Partnerships and Networks: Essential for achieving food security

By Chinedu Anarado

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

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

During the planting stage

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

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

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

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

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

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

Farmers at the Pre-Implementation Workshop

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

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

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

By Emerald Awa-Agwu and Mohammed-Faosy Adeniran

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

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

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

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

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

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

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

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

Natural disasters in China

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

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

The Conflict in Northeast Nigeria

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

Laborers loading food items in the Kano warehouse managed by eHA

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

Tracking Unknown Settlements in Anambra State, Nigeria

Since 2012, eHealth Africa has been part of national and global polio eradication efforts. For the most part, our interventions and support have been deployed in Northern Nigeria. However, when two cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) were reported in Anambra state early this year, our field operations team was deployed to conduct Vaccination tracking and hamlet buster activities for the first time in eastern Nigeria.

The exercise was conducted in nine high-risk Local Government Areas of Anambra State and the data obtained from the exercise, including habitation status, geocoordinates, and settlement names, were used to develop comprehensive microplans for an upcoming Outbreak Response (OBR) activity in the state. 

We appreciate the members of our Field Operations team who work long hours, travel to distant locations and brave difficult terrain to help us reach every last child with lifesaving vaccination services.

Click the slide show to see how the trip went.

You never know what will happen on the field, so we take everything we need

Field Officers getting ready for deployment

Sometimes the road is dusty

Sometimes, there is insane traffic

But we always move together

The terrain is never easy, so, no mode of transportation is off limits

Even canoes

It’s grueling work- The PFOs need to train LGA ward focal persons and supervisors before the commencement of the campaign

But there’s always time for a selfie

Building Local Capacity and Infrastructure for Disease Surveillance in Africa

By Chinedu Anarado

Nigeria is the only country in Africa where polio is still endemic, however, the continent is still at risk of polio returning due to low immunity levels and weak surveillance systems.  Since 2016, the AVADAR project has been implemented in 8 countries across West and Central Africa to improve the quality and sensitivity of Acute Flaccid Paralysis (AFP) surveillance by health workers and key informants within health facilities and local communities, using mobile phones and an SMS based software application. eHealth Africa trained a total of 7,847 community informants to identify and report suspected cases of AFP, which is the defining symptom of Polio.

The AVADAR mobile application

The project increased the rate of AFP detection and reporting and put the implementing countries in a better position to meet the World Health Organization’s targets for AFP surveillance. In the Democratic Republic of Congo (DRC), for example, a total of 499 true AFP cases have been reported by community informants through AVADAR, a significant improvement over traditional paper-based surveillance systems which yielded 38 cases in the same period.

The Challenge

Our goal was to model a system that would enable health systems in the implementing countries to find, report and investigate AFP cases, and that would be sustainable in the long run. It became imperative for the health systems in these countries to take ownership of and lead the implementation and expansion of the AVADAR model, and possibly replicate it for the surveillance, reporting, and investigation of other diseases of public health concern. However, without the requisite skills, most countries will fail at effectively managing the system including reporting and managing the investigation of cases, and tracking and resolving technical issues.

The Strategy

Relying on our experience with the execution of AVADAR, where some informants were groomed to take on more roles on the project, we worked with the WHO to identify champion informants who had distinguished themselves through their timeliness on the system and technical aptitude with the AVADAR devices. Some of these informants were trained to serve as investigators—who track and review reported AFP cases to confirm if they are true or not—or as technical officers, who resolve technical issues and ensure that their fellow informants are able to continue reporting suspected AFP cases.

The technical officers were grouped into two categories: first-level and second-level technical support officers. The first-level technical officers serve as the first point of contact when an informant has technical challenges with his/her device. When they are unable to resolve these issues, they escalate the challenge to the second-level technical support officers, who are usually WHO staff or investigators within the country ministries of health, with superior technical skills. The second level support officers ensure that all issues are resolved and the AVADAR system can continue to work as expected.

The Success

So far, a total of 217 first level and 57 second-level informants have been trained across all the six countries eHA supported in 2019, as well as Liberia. eHA has now ended operations in four of these six countries— Chad, the Democratic Republic of Congo, Sierra Leone, and South Sudan and the trainees are now managing the network. The technical officers were trained using a two-step approach: theory-based training that took place in a classroom setting, and field practical sessions, giving trainees the opportunity to investigate and resolve real-life technical issues in the field. eHA continues to provide support in Cameroon and Niger, leading refresher training sessions for technical support officers, and resolving advanced technical issues in the two countries.

Some AVADAR informants are also going beyond polio to detect and report other priority diseases such as Measles, Yellow Fever, and Diarrhea in their communities using AVADAR. The flexibility of the AVADAR system and its potential to be used for reporting and detecting other priority diseases leaves no doubt that these countries are better equipped to prevent future outbreaks and protect their populations.

VDD’s inroads against Vaccine Shortages in Zamfara State

By Sadiq Haruna

Even though the federal government of Nigeria, adopted the Push-Plus system of vaccine delivery in 2013, Zamfara State experienced challenges with vaccine supply and availability at the health facility level. This led to large numbers of newborns and infants being completely unvaccinated or not completing the full vaccination course. eHealth Africa began providing third-party logistics (3PL) services to the Zamfara State Primary Health Care Management Board through the Vaccine Direct Delivery project in 2019. Through the service, vaccines are delivered directly to all the government health facilities and 14 local government cold stores in the state.

See the numbers so far:

Using Geospatial Technology to Improve Vaccination Coverage Rates: A Case Study of Ganjuwa LGA, Bauchi State

By Fatima Mohammed

In May 2012, Nigeria and 193 other member states of the World Health Assembly endorsed the Global Vaccine Action Plan (GVAP), a strategy to launch the “Decade of Vaccines” during which millions of deaths would be prevented through more equitable access to vaccines, by 2020. Two important targets of this plan were that all 194 countries should attain a national coverage of 90% and 80% in every district or equivalent administrative unit, for all vaccines.

Since the launch of the plan, the National Program on Immunization (NPI) led by the National Primary Health Care Development Agency (NPHCDA), has made great efforts to increase the immunization coverage rate in Nigeria. Immunization is a top priority for decision-makers and they have collaborated with partner organizations to develop strategies to strengthen the delivery and demand for Routine Immunization (RI) and Supplementary Immunization Activities (SIAs). As a result, more children have been vaccinated than ever before1. However, Nigeria is still ranked as one of the countries with the lowest immunization coverage rates globally2. Several factors such as the insurgency in the Northeast, and cultural perceptions and beliefs leading to non-compliance and drop-out rates, have contributed to this but a major challenge has been the lack of an accurate denominator.

A child getting vaccinated during a vaccination campaign in Kogi State

What is a denominator?

A denominator usually refers to the total estimated number of eligible individuals in a population or the total estimated number of people in a target population3, 4. When delivering immunization services, health personnel develop micro plans to ensure that immunization services reach every community5. Micro-plans are used to identify priority communities, determine denominators/ eligible individuals, identify barriers and develop work plans for deploying solutions to those barriers6. Denominators are essential during the microplanning process to make sure that eligible people are not left out.  If health workers and administrators are unaware of a community’s existence, that community may be left out of micro-plans, denying eligible children the vaccines that they need. This will, in turn, reduce herd immunity in the state and eventually in the country, even though high immunization coverage rates are recorded.

An ongoing microplanning activity

For the past decade, eHealth Africa has worked with partners to support the National Program on Immunization and increasing the capacity of health systems to deliver quality health services, especially in underserved communities. eHA designs and deploys data-driven solutions and interventions that leverage Geographic Information Systems (GIS) technology, to identify and map settlements within the remotest communities, so that health workers can develop accurate, comprehensive micro-plans, to better plan and monitor health interventions.

A Data Collector collecting settlement data in Bauchi State

Through the Vaccinator Tracking Systems (VTS) project, we track the movement of vaccinators during SIAs to identify missed settlements and ensure that these settlements and their target population are reached, achieving a wider immunization coverage. Having mapped all the 36 states of Nigeria through the Geo-Referenced Infrastructure and Demographic Data for Development (GRID3) project, we provide up to date maps to states based on an accurate database of settlements and communities in  Nigeria, enabling our partner states to plan more efficiently. 

Case Study: Ganjuwa Local Government Area in Bauchi State

The Bauchi state master list of settlements contains 1,134 settlements for Ganjuwa Local Government Area (LGA). The planning for all interventions and projects in the state is based on this number. However, the eHealth Africa geodatabase has a list of 2,817 settlements for the same LGA, implying that almost 60% of the settlements in the LGA are left out during the microplanning process and consequently, during polio campaigns. Whenever eHA conducted the vaccinator tracking exercise based on the list on our geodatabase, the LGA perpetually fell below the target coverage rates.

To address this, eHA planned and conducted a “Hamlet Buster” activity to identify and rename the missed settlements in Ganjuwa LGA, in December 2019. The LGA had 2,051 machine-named settlements according to our geodatabase, the highest ever recorded in Nigeria.  Machine-named settlements occur when geospatial data collection tools pick up on features that are indicative of hamlet areas or small settlement areas. During a hamlet buster activity, field data collectors trace and visit these settlements using their geocoordinates, determine their name and accurate boundaries, and update them on the geodatabase. 

At the end of the hamlet buster activity in Ganjuwa, 1984 0f 2051 machine-named settlements were visited and renamed. This data will help to achieve the following in Bauchi State:

• Improve healthcare provision planning and Monitoring by updating the existing micro plans

• Harmonize the LGA/State master list of settlements with eHA’s geodatabase list

• Create more accurate health facility catchment area maps and targets for Routine Immunization and other interventions

“This work will help the state to achieve great milestones in health delivery because the data will not only be used for immunization but for other programs. It will make our planning for future activities easier and more realistic. The state is very grateful to eHealth Africa for this because we now have an authentic microplan. eHealth Africa also helped us to transit from paper-based to digital micro plans.”

— Bakoji Ahmed State Immunization Officer, Bauchi State.

Announcing the eHealth Africa Academy in Kano

With over a decade of experience developing and deploying digital solutions across Africa and some of the most experienced tech professionals in our team, eHealth Africa is committed to sharing knowledge and empowering the next generation to solve local problems using technology and data. We are announcing the launch of eHealth Africa Academy in Nigeria. The first cohort of the Academy, which will run from February 29, 2020, to April 25, 2020, and will focus on teaching participants basic web development skills in HTML, JavaScript, and CSS, and how to apply these skills to start a career in web design. '

The academy will use a combination of in-person workshops and online courses to cover the curriculum within the two-month period. eHealth Africa invites participants with basic computer knowledge to apply to join the Academy. The costs of the program are being covered by the organization and will be free for the participants, however, interested participants must have access to a laptop and internet, and must be able to attend the in-person workshops in Kano during the course of the program. 

Strengthening the Malaria Continuum of Care through Data Collection and Research

By Les de Wit and Emerald Awa-Agwu

In 2018, there were approximately 258 million cases of Malaria worldwide and 93% of these cases occurred in Africa. Pregnant women and children have been the focus of most Malaria eradication projects and this has led to a remarkable decrease in the prevalence and incidence of the disease in this population1. However, among young people and non-pregnant adults, the number of new cases is on the rise.1 and very little is known about the attitudes and health-seeking behavior of this group around Malaria.2

Patients at Nuhu Bamalli Maternity Hospital

To answer the questions about the knowledge, attitude and behavior patterns of young people and to inform Malaria strategy and program development to eliminate the disease, data was needed. 

With our expertise in data collection, eHealth Africa teamed up with Restless Development, a youth-led development organization, whose mission is to place young people at the forefront of change and development and CUAMM, an Italian non-governmental organization. This key goal of the project was to support the implementation of the Fighting Malaria Improving Health Project, funded by Comic Relief and GSK.

How did we do this?

eHA developed the digital survey tool, set up mobile devices for data collection and provided data visualization and analysis, as well as related training. The survey was created using an open-source tool often utilized in low resource settings, Open Data Kit (ODK). 

Following the creation of the electronic survey, tablets were installed with an ODK app and configured to download the survey form. Data was collected from 5,000 individuals between the ages of 15 - 24 in three chiefdoms within the Port Loko district of Sierra Leone. Chiefdoms are the third and lowest administrative levels of governance in Sierra Leone. eHA trained a team of young people to conduct the survey and send reports electronically. Data collection could take place in the absence of an internet connection because of ODK’s ability to store data offline and then, synchronize to the server periodically when an internet connection became available.

eHA has developed an ODK companion tool, Gather, which allows for secure turnkey integration with various data sharing solutions. Using Gather, the collected data was able to be viewed online in an open-source visualization service, Kibana. The Gather and Kibana connection allowed representation of data in near real-time - as soon as the survey responses were synced from the mobile tablets the survey results would appear live in Kibana which had been configured with a number of data monitoring dashboards to provide aggregated views of response data.

At the conclusion of the two data collection periods, the results were automatically compared within Kibana and workshops were held in Lunsar in conjunction with all stakeholders to review and discuss survey findings.

A refresher training on ODK for researchers in Lunsar, Sierra Leone

Overall, the insights gained from these projects supported learning around how action research can help young people to take a leadership role in identifying the underlying causes of public health issues in communities.

eHealth Africa in the Fight against Malaria

Malaria is a public health issue that eHealth Africa is extremely passionate about. We have collaborated with several partners to identify challenges within the continuum of care and to provide the decision-makers and program planners with solutions that are appropriate for their contexts and with data that paints a true picture of the situation so that they can make informed decisions. 

A data collector in Kaduna State, Nigeria

Recently, we supported Malaria Consortium to map nine hard-to-reach local government areas of Kaduna State and eleven hard-to-reach local government areas of Kano State. We leveraged our expertise in Geographic Information Systems to collect geospatial data relating to settlement names and locations, and the nearest functional primary and secondary health facilities to the settlements over a period of two weeks.

Also, last year, eHealth Africa partnered with Case Western Reserve University, Hemex Health and the University of Nebraska Medical Center (UNMC) to design the Sickle and Malaria Accurate Remote Testing (SMART), an integrated point of care platform that diagnoses, tracks and monitors sickle cell disease and malaria in low-resource settings. The solution won the Vodafone Wireless Initiative Project Prize. 

eHA also worked with THINKMD and the Kano State Primary Health Care Management Board (KSPHCMB) to implement a 2-month study among community health workers (CHWs) in five LGAs to determine if the MEDSINC, a digital clinical assessment platform could improve adherence to the Integrated Management of Childhood Illnesses (IMCI) clinical guidelines. 

As always, our goal is to support our partners with technological solutions that can improve health delivery and increase access to quality health services for underserved populations.

LOMIS Stock Goes National!

By Joshua Ozugbakun and Emerald Awa-Agwu

How can accurate, real-time health inventory data will improve access to essential medicines and save lives?

With over 23,640 health facilities alone in Nigeria (as at 2005), collecting, managing and keeping track of health commodity stock data can be cumbersome. For the Nigeria Centre for Disease Control and Prevention (NCDC), the agency that is tasked with ensuring that pharmaceutical and health commodities are available in all the 36 states of Nigeria and the Federal Capital Territory, Abuja, this is a major challenge. To effectively prevent, treat and control diseases, medical supplies, and essential medicines must be available at all health facilities, treatment centers, and laboratories at all times. If the NCDC is unable to keep track of its own stock inventory data, its ability to deliver on its mandate will be hindered.

Prior to now, NCDC used to stock, track delivery, and management of pharmaceutical products using paper-based documentation. This method was not only error-prone but made it difficult to access and analyze information about pharmaceutical commodities stock and allocation across the 36 states in Nigeria and Abuja (FCT). This led to delays in the decision-making process to replenish commodities and in turn, stockouts at health facilities and treatment centers. 

The resultant effects of these delays and stockouts are poor health outcomes like high mortality and morbidity rates, low life expectancies, and distrust in the health system. There are already several unpleasant stories of people who had diseases that were not detected or treated adequately because the medical supplies and essential medicines were unavailable, and the statistics only worsen as one goes from urban to rural areas.

Health workers in Chiranchi Primary Health Center using LoMIS Stock to take health stock inventory

The LoMIS Stock mobile application

To address this challenge, NCDC partnered with eHealth Africa to automate its supply chain processes for the distribution of pharmaceutical and laboratory commodities. eHA introduced and scaled up LoMIS Stock, a solution that has been used by the Kano State Primary Health Care Management Board (KSPHCMB) to manage the supply and availability of vaccines and health commodities at last-mile health facilities, since 2014 with great success.

The tool allows health workers to submit reports relating to vaccine stock availability and utilization, alongside other details as required by various users, thus ensuring that near-real-time data relating to vaccine and pharmaceutical stock inventory can be accessed by decision-makers and health program planners for evidence-based planning and action. For example, NCDC’s ability to monitor the real-time stock levels of antiviral medications like Rivabirin at health facilities will ensure that response campaigns are executed in a seamless manner and that Nigeria is better able to respond to outbreaks of viral hemorrhagic diseases.

Since October 2019, eHealth Africa’s Technical team has been working with NCDC’s Supply Chain Unit to configure/customize the tool whilst entering data on its National Stockpile onto the system. Currently, over 300 commodities have been entered onto the system and we expect more commodities to be added in the course of this year. This will ensure that the distribution of these commodities is faster and more efficient and that the agency’s operational processes are targeted and data-driven. 

eHA and NCDC are employing a staggered approach to ensure that the tool is rolled out and adopted by the State Ministries of Health, treatment centers and NCDC-affiliated laboratories across 36 states and FCT of Nigeria by June 2020.  The potential for transforming health service delivery and health information management in Nigeria through technology is limitless.

Ensuring RI quality through Monitoring and Supportive Supervision

By Fatima Adamu

A comprehensive Routine Immunization (RI) program is critical to ensure health security for any population. RI helps to prevent and eradicate diseases, support surveillance, and strengthen preparedness and response to health emergencies. Every year, the Federal Government of Nigeria spends millions of U.S. dollars on the national immunization program. As of 2015, the estimated total expenditure on vaccination was US$302,103,133.

A mother and child at the Immunization Clinic at Nuhu Bamalli Hospital, Kano State

With so much money being spent, decision-makers at various levels need to ensure that they are getting value for money. Various partners, including eHealth Africa, support the government in various capacities to strengthen the capacity of Nigeria’s health system to provide quality immunization services and thus, reach all eligible children. eHealth Africa has been working with the Kano State Primary Health Care Management Board (KSPHCMB) to answer the following questions:

• What resources (infrastructure, human resources for health) are available and what is the status of these resources?

• What is the level of knowledge of the health workforce?

• What is the quality of services provided at the facility level? Do the services provided conform with set standard operating procedures?

• What challenges prevent health workers from providing immunization at the highest quality?

These questions represent the gaps that existed in Kano State’s RI program before 2014 when the Kano Connect project was launched. KSPHCMB was riddled with poor reporting, communication, and data management systems, making it difficult for them to have a clear picture of what was taking place at the facility level.  The Kano Connect platform embedded supportive supervision to increase accountability and RI service quality. 

A Routine Immunization session at Nuhu Bamalli Hospital

Supportive Supervision and Monitoring in RI

Supportive supervision fosters program improvement by imparting knowledge and skills to health workers through a hands-on approach. During supportive supervision visits or activities, supervisors go to the health facility to observe and assess the services provided by health workers using checklists or set indicators. Based on the results of their observation, they can correct errors and note any challenges with supply and resources. It also allows supervisors to measure and monitor trends in vaccination coverage and other immunization systems indicators like safety and vaccine management by reviewing reports and data.

In Kano State, the Kano Connect project/platform provided mobile phones, Closed User Group (CUG) platform, airtime and internet access to Kano state health workers across the three levels (state, zonal, and LGA) in the state, to enable them to send RI Supportive Supervision reports through their mobile phones and communicate with their colleagues for free. The Kano connect platform allows RISS officers to send action points from supportive supervision visits as well as the geo-coordinates of the health facilities.

A RISS Program Officer conducting a supportive supervision visit to Dala Maternal and Child Health Clinic

The RISS reports are submitted near-real-time (as soon as the sessions are conducted) as soon as sessions are conducted by both the RISS officer. This helps the state to monitor and track all RISS reports across the three levels.

Additionally, through the use of our designated Kano Connect online dashboard, managers are able to visualize the RISS data for action. Similarly, LGA level staff in the routine immunization system are also able to see both their individual performance and the data collected.  By visualizing more granular-level information, the data becomes more useful for decision-making within the sector which drives solutions towards improving RI coverage rates across the state.

The Kano Connect dashboard

Kano Connect has supported the Kano state government to verify locations of over 1,000 RI health facilities across the state using our expertise in Geographic Information Systems. This has led to an evidence-based geolocation update of the database and has helped to aid planning to reach all eligible children in the state. Additionally, the platform has made HWs more accountable in conducting RI sessions as planned and provided a system for managers to track action points in the state.

Since the uptake on the use of the Kano Connect dashboard in 2016,  the RISS submissions at the state, zonal and LGA levels have reached 98%, 100%, and 96% respectively; this has improved data quality of routine immunization supportive supervision in Kano State.

Finally, in the last five years, the Kano Connect platform has provided an accountability path for the entire RI program in Kano by improving data quality and frequency and by highlighting key gaps and action points for tracking and follow up. The continuous real-time effect of the Kano Connect platform helps managers to correctly identify issues and act promptly which in turn helps to increase the RI coverage among target populations of children across Kano State. Supportive supervision as a strategy in the delivery of public health services promotes quality at all levels of the health system through the development of professional competence among the health workforce.

Is geospatial data the key to leaving no one behind?

By Jennifer Bencivenga

At its best, the 2016 Paris climate agreement is a fledgling roadmap to fundamentally changing the way humans interact with their environment; at its worst, it’s the grandest of empty gestures.

Whichever the case, global recognition of the climate crisis is certainly a step in the right direction, providing the basis for more ambitious future commitments. However, for communities already experiencing the often catastrophic consequences of a warming Earth, large-scale action and incremental progress offers little in the way of relief — their priority, simply put, is survival.

Small island developing states are quite literally on the frontlines of climate change, facing effects such as rising sea levels, climbing temperatures, and extreme weather events disproportionate to the rest of the world. Though scattered across the Caribbean, Pacific, Indian, and Atlantic oceans, they share similar… Continue reading the rest of the article on Devex

Supporting Access to Immunization through Supplementary Immunization Activities

By Abubakar Shehu and Emerald Awa- Agwu

Supplementary Immunization Activities (SIAs) are one of the four strategies put forward by the Global Polio Eradication Initiative (GPEI) in 1988. In Nigeria, SIAs include Immunization Plus Days (IPDs), Outbreak Responses (OBRs) and other immunization outreaches conducted by the Nigerian government and its polio eradication partners. The aim of SIAs is to interrupt the transmission of the poliovirus by immunizing all children under five years of age with two doses of oral polio vaccine irrespective of their previous immunization status—unimmunized, partially covered or fully immunized.

A child receiving the Oral Polio Vaccine

SIAs are intended to complement Routine Immunization. However, in some areas, they represent the major strategy for catching unimmunized children and ensuring that they are vaccinated against polio and other vaccine-preventable diseases. Access to routine immunization services may be hindered for a variety of reasons including:

• Challenges with cold chain equipment leading to vaccine damage and loss of potency, and eventually, unavailability of vaccines. Caregivers are often reluctant to return to health facilities where vaccines were unavailable. This results in missed opportunities to commence or complete the vaccination course.

• Security challenges that make health facilities hard to reach by caregivers who bring children for immunization.

• Access-related challenges such as caregivers having to travel long distances to the health facility or being unable to afford the cost of transportation

• Wrong myths or perceptions about vaccinations such as loss of fertility as a result of vaccination.

SIAs take immunization services directly to children at their doorsteps, thereby bridging any gaps that may result from an inability to access vaccines at the health facilities. By achieving a vaccination coverage of at least 80% (that is, by vaccinating at least 80% of the targeted children with a potent vaccine), herd immunity can be achieved and the poliovirus can be deprived of the susceptible hosts which it needs to survive.

Through Supplementary Immunization Activities, children who were missed by routine immunization services can be reached with life-saving vaccines

Prior to 2012, Nigeria had been conducting SIAs but was still recording cases of wild poliovirus (WPV). After a holistic examination of the immunization program, it was discovered that there was a huge disparity between the actual versus reported immunization coverage. Reports from independent monitoring and supervision groups showed that the actual vaccination coverage of the SIAs was much lower than the reported coverage. There were many missed settlements and an even larger number of missed children. It was discovered that some vaccination teams never visited the communities, instead, they would discard the vaccines and record false information in the tally sheets to account for the empty vials. Not only was this frustrating the polio eradication efforts, but it was also causing the health system huge losses as a result of the wasted vaccines.

It became imperative to develop a methodology to improve vaccination coverage and ensure that the vaccination teams visited all the target settlements during SIAs. This led to the development and deployment of the Vaccination Tracking System (VTS) in 2012.

VTS provides healthcare administrators and partners in the polio eradication space with daily insight into the activities of vaccination teams during SIAs by collecting passive tracks of the vaccination teams using Geographic Information Systems (GIS technology-enabled android phones and uploading them onto a dashboard for visualization. This provides stakeholders with near-live data about the geo-coverage of the vaccination campaign. The system also identifies missed settlements on a daily basis so that immediate action can be taken and the settlements can be included in the ongoing campaign. Another benefit of the VTS is that it increases the accountability of vaccination teams because the vaccinators know that they are under constant supervision. This greatly reduces the risk of data falsification.

The VTS dashboard provides decision-makers with near-real-time data about the progress of immunization campaigns and outreaches

So far, VTS has been used to track 82 supplementary immunization activities in 30 states of Nigeria. A significant proportion of these states have seen an exponential increase in the vaccination geo-coverage rates from the first campaign tracked to the last tracked campaign.

Increase in vaccination coverage rates

VTS makes sure that eligible children who, for any reason, are unable to receive their vaccinations through the routine immunization sessions at the health facilities, have a second chance to be protected against vaccine-preventable diseases like Polio and Meningitis.

Meet The Team - Sally Williams

Balancing work and personal life can be difficult. This is especially true if you have a demanding job like Sally Williams.

Sally is the Project Manager for Sierra Leone’s 117 Call Center and she leads a nation-wide multi-disciplinary 44-man team of District Coordinators, Project Coordinators, Administrative Support and Technical Consultants and the entire staff at the call center in Freetown. While being a project manager extraordinaire during the day, she is still able to find time daily for her passion, fitness, and exercise. 
Sally believes that teamwork is a large part of the reason she is successful in her role and can find time to ensure work/life balance. She relies on all members of her team to perform well in their individual roles and work together to accomplish the goals set for the team and because they’re successful in this, she is able to focus on strategic initiatives that have moved the 117 Call Center forward. Some of these strategic initiatives include transitioning the 117 Call Center from an ebola emergency hotline to a surveillance platform and the 117 Call Center rebranding efforts.

Sally receiving her Team of the Quarter certificate

She recognizes the fact that her team’s dedication and efforts are a key factor in achieving their goals and getting some of the accolades and milestones they are celebrating. Her team’s dedicated work is paying off. In Quarter 2 of 2019, Sally’s team was voted the winner of ‘’Team of the Quarter,’ award,’ one of eHA’s ways of recognizing teamwork, having fulfilled certain criteria-including outstanding performance, innovation, and quality, during the course of a given quarter.

“My role is a challenging but thrilling one. I have an affinity for teamwork. The favorite part of my job is interacting with my team in the districts because they are the ones in the field that go day-to-day out in the community spreading the message of 117. Their dedication is priceless.”

— Sally Williams

“When Sally is around us, you would hardly tell who is the boss. She mixes well but knows how to get us to do a good job. Her positive attitude towards us motivates us to work harder for best results.”

— Maseray Sesay, Project Assistant, 117 Call Center project

Sally works well with everybody, both within the 117 Call Center team and the eHA team as a whole, and is an inspiration to all. She is always encouraging to others and makes others feel comfortable enough to communicate openly and honestly with her. She works collaboratively, allowing everyone to bring their strengths and motivates them to identify and work on areas where they need to get stronger.

Sally loves teamwork but is also passionate about serving in an organization or team that shares her vision. Like eHA’s mission, she finds joy in serving underserved communities, and this is what makes her go the extra mile as a member of the #eHA team.

Sally with some members of her team

Sally bringing her passion to the workplace, leading fitness activities during our employee engagement events

“I love an organization that is dedicated to helping the underserved population. eHealth Africa is also a family-oriented workplace and that was appealing, especially when one is already far away from home. Knowing that our services to the community do not go unnoticed, excites me the most. Although we have trying times, the day to day challenges motivates me to do more!”

— Sally

Lessons from the eHealth Africa-Emory University Schistosomiasis Study

By Tolulope Oginni and Emerald Awa-Agwu

Schistosomiasis and nineteen other diseases are classified by the World Health Organization as Neglected Tropical Diseases. It is an acute and chronic parasitic disease caused by blood flukes called schistosoma. People become infected when larval forms of the parasite (worms) penetrate their skin during contact with infested water. 

The disease can present in two main forms: intestinal and urogenital schistosomiasis. Intestinal schistosomiasis can result in abdominal pain, diarrhea,  blood in the stool, and liver and spleen enlargement in advanced cases. The most distinguishing symptom of urogenital schistosomiasis is haematuria (blood in urine). Fibrosis of the bladder and ureter, kidney damage, genital lesions and vaginal bleeding in women, and pathology of the seminal vesicles, prostate and other organs in men. In later stages, urogenital schistosomiasis may lead to bladder cancer and infertility.

The disease is endemic to Nigeria and existing data places Nigeria as home to the highest number of recorded cases in the world. While there are insufficient research data and medical records to paint a true picture of the disease burden in Nigeria, it is estimated that 29 million Nigerians are infected with the disease and almost half of this number are children.

In June and July, eHealth Africa partnered with Emory University on a study to compare three diagnostic methods to determine their effectiveness in detecting acute and chronic schistosomiasis in low-resource settings. Accurate diagnostics are crucial to yield more information about the disease and ultimately, to achieve the goal of eliminating the disease. One of the major challenges facing the elimination of schistosomiasis is that very few infected people present at the health facilities for treatment. This can be attributed to a myriad of reasons including stigma, insufficient medical services, affordability of medical services, low knowledge of the signs and symptoms of the infection, and local perceptions and myths about the disease. The wider effect of this passive case finding (that is, cases are discovered only when infected persons visit the health facilities for treatment) and poor health-seeking behavior is that there is inadequate data to support the prioritization of schistosomiasis control by decision-makers and health program planners. In addition, medical laboratory scientists and researchers are unable to make improvements to diagnostic procedures for schistosomiasis because very few patients visit health facilities to access treatment.

During this study, eHealth Africa and two Emory University MPH students also trained 10 community health workers to administer questionnaires aimed at assessing the knowledge, attitudes, and perceptions about Schistosoma haematobium infection(urinary schistosomiasis) among communities in five Local Government Areas in Kano State.

Training of Community Health Workers

The responses from the survey yielded astounding local interpretations of the symptoms of urinary schistosomiasis. Community members saw red urine (haematuria or blood in the urine) as a normal and rather harmless phenomenon, a rite of passage or a sign of manhood for young boys. It was also linked to the menstrual cycle for girls or women. Yet another misconception was that it could be caused by staying long hours under the sun. Among women especially, underreporting of the disease was exacerbated by socio-cultural norms and beliefs that prevent them from handling urine samples in public.

Administering questionnaires at Sani Marshal Government Arabic Secondary School, Kura LGA, Kano State

With this understanding and the results of the study, eHA and Emory University hope to influence policies, strategies and plans around the diagnosis and control of Schistosomiasis in Nigeria.

Meet the Team - Maryam Haruna

What do you do when you have to get 30 people to 25 destinations?

We don’t know but Maryam Haruna does.

Maryam Haruna works with the operations team at our Kano campus as the Senior Associate in charge of travel. Here is how she works traveling and accommodation miracles for our staff coming in and out of base locations on a daily basis.

1. Be prepared, even in your sleep

Keeping track of travels is no mean feat! Sometimes, demands for tickets come at odd times and require urgent attention. Maryam’s strategy is to have her work tools on her at all times so that she can access and verify information and respond to travel requests. Of course, this is slightly easier for her because she used to be a Project Field Officer (PFO). Before joining the operations team, Maryam worked on several field tracking and disease surveillance projects and this experience helps her to anticipate and mitigate the challenges of field staff who require her support.

2. Think fast but pay attention to detail

In Maryam’s line of work, it is all too easy to mix up information about who is going where and when. She prevents this with her keen eye for details and her best friend, Google Calendar! Her calendar is one of her most priceless tools and she uses it to manage her time and keep track of appointments and deadlines.

Maryam at work

3. Communicate frequently and clearly

There will always be changes and last-minute developments to accommodation and travel bookings. Sometimes, flights can get delayed for hours leading to changes in pick-up and drop-off arrangements. Maryam has to ensure that she shares information with the fleet team, the staff member and any other stakeholders as soon as possible.

4. Reward yourself

After a long day, she congratulates herself with a pat on the back and a bowl of frozen mango slices.

Internship Spotlight: Lessons from my eHA internship

By Hassan Cecil Bangura

I am Hassan Cecil Bangura,  a finance intern with eHealth Africa (eHA)  in Sierra Leone. I joined eHA as an intern in  January 2019. My internship here at eHA has been a learning opportunity for me, in preparation for opportunities in the future. Being an intern at eHA is one of the best things that has ever happened to me. There are several lessons I have learned from my internship experience.

I learned practical accounting skills that have added more value to me

I started my internship with the spirit to embrace new things that will positively impact my career. I am an Applied Accounting graduate from the Institute of Public Administration and Management (IPAM), University of Sierra Leone (USL). In the classroom, I learned the theoretical aspect of being an accountant, but I lacked the practical skills. My internship with eHA has added more value to my education by giving me hands-on experience. From the first day at eHA, I have been given tasks and responsibilities that have broadened my horizon and I have now mastered tasks that I had only learned about in theory, such as bank reconciliation; periodic financial analysis to identify and resolve issues, gaps, and variances, financial planning and reporting, among many others. In practice, I can now execute a payment process, from requesting stage up until disbursement. I never would have gotten this in the classroom.

The eHA finance team is a mentoring team.

Everybody wants to be in a team where people are willing to pass on the skills they have learned. I am in the right place, given the exposure and mentorship I have received from members of the eHA finance team in Sierra Leone. This will last me a lifetime. We have built good relationships such that I can even call on anyone from the team after my internship is completed, trusting they will help in solving any problems I might have. Let me just pause for a while and appreciate the finance team for making my internship at eHA a memorable and fulfilling one.

How to build my resume. eHA is preparing me for my next job. I have learned so much and not just related to my role in the Finance team, but also on getting myself ready for future job opportunities. The culture at eHA encourages good work ethics and continuous professional growth. eHA offers free access to online courses to staff members, that allows us to continue to learn about subjects that can sharpen our skills. With this, I am convinced my internship with eHA is a springboard for larger opportunities. In addition to the online courses, sometimes teams within eHA organize workshops to allow us to learn from each other. I was fortunate to be able to participate in a Writing a Winning Curriculum Vitae (CV) and Interview Guide mini workshop organized by the Human Resources Department in Sierra Leone. That training opened my eyes to see the common mistakes people make when drafting CVs and applying for jobs. The experience I have gained with eHA is in itself a CV builder. After my internship with eHA, I am sure that I can take up any accounting role with ease.

eHA has enhanced my communication skills and increased my self-confidence.

My whole life I have felt like a shy, awkward and introverted, I didn’t feel that I had the skills required to deal with groups of people. I lacked self-confidence. But since I joined eHA, I have further developed my communication skills and increased my confidence as a result of our weekly internal finance department meetings. Each team member (yes even interns) is required to present to the team and give updates to the rest of the team about their accomplishments throughout the past week. With this weekly practice, I have gradually learned to overcome my shyness and apprehension to speak in front of groups of people. I might not be ready to speak to a stadium full of people but I certainly feel more comfortable about speaking up in larger all staff meetings.

Gaining work experience is key for boosting employability, especially as an aspiring accountant. eHA has given a truly unique opportunity to grow professionally and personally, for which I am forever grateful. I have the requisite experience to perform excellently in future accounting roles, especially within International Non-government Organizations (INGOs).

Mark Your Calendar: The July Tech Meetup

Join us for the July session of the Kano Tech meetup. This month’s session will focus on Geographic Information Systems. If you would like to find out more about GIS and learning how mapping can transform all sectors of society, don't miss this edition!

Attendance is free but registration is required.
Not in Kano? No problem. Join us online at the same date and time:

eHA and Afrolynk co-host Meet Your Neighbors in Tech for Global Good

eHA and Afrolynk teamed up with Unicorn Workspaces to host a meetup that brought together the community of innovators that makes Berlin, Germany a hub for technology-driven social impact.

Approximately fifty attendees listened to talks related to different aspects of leveraging technology for social impact before getting to know one another during a networking session.

The speakers were Moses Acquah, the founder of Afrolynk; Sabine Claassen, a Senior UI/UX Designer at eHealth Africa; Dr. Seth Kofi Abrokwa from the Robert Koch Institute; and Vanessa von Frankenberg, a senior venture developer and project manager at Digital Health Factory.

See photos from the event below.

Dr. Seth Kofi Abrokwa discussing "Predictive Analysis in Digital Health Care"

Vanessa von Frankenberg of Digital Health Factory discussing "Innovative Ways to Use Digital Health for Global Good"

Sabine Claassen, Senior UI/UX Designer at eHA discussing "Problem-first Design"

Hosts, Jennifer Bencivenga and Sannssi Cisse

Moses Acquah, founder of Afrolynk, discussing "Understanding your Customer to Make an Ethical Viable Digital Business"

Meet the Team - Masud Abdullahi

Masud Abdullahi is the face of eHealth Africa at the Katsina Emergency Operations Center (EOC).

As office manager, Masud makes sure that our polio eradication partners, who utilize the EOC have access to all amenities including steady electricity and internet connectivity at all times so that Routine Immunization reports and data from Supplementary Immunization Activities (SIAs) can be promptly reviewed and acted upon.

He has been the Office Manager at the  Katsina EOC for three and a half years now but insists that every day feels like the first day that he resumed. He is still in awe of the time and efforts that go into polio eradication and surveillance.  In addition to managing his eight-person team, he supervises how the assets and supplies that are deployed to the EOC are used. He represents eHA at meetings, builds and maintains relationships with external stakeholders and serves as eHA’s liaison person in Katsina state. 

Masud’s driving force is to never be the weak link in any organization or team. This mindset has helped him evolve from being just a boss to a leader who leads by example. He is especially proud of his team and in his eyes, his greatest achievement is that he is able to lead and build the capacity of his high-performing team so that they can support the organization's objectives and initiatives.

Despite his quiet exterior, he is very adventurous and curious about other places and cultures. He satisfies this curiosity by traveling and watching movies.

“I am proud of how far I have come. Since I started working at eHA, I have gained several skills from the numerous trainings that the organization has organized. I have learned how to use digital tools and solutions to support polio eradication activities such as mapping and microplan development. This has increased the value that I add to our work and my potential to be an asset to any other organization. The work at eHA is very rewarding. Last year, the EOC was a command center for Cerebrospinal Meningitis, Cholera, and Yellow Fever outbreaks and I am glad that I contributed to those efforts, in some capacity”

— Masud Abdullahi

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

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

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

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

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

Why Schistosomiasis? What inspired this project?

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

What's the purpose of this research study?

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

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

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

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

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

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