Pushing the Boundaries of Routine Immunization coverage

By John Momoh & Emerald Awa-Agwu

In 2017, following the results of the 2016-2017 Multiple Indicator Cluster Survey/ National Immunization Coverage Survey (MICS/NICS) Report, which put Nigeria’s routine immunization (RI) coverage rate at 33%,  the National Primary Health Care Development Agency (NPHCDA) declared a state of emergency on RI in Nigeria 1. This led to the establishment of the National Emergency Routine Immunization Coordination Centre (NERRIC) and its state-level counterparts, across the 36 states of the federation. NERICC and SERICC targeted states and local government areas that had low immunization coverage rates with various interventions, aimed at attaining a RI coverage rate of 84% by 2028. The majority of states in this category are in Northern Nigeria 2. 

Many reasons exist for low vaccination coverage rate including non-compliance by households, insufficient vaccines, health workers, and/or health facilities to meet the demand for immunization services. However, what happens when you have all these factors combined with insecurity, displacement of people, and physical destruction of health facilities?

eHA consultant in Magumeri LGA training the LGA RIE team on the use of electronic data collection methods

It’s an Emergency
The insurgency in Northeast Nigeria has been ongoing since 2009 and the current reality is that health workers and households face grave challenges delivering and accessing RI services. There are issues of security to consider as well as the migration/abandonment of settlements which hinder proper planning and execution of routine and supplementary immunization activities (SIAs). This has led to consistently underserved populations and thus, low immunization coverage rates.

eHA consultant in Biu LGA supporting the LGA RI Officer to micro-plan using GIS Maps

The Strategy
To alleviate this, the Borno State Emergency Routine Immunization Coordination Centre, in close collaboration with partners including the World Health Organization (WHO), Rotary International, the U.S. Centers for Disease Control and Prevention (CDC), the United Nations Children’s Fund (UNICEF), the Bill & Melinda Gates Foundation (BMGF), eHealth Africa (eHA), Solina Health, and Novel-T launched the Routine Immunization Expansion (RIE) strategy to expand RI activities to security-challenged areas in order to improve the coverage rates. This strategy uses Geographic Information Systems (GIS) solutions as the basis to identify and target settlements for RI sessions and provide proof of visitation, thereby, improving routine immunization coverage.

eHealth Africa's Role
We have leveraged our expertise in data management solutions and Geographic Information Systems (GIS), to provide end-to-end support for the implementation of the RIE strategy in Borno. We provide the RI teams with up-to-date GIS maps and a list of settlements that they use during their microplanning activity to estimate target populations and allocate catchment areas to health facilities across the state. Using these tools and local knowledge, the teams prioritize and plan what areas to reach using criteria like accessibility, habitation status, and the proximity to adjoining settlements. Furthermore, this allows each LGA to estimate the optimal number of teams and days required to cover all their targeted settlements for each round of RIE implementation. This process is critical to the program because it has a direct impact on logistics and finance planning. During RIE field implementation activities, we monitor RI teams’ coverage in security-compromised areas using GPS-enabled Android phones, similar to what occurs in the Vaccinator Tracking System project.

At the end of each round, we develop a post-implementation report and updated map which are shared with the relevant stakeholders for informed decision-making and progress monitoring.

The Progress So Far

As a result of using GIS technology, routine immunization coverage in security-challenged areas in Borno has increased from 12% in April 2019 to 88% in December 2019.

These results show the significant impact that innovative data solutions and GIS technology, combined with contextual insight and partnership can have on health interventions in low-resource settings.

Reducing eHealth Africa’s Carbon Footprint

By Onche Ogbole

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

What We Did and How It’s Working

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

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

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

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

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

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

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

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

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

Partnerships and Networks: Essential for achieving food security

By Chinedu Anarado

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

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

During the planting stage

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

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

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

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

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

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

Farmers at the Pre-Implementation Workshop

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

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

Improving Emergency Response by Strengthening Humanitarian Supply Chain and Logistics: Warehousing

By Emerald Awa-Agwu and Mohammed-Faosy Adeniran

In the last five years, the world has seen a progressive rise in public health emergencies, leading to an increased need for humanitarian aid and relief 1.

During humanitarian response activities, large quantities of supplies including food and non-food items, essential medicines and even, human resources need to be deployed to the areas affected by the crises, within the shortest possible time. Sound logistics and warehousing infrastructure becomes imperative, as it could reduce the lead time and cost of transporting essential supplies to these areas; thus alleviating the disaster2.

Over the years, supply chain professionals have had to strategize to develop resilient, context-appropriate approaches to respond to a wide spectrum of crises in different geographical locations. Warehousing is an essential portion of these approaches as they can greatly enhance a health system’s capacity to be prepared for emergencies by storing needed supplies in central locations so that they can be distributed more promptly, in case of an emergency. During an emergency, they help to shorten the time spent getting aid to the affected people and thus reduce negative outcomes such as hunger, injury and/or death.

Here are some examples of how warehousing and logistics are being used to improve emergency response:

The Ebola Virus Disease (EVD) Outbreak in Democratic Republic of Congo (DRC)

The EVD outbreak in DRC started in August 2018 and for the response program led by the World Health Organization (WHO), the major challenge was getting medical and non-medical supplies to the DRC’s conflict-affected Northeastern region. To address this challenge, the WHO set up secondary hubs in Beni and Butembo towns (within the affected area), and five other district warehouses to receive supplies from the main warehouse hubs in Kinshasa (the capital city of DRC) and in Goma, the capital of North Kivu province. 

The complex logistics of Ebola response. Photo credit: World Health Organization

Through these hubs, the WHO has coordinated the storage and distribution of 17 million gloves, over 2 million surgical masks, 909 thousand gowns and over 200 thousand doses of Ebola vaccine, to enhance the Ebola response operations. The combined volume of these supplies is equivalent to two Olympic-sized swimming pools but it has been worth it. More than 1000 people have survived EVD in DRC and over 257,000 have been vaccinated.

Natural disasters in China

China is one of the most disaster-prone countries in the world. Between 2006 and 2010, the country recorded 90,000 deaths and economic losses worth more than 160 billion dollars as a result of natural disasters 3. In line with their 2015 Guidance on Strengthening the Construction of Natural Disasters Relief Supplies Reserve System, victims must receive basic relief items within 12 hours after the disaster breaks out. 

To achieve this, the Chinese government set up 24 relief supplies warehouses in cities around the country, while local authorities at the county to province-level were expected to replicate similar warehouses, especially in hazard-prone locations, taking the population distribution to account 4.

The Conflict in Northeast Nigeria

Since 2014, Northeast Nigeria has been plagued with insurgent activities, heightening the food and nutrition insecurity of vulnerable populations, and leading to the displacement of 1.92 million people. Another 7.7 million people in Borno, Adamawa, and Yobe states require humanitarian assistance. The World Food Programme (WFP) has supported national and state emergency efforts in Nigeria since 2015, by providing food and cash aid to 1.2 million internally-displaced people on a monthly basis.

Laborers loading food items in the Kano warehouse managed by eHA

During an emergency, the ultimate goal is to contain the emergency within the shortest possible time so that the loss of lives and property, as well as the disruption of economic activities, can be minimized. In such scenarios, both supply-side actors (health system administrators and providers) and demand-side stakeholders (affected populations and members of the general public) need to have the commodities that they need to respond to the emergency and to recover from the emergency, respectively.