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 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. 

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.

Equipping Laboratories for Stronger health systems

By Emmanuel Uko

The journey of supporting and augmenting laboratories in Africa has only started, and evidently, the gap is huge. At the WHO Polio lab in Maiduguri, Borno State, eHA identified cases of damaged, obsolete and inadequate equipment and swung in to supply the needs with support from the World Health Organization (WHO).

As we walked into the office of Professor Marycelin Baba, the Director of the Laboratory, Professor of Medical Virology and lecturer with the University of Maiduguri, we could tell how busy the facility had become on a daily basis. Samples from patients were brought in  on a queue for processing. “Our work here is becoming satisfying”, Prof told us expressively, “especially with partnership from the World Health Organization (WHO) and eHealth Africa (eHA). They have provided various major equipment that enable the center to remain functional”, she said, her passion unwavering for 32 years in the profession.

The lab in Maiduguri, was set up by  Global Polio Laboratory Network (GPLN), to distinguish poliovirus as a cause of acute flaccid paralysis (AFP) from AFP caused by other diseases. It serves the northern part of Nigeria while the one earlier established in Ibadan, Oyo State, serves the southern part of the country. 

Prof. Marycelin Mandu Baba, Director, WHO Polio Laboratory in Maiduguri, is happy to have participated in the polio eradication process in Nigeria.

Photo Credit: eHA

The WHO Polio Laboratory in Maiduguri, like many other labs in developing countries, often  grapples with acute shortage of equipment, reagents, machines, power supply and human resource, which affect its productivity. Research has shown that the number of optimally functional laboratories accredited to international standards were 380, as of 2014; 91% of these were in South Africa. This means that 12 out of 49 countries in the region had one or more laboratories accredited to international quality standards; 37 had none. However, the Global Polio Laboratory Network consists of 146 WHO-accredited polio laboratories, in 92 countries, across the six WHO regions of the world.

Nigeria has 2 of those 146 WHO-accredited polio laboratories. eHA currently provides support to 7 laboratories: 2 in Nigeria, one each in Uganda, Kenya, Ethiopia, Egypt and the Democratic Republic of Congo. The organization is strategizing to commence support to laboratories in Cameroon, Côte d'Ivoire, Ghana, South Africa, Senegal and Central African Republic. This support will improve laboratory and diagnostic services for Africa’s teeming population. “We continue to carry out needs audits and take steps to offer solutions where we identify gaps,”  said eHealth Africa’s Project Manager, Tolulope Oginni. eHA has supported the lab with digitized biosafety cabinets for tissue culture, a Polymerase Chain Reaction (PCR) Workstation, a PCR thermomixer, multi-channel and single-channel pipettes of varied volumes for serology.

Dr Muhammad Talle of the WHO Polio Laboratory in Maiduguri showcases how the new PCR thermomixer donated by eHA works.

Photo Credit: eHA

Dr. Muhammad Talle remains hopeful that the lab will continue to deliver appropriate services according to approved standards.

Photo Credit: eHA

“eHA has brought us relief”, said the Assistant Director for Lab Technical Operations, Dr Bamidele Oderinde, who came in later to the conversation. “The new machines help to reduce technical problems and the functionality complaints we have. We have upgraded our operations, research capabilities and training standards for our students”.

Professor Baba remains keen on contributing her quota towards the eradication of viral diseases, through differential diagnosis of acute flaccid paralysis. According to her, the newly equipped lab benefits people beyond Borno State and extends to other parts of Nigeria. Supporting this lab and other laboratories is part of eHA’s service areas, to build and operate effective laboratories in-country across the globe, and develop the tools and technology needed for effective dissemination and use of public health-related information.

The Director, Prof. Marycelin Baba (3rd right), with eHA delegates and other staff of the laboratory, during eHA’s visit to the lab.

Photo Credit: eHA

eHealth Africa among winners in 2021 edition of the Wiki Loves Africa Photo Contest

By Oladipo Olurishe

2nd Place Winner Wiki Loves Africa Photo Contest 2021

Our submission to the Wiki Loves Africa 2021 Photographic Competition came 2nd place out of over 8000 entries.

Wiki In Africa, the international organizers of the Wiki Loves Africa challenges the global photographic community each year to respond to a call for photographs of life in Africa along a specific theme. This year, the competition called for photographers to contribute images that visually interrogated the theme of Health + Wellness within the African context but looking at the positive aspects within that sector of African life.

The image which emerged as a global winner was shot at the Kano head office of eHealth Africa during a Malaria Microscopy Training conducted by our Laboratory team. The image was uploaded by Dr. Nirmal Ravi who leads the team and was present during the session.

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.

eHealth Africa and Emory University take on Schistosomiasis in Kano State, Nigeria

Chibuzor Babalola and Angela Udongwo with eHA’s Tolulope Oginni (center)

Schistosomiasis (Snail fever) is one of twenty communicable diseases classified by the World Health Organization as Neglected Tropical Diseases. The disease has dire health and economic consequences including disability, infertility, stunting in children and death.

Its close link with poor hygiene and sanitation, make its burden higher in poor, rural communities. Schistosomiasis is contracted when people are exposed to water infested by parasitic worms called Schistosomes. According to the World Health Organization, over 250 million people worldwide are affected by this disease and 90% of them live in Africa.

This public health impact drove Emory University Masters students, Angela Udongwo and Chibuzor Babalola, to partner with eHealth Africa’s Kano Lab to conduct a two-month research study in Kano State Nigeria. In this interview, they share the inspiration behind the study and their expectations for the research.

Why Schistosomiasis? What inspired this project?

We were inspired to conduct this study because of the public health impact of schistosomiasis. Nigeria is one of the Schistosomiasis-endemic countries and in fact, has the highest number of cases worldwide. Kano state is one of the five states with the highest burden of the disease in Nigeria. There is a need for more cost-effective, accurate and sensitive field applicable diagnostics to achieve the goal of eliminating the disease.

What's the purpose of this research study?

The purpose of this research is to compare the sensitivities and specifities of three diagnostic methods—polymerase chain reaction (PCR), loop-mediated isothermal amplification (LAMP) and microscopy—for detecting Schistosoma haematobium (urinary blood fluke). The research will examine the appropriateness of these methods for field diagnosis in low-resource settings and for detecting both acute and chronic schistosomiasis. We are also administering questionnaires to assess the communities' knowledge, attitudes, and perceptions about schistosomiasis.

How did you end up doing this in Kano at eHealth Africa?

eHealth Africa was accepting interns from Emory University for summer research and having introduced my research idea to one of the co-founders at a previous event in my school, I applied. eHealth Africa is providing us with the lab space and equipment to conduct this research. Our project activities are supervised by the Lab team here in Kano and we are truly blessed to have this opportunity.

Their project is supervised by eHealth Africa’s Lab coordinator, Tolulope Oginni

What do you hope to accomplish at the end of the study?

The end goal of this study is to develop a device that is capable of detecting schistosomiasis among people with a low burden of infection. We intend to use the results of this research as preliminary data for future research and grant-funded projects. In the long term, we also hope that it will provide evidence to influence the improvement of policies on field diagnosis of schistosomiasis.

Innovations in Newborn Sickle Cell Screening

By ZIllah Waminaje

In Africa, 50% to 90% of children who have sickle cell die before their fifth birthday1. To improve their chances of survival, health systems must integrate Newborn Screening (NBS) for Sickle Cell Disease (SCD) with comprehensive treatment and management plans.

For almost five decades, newborn screening for SCD has been conducted using conventional procedures such as electrophoretic techniques, isoelectric focusing (IEF), high-performance liquid chromatography (HPLC) and DNA analysis, which require specialized laboratories with stable electricity, long sample processing times, expensive equipment and reagents, and highly skilled personnel. These methods, while ideal and feasible for developed countries, are inappropriate for low-resource settings like sub-Saharan Africa where 70% of SCD sufferers reside.

Screening with Sickle SCAN Device

Sickle SCAN is an innovative, cost-effective point-of-care (POC) device that has been developed by Biomedics Inc. to address the challenges of SCD diagnostics in low-resource settings. It is a simple rapid point-of-care test kit that can detect the presence of Hemoglobin A, S, and C and yield results within 5 minutes using blood from a heel/ finger prick or vein. In addition to newborn screening, the Sickle SCAN device can be used for premarital/preconception genetic counseling, blood donor screening, and general screening.

Sickle SCAN

Several features make the Sickle SCAN ideal for low-resource settings and large-scale mass screening programs. The first is that it does not require specialized technical knowledge to administer or read the test results. Anyone can be trained to use the device. The device does not require any special equipment or electricity and thus, eliminates the time, resources and logistics needed to transport samples to a laboratory. Finally, the short result turnaround time allows for the prompt identification of SC-positive babies so that early treatment can commence and survival rates can improve.

Since December 2018, eHealth Africa has partnered with Sickle Cell Well Africa Foundation (SCWAF), Pro-Health International and the Presidential Committee on the North- East Initiative (PCNI) to hold Sickle Cell awareness and testing outreaches in Adamawa, Bauchi, and Gombe states. Over 1000 people in all three states were screened using Sickle SCAN rapid diagnostic test kits. Patients who tested positive for sickle cell disease were immediately given routine medication and referred to sickle cell clinics.

Sickle Cell Outreach in Hong LGA, Adamawa

Since healthcare in many African countries is community-based, rapid POC test kits like the Sickle SCAN can be easily integrated into existing health programs like routine immunization at primary health care centers or health insurance schemes to facilitate universal screening and ensure sustainability. This will ensure that relevant data on SCD births, morbidity and mortality rates and long term outcomes are captured.

Sickle Cell Awareness and Testing Outreach in Toro LGA, Bauchi

eHealth Africa continues to work with partners to address health inequalities by ensuring equal access to quality and effective diagnostic tools to achieve universal health coverage.

How eHealth Africa supports Universal Health Coverage across Africa

By Emerald Awa- Agwu

April 7 is World Health Day and this year, the World Health Organization (WHO) is focusing on Universal Health Coverage (UHC).

WHO: Universal Health Coverage - What does it mean?

Good health is crucial for developing economies and reducing poverty. Governments and decision-makers need to strengthen health systems so that people can get the healthcare and services that they need to maintain and improve their health, and stay productive.  However, improving access to health services is incomplete if people plunge further into poverty because of the cost of health care. WHO estimates that over 800 million people spend at least 10% of their household budget on health care which is indicative of catastrophic health expenditure (CHE).  CHE can mean that households have to cut down on or forfeit necessities such as food and clothing, education for their children or even sell household goods.

One of the targets of Sustainable Development Goal 3—Ensure healthy lives and promote wellbeing for all at all ages— is to achieve universal health coverage by 2030. Therefore, achieving UHC has become a major goal for health system reforms in many countries, especially in Africa.

Through our projects and solutions, eHealth Africa supports countries across Africa to strengthen the six pillars of universal health coverage.

1. Health Financing for Universal Health Coverage

WHO recommends that no less than 15% of national budgets should be allocated to health. We believe that accurate and up to date data, can ensure that available health funds are better allocated. In Nigeria,  we worked with several partners to map and collect geospatial data through the Geo-Referenced Infrastructure and Demographic Data for Development (GRID3) program. Data relating to over 22 points of interest categories including health facilities, was collected across 25 states and the Federal Capital Territory in Nigeria. This data helps decision-makers to distribute resources and plan interventions that target the people who need it most.

2. Essential Medicines and Health products

Vaccines are some of the most essential health commodities

Countries decide what medicines and health commodities are essential based on the illnesses suffered by the majority or significant sections of their population. They must also ensure that quality, safe and effective medicines, vaccines, diagnostics, and other medical devices are readily available and affordable.

When essential medicines and health products are procured, it is important to maintain proper records and to ensure that health facilities do not run out of stock. eHealth Africa created Logistics Management Information System (LoMIS), a suite of mobile and web applications, LoMIS Stock and LoMIS Deliver that address challenges in the supply of essential medicines and health products such as vaccines and drugs. In Kano State, health workers at the facility level use the LoMIS Stock mobile application to send weekly reports on the vaccine stock levels, essential drug stock levels and the status of cold chain equipment. Supervisors can view the reports in near real-time through the LoMIS Stock Dashboard and plan deliveries of medicines and health products to prevent stockouts of vaccines and essential drugs, using LoMIS Deliver. LoMIS Deliver reduces errors by automating the process of ledger entry to capture the number of vaccines on-hand at the facility and the quantity delivered.

3. Health systems governance

Health system governance according to the WHO is governance undertaken with the aim of protecting and promoting the health of the people. It involves ensuring that a strategic policy framework exists and providing oversight to ensure its implementation. Relevant policies, regulations, and laws must be put in place to ensure accountability across the health system as a whole (public and private health sector actors alike).  Effective health systems governance can only be achieved with the collaboration of stakeholders and partners who will support the government by providing reliable information to inform policy formulation and amendments. Over the years, we have worked with several partners to provide this support.

4. Health workforce

Health systems can only deliver care through the health workforce

The attainment of UHC is dependent on the availability, accessibility, acceptability, and quality of health workers1. They must not only be equitably distributed and accessible by the population, but they must also possess the required knowledge and skills to deliver quality health care that marries contextual appropriateness with best practices.

Recognizing this, eHA supports the Kano State Primary Health Care Management Board (KSPHCMB) to improve health service delivery by providing health workers in Kano State with access to texts, audio courses, and training modules through an eLearning solution. Through the eLearning web and mobile-enabled platform, health workers can gain useful skills and knowledge on a wide range of topics. Read about the pilot of the eLearning solution here.

In Sierra Leone, we work with the Ministry of Health and Sanitation (MoHS), U.S. Centers for Disease Control and Prevention (CDC) and the African Field Epidemiology Network (AFENET) to implement the Field Epidemiology Training Program (FETP). Through FETP, public health workers at the district and national level gain knowledge about important epidemiological principles and are equipped with skills in case/ outbreak investigations, data analysis, and surveillance. This positions Sierra Leone to meet the Global Health Security Agenda target of having 1 epidemiologist per 200,000 population. In addition, we support Sierra Leone’s MoHS to build additional capacity in frontline Community Health Officers (CHOs), who are based at the Chiefdom level through the management and leadership training program. CHOs are often the first point of contact for primary care for the local population and the MLTP program equips them to provide better health services and improve health outcomes at their facilities.

5. Health Statistics and Information Systems

In line with our strategy, we create tools and solutions that help health systems across Africa to curate and exchange data and information for informed decision making and future planning.  The Electronic Integrated Disease Surveillance and Response (eIDSR) solution has been used in Sierra Leone and Liberia to transform data collection, reporting, analysis, and storage for a more efficient response and surveillance of priority diseases. Its integration with DHIS2, a health information system used in over 45 countries, makes it easy for health system decision makers to visualize data and gain insight into the state of public health. Read more about our other solutions Aether and VaxTrac. In addition, we also support the Nigeria Center for Disease Control and Prevention (NCDC) by creation and maintenance of a data portal which serves as a repository for all datasets that are relevant to detecting, responding and preventing disease outbreaks in Nigeria.

6. Service delivery and safety

Staff at the Kano Lab

The Service delivery and safety pillar encompasses a large spectrum of issues including patient safety and risk management, quality systems and control, Infection prevention and control, and innovations in service delivery. With our experience working to respond to polio and ebola virus emergencies across Africa, we support health systems to mount prevention and control programs at the national and facility level. We are also committed to creating new technologies and solutions that can help health providers to develop better models of healthcare. We also construct health facilities ranging from clinics to laboratory and diagnostic facilities that utilize state of the art technology to correctly diagnose diseases such as Sickle Cell Disease, Meningitis, and Malaria.

Our Sokoto Meningitis Lab has been at the forefront of meningitis testing and surveillance in Northern Nigeria, offering reliable and prompt diagnoses to support the prevention of future outbreaks.

eHealth Africa continues to work with governments, communities and health workers so that everyone can obtain the quality health care, in a prompt manner and from health workers and facilities within their communities, thus achieving universal health coverage.

eHealth Africa renovates Njala University research center with CDC funding

By Sahr Ngaujah

eHealth Africa (eHA) in partnership with U.S. Centers for Disease Control and Prevention (CDC), has renovated the  Njala University research center at Tiwai Island, in a drive to support one-health surveillance activities in Sierra Leone. The project was funded by CDC, with the objective of improving knowledge and infrastructure capacity at Njala University research center to perform routine Ebola and infectious disease surveillance.

Research began on Tiwai Island in the early 1980s, with studies on primates, other mammals, forest dynamics etc. This research was vital for disease and one-health surveillance activities as Sierra Leone, ebola virus disease outbreak was traced to bats and primates. However, over the years, the facility had fallen into disrepair and was unusable. Renovation of the Tiwai Island research center commenced in November 2018. eHA has now completed renovations on the entire campus including storage room; kitchen, meeting areas, and dormitories. The facilities were equipped with solar power, which now provides uninterrupted power on a daily basis, solar powered water supply in order to ensure adequate water supply during the dry season.

“Those who had visited the Tiwai Research Center before now, would agree with me that there is much difference after the renovation. We are happy that this facility is now ready for use. Communities and stakeholders associated with Tiwai are very grateful. This was made possible through funding from the CDC and renovations by eHealth Africa.”

— Dr. Lebbie, Head of Department of Biological Science, Njala University- Head of the Njala Research Center

“CDC has been working with Njala since the Ebola outbreak. CDC has a strong relationship with the Njala team and helping them to have more capacity to do testing to look for viruses, including the Ebola virus that caused the outbreak here. We are looking for other viruses that are in the environment so that we can know more about our environment, learn to live safely with it, and prevent outbreaks from happening. We want to prevent disease outbreaks, and we’re doing that by helping the people of Sierra Leone find those viruses themselves – to study them here so that they don’t rely on outside help. We have seen great success with Njala University and their team doing this work here. CDC is eager to continue to support that effort because we’re so impressed by what’s been done already.”

— Dr. Brigette Gleason, Surveillance and Program Lead CDC Sierra Leone Country Office

These renovated structures go to benefit not only Njala University students and faculty and  Sierra Leone’s Ministry of Health and Sanitation (MoHS), but also international researchers.

“We will be inviting international auditors who will be resident here to do research; and through that, job opportunities would be opened to the community.’”

— Dr Lebbie

Partnering to Address Sickle Cell Disease in Northern Nigeria

By Muhammed Hassan

According to the U.S. Centers for Disease Control and Prevention (CDC), Nigeria alone accounts for more than 100,000 new sickle cell births every year1. Statistics from African region of the World Health Organization (WHO) puts the prevalence of the Sickle cell trait in Nigeria at 20% to 30%2. In sub-Saharan Africa, very few control programs exist and those that do exist, lack national coverage or the facilities to manage patients. Proactive, routine screening for sickle cell disease is not common practice so diagnosis is usually made when a severe complication occurs.

At eHealth Africa, we aim to improve the quality and availability of healthcare for underserved populations and to increase access to timely and quality diagnostic services. We partnered with Sickle Cell Well Africa Foundation (SCWAF), Pro-Health International and the Presidential Committee on the North- East Initiative (PCNI) to hold a two-week outreach in Bajoga LGA, Gombe state, and Toro LGA in Bauchi State from the 2nd-16th December 2018.

The team hosted community and school outreaches in both LGAs. Beneficiaries of the outreaches in both LGAs were educated about Sickle Cell Disease (SCD), inheritance, signs and symptoms, and the importance of genotype testing for SCD and prevention. Free genotype tests were conducted using the Sickle Scan Rapid Test Kit.

Patients who tested positive for SCD and those who presented with severe complications were given routine medication, advised on first-level crisis management and referred to tertiary hospitals. eHealth Africa captured, stored and analyzed the results of the tests. The analyses provided insight into the geographic distribution of patient and the average age distribution of patients who tested positive for SCD and the categories of complications presented at the outreach.

eHealth Africa, Pro-Health and SCWAF presented these results at stakeholder meetings in both states and provided evidence-based recommendations to enable the states to tackle Sickle Cell Disease. Going forward, eHA intends to work with Pro-Health to develop a comprehensive data collection tool which will support tracking and follow up of SCD patients in Prohealth Sickle Cell Clinics.

The Impact: