who are usually WHO staff or investigators within the country ministries of health, with superior technical skills. The second level support officers ensure that all issues are resolved and the AVADAR system can continue to work as expected.

The Success

So far, a total of 217 first level and 57 second-level informants have been trained across all the six countries eHA supported in 2019, as well as Liberia. eHA has now ended operations in four of these six countries— Chad, the Democratic Republic of Congo, Sierra Leone, and South Sudan and the trainees are now managing the network. The technical officers were trained using a two-step approach: theory-based training that took place in a classroom setting, and field practical sessions, giving trainees the opportunity to investigate and resolve real-life technical issues in the field. eHA continues to provide support in Cameroon and Niger, leading refresher training sessions for technical support officers, and resolving advanced technical issues in the two countries.

Some AVADAR informants are also going beyond polio to detect and report other priority diseases such as Measles, Yellow Fever, and Diarrhea in their communities using AVADAR. The flexibility of the AVADAR system and its potential to be used for reporting and detecting other priority diseases leaves no doubt that these countries are better equipped to prevent future outbreaks and protect their populations.

Lessons from the eHealth Africa-Emory University Schistosomiasis Study

By Tolulope Oginni and Emerald Awa-Agwu

Schistosomiasis and nineteen other diseases are classified by the World Health Organization as Neglected Tropical Diseases. It is an acute and chronic parasitic disease caused by blood flukes called schistosoma. People become infected when larval forms of the parasite (worms) penetrate their skin during contact with infested water. 

The disease can present in two main forms: intestinal and urogenital schistosomiasis. Intestinal schistosomiasis can result in abdominal pain, diarrhea,  blood in the stool, and liver and spleen enlargement in advanced cases. The most distinguishing symptom of urogenital schistosomiasis is haematuria (blood in urine). Fibrosis of the bladder and ureter, kidney damage, genital lesions and vaginal bleeding in women, and pathology of the seminal vesicles, prostate and other organs in men. In later stages, urogenital schistosomiasis may lead to bladder cancer and infertility.

The disease is endemic to Nigeria and existing data places Nigeria as home to the highest number of recorded cases in the world. While there are insufficient research data and medical records to paint a true picture of the disease burden in Nigeria, it is estimated that 29 million Nigerians are infected with the disease and almost half of this number are children.

In June and July, eHealth Africa partnered with Emory University on a study to compare three diagnostic methods to determine their effectiveness in detecting acute and chronic schistosomiasis in low-resource settings. Accurate diagnostics are crucial to yield more information about the disease and ultimately, to achieve the goal of eliminating the disease. One of the major challenges facing the elimination of schistosomiasis is that very few infected people present at the health facilities for treatment. This can be attributed to a myriad of reasons including stigma, insufficient medical services, affordability of medical services, low knowledge of the signs and symptoms of the infection, and local perceptions and myths about the disease. The wider effect of this passive case finding (that is, cases are discovered only when infected persons visit the health facilities for treatment) and poor health-seeking behavior is that there is inadequate data to support the prioritization of schistosomiasis control by decision-makers and health program planners. In addition, medical laboratory scientists and researchers are unable to make improvements to diagnostic procedures for schistosomiasis because very few patients visit health facilities to access treatment.

During this study, eHealth Africa and two Emory University MPH students also trained 10 community health workers to administer questionnaires aimed at assessing the knowledge, attitudes, and perceptions about Schistosoma haematobium infection(urinary schistosomiasis) among communities in five Local Government Areas in Kano State.

Training of Community Health Workers

The responses from the survey yielded astounding local interpretations of the symptoms of urinary schistosomiasis. Community members saw red urine (haematuria or blood in the urine) as a normal and rather harmless phenomenon, a rite of passage or a sign of manhood for young boys. It was also linked to the menstrual cycle for girls or women. Yet another misconception was that it could be caused by staying long hours under the sun. Among women especially, underreporting of the disease was exacerbated by socio-cultural norms and beliefs that prevent them from handling urine samples in public.

Administering questionnaires at Sani Marshal Government Arabic Secondary School, Kura LGA, Kano State

With this understanding and the results of the study, eHA and Emory University hope to influence policies, strategies and plans around the diagnosis and control of Schistosomiasis in Nigeria.

Going digital improves Disease Surveillance in Sierra Leone

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.

Nwanyibuife Obiako, Senior Programs Manager, eHA Sierra Leone, making a statement during the eIDSR rollout closing ceremony

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.

“Thanks to eIDSR, we have seen an improvement of multiple surveillance indicators, such as reporting completeness and timeliness. It’s evident that a critical part of this success is partnership and collaboration.”

— Nwanyibuife Obiako, Senior Programs Manager, eHA Sierra Leone

Nelson Clemens, eHA’s eIDSR Project Coordinator presenting during the eIDSR rollout closing event

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.

“The electronic system has reduced the number of data entry errors in half, and is capturing and verifying data 60% faster than the paper-based IDSR system.”

— CDC

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.

“...My colleague Surveillance Officers would agree with me that eIDSR has relieved our stress. eIDSR roll-out commenced in the Kambia district in November 2018. A week following the roll-out, we achieved 98% of timeliness of reporting and has not gone below 90% since.”

— Usman Barrie, District Surveillance Officer, MoHS, Kambia district.

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.

Modelling Disease Surveillance Systems that work in Chad and Niger

By Tope Falodun and Emerald Awa-Agwu

Participants in Maradi, Niger after the training

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.

Chad 1st level supports going through pre-test during the transition training in Bokoro, Chad

“AVADAR has had a great impact on AFP surveillance, directly and disease surveillance as a whole by improving communication and information transfer.”

— Mbaielde Felix, Head of Abirebi Health Area, Bokoro District, Chad

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.

“AVADAR has allowed us to communicate with the informants, the district management team and the health delegation on the report of other diseases other than the AFP.”

— Abakar Mahamat Kalbassou, Head of Abgode Health Area, Bokoro District, Chad