Fighting Cholera with the Power of Geospatial Mapping

By Ayodele Adeyemo & Hawa Kombian

The Cholera Threat

According to the World Health Organization (WHO), cholera (an infectious disease which causes acute watery diarrhea) remains a global threat to public health with an annual average of 82,000 deaths. In Nigeria, the cholera burden has been an average of 10,000 cases annually with over 70% of the cases coming from Bauchi, Yobe, and Zamfara states.

Following the review and recent publication of WHO guidelines on cholera control, the Nigeria Centre for Disease Control (NCDC) has begun the implementation of innovative approaches to tackle cholera via:

• Strengthening disease surveillance for early detection and quick response through innovative use of technology and data.

• Improving coordination for technical support, resource mobilization, and partnership.

• Adopting a multi-sectoral approach to meet the 2030 cholera elimination by working with the environment and Water and Sanitary Hygiene sectors to ensure that communities have good water and sanitary facilities which will prevent further outbreaks

The Digital Health Advantage

What does an innovative model for cholera prevention and control look like?

In 1854, John Snow mapped out the cholera deaths during an outbreak and observed that they all occurred within short distances and were clustered around the Broad Street pump. He went ahead to carry out statistical tests to illustrate the connection between the source of water and the cholera cases.

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Source: Netcentric Advocacy

In synergistic partnership, NCDC and eHealth Africa (eHA) used advanced geographic information systems (GIS) technologies to build on John Snow’s ideas of mapping. eHA uses data-driven solutions and tools to improve community health, with specific expertise in the design, development, validation, and deployment of predictive models for diseases like cholera.

GIS allow experts to explore different aspects of a geographical point. The identification of patterns can drive insights and enable health stakeholders to make informed decisions about how to best plan public health interventions. Due to computational and technological advancement, GIS has been used in public health for epidemiology, resource planning, and surveillance among others.  

NCDC and eHA were able to utilize GIS capabilities to enhance the data management within the NCDC National Incident Coordination Centre (ICC). The ICC serves as a the emergency operations center for coordinating disease outbreaks at the national level.

eHA’s GIS and Data Analytics team works with the NCDC to map cholera hotspots (areas where cholera persists) across Nigeria’s Local Government Areas (LGAs). At the start of the outbreak, hotspot analysis helps determine where to vaccinate and what quantity of vaccines are required per LGA. This exercise ensures the effectiveness of the oral cholera vaccine immunization campaigns which are rolled out to stop the spread of disease.

In planning, data from 2012-17 displays the spread of cholera outbreaks and also shows the relative risks of the various LGAs which have reported an outbreak during the five year period.

The Big Picture Data Source: Nigeria Centre for Disease Control

Data Source: Nigeria Centre for Disease Control

We layered the 2018 outbreak data with the historical hotspot analysis to identify specific trends and possible overlaps. The result of the hotspot analysis identified 83 LGAs as hotspots, with 87% reporting at least one case with over 70% of the burden from Bauchi, Kano, and Zamfara states. The LGAs identified as hotspots have enabled the government to make informed decisions about where to request vaccines to ensure that the most vulnerable areas are supported.

Data Source: Nigeria Centre for Disease Control

We continue to collaborate with the NCDC to strengthen cholera surveillance in Nigeria. The partnership ensures that data management and analysis expertise contribute to faster response and informed decision making before, during and after outbreaks.

This work was done in collaboration with the following partners:

• Yennan Sebastian- NCDC

• Adesola Ogunleye - NCDC

• Heloise Lucaccioni - UNICEF

• Helen Adamu - UMB

• Kobi Ampah- WHO Geneva              
  

How eHealth Africa supports Universal Health Coverage across Africa

By Emerald Awa- Agwu

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

WHO: Universal Health Coverage - What does it mean?

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

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

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

1. Health Financing for Universal Health Coverage

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

2. Essential Medicines and Health products

Vaccines are some of the most essential health commodities

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

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

3. Health systems governance

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

4. Health workforce

Health systems can only deliver care through the health workforce

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

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

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

5. Health Statistics and Information Systems

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

6. Service delivery and safety

Staff at the Kano Lab

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

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

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

Meet the Team: Muhammed-Naziru Halliru

Meet Muhammed-Naziru Halliru, a State Coordinator with our program delivery team!

Naziru is involved in planning, organizing and delivering activities to ensure that the objectives of the Geo-Referenced Infrastructure and Demographic Data for Development (GRID3) project are achieved. Following the mapping of the 36 states of Nigeria, he coordinated stakeholder engagement at the state level to garner government support for the use and application of geospatial data for better economic planning, resource distribution and decision making across a variety of sectors including health, education, agriculture, housing, and transport.

In addition to this, he supports capacity building activities for data managers at the State Ministry of Health, State Primary Health Care Management Board and the Health Management Information System department to equip them to manage, analyze and use the data stored on the GRID3 portal.

Although he has been with eHealth Africa for only a year, Naziru has made very significant contributions to his team and project. Under his supervision, the GRID3 project mapped 10 states across three geopolitical zones: North Central, North East, and North West and collected geospatial data on 19 point of interest categories. This data has been instrumental in improving the impact and effectiveness of polio eradication efforts in these states.

Naziru credits eHA with his new exposure and familiarity with technological tools which have enabled him to achieve his work goals more efficiently. eHA, according to him, has improved his communication and stakeholder engagement skills, which he believes will be invaluable to him in the long run.

“I am particularly proud that I am now able to use modern data management systems and technologies to deliver my role successfully. My work at eHealth Africa has also given me the opportunity to meet and engage with high-profile government officials including governors to advocate for the use of reliable geospatial data for better decision- making.”

— Muhammed-Naziru

eHealth Africa supports Sierra Leone’s Public Health Services for better response to public health emergencies

By Uche Ajene

The first-documented most widespread and deadly outbreak of the Ebola Virus Disease (EVD) in West Africa devastated three countries: Guinea, Liberia, and Sierra Leone. The outbreak started in May 2014 and by November 2014, during the height of the outbreak, Sierra Leone recorded over 500 new cases of Ebola a week. By October 2015, a total of 8,704 EVD cases had been diagnosed, and 3,589 people had died of Ebola in Sierra Leone.

This disease caught the country’s Ministry of Health and Sanitation (MoHS) by surprise. The outbreak could not be effectively managed because the country did not have the requisite capacity (structure and staff) and systems -Standard Operating Procedures (SOPs), policies and plans, to effectively manage and mitigate the risks posed by the disease.

Ebola’s destruction on the peoples of Sierra Leone and the absence of appropriate structures to deal with future outbreaks, prompted the establishment of Public Health National Emergency Operations Center (PHNEOC) in  June 2015, as a coordination structure charged with the responsibility of providing public health emergency preparedness leadership, scientific and technical situational awareness and advice at a national level.

As Sierra Leoneans reflect on the atrocities of Ebola and other emergencies, this question becomes inevitable: Is Sierra Leone better prepared to address any future public health emergencies?

To better prepare for future outbreaks, the U.S. Centers for Disease Control and Prevention (CDC), in collaboration with the Ministry of Health and Sanitation and eHealth Africa, conducted successful trainings for health workers and other stakeholders on Public Health Emergency Management, Risk Communication,Threat and Hazard Identification and Risk Assessment (THIRA), Incident Management Systems and Public Health Operations and Management. These training sessions were done in Bo, Bombali districts and Western Area Urban with the involvement of health workers, district councillors, the national security agency and members of the agricultural sector. These trainings are geared towards improving the PHNEOC’s capacity to better prepare for health-related emergencies.

The PHNEOC/MoHS as beneficiaries have acquired increased knowledge on the method of approach in risk mitigation, analysis, preparedness, response, and recovery. For instance, EOC Focal Persons have been trained in all districts in Sierra Leone to decentralize command and control approach which has provided the necessary pace, efficiency, and structure for response efforts and foster real-time reporting and bridged the gap in communication from the districts EOC’s to the national EOC. eHA, with support from CDC, has embarked on introducing tools that seek to improve the coordination strategy of the PHNEOC such as the Virtual  Emergency Operations Center (EOC) communication platform tool. eHA has partnered with MoHS with support from CDC to train about 200 PHNEOC/MoHS staff on various public health emergency topics such as tabletop simulation exercises on Cholera and Lassa Fever; Executive Management training and Virtual EOC training.

“I have participated in several trainings, I must confess that knowledge gained in this training is exceptional and can contribute meaningfully in any future outbreak and also benefit my District Health Management Team (DHMT) with management skills.”

— Sahr Amara Moiba

Virtual EOC training participants

Sahr Amara Moiba, District Surveillance Officer and EOC focal person in Kono district, is one of the 200 beneficiaries of the EMP training.

In 2018, there was a Measles outbreak in Pujehun and Kambia district. The EOC focal persons in these districts sent in a daily situational report to the national EOC which was presented to partners during the daily briefing meetings held at the EOC.

As part of the effort to strengthen the PHNEOC preparedness and response capacity, and also improve on the country’s Joint External Evaluation scores, eHA in collaboration with MoHS with support from CDC, developed SOPs for public health response. These SOPs will help improve on the response strategy of the PHNEOC in a coordinated way.

“These SOPs will help foster a coordinated response in an event of any public health emergency.”

— Mukeh Fambulleh, Program Manager of the PHNEOC

Meet the Team - Sylvia Kalley

Meet Sylvia Kalley, our Grants and Contracts Senior Manager,  who works in our Sierra Leone office!

Sylvia joined eHealth Africa (eHA) approximately 2 years ago. She plays an integral role at eHA, as she supports the entire project and program portfolio of eHA, across our country offices. She leads the grants and contracts department and is ultimately responsible for the effective management of the full life cycle of projects, from pre-award to close-out.

She manages a team of four, who all contribute to ensuring that the Grants Management office meets the requirements of our clients. When Sylvia first joined the team, she focused on identifying gaps with regards to Grants Management and better internal controls for meeting donor requirements and fostering accountability, in her first year. Now, in her second year, she leads her team to address those gaps and create solutions for better grants and contracts management.

Sylvia’s biggest contribution has been the formalizing of the Grants Management Office including the establishment of the New Business Development Department. Having a formalized office allows for a one to one ratio between a member of our department and each contract within the eHA portfolio. This oversight allows the organization to meet the requirements of each of its contracts as well as improve our credibility with our clients.

Sylvia is particularly proud of her achievements in streamlining the Award Set Up Process for the organization. Before the establishment of this process, visibility regarding signed contracts was quite limited to a few. In collaboration with the larger Finance & Administration team, they created a thorough award set up and project extension notice which provides key information to set up a project in their accounting system once the official contract is signed.

We are happy and proud to have Sylvia as part of our eHealth Africa team.

Would you like to be a part of our team? Click here to find out more.

Building Ecosystems that Drive Change

Our experience and track record working to implement projects across our focus areas have shown us that without a unified, collaborative approach, interventions tend to be ineffective and sometimes, inappropriate for the contexts that we work in. We know that solutions and systems are more impactful when they are built in proximity to the environments in which they are needed, and in partnership with stakeholders who have a close grasp of the challenges to be addressed.

Our goal is to build solutions that address local needs harnessing the power of technology and data. Therefore, we invest in growing the tech ecosystem and sharing our knowledge, lessons, and experience with our partners.
We host meetups and hackathons to create platforms for innovative organizations and individuals to share their work with the global tech community and to support governments with real, context-appropriate solutions to their development challenges. Recently, our GRID3 team partnered with CoLab Innovation Hub, the Kaduna State Bureau of Statistics (KDBS), the Kaduna State Budget and Planning Commission, the Kaduna State Government, and Kaduna ICT Hub to hold KadHack2018, a first of its kind hackathon aimed at providing software developers and stakeholders in the technology sector to engage the Kaduna state government and gain firsthand insight into the challenges in the Education and Health sectors, in order to come up with software prototypes that could be further developed to solve problems within those sectors.

Currently, most learning and education in Nigeria’s tech field are driven by the individuals themselves using resources, which are often external and not based on local challenges. An ecosystem should be self-sufficient. This means that members of the ecosystem should be able to learn, grow, earn and contribute to building the ecosystem. To this end, eHealth Africa is interested in further building the tech ecosystem in Kano State as a pipeline for developing tech talent to build solutions for the local context. Our software team is hosting its March tech meetup on the 30th of March, 2018 at the eHA Kano Campus by 12 pm. The event will feature in-depth knowledge sharing sessions with our team using real, relatable challenges and practical solutions. Read about our last meetups in Berlin and Kano.

If you are interested in gaining more knowledge to build software solutions that address challenges in health, education, and agriculture, then, register to attend the event here.

eHealth Africa and partners boost Sierra Leone’s surveillance capacity through 117 Call Center

By Uche Ajene

Photo caption: Alexander Taylor, 117 Call Center Manager conducted a tour of the upgraded facility

Between 2018 and 2019, eHealth Africa (eHA) and the Ministry of Health and Sanitation (MoHS) worked together to ensure that Sierra Leone’s surveillance efforts were strengthened through the use of 117 Call Center.

The 117 Call Center is a Sierra Leone Ministry of Health and Sanitation initiative that was set up in 2012 as part of a wider support system to improve maternal and child health. In 2014, eHA partnered with the Ministries of Health (MOH) in Guinea, Liberia, and Sierra Leone to scale up existing universal toll-free numbers to become Ebola focused call centers. The 117 Call Center was scaled-up in response to the Ebola Virus Disease (EVD) outbreak - to serve as a tool to document, track and provide follow-up on suspected EVD cases and deaths. The 117 Call Center provides an early warning mortality and syndromic surveillance system tool that can detect, prevent and respond to disease outbreaks. Communities are sensitized to call the 117  line and report all deaths, suspicious illnesses, and events. In Sierra Leone, the 117 Call Center has helped to solve many issues like improving community death reporting through mortality surveillance; real-time alert reporting for infectious death, increasing alert and data support to the maternal & perinatal disease surveillance.

Recently, the 117 Call Center has seen major transformation-from extending the facility and giving it a facelift, to upgrading software for a more efficient system that the peoples of Sierra Leone can trust and utilize.

“We have upgraded the call center software for a more accurate and precise data collection. Our community health workers play a very vital role in reporting cases to 117. We have added a new caller category of Community Health Workers. We also provided internet services for all the districts for real-time reporting and data collection for 117. We have also improved on our SMS software service that now provides a single text code to a caller to receive the burial code which confirms that they have indeed called 117.”

— Sally Williams, 117 Project Manager, eHA.

In an effort to get the districts more engaged, 117 is not just centralized in Freetown. Alert desks have been set up in all 14 districts with District and Data coordinators there to manage the calls in real time.

“The 117 Call Center is making positive strides in the country and the upgrade has taken it to international standard. 117 is easier to rebrand, given its popularity across the country.”

— Dr. A.J. Moosa, Deputy Director - Health Security and Emergency.

Strengthening the surveillance system in Sierra Leone through the 117 Call Center is an unending quest.

“We are planning on re-branding 117 and utilizing the social mobilization officers especially in the districts so that we can reach a greater number of our communities and encourage people to call 117 for any and all emergencies!”

— Sally Williams

The 117 Call Center actively participates in the Surveillance Technical working group of the government of Sierra Leone’s One Health Approach Initiative, where the most updated information is shared as received via our call centers to guide interventions. Every day, the 117 Call Center is striving to produce better quality data to drive the evidence-based approach when handling public health issues in the country.

International Women’s Day Spotlight: #BalanceforBetter

International Women's Day is a global day celebrating the social, economic, cultural and political achievements and contributions of women. The day has been celebrated for well over a century, since 1911 and draws attention to the need for more progressive mindsets, inclusive behaviors and continuous efforts from everyone, everywhere and at every level, to promote women’s equality.

Balance is not a women's issue, it's an economic issue. Gender equality and women empowerment are central to the attainment of all the United Nation’s Sustainable Development Goals. This year’s theme, #BalanceforBetter highlights the value that women add to their families, communities, economies, and to the world; as well as the contributions that they can bring to the table if they are given seats. Achieving balance requires that the voices and experiences of both men and women are considered and integrated at the inception of policies, innovations, and programs. No one should be left behind.  

Here at eHealth Africa, we embrace gender balance and we recognize its role in ensuring that businesses and projects, including ours, thrive. eHealth Africa is an equal opportunity employer and we have put policies in place that support both men and women to achieve their professional and personal goals. Our workplace policies on diversification and maternity leave challenge stereotypes in the workplace and encourage women at every stage of life to maintain the balance between their roles in their personal and professional lives. We are especially proud of the gender balance in our leadership. Our board of directors is 60% female and most members of our senior management team, are women.

Today, we recognize and thank the women we have worked with—the mothers who take their children to the health facilities we support, the female health workers who mobilize them, our staff at our country offices who create tools for collecting and analyzing reliable, real-time data and the women in governments across Africa, who plan programs and formulate policies that shape health systems.

We can all do something to support gender balance for a better world. Put your hands out and strike the #BalanceforBetter pose, as we celebrate women all over the world!

eHealth Africa renovates Njala University research center with CDC funding

By Sahr Ngaujah

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

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

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

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

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

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

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

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

— Dr Lebbie

eHealth Africa supports data collection on the prevalence of Hepatitis B in three districts in Sierra Leone

By Uche Ajene

eHealth Africa (eHA) is supporting data collection on the prevalence of Hepatitis B in the Bo and Bombali districts, and Western Urban area in Sierra Leone, through its Hepatitis B Sero Survey project. U.S. Centers for Disease Control and Prevention (CDC) is funding this project.

A Sero Survey is a test of blood serum from a group of individuals to determine seroprevalence.

The African Regional Committee of the World Health Organization in 2014, endorsed a resolution to reduce chronic Hepatitis B virus (HBV) infection prevalence to <2% in children less than 5 years of age in all member states by 2020. In Sierra Leone, there is no accurate data on Hepatitis B Virus (HBV) infection among children and women of childbearing age. Hence the need for a survey to determine the prevalence of HBV infection among infants, children and women of childbearing age in order to inform the HBV vaccination policy of Sierra Leone.

In 2007, the country introduced the Hepatitis B vaccine as a component of the pentavalent vaccine provided at 6, 10 and 14 weeks of age. However, a birth dose of Hepatitis B vaccine recommended by WHO to prevent mother - to - child HBV transmission is not yet included in the routine immunization schedule.

The Hepatitis B community serosurvey conducted in the 3 districts, targeted some 2,544 infants aged 4- 24 months and their biological mothers to evaluate the risk of mother to child transmission and subsequent need for a Hepatitis B vaccine birth dose; and also 2,332 children aged 5- 9 years to assess the impact of childhood pentavalent vaccine on the prevalence of Hepatitis B virus infection among children.

Prior to collecting data, a five- day classroom and practical field training was conducted to:

• build the knowledge of the surveyors

• identify households

• counsel families ahead of the survey

• conduct a rapid diagnostic test on Hepatitis B and  the processing and tracking of venous blood specimen

As part of the training, a practical field exercise was also conducted to pretest participants’ knowledge on the classroom training.

eHA is a technology-driven organization. In a drive to discourage potential errors via paper-based methods and to present an automated approach to health data collection, eHA also trained supervisors and phlebotomists on the use of the Open Data Kit (ODK) tool. eHA provided the phones and data for the survey and installed the ODK  app (which is used for data collection in the field), the age= app for age calculation, and the  ODK dashboard. With ODK, data collection is done easily, and survey activities monitored in near real time.

A total of 3,934 forms were submitted via the ODK tool of which 3,158 (80%) of households visited were willing to participate in the survey. Out of the 2,232 households selected for children aged 2 months - 24 months, 1,704 children were enrolled which is 76% and 1,604 biological mothers of these children were also enrolled.

For the 5-9 year-olds, out of the 2,250 households selected, 80% participated with 1,811 enrolled. For children with vaccination cards, 1,186 were enrolled and 401 for the 5- 9 year- olds. A total of 551 serum samples were collected during the 6-week community serosurvey.  

eHA continues to work with the CDC and other partners with a view to increasing the early detection and reporting of government-identified priority diseases, especially when very little is known about HBV prevalence in Sierra Leone.

Technical Career Development at eHealth Africa

Health systems, especially in within Africa, face the challenge of delivering high-quality services to an ever-growing population with limited resources. This has necessitated the development of innovative approaches to expand access to healthcare to larger numbers of people, even in the most difficult-to-reach locations. The role of electronic and mobile technologies, ranging from simple SMS messaging for reporting and complex information and data management systems for studying patterns in disease prevalence, in the transformation of healthcare delivery has become more evident.

eHealth Africa was founded in 2009, on the belief that adapting technology to meet local needs and settings, is the key to delivering better health services. A decade later and with projects such as the Geo-Referenced Infrastructure and Demographic Data for Development (GRID3) and solutions such as LoMIS Suite and Gather under our belt, eHealth Africa is an established leader in the Global Health Informatics (GHI) space.  Our approach to technology is that systems designed in proximity to the environment in which they are needed are stronger, more effective, and help close the gap between design and use.

Our GHI program spans several technical areas including software development, Geographic Information Systems (GIS) & Analytics, Information Technology & Engineering Operations, Business Analysis and DevOps Engineering. We therefore constantly seek to connect and leverage our work across focus areas while attracting and retaining the best employees. Through a more deliberate focus on employee development, we focus on building and keeping an outstanding Africa-based team to execute our work.

There’s always time to laugh when you love your job

Some members of our GHI team share some of the ways that eHA supports the development of careers in tech.

Evance, Senior Software Developer in Software & Solutions Development

“Working at eHealth Africa is by far, the most rewarding career experience I have had. I joined eHA two years ago and before that, I had several years of experience developing software for customer-oriented companies. At eHealth Africa, the focus is on saving lives in the most constrained environments in Africa. Not only have I worked on many projects, all requiring different technical specifications and I have done so in three countries namely, Guinea, Liberia, and Nigeria, using some of the coolest technologies available in our age such as Big/Sensitive data management, Offline- aware apps, Biometric identification). Creating software for various contexts and needs, motivates and challenges me to be more creative and to try new methods. I have grown as a software developer because of the work that I do at eHA. It is an amazing feeling for me to see how the codes I write contribute to improving healthcare among underserved populations.”

— Evance

Sandra, Senior Business Analyst in Software & Solutions Development

“As a Senior Business Analyst with the GHI program, I work in the capacity of a project manager, responsible for planning and executing a project. I am also responsible for the requirements analysis and documentation, specifications, development cycle and execution of a variety of GHI projects. eHA has provided me and my colleagues with a platform to excel. I have been given way more opportunities in just 1 year working with eHA, than in the two years I spent working with other organizations. At eHealth Africa, there are a lot of opportunities for career growth within the organization, irrespective of your tech inclination. I joined eHA as a Business Analyst in 2017 and by the end of 2018, I had been promoted twice. I have worked on many projects and last year, I was made the project lead for an eLearning initiative for employees and clients. Thanks to eHealth Africa, I and other colleagues were trained and have received the Projects in Controlled Environments (PRINCE2) certification, which is invaluable for a career in project management. The organization expects great results from their staff but what is most important is that eHA pushes and supports us to achieve our personal development and career goals.”

— -Sandra

Oluwafemi, Associate Manager, DevOps Engineering

“DevOps is a growing culture which was born out of the need to roll out incremental changes to software several times daily. In the past, it was not scalable or automated; now with new technologies in cloud computing, automation and deployment, development and operations process are easier and more cost-cutting.
At eHA, we use open source technologies to solve health-related challenges in contexts which are constantly evolving. It is very important for the solutions that we create to move from writing to pushing to production within minutes. DevOps simply eliminates the barrier between the people who develop software and those who operate it, allowing the development of solutions that integrate functionality with enhanced usage and minimal error. I joined eHA about 2 years ago as a DevOps engineer and in that time, I’ve worked with the team on the best and most cost-effective way to evolve and improve our solutions at a faster pace.
The best part of working in eHA, for me, is that there’s always room to learn and grow. I am continuously exchanging knowledge and learning about the latest technology trends to keep up with the ever-growing DevOps culture.”

— Oluwafemi

Detan, Associate Manager in Geographic Information Systems

“There is a tendency for techies to be somewhat distant from the clients who use their software or solutions. eHA allows members of the GHI team to be seconded to other eHA offices in Berlin, Sierra Leone, and Liberia and to clients in different parts of the continent (Chad, Cameroon, Niger) in order to ensure that the team is fully embedded with clients and fellow technical consultants. This provides a deeper grasp of the context and increases empathy towards the client and the work that we do, making work enjoyable, irrespective of the inherent challenges and risks in implementing a project.
In addition, jobs roles within the organization and division allow for flexibility and adaptability to suit project requirements and career goals. For example, business analysts may double as project managers on a small project, and there are opportunities for project managers and UI/UX designers to transition into product management roles if they are interested in such career paths, while technical leads may also double as technical project managers if need be. Members of the GHI team attend and plan conferences, hackathons and other meetups within the technology industry. This helps our team stay abreast with new trends in our field so they can improve themselves, and deliver better results.”

— Detan

eHealth Africa is committed not just to delivering data-driven solutions that address systems-level issues across Africa, but to providing career and learning opportunities to tech enthusiasts. We are passionate about sharing our knowledge, experience, and skills with the next generation in order to inspire positive change. eHealth Africa frequently hosts tech meetups in Kano and Berlin to bring together individuals who are interested in developing technological tools for development.

If you are interested in pursuing a career in tech or global health informatics with an established leader in the field, visit the careers page on our website to keep up with internship or job opportunities.

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

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

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

How AVADAR works

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

Global Polio Eradication Initiative: AFP Surveillance indicators

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

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

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

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

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

AVADAR dashboard

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

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

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

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

Meet the Team - Ori Okibe

Meet Ori Okibe, the Operations Administration Coordinator at our head office in Kano.

She joined eHealth Africa over five years ago as the Administrative Coordinator of the Sokoto State Polio Emergency Operations Center (PEOC), where she provided administrative support to the EOC team and partners. In no time, she rose to become the State Manager of the PEOC where she managed the daily operations of the EOC including staff, fleet, and other assets.

Currently, she supervises the administrative and operational activities of the procurement, warehouse and logistics team. She is in charge of managing vendors according to master service agreements and ensuring that the procurement and supply chain team meets delivery deadlines.

Recently, Ori worked with the team responsible for the renovation of three zonal offices of the National Primary Health Care Development Agency (NPHCDA) in Bauchi, Kano and Niger states. Ori is most proud of the role that she and her team played in the containment of the Ebola Virus disease outbreak in Lagos State in 2015. Some of her other achievements include managing the initial setup of the Sokoto Meningitis Lab by ensuring that all logistics, travel, and procurement needs were met.

Ori credits eHA with giving her and other staff opportunities to discover and showcase competencies which they may never have discovered otherwise. In recognition of her dedication and service towards the eradication of Polio in Sokoto State, she and nineteen other recipients in Nigeria were presented with the Rotary International Meritorious Award for Polio Service in 2018.

“In the course of meeting my work objectives, discover skills and competencies that I didn’t know I possessed. These have enabled me to overcome several challenges and offered opportunities that I ordinarily would not think I can handle. Even though my role is mostly operational, I support core project delivery in so many ways and I know that I am giving back to the society”

— Ori Okibe

We are proud to have Ori on our team. If you would like to join us, please visit our careers page.

Benefits of a Direct Delivery Model

By Adamu Lawan and Emerald Awa- Agwu

eHealth Africa's third- party logistics service, VDD ensures that vaccines are delivered to last mile health facilities in a timely manner

Vaccination is one of public health’s most cost-effective interventions. According to the World Health Organization1, it prevents between 2 million to 3 million deaths every year. Even though there has been great progress towards achieving universal coverage, there are still 20 million unvaccinated and under-vaccinated children worldwide. To reach these children and to meet global disease elimination targets, all countries must provide an uninterrupted supply of potent vaccines to the most hard-to-reach and conflict-affected areas.

Nigeria has experienced challenges in maintaining functional vaccine cold chains and supply chains, leading to low vaccination coverage rates. Nigeria’s cold chain system consists of five levels: a national cold store which stores all vaccines in the country and supplies six zonal cold stores located in each of Nigeria’s six geopolitical zones. The zonal stores supply vaccines to the state cold stores, which in turn supply the LGA cold stores. The primary health care facilities staff have to visit the LGA cold stores to collect their vaccines on a weekly or daily basis depending on the status of their cold chain equipment.

This system was inefficient and time- consuming because health workers from over 9,000 health facilities in Nigeria often had to leave work to collect vaccines when they could be treating patients instead. In addition, the system was fraught with high operational costs and poor vaccine stock visibility, especially in transit.

To alleviate this problem, the Nigerian government adopted a direct delivery model called Push Plus in 2013, to transform its supply chain at the state level. A direct delivery model is one which delivers vaccines and dry goods directly from the state cold store to the last mile health facilities according to customized schedules, bypassing the LGA warehouses completely and preventing stock-outs.

The benefits of this model have been enormous. The direct delivery model has freed up an additional 1- 6 hours each week for health workers to attend to patients—time previously spent by health workers in transit to obtain vaccines. In addition, vaccine availability at the last mile health facilities has improved. By increasing the number of health facilities that have functional cold chain equipment, health posts and smaller health facilities can receive vaccines from closer health facilities instead of going to the LGA cold store every day. This has led to a massive drop in the stock-out rate. In Kano state, vaccine stock-out rates dropped from 93% to 3% and in Lagos State, from 43% to none. Not surprisingly, the immunization coverage of Lagos State increased from 57% to 88%. WHO2 lists vaccine shortages and stock-outs as a major cause of missed opportunities to vaccinate.

Nigeria is projected to spend about US$ 450 million by 2020 on vaccines, By increasing vaccine accountability and visibility, the direct delivery model has also reduced the amount of money that could be lost due to wastage and pilfering of vaccines.

eHealth Africa implemented Vaccine Direct Delivery, a third-party logistics service based on the direct delivery model in Kano State from 2014 to 2016 and currently implements it in Bauchi and Sokoto states. We work with the state primary healthcare development agencies to ensure that vaccines and dry goods are delivered safely and in a timely manner to health facilities. Using our LoMIS Deliver solution, eHA plans, schedules, and routes deliveries to enable health delivery officers choose the correct quantity of vaccines and dry goods from the state cold stores and deliver them to health facilities equipped with cold chain equipment. The process of determining what quantities to deliver at the health facility is fully automated to avoid manual errors. The project also incorporates reverse logistics—returning balance stock or waste, if any to the state cold store. VDD provides governments and other stakeholders with accurate, near real-time data for decision making and forecasting.

Through VDD, over 28 million doses of vaccines have been delivered to health facilities in Kano, Bauchi and Sokoto State from 2014 to date, reaching over 13 million children under the age of one. eHealth Africa continues to support governments across Africa with system-level approaches to transforming health service delivery.

Welcoming Micheline Ntiru to eHealth Africa’s Board of Directors

At eHealth Africa, our greatest strength is our people. We believe in attracting and working with passionate, motivated individuals who add value to the work that we do to build stronger health systems across Africa. We are pleased to announce the appointment of Micheline Ntiru as a member of eHA’s Board of Directors.

Micheline joins Andrew Karlyn, My T. Le and our Executive Directors, Evelyn Castle and Adam Thompson to provide professional governance, mentorship to senior leadership, guidance on critical organizational functions, and global representation in order to support and strengthen eHA.

Micheline has 20 years of experience in small and medium enterprises (SMEs) growth, impact investment, sustainability, and public health management globally. She is a coach and business facilitator for the SEED Program at Stanford University’s Global Business School, an initiative to transform business and leadership practice among high-performing CEOs of SMEs in Africa. In addition, she provides portfolio and deal structuring advice to private equity and venture capital investors in Europe and North America.

Within the public health space, she has held several management and advisory positions with leading nonprofit organizations such as Care International and Helen Keller International, on thematic areas such as maternal and child health, Malaria and HIV/AIDS and public health nutrition.

To learn more about Micheline and the other members of our Board of Directors, visit the “Our People” page on our website. We look forward to working with her in the months and years to come.

Internship Spotlight: Justice Agbadu's Top 5 Reasons Why You Should Intern with eHealth Africa

By Justice Agbadu

My name is Justice Agbadu, a student of the African Institute for Mathematical Sciences (AIMS) in South Africa. As part of the Industry Immersion Program in my school, I joined eHealth Africa as an intern with the Geographic Information Systems (GIS) & Analytics department. Any student aspiring to begin a career knows that an internship is invaluable for gaining on-the-job skills, experience and for establishing necessary contacts. Internships help to integrate theoretical knowledge gained in school with day to day practical field application. An employer is more likely to hire a candidate with internship experience than someone who has no experience, especially at the entry level.

I have been with eHA for a little over five months and it has been a wonderful experience

Here are my top 5 reasons why you should intern with eHealth Africa.

1. Working with some of the most genius minds across the world

eHealth Africa’s young, dynamic workforce is made up of smart people from countries all over the world. I have had the opportunity to work with people with varying skill sets and levels of experience in different fields and I am shocked by how much I have already learned. I am also gaining knowledge outside my field and learning about different cultures.

2. Conducive Working Environment

eHealth Africa is located on serene, beautiful grounds that relax you and make you glad to be at work. All staff members are provided with all the tools that they need to deliver the desired results. I love the fact that every department has its own feel and vibe. In my department, GIS, we are pretty laid back and you can often find us seated on bean bags analyzing geographic data collection tools. My favorite part of my work environment is the people—they are friendly and always ready to answer my numerous questions. This helped me to settle in quickly despite the fact that I had never visited Kano.

3. Personal and professional development

One of my favorite quotes is by Mark Twain—”The two most important days in your life are the day you are born and the day you find out why.” I can definitely say that this internship at eHA has helped me discover my professional direction and career goals. This is really important because a lot of people are moving through the motions without having clearly defined goals and objectives.  I have also discovered personal skills and competencies that I never knew I possessed. eHA easily has the largest GIS team in Africa and there is always something new and challenging to work on; so I am gaining knowledge that most people don’t have access to, which positions me as a valuable asset in this field.

4. Opportunities for Career Growth

eHealth Africa’s team is spread across several countries in Africa as well as in Berlin and the US. We implement data-driven projects in five focus areas: Disease Surveillance Systems, Health Delivery Systems, Laboratory & Diagnostics Systems, Nutrition & Food Security systems, and Public Health Emergency Management Systems. This wide scope of work means that staff have various opportunities to grow and migrate within the organization. In the course of my internship, I have seen staff move to Nigeria from other country offices and vice versa. Some staff in the organization started out as interns just like me and have now become project managers. eHA is an established thought leader in the field of technology and data for health systems strengthening so I know that having this internship experience on my CV already highlights me as a valuable talent to other organization.

5. Solving Real-world Problems

eHA works to address real problems such as access to quality health care and services and nutrition. One of my favorite projects is the Vaccinator Tracking Systems, a project that captures passive tracks of vaccination teams during the Immunization Plus Days using a mobile application installed on Android phones. Using GIS technology, eHA is able to provide governments with near real-time data on the vaccination coverage during IPDs to aid planning and decision making. I am very glad that I am contributing in some way to the eradication of Polio in Nigeria. This internship experience has made me more passionate to do more to help underserved populations in Africa and to improve their quality of life.

The experience so far has been very rewarding and I look forward to more opportunities to contribute to the work at eHA.

Looking for or interested in an internship spot, visit our careers page for more information.

NPHCDA Zonal Office in Kano gets an Upgrade

An often neglected aspect of executing health projects or interventions is the availability of functional infrastructure. A comfortable working environment and the availability of work tools such as internet and communication systems have a positive impact on employee performance and increase work productivity.

eHealth Africa collaborates with partners to design, build, restore and maintain diverse sites and facilities. With funding from the Bill and Melinda Gates Foundation (BMGF) and in partnership with the National Primary Health Care Development Agency (NPHCDA), we renovated the administrative block of three NPHCDA zonal offices in Kano, Minna and Bauchi states in 2018.

The renovated NPHCDA zonal office in Kano

The focus of this renovation was on alleviating the perennial problem of insufficient workspaces and power outages which have hindered staff from delivering on tasks. The administrative offices were fitted with new work tables, chairs and office equipment. The reception area and the conveniences were also refurbished. eHealth Africa renovated a thirty-seater conference room and fitted it with audio and video conferencing technologies like microphones and a projector system.

30- seater conference room

eHA also upgraded the IT facility in these facilities, installing a state of the art data/ server system.  In addition, an off-grid hybrid (Solar and wind) power system was installed to provide 24-hour electricity. Solar panels are a cost- effective electricity source that will not be financially burdensome on the agency in the long- run.  

On the 18th of December, 2018, the staff of the Kano Zonal NPHCDA office moved into the newly renovated office. eHealth Africa also conducted a technical know-how/ product knowledge training for relevant staff at the Kano zonal office to enable them configure, use and properly use the IT facilities.

NPHCDA zonal staff and eHA renovation team at the renovated Kano zonal office in Naibawa

Are you interested in our infrastructure services? Click here to read more.

Three things I learned at the 2018 ASLM Conference

By Tolulope Oginni

At eHealth Africa, we aspire to operate effective laboratories that use state-of-the-art tools and technologies to collect, analyze and disseminate usable, reliable data that can help governments, stakeholders and the health system in general, to mount appropriate responses to public health threats.

The 4th conference of the African Society for Laboratory Medicine (ASLM) was held in Abuja, Nigeria from 10-13 December 2018. This year, the focus was on “Preventing and Controlling the Next Pandemic”. The event provided a platform for stakeholders in the international laboratory medicine community to address issues, share best practices and develop innovative approaches to combat current and emerging health threats.

Conferences are an exciting, interactive way to learn new things in any field. I was excited to attend the 2018 ASLM conference with a colleague from our Sokoto Meningitis Lab. Here are three new things I learned.

1. The need for labs to adopt External Quality Assurance (EQA) to improve their laboratory processes and performance

External quality assurance is a system for objectively checking a lab’s performance and processes by comparing it against an external agency or facility. EQA helps to identify systematic problems associated with kits and operations so that corrective action can be taken immediately. By participating in external quality assurance, training needs and capability gaps among lab staff can be identified and solved so that the lab can produce more accurate and reliable results. This is especially important for labs in Africa which are the backbones of disease surveillance and response.

2. Increasing efficiency in lab diagnosis and testing

One of the resounding themes at the 2018 conference was the need for labs across Africa to learn and adopt modern testing techniques such as Multiplexing and microfluidic assays in their operations. Multiplexing and microfluidic assays allow various investigative procedures to be simultaneously conducted on two or more analytes—chemical components of interest—using the same biological sample. By reducing the time spent preparing samples and conducting multiple tests, it boosts efficiency and reduces wastage.

3. Collaboration in public health research

At eHealth Africa, we design and partner in public health laboratory research in order to contribute to the body of knowledge and increase access to quality information in the field of laboratory and diagnostics in Africa. We are currently collaborating with the International Foundation Against Infectious Disease in Nigeria (IFAIN) and University of Nebraska Medical Center (UNMC) on an investigative device that can increase access to sickle cell diagnostic services to low resource settings. In addition, we are collaborating with Sokoto state government to provide round-the-year laboratory-based meningitis surveillance in Sokoto, Kebbi and Zamfara state.

However, public health research in Africa is a field that is still largely untapped and one which requires a lot of strengthening. I was very pleased when the conference devoted an entire pre-workshop conference to Manuscript writing and research conceptualization. In addition, it gave me the opportunity to meet Professor Iruka Okeke, a professor of Microbiology whose work I have followed since my days as an undergraduate. One of the plenary sessions focused on synergizing partnerships which I believe is important for growth in this field. As one of the speakers said, “...the problem with public health research in Africa is not a lack of partners but lack of coordination of the many activities conducted by various partners.”

With friends at the conference

It is imperative that labs in Africa position themselves properly to support epidemiological surveillance systems. In West Africa especially, labs must do more to meet the standards set by their counterparts in Southern and Eastern Africa international accreditation such as ISO 15189. A large number of accredited labs in Nigeria are government-owned research labs. Work still needs to be done by privately- owned labs to attain this accreditation. In the face of emerging public health issues, now more than ever, efforts must be made to strengthen public-private partnerships and participation in laboratory medicine.

Partnering to Address Sickle Cell Disease in Northern Nigeria

By Muhammed Hassan

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

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

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

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

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

The Impact:

Practical Solutions to Challenges in Reporting: LoMIS Stock and eIDSR

By Abdullahi Halilu Katuka and Emerald Awa- Agwu

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

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

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

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

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

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

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