Blog — eHealth Africa - Building stronger health systems in Africa

Field Tracking System - transparency and efficiency redefined

By Uche Ajene and Detan Oyedele

In 2016, the Field Tracking System (FTS) was borne out of a need to provide a means for tracking vaccinators in Cameroon for the World Health Organization (WHO). The first system was developed as a collaborative effort between eHA and WHO to address the needs for polio vaccination tracking in Cameroon.
The question WHO Cameroon wanted to answer was "How do we know where the vaccinators have visited on a daily basis and how do we make adjustments to their plans while they are still in the field?"
The challenge was that vaccination teams were in extremely remote and unreachable villages for several days and they only had one chance to vaccinate children during campaigns. Any locations missed had to be addressed during the campaign.
The solution eHA and WHO Cameroon came up with was to use low-end smartphones to capture geo-coordinate information called "tracks" every 90 seconds to infer that locations where vaccinators stayed in for about 2 minutes, a vaccination occurred. We deployed the offline system in Cameroon, powered by our robust database that contains attributes and constraints that could easily be modified and adjusted based on factors that affect where vaccinators have reached and the time spent there. Such factors include the size of the house, village or community, security situation, road network, etc.
The output was an offline dashboard showing communities and households that were visited, partially visited, not visited, that the field teams used on a daily basis to assess their performance and readjust the next day’s plan during the campaign. This was great! And then users wanted more.

I am frankly delighted that we have introduced etracking. etracking has enabled us to know the serious and hardworking vaccinators and the unserious ones
— Head of Supervisors - Pagui, Cameroon January 2017

 

FTS is currently adopted in 3 African countries (Nigeria, Cameroon & Chad) for more generic tracking purposes of vaccinator and supervisory teams, sales teams, service administrators, data collectors. Some use cases worthy of note are:

 

  • User’s ability to define and modify campaigns by defining dates, with phones automatically sending tracks to a remote server and coverage automatically calculated. With the online and offline dashboard access, users can download reports and generate insights across multiple campaigns.

  • We work with our users to plan field activities on a daily basis based on predefined communities and attributes across static and dynamic administrative levels in any area.

  • Additionally, when our users need to collect sources of data while they are in the field, we can help them integrate the data with the FTS to provide more insights into the field work beyond coverage information. Case in point - WHO Cameroon & WHO Chad were able to corroborate coverage information from vaccinators with additional supervisory data that validated vaccination efforts by capturing actual number of children vaccinated using Open Data Kit (ODK) forms as an input. This means that coverage expectations of "visited" was complemented by the actual number of children vaccinated captured by ODK forms. This then helped them to further to investigate anomalies.

With the FTS, now we are 100% certain that we have reached everywhere in the islands
— Sam Okiror (Head, Lake Chad Task Team), June 2018

 

We are now working with our users to build a generic tracking and monitoring system that can be triggered by other inputs besides  geo-coordinates. Consider a system that reports coverage based on predefined user criteria and triggered by user-defined events or change in status. Ultimately, FTS will receive input from various sources both offline and online. We are excited about the possibilities with FTS and building collaboratively with our users to meet their specific demands.

Come one, Come Tech Enthusiasts!

By Emmanuel Monehin

We, at eHealth Africa are passionate about growth and learning. Not only do we push ourselves to grow and learn, we actively share knowledge with partners and interested individuals with the aim of inspiring positive change.

Last weekend at our Kano campus, eHealth Africa in collaboration with EnovateLab hosted a tech meetup, an initiative aimed at encouraging the development of local tech champions and entrepreneurs, especially in the areas of health delivery, nutrition and food security systems and, social impact in Kano State, Nigeria.

Click through the slideshow to find out what happened at the meetup.

Aether and Gather - Open Source Release

By Dave Henry & Benedetta Ludovisi

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Today is a very special day for eHA and the Aether and Gather development teams. Today these two projects are finally being released as open source software!

Aether, the software development platform for data exchange, curation and publication, is available to anyone to be evaluated and used to jump-start the creation of data-driven ehealth solutions.

Gather, the Aether-based solution for large scale data collection is also available, providing an end-to-end pipeline for streaming Open Data Kit survey responses to the CKAN Open Data Portal and other applications.

Read more about the reasons we created these two projects in our interview with the Aether team, and get more information on the Aether and Gather microsites.

If you are eager to get your hands on the software, you can try it yourself by following the step-by-step Gather “getting started” guide.

We look forward to hearing your feedback on our forums, and to seeing the amazing things that you do!!

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MEDSINC Pilot Study Closeout meeting and Certificate Conferment Ceremony

eHealth Africa, THINKMD and Kano State Primary Health Care Management Board (KSPHCMB) collaborated to implement a digital platform called MEDSINC among Community Health Workers (CHWs) in 5 metropolitan Local Government Areas (LGAs). Covering 15 Health facilities, MEDSINC supports the management of illnesses under the Integrated Management of Childhood Illnesses (IMCI) and empowered CHWs with skills to carry out physician-like clinical assessments on sick children within 2 months – 5 yrs of age. The close out meeting which held July 19, 2018 was presided over by the Executive Secretary, KSPHCMB, Dr. Nasir Mahmoud and with the support of Juliet Odogwu, Megan McLaughlin and Dr. Aisha Giwa, he presented certificates of completion to the CHWs. The ceremony consolidated our collaborative efforts in empowering CHWs with training and on-the-job support to improve the quality of care provided at primary health care level in the state. 

Participants with their certificate

Participants with their certificate

The pilot study was completed in 2 months and involved a 6-weeks implementation period (June 4 – July 13) and 3 stages of data collection – Pre, Mid and Post-Implementation IMCI observational data collection. Over the implementation period, CHWs used the platform to assess children in the health facilities. A total of 2,239 children were assessed using MEDSINC and a 41% increase in the number of IMCI observational data points collected at baseline (pre-implementation) was observed after mid-implementation data collection. This indicated an increase in the quality of assessments provided by the CHWs using MEDSINC. The feedback from the CHWs throughout the implementation period was positive and contributed to the ongoing improvements on the MEDSINC platform.

Spotlight - eHA Internships

An interview with on of our Laboratory Interns: Faiza Hamisu Aliyu

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Tell us a little about yourself
Faiza: My name is Faiza Hamisu Aliyu. My first degree is in Microbiology from Kano State Polytechnic. I also have a diploma in Laboratory Science from the same school. I am currently in my National Youth Service Corps service year and I intend to obtain a postgraduate degree in Epidemiology when I’m done.

How did you join the eHealth Africa team?
Faiza: I was posted to eHealth Africa for my service year in August 2017. I had always wanted to serve in an organization that would give me the experience I need to begin my career. When I was posted to eHA, I was quite nervous because I had no knowledge of the organization or the type of work they do.

Describe your experience on your first day- how did you feel? What was running through your mind?
Faiza: I was assigned to the Laboratory and Diagnostics department as an intern. The laboratory department had two ongoing studies at the time which were the Induced Sputum Study and the HemeChip Clinical trial.  I remember thinking that the laboratory had so much equipment that I was not conversant with and I was worried that I wouldn’t be able to master them. One of the first things that struck me about eHA was that they use technology for everything! There was so much to learn.

 You don’t sound worried anymore, in fact, you look very at ease with all the equipment now
Faiza: After a few days, I realized that there was no need to worry because my supervisor was very patient with me. He trained me for a very long time to use all the technologies in the lab. He always encouraged me to ask questions and to seek clarification whenever I was unsure of something. I learnt to use lab data software like RedCap, FreezerPro, and Odoo. I was also trained to receive, register and process various biological samples. I learned how to use the HemeChip device to determine genotypes from blood samples and how to collect and process sputum samples.

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What do you like best about eHA?
I love working at eHealth Africa. The staff are very welcoming and eager to help. No one treats me differently from any other staff even though I am an intern. I love the fact that eHealth Africa provides opportunities for everyone to learn and grow in their career and in any other areas of interest.
Apart from my lab work, I gained several useful skills in different fields. I worked with the Geographic Information Systems team to validate and clean data from the mapping of settlements in Borno state. I also worked with the Monitoring, Evaluation and Research (MER) department to enter data from over 500 respondents in a study to assess access to care by snakebite victims. One of my biggest takeaways from eHA is to deliver every task with utmost diligence.

Is there anything you want to say to the eHealth Africa team and to anyone looking to join?
My NYSC year will be over this month but the experiences and knowledge that I have gained will be mine for the rest of my life. I am very grateful to eHealth Africa and I encourage everyone who wants to grow and gain hands- on experience to join us.

To find internship spots and other ways that you can join the team at eHealth Africa, please visit our careers page or our website

Sustaining impact: Lessons from Kano Connect’s handover

By Fatima Adamu and Abdullahi Halilu Katuka

Kano Connect is a communication and information sharing platform developed by eHealth Africa, with funding from Bill and Melinda Gates Foundation in 2014. It features electronic management tools such as comprehensive directories of all the health facilities and health workers across all levels in Kano State. Using the platform, health workers can submit and review reports on routine immunization from their mobile phones or through a dashboard.  Health workers on the Kano Connect platform can access the contact details of any staff and communicate for free within a closed user group resulting in prompt and quality reporting, improved visibility and effective accountability.

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In 2016, eHA officially handed over the Kano connect project to the Kano State Primary Health Care Management Board. However, we continue to provide support and guidance in line with our vision. Prior to the handover, reporting rates through the platform were at an average of 25%. After the handover, reporting rates increased to an average of 95%.
This demonstrates the importance of working hand in hand with the states which we work in to ensure  the sustainability of our projects and our impact.
In this blog post, we share 2 key lessons from eHA’s approach to building state ownership of the Kano Connect platform

Lesson 1: Build capacity
In the course of the Kano Connect project, eHA conducted a total of 21 trainings and workshops for over 1400 health workers across all administrative levels of the Kano state health system. The health workers worked on diverse thematic areas such as Maternal and Child Health, Nutrition, Pharmaceutical Services, Epidemiology and Disease Control and Routine Immunization.
They were trained on how to use an android phone, send Routine Immunization supportive supervision reports using the Open Data Kit (ODK) e-forms, how to use the dashboard for decision making, reporting through the LoMIS Stock applications, using the LoMIS Stock dashboard for decision making ensuring that all the stakeholders understood the platform.

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Lesson 2: Train your Replacement
eHealth Africa trained 5 health workers as the pioneer members of the Kano Connect Operations Unit to manage the day to day running of the Kano Connect project. The unit members were trained on the standard operating procedures of the eHA Kano Connect team and how to execute daily tasks including:  

  • Administrative management of the Kano Connect project

  • Capacity building of Kano Connect users, including onboarding of new users

  • Dashboard management (updating, adding, and deleting user information)

  • Collation of summary reports from dashboards

  • Information and data management through form hub

  • Conducting surveys (paper-based and electronic)

Presently, I’m a data management officer for Kano Connect. eHealth Africa trained me and other Kano Connect operation unit staff to manage Kano Connect dashboard issues like updating, adding, and deleting user information and exporting Information and data management through form hub to populate a report
— Shamsuddeen Muhammad, Kano Connect Data management officer

Presently, Kano Connect is piloting its e- learning mobile application and dashboard  in three local government areas: Fagge, Nassarawa and Gabasawa local government areas in Kano State. Kano Connect eLearning provides access to learning materials and resources that health workers can access on their mobile devices.

Once again, eHealth Africa is partnering with Kano State to ensure that that knowledge gaps are identified and that health workers can gain skills and knowledge for improved health delivery.

Aether - An interview with the team

eHealth Africa developers are active in a number of open source communities. Indeed, many of eHA’s solutions have incorporated open source software such as Open Data Kit (ODK), CKAN, OpenHIE, DHIS2, and Humanitarian OpenStreetMap (HOT).  We are just weeks away from giving back to the community in the form of two new projects - Aether and Gather. We’re excited to support others who are developing solutions for the global good.

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We interviewed the team behind eHA’s Aether to discuss the reasons why they created an open source development platform for data curation, exchange, and publication.

Aether is being developed by a multi-country team working in three different continents, so it was a challenge to sit down with them all in one place. Still, we talked with four people key to its development and asked them what exactly Aether is and why eHA decided to create it. Our conversation included the Director of eHA’s Global Health Informatics Dave Henry, Aether Product Manager Doug Moran, Systems Architect Shawn Sarwar, and Technical Team Lead Adam Butler.

Why is eHA developing Aether?

During our discussion, Shawn Sarwar explained that throughout eHA’s years of experience developing ehealth solutions we faced recurring challenges when scaling the impact of our products within the communities we serve.

Although eHA develops great tailored solutions for specific problems and customers, we were not always leveraging possible synergies between different projects. Shawn gave three reasons why solutions are typically been developed as stand alone projects:

  1. Customization can create maintenance challenges. When multiple customers use a particular solution, a certain level of customization is required. The various codebases can drift apart, making it difficult to apply bug and security fixes across all of them.

  2. There isn’t always a standard set of components across projects. One team may know one technical stack, while another could have a different preference. This leads to the siloing of potentially useful components according to people’s comfort and familiarity.

  3. Almost every project needs to integrate with one or more external systems. Because of this requirement, teams normally plan to write their own integration to exchange data between different applications.

As a consequence, we became very good at creating variations of common solutions. But instead of reinventing the wheel each time, what if we could capitalize on a framework for the development of ehealth solutions? This, Dave Henry explained, is what drove eHA to develop Aether.

He explained that these challenges are not unique to eHA; they point to a broader issue that slows development and deployment of many healthcare systems. Information and Communication Technology (ICT) solutions for global public health use cases rely heavily on open source software, but while individual open source applications have been put to good use, the ability to integrate them into sophisticated solutions has been limited to countries with sufficient funding and visionary, determined leadership. Dave explained that even the most successful solutions leave behind a legacy of isolated data silos. Last September, eHA decided to wrangle these problems by setting twin goals:

  1. Simplify the integration of popular ehealth applications.

  2. Provide a consistent way for data to flow from these applications directly to where it needs to go.

Today the Aether team is pleased to announce the results of this effort: the Aether platform and it’s first companion solution Gather.

What is Aether ?

Aether is a platform for data curation, exchange and publication.
— Dave Henry, Director of Global Health Informatics, eHealth Africa

More precisely, it is an integrated set of tools and services that allows developers to connect to data sources, interpret data structures, and map attributes into a normalized set of entities defined by a formal schema. Aether flows the resulting data in real-time to one or more downstream destinations. The publication process is open and modular – the destinations receive data based on the schema (a de facto contract) and are completely insulated from the source systems. Data can be delivered concurrently to multiple destinations.

In this way, Aether facilitates the flow of data between data-producing and data-consuming applications, enhances data security and privacy, and accelerates the transmission of data between organizations. Basically, Aether allows for faster and more accurate data-driven decision making that helps save lives.

Aether helps organizations exchange health data faster and easier, but most of all it improves the productivity of developers that create ehealth solutions. According to  Doug Moran, Aether is a product built by developers for developers to facilitate their work and free them to focus on the actual solution rather than infrastructure. Solutions become easier to deploy, maintain, and upgrade than traditional one-off projects built from scratch.  By building on a common foundation, the software development process becomes well defined, predictable, and repeatable.

Basically, Aether is a framework of best practices for ehealth systems design. The Aether developers have done much of the dirty grunt work so that the project teams can do the exciting and heroic stuff that solves real problems for real people.

And what about Gather ?

Dave also talked to us about Gather, the first solution and use case built on the Aether platform. Gather leverages Aether and 3rd-party open source software to collect and distribute data collected during large scale field surveys, receives survey data from forms submitted via Open Data Kit (ODK), and ingests it into an Aether pipeline for processing and distribution. The Gather solution includes the ability to flow data into ElasticSearch / Kibana as well as the CKAN Open Data Portal.  The Aether platform services are used to package and operate the ODK components, the Gather user interface, the Aether core modules and the Aether publishers.  Gather is just the first – but arguably the most universal – use case that eHA will address with Aether.

Technical Team Lead Adam Butler elaborated on the implementation of Gather across the countries where eHA’s operates. He explained that in Sierra Leone, the CHAMPS (Child Health and Mortality Prevention Surveillance) network uses Gather to collect data as part of an initiative to identify and prevent child death. In Nigeria, the GRID (Geospatial Reference Information Data) project uses Gather to collect spatial reference data and other points of interest such as health facilities, schools, markets, and post offices to create a geo-database that the government uses for data-driven decision making. In the Democratic Republic of the Congo, the DRC Microcensus project used Gather to conduct a microcensus in the region of Kinshasa and Bandundu in order to predict how many people live in each settlement and estimate the total population for DRC, information that is playing a vital role in the current Ebola outbreak.

What is eHA’s vision for Aether ?

According to the Aether team, eHealth Africa’s goal is to establish and support a vibrant global community around Aether and Aether-enabled solutions. Aether serves three distinct purposes:

  1. A platform for integrating, distributing, and operating sophisticated solutions for specific ehealth industry use cases.

  2. A facility for organizations that are taking their first steps into data governance and (internal) application interoperability.

  3. A controlled “on ramp” for organizations that engage in formal data sharing using international standards.

Aether will be launched as open source software this summer. Stay tuned for the release announcement!

Solutions based on Aether enable faster and more accurate data-driven decision making that helps save lives.