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.

Strengthening Blood Management Systems with Digital Tools

By Emmanuel Uko

Every month, eHealth Africa (eHA) convenes stakeholders and subject-matter experts on a fresh episode of the Insights Webinar for topical discussions, solutions and recommendations that improve public health and contribute to the attainment of SDG goal 3: good health and wellbeing for all. The aim is to share lessons learned across different areas of project implementation and to offer recommendations.

The 8th edition of the Insights webinar was focused on how digital tools can strengthen blood management systems. Alluding to the topic, one of the panelists, Dr. Mohammed Farouk (MD, MBA), Managing Director of the Africa Society for Blood Transfusion (AfSBT), said “Incorporation of technology and data-driven solutions makes the blood management value chain more seamless. Recruitment of donors is done with online questionnaires, after which the donor institution determines eligibility of the donor, then invites them to the donation center.” This process saves time and resources as donors are only invited on appointment, based on schedule.

Still on eligibility, Michelle Vermeulen, Head of Marketing & Public Relations at Western Cape Blood Services in South Africa outlines the criteria: “In order to be an eligible donor, criteria differ from country to country. However, generally, one must be between the ages of 16 and 75, weigh more than 50 kg, be healthy on the day of donation, without flu or symptoms of cold, and be leading a healthy sexual lifestyle.”

In addition, Emmanuel Nene Dei, Head of Planning, Monitoring and Evaluation at the National Blood Service, Ghana, further stated that “An eligibility quiz for prospective donors helps to shorten the recruitment process. Those not eligible are, with their consent, linked up with other healthcare facilities for quality healthcare, as necessary.” Francis Ayo, Technical Project Manager in the Informatics Department at eHealth Africa, added that “Integration of data-driven technology creates visibility, accountability and transparency, leading to appropriate decisions about quantity and types of blood products required at specific health facilities, while third-party logistics systems carry out the distribution and ensure supplies where needed.”

The webinar had 160 online participants from Canada, Ethiopia, Germany, Ghana, Guinea, Nigeria, Rwanda and Sierra Leone; and eHA’s live LinkedIn audience (eHealth Africa), had 1,441 viewers at the time of the webinar. eHA’s Strategic Engagement Lead / Senior Manager, in Berlin, Germany, Johanna Roegele, who has worked on the management of the blood supply chain observed that eHA and partners have modelled a system to ensure continual availability of blood products. She recommended that such models be replicated especially in other African countries.

From their vast experience, the panelists shared other lessons for effective blood supply chain management: donors prefer to be contacted with personalized messages (SMS, Whatsapp and emails) rather than general messages sent to everyone. Personalized messages enhance the likelihood of recurrent donations, especially for first-time donors. More so, social media and traditional media help create visibility for institutions and to attract donors. Digital interoperability between digital blood management information systems and testing machines reduces human error, speeds up testing time, increases accuracy, eliminates waste and averts silo functioning. In addition, drone-based delivery to hard-to-reach areas, saves more lives especially in emergencies.

Human-centered project design approach should be applied, taking into consideration inputs and needs of stakeholders and potential beneficiaries. In the data management process, privacy of clients is paramount while keeping appropriate databases updated for tracking and monitoring of trends in blood services.

eHA’s monthly Insights webinar is an opportunity to learn more about how experts are resolving public health issues with the use of digital technology and data-driven solutions, sharing both the solutions and the lessons in creating them for replication.

Help Desk - Optimizing Real-time Response Structure for Digital tools

By Emmanuel Uko

In 2022, eHealth Africa conducted a gap analysis to identify support areas for the Electronic Management of Immunization Data (EMID) system IT infrastructure. The analysis  revealed the weaknesses and strengths of the current issue resolution approaches and the requirements for improving the current system. The help desk operations was identified  to ensure the smooth utilization of the EMID system and increased vaccination coverage data in Nigeria.

Physical and infrastructural constraints were identified: the help desk occupied an open space that was easily accessible, the server room was unrestricted and thus used for other purposes, too. Basic work tools for call agents, like  headsets, and  laptops were either not available or obsolete.

Helpdesk setup at NHPCDA, before and after the optimization.
Photo Credit: eHA

Similarly, operational challenges also existed: downtimes, issues and resolutions were communicated to the leads only through Whatsapp. In addition, a web-based system where users could access resources and information to resolve issues was lacking. More so, information history showing trend of cases and projections was non-existent. There was no existing standard operating procedure for the help desk to guide the team on how to handle issues, especially during off-peak hours. Finally, the support process flow was not fully defined/documented. Thus, the optimization of the help desk support was needed.

“I learnt how to use the native EMID application, as it is more user-friendly than the old one. Specifically, the ability to contact help desk and lodge complaints almost in realtime, whenever issues need to be resolved, is a real advantage that will speed up our work.”
- Ojetade Victoria Oyebimpe, EMID Focal Person, Ede South LGA, Osun State.

eHealth Africa (eHA) software development and help desk teams worked to develop a real-time response structure that caters to users’ needs within the optimized EMID application. As is the universal practice, the structure provides a centralized help to users of the application. The improved EMID help desk at the National Primary Health Care Development Agency (NPHCDA) ensures availability of personnel at every level of troubleshooting, to resolve issues down to zero for both the NPHCDA staff and end users of the EMID app.

Solomon Emmanuel, eHA’s Manager, Helpdesk, anchors training for NPHCDA helpdesk agents.
Photo Credit: eHA

With support from the Global Alliance for Vaccines and Immunization (GAVI), eHealth Africa procured the required IT equipment and facilities for renewable energy to ensure uninterrupted power supply to the IT server rooms, secured furniture and fittings; planned and implemented the setup in collaboration with the NPHCDA. In addition, eHA organized training sessions for the ICT unit at the agency on standard help desk processes and procedures based on the Information Technology Infrastructure Library (ITIL) methodology. They defined, developed and documented standard operating procedures for help desk, operational-level and service-level agreements to guide process flow, from issues escalated by recorders to their resolution stage.

“The native EMID app now helps us determine who, how and where to send complaints to, unlike the old one.”
- Akinyemi Yemi, EMID Focal Person

Jamil Galadanchi, eHA’S Senior Manager, Software Engineering, during a training for NPHCDA, on use of the EMID software.
Photo Credit: eHA

eHA also provided suitable work areas to prevent noise penetration and work tools such as desktops and laptops, display screens with a display/monitor to enable the helpdesk operator to manage multiple screens. This allows for a quick review of the several platforms that may be needed to resolve an issue, or for real time monitoring of the key equipment needed to ensure the EMID system works adequately with limited downtime. eHA also set up the Zendesk application to issue ticket IDs and track issue resolution, an access control system for the help desk main entrance, IT office door leading to the server room, and the server room itself to prevent unnecessary access. Lastly, a solar energy system was also set up at the NPHCDA to power the facilities and ensure a 24-hour electricity supply.

“In addition to its capacity to validate clients’ records in real time, it is now easy to ask questions and access the help desk for support.”
- Egunsola Ayobami Abiodun, EMID Focal Person, Isale-Agbara PHC, Osogbo, Osun State

As a result of the optimization, the help desk can respond to different levels of issues raised. The diagrams below portray mapped help desk support flows according to Tiers 1, 2 and 3 support required. They depict the help desk process flow, from the EMID users, the channels for registering queries, the different levels of helpdesk support system, and the process of resolving issues, the operational phases of response to queries from the end users and the processes involved in using the Interactive Voice Response flow in reporting and resolving EMID issues.

Helpdesk support for pilot training and user assessment test
Image: eHA

Helpdesk support for pilot training and user assessment test
Image: eHA

In addition, below is the Interactive Voice Response (IVR) support flow:

Interactive voice response support flow
Image: eHA

The process of developing the EMID application got all stakeholders working together, each one fulfilling relevant roles for the optimization of the application and realization of the help desk setup. eHA and partners learned important lessons in the course of executing the project. Buy-in and collaboration by relevant stakeholders from the beginning of the project proved necessary for its successful implementation. Setting out deliberate strategies that enable all partners to be carried along especially during important planning and decision making processes, budgeting and procurement, contributed to attaining success. More so, aligning the scope of work with appropriate timelines helped partners to manage the project for successful delivery.

“The new desktop for helpdesk now helps in resolving issues quicker, the monitors and screens help to give a clearer view of the issues presented and there is now a better working environment that enables us to resolve issues more promptly.”
- Nabil Nuhu Bamalli, System Administrator at NPHCDA.

Working as a Recorder is Easier with the Optimized EMID Application

By Farid Suleiman

Opening interface of the EMID Mobile Application

The Electronic Management of Immunization Data (EMID) is Nigeria's homegrown digital platform for the collection, storing, and analysis of covid-19 immunization data. It is domiciled at the National Primary Health Care Development Agency (NPHCDA).

The first version of the app was rolled out by the Nigerian Minister of Health in 2021, as a platform to ensure a smooth COVID-19 vaccination process across the country.

With the rise in the number of unvaccinated adults and unimmunized children in Nigeria, NPHCDA saw the need to scale up the EMID application beyond its regular use for COVID-19 vaccination data to capture and store information on other immunization activities. However, the capacity of the application was below its intended use, with multiple functionality errors, hence the need for an optimized version of the app.

eHealth Africa (eHA), partnered with NPHCDA, to optimize the app for newly defined and broadened functions. They further piloted its use in selected states towards its deployment for use. 
The mobile application provides a gateway for inputting immunization data. This enables the end-user-recorders to work hand in hand with vaccinators across the country to upload data in real-time to the platform. This data enables stakeholders to analyze and monitor the progress of vaccination teams on the field, and where necessary, come up with better strategies to enhance the effectiveness of the immunization program.

Tasiu shehu Jigawa State EMID focal person

Photo Credit: eHA

Abdullahi Muhammad, like other recorders, was quick to spot the changes the new app had come with. He observed: “a lot of features have been simplified on the new EMID application. The data input process and its submission to the server have all been simplified, this will make the work easier.”

Globally, digital tools such as EMID help keep track of information about people vaccinated, types of vaccines they received, doses, location, and other relevant data key to the success of vaccination campaigns. As of January 2023, three years after the commencement of covid-19 vaccination, over 60 million eligible Nigerians have received the vaccine. It is safe to say that Nigeria's immunization strategy, of which EMID is a part, has been successful. The optimization of the EMID app adds value to the overall success, especially on the EMID application’s ease of use, optimized process flow, help desk setup, and renewable power supply.

The optimized EMID application has integrated a client validation tool used to take pictures of the client to validate their presence at the vaccination site. Other validation features such as the geofencing feature ensure that data is only collected by fixed teams when they are within the geographical location assigned for their data entry to be registered on the app, eliminating the possibility of procuring services and the new liveness detection feature which ensures that beyond the still photos of clients, facial feature movements such as blinking are required for verification of client vaccination. This eliminates the possibility of utilizing pictures/static images for data entry. The national team can now have a higher level of confidence in the vaccination data generated using the tool.

The new application also allows recorders to capture data in environments where network connectivity is at its lowest. The specific additional feature is a draft page that prevents the loss of incomplete data. Recorders no longer need to resort to manual synchronization of data when there is internet connectivity as the new application allows automatic data synchronization once internet connectivity is restored. The sort and filter functionality has also been included to allow for ease in identifying previous records via the new native EMID mobile application. Rilwanu Dahiru, another EMID Recorder, describes the use of QR codes for client search as making their work even easier. He says, “if I have the QR code of a client, I search directly for the record without inputting the vaccination number or name.”

Overall, the level of flexibility on the optimized app now allows vaccinators to record and validate client details themselves without having a different validator assigned to them while on duty.

The troubleshooting feature-the FAQs and Help center provides easy access to support questions or challenges that arise while using the application. The help center also has links to the various channels that allow for direct communication with the EMID helpdesk support office.

Optimizing the National Electronic Management of Immunization (EMID) Data Tool for Improved Efficiency

By Emmanuel Uko

The Electronic Management of Immunization Data (EMID) system was designed to facilitate the overall management of immunization data and other programs at Primary Healthcare Centers (PHCs) including vaccination scheduling, real-time entry of clients’ data, and collation, analysis, and validation of such data.

The health sector depends heavily on data for planning. To ascertain how well a country’s immunization plans and implementation are going, adequate information is necessary. The World Health Organization states that immunization data helps to monitor improvements in vaccination trends and identify gaps for its surveillance processes. More so, there is a consensus among vaccination stakeholders that real-time data reporting has allowed decision-makers to follow-up on the unvaccinated and forecast needs for supplies.

Coordinator, Business Application Support at eHA, Diligence Saviour-Albert (left) is confident that users of the native EMID app will use it optimally as she trains them on its different components.
Photo credit: eHA

Since March 2022, eHealth Africa (eHA), has supported the National Primary Healthcare Development Agency (NPHCDA) in Nigeria to optimize the functionality of the Electronic Management of Immunization Data (EMID) System. This optimization is funded by Global Alliance for Vaccines and Immunization (GAVI). They identified the need to fill up the vaccination data gap, after seeing  lapses in the primary data capture tool - the EMID application. Users of the unoptimized app expected more than it was offering. Dr Oyetunde Olasunboye, the Osun State EMID Focal Person said, “the functionality of the system declined noticeably and would sometimes become difficult to input client’s information, search for, or confirm clients’ details. More so, it became increasingly difficult to scan a client’s quick response (QR) code, although this was mostly dependent on the device at the user’s disposal.” These errors adversely affected the application’s functionality.

These inadequacies gave rise to the need for optimization of the EMID application to enable it function at its best for end users at health facilities. “We developed a roadmap for an optimized application that would be scalable country-wide. We built and deployed the optimized application, we conducted training and capacity-building activities for NPHCDA EMID team at national and state levels, and recorders at the PHCs, in preparation to hand over the optimized system to the agency”. Said Stephanie Okpere, eHA’s EMID Project Manager.

Similarly, Kasim Sani, a Network support staff at NPHCDA ICT Unit, said this about the optimized helpdesk: “The new setup has made our work more responsive to clients’ needs. We are able to detect and resolve issues more promptly and applications can now be deployed on the server seamlessly.”

In preparation for the deployment of the optimized app, eHA trained 351 users including recorders, EMID focal persons at State and Local Government levels, and piloted its use across selected states within the six geopolitical zones of Nigeria. From each of the states, eHA selected one rural Local Govermment Area (LGA), one urban LGA and one LGA with poor internet connectivity.

Health Information Recorder, Ife South LGA in Osun State, Tope Oluwatoyin (right), displays a native (optimized) EMID application from his tablet, hopeful that the application would resolve challenges he used to encounter with the old EMID app. 
Photo Credit: eHA

In collaboration with the ICT Unit at NPHCDA, eHA also trained users on help desk use and structure for issue resolution, support process flow, roles and responsibilities of the support tiers, and the use of support channels like email, Whatsapp and phone lines.  Specifically, the training focused on how to download and log into the application, how to conduct online and offline mode check, searching, filtering and updating of records, manual syncing, import and export of records. Participants were also shown how to navigate to the help section and the frequently asked questions (FAQs) on the native application. The optimized application ensures seamless management of vaccination data at national and subnational levels.

When GIS and public health experts converged in Geneva

By Chinedu Anarado

On May 9th, the World Health Organization (WHO) formally launched the GIS Centre for Health. The center will manage the production and use of geospatial data and geographic information systems (GIS) towards strengthening public health interventions. Before now, WHO programs and units ran their health data independently. The center will now ensure a dedicated approach to producing and using essential GIS data through the various projects implemented at the center. In addition, it will drive capacity building, partnerships, and collaboration, expansion of GIS infrastructure, and deepening of the geospatial culture within the WHO.

Cross-section of WHO GHFD staff and the GHFD implementing partners (IPs) during the GIS Centre launch in Geneva

eHealth Africa (eHA) participated in this event as a key implementing partner on the Global Health Facility Database (GHFD) project. The GHFD project is one of the projects managed by the GIS Centre. It is also a crucial proof of concept on the value of a center with responsibilities to drive geospatial data generation and usage. The open-access Snakebite and Envenoming Platform is another initiative that leverages support from the GIS Centre, using the latest ArcGIS software. The platform addresses the lack of antivenom in vulnerable communities and improves available information about local snakebite risks.

Screenshot of the Snakebite GIS story map

The database operates as a global reference for anti-venom and snakebite health information. It was established in September 2021 and currently provides snakebite data, risk, nearest health facility for anti-venom etc. The solution is now being expanded to seven countries in East and West Africa, where priority health facilities will be analyzed for accessibility and anti-venom stockpiling. With a GIS-based web mapping, venomous snakes, their distribution ranges, venoms, anti-venoms, and manufacturers of anti-venoms with be available at the click of the button. In the next phase, the database will include data on health facilities and drive time relative to the victim's location. Anyone with internet access can access the platform for information and contribute photos and data to update snake habitats, ranges, and behavior.

The GIS Centre launch was also a gathering of key stakeholders in the GIS, public health, and humanitarian space who identify with the increasing value of geographic information systems (GIS) and the various use cases that will benefit their efforts beyond public health. In addition, we discussed support functions such as data collection tools, GIS usage case studies from the WHO Africa Regional Office, and new GIS features on open data collection kits.

The GIS Centre will leverage WHO's historical experience and knowledge in deploying GIS capabilities in driving public health delivery. Some of these are seen in the distribution of COVID-19, the polio eradication campaign, and the deployment of geospatial maps to support malaria programming.  

eHealth Africa is excited at the prospects of deepening its GIS capacity by partnering with the WHO GIS Centre for Health. Our extensive experience implementing vaccine tracking systems, mapping hard-to-reach localities, supporting immunization campaigns, and microplanning with geospatial maps and data signposts our commitment to using geospatial technologies in public health practice.

Remote Data Collection as a First Step for Developing a Digital Information System to Guarantee the Supply of Quality-Assured Blood to the South African Population

By Dr. Alexander Pinz

The project    

The provision of safe and high-quality blood and blood products is a significant challenge for blood establishments in times of crisis. Depending on the crisis at stake, blood demand may suddenly explode, e.g. with mass casualty events; or there will be shortages in blood supply because of infectious diseases (epidemics, pandemics), and environmental catastrophes (e.g. floods, droughts). In these situations, it is important that blood establishments can rely on adequate information and emergency plans, enabling them to ensure the continuous supply of blood and blood products to both the entire population, and the persons severely hit by the crisis. However, currently, blood establishments are rarely included in national or regional emergency management plans. They often lack adequate information technology, enabling them to foresee slowly emerging crises or to react appropriately to catastrophic events that suddenly happen. According to the participants in the CoordinatedBlood-Workshop, which took place in Berlin in September 2018, these challenges apply to the South African blood supply system, too.

To better prepare blood establishments for crises, the BISKIT-consortium—comprising eHealth & Information Systems Africa, the Paul-Ehrlich-Institut (German Federal Institute for Vaccines and Biomedicines), and the Working Group Inter-disciplinary Security Research (Free University Berlin), the European Research Center for Information Systems (University of Münster), and the Chair for Software & Digital Business (Technical University of Darmstadt)—has started the project Blood Information System for Crisis Intervention and Management, funded by the German Federal Ministry of Education and Research. The aim of this research project is to improve the supply of safe and quality-assured blood and blood products before, during, and after a crisis to the South African population. To achieve this objective, the consortium is going to 

• develop an information-system including a user-interface (demonstrator) for data-based decision-making, 

• develop crisis management plans and recommendations for crisis communication, and

• organize and implement capacity building training on the use of the demonstrator.

The challenge

To accomplish these objectives, we need an enormous amount of data. First, we have to map the South African blood transfusion as well as crisis management systems, including their major stakeholders. Second, we have to visualize the entire blood supply chain from vein to vein. Thus, we have to assess every single process step such as donor recruitment, donation, processing, and testing, transportation, and storage, as well as issuing of blood products. Also, we need GIS data on the locations of the relevant facilities like blood establishments, mobile clinics, hospitals, etc. Finally, we need quantitative data on the duration of each process step, the number of donors/donations, number of products, etc. However, due to the COVID-19 pandemic, we are not allowed to fly to South Africa to start our data collection process. So what can we do?

The solution

We exploited the digital tools available to us to start a virtual data collection process. Thus, we use video conference systems to implement key-informant interviews with relevant stakeholders of the South African blood transfusion and crisis management system. We store the data in a CKAN-portal that only members of the BISKIT consortium can access. To make the information obtained via these interviews available to the entire consortium, we transcribe the interviews with artificial intelligence software. We then analyze the anonymized transcripts with cloud-based as well as standard qualitative analysis software.

Having, so far, conducted 20 key informant interviews with persons responsible for different parts in the blood supply chain, and the crisis management system, we have t great insights into how the South African blood transfusion and crisis management systems work. We can use these insights to map the relevant actors and processes of the respective systems. In addition, we now have a notion of the different data available for upload. With this information, we start modeling the blood supply chain from a logistical perspective, and, thus, get the project started.

The world saw more video calls this year due to the COVID-19 pandemic.

Sure, virtual data collection differs from data collection on-site. The social aspects of collaboration are missing. Nevertheless, in the interviews, we created a good atmosphere with the project partners in South Africa. Using video calls enabled us to at least see each other and get the relationship-building process started. This adaptation to the travel restrictions resulting from the COVID-19 pandemic has shown us we can collect data with digital technology. This approach enables us to better focus on the travels that are relevant for project success. It helps us to reduce our carbon footprint of development cooperation work. However, we are also looking forward to getting to know our project partners in person. Because in the end, this will further improve the quality of the data we can collect, and, thus, contribute to the aim of increasing the resilience of the South African blood supply system by using digital technology.

Dr. Alexander Pinz is the Project Manager for the Blood Information System for Crisis Intervention and Management (BISKIT) project at Paul-Ehrlich-Institut (PEI). PEI is the leading organization within the BISKIT consortium and responsible for coordinating the project implementation.

The Strides of Polio Vaccination in Hard to Reach Areas (HTRs) in Borno State

By John Momoh

As Nigeria marks 3 years and 10 months without a new wild poliovirus case, here is how the program has contributed to the Polio Eradication initiative in Borno State since 2016:

Inaccessibility to some settlements in  North East, Nigeria presents a great challenge to the immunization program in states like Adamawa, Borno, and Yobe states where the ongoing conflict is most severe. Health facilities in these states have been destroyed leading to a reduced number of eligible children being reached with Routine Immunization (RI) services. The mass displacement of people, migration from settlements, and insecurity have all hindered the planning and execution of Supplementary Immunization Activities (SIAs) such as Immunization Plus Days (IPDs) and Outbreak Response (OBR) campaigns in the region.

A child receives his vaccination at a settlement in Maiduguri, Borno state during an IPD campaign

In 2016, after a wild poliovirus outbreak in Borno, the  Borno State Primary Health Care Development Agency (BSPHCDA), in close collaboration with World Health Organization (WHO), the Bill and Melinda Gates Foundation (BMGF), U.S Centers for Disease Control and Prevention (CDC), United Nations Children’s Fund (UNICEF), eHealth Africa (eHA), Solina Health and other partners, launched the Reach Every Settlement (RES) and the Reaching Inaccessible Children (RIC) to access under-5 children in partially Hard to Reach (HTR) and HTR settlements respectively in order to interrupt the transmission of the virus.

Polio eradication partners at a working group meeting

eHealth Africa has been supporting the projects by leveraging our expertise in Geographic Information Systems, field operations, and logistics to collect and analyze geospatial data to aid near real-time monitoring of the program and decision-making by the state and relevant key stakeholders.

Reducing eHealth Africa’s Carbon Footprint

By Onche Ogbole

At eHealth Africa, we attribute our successes in the interventions and programs we implement to the virtuous cycle that uses data to drive decision-making and execution. As an organization, we also employ the same virtuous cycle in our operations to become more efficient and sustainable. As we work to strengthen health systems and improve the lives of people in the communities we work in, we also have to look at how we operate to ensure that our operations do not burden or negatively impact the communities we live and work in.  As we reviewed how we work, we asked ourselves about our consumption of energy and had to challenge ourselves to become more energy efficient to reduce our carbon footprint while reducing our costs. When we started the journey towards energy efficiency, we knew that we had to do a better job with energy waste as it accounted for approximately 20% of our energy consumption. We knew that our approach had to be multi-pronged to get the results that we wanted for ourselves and needed to reduce our negative impact on the environment. Our approach included implementing policies, educating our people, and using technology and data to improve our systems.

What We Did and How It’s Working

In 2019, we started implementing our plan to be more energy-efficient and ensured that data was the bedrock of our decision-making and optimization. Our plan included: 

• Installing an energy management system (EMS). This smart system has automated the most common way we use energy, switching lights on and off. Now we no longer had to hope that the last person to leave the office remembered to switch off the lights,  it now happens according to a schedule.

• Installing a renewable energy system. Currently, we have installed a 180kw inverter systems at our Kano campus to provide backup to the existing diesel generator, and grid. These energy sources run on a schedule using a cloud-based monitoring, and scheduling system. eHA has generated 127,236.41kWh between January 2019 and March 2020 across most of our locations in Nigeria.

• Installing an Automatic Transfer Switch (ATS) in the Power house. This allows us to automatically select the appropriate available energy sources based on our load demand.

• Using energy-saving appliances looking for the most  eco-friendly options

• Conducted energy audits at our locations across Nigeria to determine load usage and design systems that best matched the usage at each location

• Facilitated environment and energy management training to our colleagues: We educated them about our environmental impact and energy management. This gave a clear perspective on how we can individually continue to reduce our electricity usage. This was complemented by introducing policies that supported better energy consumption. We have since observed an increase in employee awareness and a positive change in employee behavior. By December 2019, we observed a 30% decrease in our energy bills.

• Monitoring, tracking, and measuring daily energy usage. Currently, the engineering team keeps track of the daily energy consumption of all units at the Kano campus. This helps us know which block is consuming more energy and to see how we can immediately address the inefficiencies.

These energy efficiency measures put into place help us to ensure environmental sustainability at eHA. Last year, these measures contributed to the reduction of CO2 emission by 129 tons at the eHA Kano campus and 201.4 tons across all other locations. We will continue to do our part to reduce our carbon footprint and look for innovative and proven solutions to reduce our energy waste.

Partnerships and Networks: Essential for achieving food security

By Chinedu Anarado

By 2030, the United Nations (UN), and its agency, the Food and Agriculture Organization (FAO) hope to have achieved Sustainable Development Goal 2—end extreme hunger in the world. As of 2017, an estimated 821 million people globally are facing extreme hunger. The bulk of this group lives in Sub-Saharan Africa, where 237 million people were undernourished. In Northeast Nigeria alone, 2019 saw an estimated 2.6 million people left severely food insecure due to the insurgency and conflict1.

Climate change, poor farming practices and the nonexistence of sustainable partnerships and support systems all contribute to the growing cases of low crop yield. Most farmers do not have access to the right kind of information, and where they have information, they lack sustainable support to implement them.

During the planting stage

Recognizing this, the UN identifies the need for governments and private actors around the world to ramp up investment through enhanced international partnerships, research and extension services, and technology. This will increase agricultural productivity in developing countries, thus strengthening nutrition and food security systems. 

Here is how eHealth Africa leveraged partnerships and existing structures to drive the introduction and adoption of the Farm Management Tool (FMT) among 25 farmers in Kano State.

• FMT started as Cornbot, a mobile application built in partnership with Dr. Cornelius Adewale, the Bullitt Environmental Dellow at Washington State University. The application was built to aid farmers to identify, detect, manage and control Fall Armyworm (FAW), a major pest of maize and 85 other plant species. It was an entry for the 2018 FAW Tech Prize jointly sponsored by Feed the Future, the United States Agency for International Development (USAID) and the Centre for Agriculture and Biosciences International (CABI). These platforms continue to provide financial support, expert knowledge, and interventions to local farmers around the world.

• Upon winning the Frontier Innovation Award, eHA and WSU utilized the prize money to build FMT. The project was implemented in a three-pathway approach consisting of a mobile application and a web-based dashboard to aggregate data, face to face training sessions and practical hand-holding sessions. To recruit the farmers, eHA and WSU partnered with the Kano State chapter of the National Agriculture Extension and Research Services (NAERLS) to hold a pre-implementation workshop for 40 smallholder farmers. The workshop gleaned useful information that helped the project team to understand the farmers’ current agricultural practices, challenges, and level of knowledge.

A local farmer watches a video about bio-pesticide production using Neem leaves

• After the workshop, 25 farmers were selected to participate in the study. They each earmarked 25 square meters of test farmland to test the efficacy of incorporating four Good Agricultural Practices (GAPs) put forward by FAO, on crop yield. eHA partnered with Gwarmai Consulting, a local consultancy company to provide handholding support to the farmers, from pre-planting to harvest. The farmers learned soil testing, pest scouting, weeding, plant spacing, fertilizer application, and ash application for soils with high alkaline content.

Farmers at the Pre-Implementation Workshop

The results were impressive. In comparison to the Kano State average Maize yield of 2,750 kg/hectare, test farms recorded a 116% increase. Test farms also had a 195% increase compared with the national average of 2,020 kg/hectare.

In addition, the farmers acknowledged the value of the new information and committed to imbibe them and share with other farmers within their networks. It is often said that information is power. However, the information will never produce the desired effect without platforms and networks to get it across to those who need it. The success of the Farm Management Tool is an example of how Nigeria can reverse food insecurity if the right partnerships and platforms are leveraged to get much-needed information and skills across to local farmers.

The Importance of High-Quality AFP Surveillance Data in the Fight to Eradicate Polio

Polio is targeted for eradication because the presence of the virus anywhere means that children everywhere are at risk. The Global Polio Eradication Initiative (GPEI) focuses on strengthening Acute Flaccid Paralysis (AFP) surveillance worldwide to detect and respond to the poliovirus, to build herd immunity to protect the population and to halt the transmission of the virus. The data on the spread of AFP is invaluable especially for polio-endemic countries like Afghanistan, Pakistan, and Nigeria because it helps in determining whether they can finally be certified polio-free.

There are four steps involved in AFP surveillance and the Auto- Visual AFP Detection and Reporting (AVADAR) project responds to the first step—finding and reporting children with AFP—in eight priority countries in Africa. In many of these countries, disease surveillance and notification officers (DSNOs) at the health facilities are unable to actively find AFP cases for reasons ranging from difficulty in accessing settlements to security challenges. AVADAR trains community informants to search for and report the presence and/or absence of children with AFP in their community, using a mobile application. The application also has an embedded video that shows a child with AFP so that community informants can better recognize an AFP case. This reduces the burden on the DSNOs and allows them to focus on confirming if the case is truly AFP or not.

How AVADAR works

To ensure that AFP surveillance is conducted impactfully and that the AFP surveillance data collected is accurate, timely and of high quality, the GPEI defined five global indicators: Completeness of reporting, Completeness of case investigation, Completeness of follow-up, Sensitivity of surveillance and Laboratory performance.

Global Polio Eradication Initiative: AFP Surveillance indicators

AVADAR was designed by eHealth Africa, Novel-T, the World Health Organization (WHO) and other partners, to contribute to the achievement of the above targets. Below are the measures that have been put in place to ensure the collection and use of high-quality data to track and reports suspected AFP cases, and to inform decision making for polio eradication.

• Coverage: To decide where to site an AVADAR system, WHO carries out an assessment of the target country/districts to identify rural, hard-to-reach and underserved communities which are typically more predisposed to poliomyelitis. The AVADAR system, equipped with geospatial tracking capabilities is then deployed to community informants/ AFP reporters. This unique feature of the application helps to validate the location of the suspected AFP case, independent of the reporter.  

• Reporting: The AVADAR application allows informants to deliver reports anywhere and anytime in order to prevent data loss and to ensure near real-time, accurate reporting.  The app is designed to be used by people with basic literacy levels and is available in eighteen local African languages for ease of understanding. A report is better able to provide insight and enhance planning or decision making when it is timely. One of the key weekly metrics captured on the AVADAR dashboard is the number of complete results that were submitted as at when due, thus ensuring that all informants are actively engaged. Informants are expected to look out for and report cases of children aged 15 years and below, who have any form of physical deformity on the limbs or arms. In the event that no AFP case has been sighted within a week, the informant must send a ‘no report’, to validate his presence on the system.  

  AVADAR has improved the rate of AFP reporting compared to the traditional system of AFP reporting. For example, between June 2017 and June 2018 in the Lake Chad Basin countries(Chad, Niger, Nigeria, and Cameroon), the AVADAR system recorded 589 supsected cases against the 213 cases recorded by the traditional AFP Surveillance system.

• Verification: Paralysis in children can be caused by several agents including the Poliovirus. After the community informants submit their reports of suspected AFP cases, trained health workers carry out further investigations to confirm if they are true AFP cases. The WHO has designated laboratories all over target countries that are certified to test fecal samples and isolate the poliovirus. AVADAR weekly reports show how many suspected AFP cases were reported, how many were tested and the number of cases confirmed to be true AFP cases. This sort of data measures the cost of a single confirmed AFP case, the prevalence and incidence of AFP in target areas, thus enhancing the quality of AFP surveillance data for decision making.

AVADAR dashboard

Having data on the spread of AFP in a geographic location helps with planning towards its containment. Since Poliomyelitis is mainly oral-fecally transmitted, sanitization and sensitization of the environment and inhabitants respectively can help reduce the spread of polio.  AFP data gathered across different locations has been used in making an informed decision on determining the number of health workers that can effectively manage its spread to neighboring communities. On the contrary, no data or false data could lead to health workers focusing their energy in wrong locations thereby risking the spread of polio and the extension of its existence.

Without reliable and accurate AFP surveillance data, true progress towards polio eradication cannot be measured. AVADAR’s impact in high-risk countries across Africa demonstrates how context-appropriate interventions and solutions can transform disease surveillance and emergency management systems.

“One of the most important features of the AVADAR system is the engagement of over a hundred community informants per county. They are trained and equipped for the first time to provide timely reports that can be accessed at all levels from the county to the national level and beyond, thereby allowing suspected cases to be investigated in an accurate and efficient way.”

— Dr Sylvester Maleghemi, WHO Polio Eradication Initiative Team Lead, South Sudan

Practical Solutions to Challenges in Reporting: LoMIS Stock and eIDSR

By Abdullahi Halilu Katuka and Emerald Awa- Agwu

LoMIS Stock is an electronic stock management tool, developed by eHealth Africa as a part of a suite of mobile and web applications that address supply chain and logistics challenges in health systems, especially in Northern Nigeria. LoMIS Stock helps health workers report and keep track of vaccine stock usage and availability at the health facility level. Using these reports, their supervisors can prevent stock-outs at their health facilities by ensuring that vaccines and other commodities are always available. The information from LoMIS Stock also gives governments the real-time data that is needed to plan programs and interventions and to resolve issues.

The LoMIS Stock solution was introduced to Kano State in 2014 and is currently the official logistics management tool for Kano State Primary Health Care Management Board (KSPHCMB). Currently, the State cold store, all 44 Local Government cold stores, and 484 apex health facilities in Kano send weekly reports using the LoMIS Stock application.

Although health facilities reporting times have dropped by over 50% and reporting rates have tripled since the introduction of LoMIS Stock, certain facilities in hard to reach areas were consistently unable to send reports due to mobile data network challenges. Gleaning from lessons learned from a similar challenge encountered with our electronic Integrated Disease Surveillance and Response System (eIDSR) solution in Sierra Leone, eHealth Africa added an SMS compression feature to the LoMIS Stock application.

In Sierra Leone, we have recorded a significant improvement in the number of facilities that send timely reports using the eIDSR application. Health facility workers in Sierra Leone use eIDSR to collect data offline on epidemiologically important diseases and send surveillance reports. Initially, in areas with poor connectivity, the application would store the reports and submit automatically as soon as an internet or mobile connection became available. However, this meant that such facilities didn’t always meet the targets for timely reporting.

Introducing the SMS compression feature enabled health workers in the defaulting facilities to send their weekly reports using a USSD short code if an internet connection or mobile data was unavailable. Thanks to this feature,  all the districts in Sierra Leone consistently exceed the World Health Organization (WHO) African region and national report completeness and timeliness targets.

The USSD feature for LoMIS Stock has been piloted with the pharmaceutical department of KSPHCMB to monitor incoming and outgoing stocks and the results have promising. In the first month, the stock count report at the pilot health facilities shows 100% stock sufficiency reporting and 0% wastage. After the pilot period, the feature will be rolled out to all departments of KSPHCMB to allow better reporting and increased efficiency across health facilities in Kano state.

Innovative problem solving is one of our values at eHealth Africa and this is an example of how eHA develops context-specific solutions to problems in healthcare delivery.