Uniting Against Circulating Variant Poliovirus: Traditional Leaders Lead the Way

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

by Moshood Isah

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

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

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

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

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

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

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

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

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

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

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

by Moshood Isah

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

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

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

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

eHealth Africa leading panel session at the 4th ADHS

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

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

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

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

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

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

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

Click here to learn more and register to attend.

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

by Moshood Isah

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

by Moshood Isah

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

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

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

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

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

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

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

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

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

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

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

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

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

by Favour Oriaku

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

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

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

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

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

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

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

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

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

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

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

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

By Tijesu Ojumu

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

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

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

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

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

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

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

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

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

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

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

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

by Moshood Isah

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

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

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

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

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

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

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

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

Community Feedback

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

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

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

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

Empowering Nigeria’s Healthcare System with EMID App Training

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

by Favour Oriaku

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

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

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

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

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

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

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

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

by Moshood Isah

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

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

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

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

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

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

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

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

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

Immunization Recorder in Doma LGA of Nasarawa State

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

Celebrating the Handovers of EOCs in Zamfara and Kebbi States

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

by Favour Oriaku

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

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

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

Zamfara State's EOC Handover

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

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

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

Kebbi State's EOC Handover

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

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

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

A Testament to Partnership and Progress

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

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

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

By Tijesu Ojumu

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

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

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

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

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

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

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

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

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

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

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

eHealth Africa's Integration of Digital Solutions for Public Health Impact

By Favour Oriaku

eHealth Africa (eHA) has the strong belief that access to proper healthcare is a right, not just a privilege. Consequently, eHA continues to create innovative solutions that provide underserved communities in Nigeria with the tools to take charge of their health and well-being. Through their digital innovations, eHA is bridging the gap between technology and healthcare. Currently, the organization is improving their offering by merging their two main applications - LoMIS Deliver and  LoMIS Stock - into one, all-encompassing platform: LoMIS Suite. This platform will enhance the management and delivery of vaccines and other health supplies. By doing so, ensuring that essential healthcare services are consistently available. 

LoMIS Deliver alone has successfully delivered over 17 million vaccine doses and 16 million essential goods to their destinations, overcoming logistical challenges to keep healthcare running smoothly. At the same time, LoMIS Stock has provided healthcare workers with a more efficient way to report, offering real-time visibility of stock levels and streamlining the planning process through a mobile app.

The merging of these two applications by eHA, promises to be a powerful tool for improving existing health systems. It will help manage stock levels, track deliveries, and enhance decision-making processes with ease and precision. With these merged applications, every piece of data collected will contribute to better delivery schedules, improved stock availability, and, most importantly, ensuring that every member of the community has access to essential healthcare services. The integration of the LoMIS applications represents not just a technological advancement, but a ray of hope for a society in pursuit of a dependable and efficient healthcare system at the last mile.

Fatimah Howeidy, the project manager, shares her perspective, saying: "Every data point we collect represents real people, families, and their futures. By merging our LoMIS Deliver and LoMIS Stock applications, we're not only improving our technology but also ensuring that vaccines and health supplies are always available when and where they're needed most, and the process is managed using a more improved system."

This initiative is supported  by the Digital Health Innovation Accelerator Program (DHIAP), which was launched in 2021, and is powered by the WFP Innovation Accelerator and BMZ digilab – the innovation lab for digital solutions, initiated by the Federal Ministry for Economic Cooperation and Development (BMZ) in collaboration with GIZ, the German Development Bank KfW, and the Bill and Melinda Gates Foundation. eHA project has been selected as one of 5 finalists for the WFP Sprint Programme, and is supporting the implementation by providing  financial support, as well as access to mentorship, guidance, and a strong network of peers and stakeholders to inspire and share knowledge and best practices. 

Through initiatives like these, eHA is empowered to offer not just technological solutions; they are weaving a future where healthcare is consistent and accessible to all. This future includes mothers who wish to see their children thrive without vaccine-preventable diseases, healthcare workers who rely on dependable data and supply chains, and communities that rightfully deserve equitable healthcare. In the synergy of technology and health facilitated by eHA, each vaccine delivered represents a stride towards improved health outcomes. Every report submitted through the app strengthens the battle against vaccine preventable diseases. And each decision made with precise, real-time data paves the way for equal healthcare accessible to all.

Fatimah encapsulates eHA's spirit by saying, "Our solutions, especially when combined into the LoMIS Suite platform, are more than just applications. They are our commitment, represented in data, ensuring that every child and every family in our communities has reliable healthcare."

In this intricately woven digital solution created by eHA, technology and health are seamlessly interconnected, ensuring that each individual and every community can consistently count on fair and reliable healthcare. It's not just a project; it is a commitment to accessible healthcare through the power of technology and unwavering dedication of our healthcare professionals.

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.

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.

In Nigeria, eHealth Africa Optimizes Systems for Seamless Vaccination Data Collection and Retrieval

By Emmanuel Uko

Building and optimizing software applications to improve public health outcomes is at the core of  eHealth Africa’s work. With the Electronic Management of Immunization Data (EMID) application, the organization went beyond optimizing the app to redesigning a new process flow for vaccination data capture. The redesign of an optimized process flow was necessary as research shows that inadequate health data is a challenge in Nigeria due to unintentional duplication, lack of synchronization and dearth of data storage systems.

The quality of data collection tools and the uncoordinated nature of the collection process compounded the data challenges, thus the need for a redesigned data collection process flow. eHA’s Technical Project Manager, Software Engineering, Dayo Akinleye said, “The redesigned process flow was necessary because the new process eliminates the possibility of duplicate records for offline users; utilizes the current quick response (QR) code for easy identification and seamless operation; and eliminates redundant information generated on the Public Registration portal (PubReg). The old process flow used the KoboCollect platform, so it did not have these capabilities. It was also unable to synchronize with the District Health Information Software (DHIS2).”

Former process flow with the old EMID application
Image: eHA

New process flow with the native (optimized) EMID application
Image: eHA

Both process flows allow users to register via the PubReg portal and receive registration ID before visiting the vaccination center to receive the vaccine. At the vaccination site, both processes allow for manual registration of clients into the EMID physical register, and receive a vaccination card with QR code.

eHA’s EMID Project Manager, Stephanie Okpere (right), during a Strategy Group meeting at NPHCDA Headquarters, Abuja.
Photo Credit: eHA

Tope Falodun,  eHA’s Associate Project Manager on the EMID project, affirmed that “the new process departs from the old as it allows for instant validation of clients once registered. Upon successful validation, the optimized EMID system generates a vaccination ID for clients that register at the physical site. For those who register via PubReg, their registration ID is replaced with the vaccination ID, eliminating duplicates, unlike the old system. The new vaccination ID is generated from the QR code for both online and offline clients to avoid duplicate registration. If the registration on the optimized (native) app is unsuccessful, the error message redirects the user to the specific item that needs to be updated or corrected. After correcting the error message the recorder saves the information to complete the registration and validation process.”

EMID Recorder for Isale-Agbara PHC, Egunsola Ayobami (middle), at the pre-deployment training of the native (optimized) EMID application in Osogbo, Osun State
Photo Credit: eHA

End users have found the new process flow more responsive than the old one, and better fit for purpose. As the EMID Recorder at Isale-Agbara Primary Healthcare Centre in Osogbo, Osun State, Egunsola Ayobami, confirmed, “one of the important variations from the old system is the ability to validate a client instantly, making the work easier and faster. It is also easier to use. When in doubt, I now know how to contact helpdesk, and their responses are instant,” he concluded.

Deployment of the native EMID application across Nigeria, with its optimized process flow, guarantees seamless data capture, storage and real-time retrieval. 

eHA’s areas of  expertise are data management, project logistics, infrastructure and ICT services, working in the following focus areas: health delivery, public health emergency management, disease surveillance, laboratory and diagnostics, and nutrition and food security.

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