World Tuberculosis Day: Investing in diagnosis to save lives

By Juliana Jacob

Tuberculosis (TB) is one of the world’s most significant causes of mortality, and it is also the first from a single infectious agent. 1.7 million people died from tuberculosis (TB) in 2016, with Africa accounting for over 25% of the total deaths. Tuberculosis is not incurable, but timely diagnosis is necessary to get proper treatment. However, lack of access to health facilities that provide diagnostic and treatment services is an obstacle for people in low-resource settings.

Why is TB diagnosis a challenge in Sub-Saharan Africa? Here are some facts you need to know about diagnosing and treating TB in Africa.

1. Ten million lives were saved in the African Region between 2000 and 2014 through TB diagnosis and treatment. When suspected patients of TB receive timely and accurate diagnoses, they are empowered to seek treatment which increases their chances of curing non-drug-resistant strains of TB.

2. Nigeria accounted for about 12% of the enormous gap between the number of new cases reported (7.0 million) and the estimated 10.0 million (9.0–11.1 million) incident cases in 2018. This gap was due to underreporting of detected cases and underdiagnosis.

3. In 2017, 10 million patients fell ill with tuberculosis; 36% were undiagnosed or detected and not reported. In many countries across Africa, the number goes higher. In Tanzania, it is as high as 55%.

4. Funding for TB diagnosis and treatment has doubled since 2006 but still falls far short of what is needed. When the funds required are not available, there will be a significant reduction in the number of people diagnosed with TB.

Diagnosis of TB remains a challenge in developing countries, and innovative interventions can help bridge the gap in TB diagnosis and treatment. One of such interventions is  Health Telematics Infrastructure (HTI). eHealth Africa worked with the Charité University of Medicine to design HTI, a digital solution to improve, analyze, and evaluate the diagnosis and treatment of TB and HIV. We implemented HTI in St. Francis Referral Hospital (SFRH), Ifakara Health Institute (IHI) in Ifakara, and Kilombero District (central Tanzania). 

HTI is an SMS-based solution that allows patients to get their TB and HIV test results faster through text messages. Before the implementation of HTI, patients would travel long distances to Ifakara to get tested and return at a later date to get their results. Many patients did not return to Ifakara to collect their results due to the cost of transportation and other factors. Without their diagnoses, patients did not seek treatment and potentially infected more people.

Some benefits of the HTI system include; accurate and timely diagnosis of suspected patients of tuberculosis, patients having access to cutting-edge diagnostic methods, and a treatment process that is structured and monitored to ensure that patients follow through with their entire treatment process. 

The system sends reminders to patients to inform them about the next step in their treatment plan. This method of getting test results via SMS saves time. It removes barriers to TB treatment clinics that were previously inaccessible to the people of these communities due to long distances. We gathered information from patients using a tablet and open-source software ‘open data kit (ODK) collect.’ We used Aether and Gather to analyze the data from the ODK collect app. As a security measure, we also installed data protection so that we can retrieve data in the event of a loss. We have successfully routed 79.9% of SMS correctly to the patients.

To end tuberculosis, we must coordinate and implement approaches that will help us scale the hurdles associated with TB diagnosis, especially in low-income countries and communities. Communicating test results to patients on time and effective communication on TB diagnosis will decrease the number of people who die from the disease because they better understand their condition and can start appropriate treatment regimens. 

Towards a More Evidence-Informed Intervention

By Hafsat Jaafar, Sunday James and Stephanie Okpere

While cost-effective interventions exist, utilization of nutrition services and maternal care remain drastically low.

The roots of poor nutrition and maternal health lie in human behavior. Improvements in nutrition and maternal health outcomes are not possible without broad widespread changes in the everyday behaviors of people and institutions that influence them. There is a significant lack of comprehensive understanding of the various structural and sociocultural issues that pose a challenge in boosting nutritional and maternal status in Nigeria. Exploring the complex network of intrapersonal and community factors influencing the utilization of these services will aid in the development of targeted interventions to support this population.

Stakeholders who attended the KAPs study validation workshop physically

Changing behaviors for nutrition and adolescent health requires a variety of approaches. -The lack of adeptness or understanding contributes to negative nutrition behaviors. People also practice certain behaviors when they believe them. Myths, misinterpretation, cultural practices, and other drawbacks including cost, location, and availability are major quagmires that can stand in the way of change or desired behaviors.

eHA-ANRIN consortium via the Accelerating Nutrition Results in Nigeria (project) in Kaduna state is providing basic nutrition, reproductive and adolescent health counseling services in 12 LGAs in Kaduna state. In addition to this, we are conducting a Knowledge, Attitudes, and Practices ((KAP) study around nutritional behavior and adolescent health amongst women and children under 5 years of age in Kaduna State. This formative study aims to develop a multidisciplinary and comprehensive approach that would positively influence nutritional and birth spacing behavior within our target groups.

The motivation for this approach is to allow for the evaluation of outcomes towards understanding how eHA-ANRIN can increase the utilization of quality, cost-effective nutritional services for the target group. Specifically, these insights will support the development of a behavior change communication strategy as well as the development of information, education, and communication (IEC) materials by the consortium partners.

A group photo of stakeholders after the session in Kaduna State.

Considering that behavior change approaches are essential to foundational cross-cutting change strategies for the achievement of program results. eHAANRiN hopes to use a balanced approach in its programming with supply and demand-side interventions. Efforts will be made to ensure the study is robust: key influencers of nutritional and reproductive health behaviors across the various segments of the state will be part of the study. We will also work very closely with our stakeholders; the Kaduna state government, all the relevant agencies, partners, implementers amongst others in the state to ensure that their insights are also captured. BUSARA, a member of the eHA - ANRIN consortium has strong experience delivering similar studies and currently leads the delivery.

Through this study, the consortium aims to; 

• increase access to nutrition and birth-spacing commodities and tailored counseling for the target population, particularly in hard-to-reach (HTR) areas

• generate demand for commodities and counseling by deploying behavioral science techniques; 

• and integrate a data-led approach to improve the delivery of essential products and services.

In the aftermath, the KAPs study plans to pinpoint the motivation, latitude, and challenges that influence the target group’s behavior, define behavior change objectives, and the mix of intervention and behavior change communication  products and campaigns to help our target group to live a healthy and fulfilled life.

#BreakTheBias: A step closer

By Juliana Jacob

While many organizations attempt to increase the number of women in the workforce, there is still a disparity between the number of women in the workplace compared with men, especially in the tech industry. As of 2021, women held only about 25% of jobs in the technology industry. Further studies show that the number of female software engineers has gone up by only 2% in the last 21 years.

As an organization, we are passionate about using modern technology tools to make data-driven decision-making to strengthen health systems across Africa. To ensure the sustainability of our interventions, we work to increase tech talent in the countries we work in. In 2016, we launched the eHealth Africa Academy in Guinea to develop technical talent that would maintain and improve the disease surveillance applications we introduced in the country during the 2014 Ebola outbreak. In 2020, we relaunched the eHA Academy in Kano, Nigeria to address the needs of the growing tech ecosystem in Kano and neighboring cities.

We completed successful in-person cohorts in Kano and when the COVID-19 pandemic started we switched to a virtual format which allowed us to attract even more participants from across Africa. With the influx of new participants, we expected the number of women who applied to eHA Academy to increase, however the percentage of women still remained at approximately 20%. This low percentage was troubling to us because as an organization, we are committed to building a more diverse and equitable workplace and have implemented strategies to increase the number of women in our workforce. 

It was important to us to increase the number of women trained by the Academy, so we decided to host an all-female cohort of the Academy to remove any barriers preventing women from applying. The reception of the all-female cohort was overwhelmingly positive and the number of female applicants increased exponentially. This all-female cohort started in January, and I spoke to some of the participants as they round up their classroom training and prepare for their internship placements.

Safinaz Mubarak
El Behaira, Egypt

Safinaz is a GIS specialist who intends to apply the knowledge she has gotten from the Academy to become a better programmer.

Her motivations…

Choosing this industry was a challenge for me. In the area I live in right now, they expect girls to get married after high school and not pursue high learning. But I chose survey and Maths which is a field dominated by men.

I wanted to expand my career by gaining new knowledge. At the moment, I work as a GIS specialist, and we use programming. So I joined the academy to learn how to do better programming and apply it in my daily tasks. Someone once said to me ``I couldn't become a programmer because I was a girl, that was all the motivation I needed to become one.

On her experience so far with the Academy…

I have no regrets. One thing I loved about the academy is that if you have the basic requirements, you will get all the help you need to do well. It was difficult being a part of an academy before now, so I am grateful I was selected. I didn’t know they would select me because I was not a programmer and I studied geography.

On her outlook on her future career in tech… 

Before this time, I would have said I do not have equal chances with men. But with the progress being made with bridging the gap, I feel confident that my chances are high.

As a medical doctor, the eHA Academy was Cynthia’s only way of venturing into the tech industry.

Her Motivations…

Coming from the medical field and now getting into the tech industry, I think the system favors men because there are more men in the workplace. I thought that with the increasing number of women getting into tech careers, we were going to see a change, but I feel there is a disparity and that translates into the support and opportunities given to women.

For me, I chose eHA Academy because I was looking into getting into the tech space and while speaking to people who work in the industry, I found out about the eHA Academy through someone on LinkedIn. I looked into it and I liked it. It includes not only coding but also encompasses healthcare. That’s a big deal for me since I want a career in both tech and medicine and eHA Academy was the perfect platform for me.

Dr. Cynthia Nabukanda Waliaula
Nairobi, Kenya

What she does to challenge the stereotypes…

As an African woman, I am always in the minority, even in my workplace. Diversity and inclusion have been really important to me. The way I have done that has been recognizing first that there needs to be a more diverse and inclusive environment in technology. How that works is for other women and girls to see people like them doing well in that field. When you see people like you doing things, you know you can be like them. I also amplify the voices of women through my Podcast. We need to tackle diversity and inclusion from the grassroots and not at the top.

On her experience so far with the Academy…

It has been very interesting and good. We started with simple things and now we are building more complex things. One of my favorite things about studying in the eHA Academy is the support that you get. We have mentors and others ready to step in to help. We also have platforms where people can share problems and roadblocks and get the help they need. I will recommend it to more women and girls.

Joy Alikali
Ibadan, Nigeria

From listening to her brother and his friends talk passionately about the tech industry, Joy developed an interest in becoming a tech guru.

Her Motivations… 

I am tech-savvy; I am good with gadgets. Also, when I stayed with my brother after school who was a software engineer, I got interested. I got exposed to terms like front-end, back-end, and product management. I started trying out things on my own and I found out that in the tech industry, you can build value for yourself and solve problems.

What she does to challenge the stereotypes…

First, I will speak up because now I know better. I know what I offer. I will also encourage awareness to be made against gender biases. Also, if I am in a position of influence,  I try to encourage equity on both sides.

On her experience so far with the Academy…

The journey has been an interesting one. Let me be honest, when I first started, we did the first challenge “Hello world”, and had to wait for the next challenge. I thought the academy was going at a slow pace, but I didn’t know we were in for it. When the next challenge came up, it had a lot to do with HTML and CSS. Our mentors have been of great help. Any time you reach out, they will help. They broke down software development in such a way that even a little child will understand. I will recommend this academy and cohort for anyone who has an interest in getting into the tech industry.

Getting more women into the tech industry requires several approaches that will ensure that more women are interested, considered, and prepared for tech roles. While we are far from balancing the gender disparity in the world, with initiatives like these, we are at least a step closer to breaking the bias that exists in the tech industry.

Click here to learn more about eHA Academy and to get involved

Five crucial points for a successful data collection exercise

Insights from the Kano State Primary Health Care Monitoring and Evaluation systems assessment

By Chinedu Anarado

Are you planning a data collection exercise? If yes, you will be best served with some of our field experience implementing various data collection activities. eHealth Africa has more than a decade of experience collecting large-scale data, including qualitative and quantitative data. These span geographic information system data, vaccination and vaccinator tracking data, implementation of health systems improvement, and reproductive health services surveys. At every point in a calendar year, eHealth Africa team members are in a remote community interacting with locals and trying to understand the reason for some challenges preventing effective public healthcare service delivery.  

We recently concluded data collection efforts in Kano state to assess the challenges to data use in decision making within the monitoring and evaluation (M&E) framework of the Kano State Primary Healthcare Management Board (KSPHCMB). Leveraging support from Technical Advice Connect (TAConnect), eHA designed a mixed study to help us identify the quality of data, their collection process, and how best to encourage empirical decision making and improve the quality of healthcare services delivery. From a sampling population of over 1000 persons within the state primary healthcare (PHC) M&E system, including data generators and data users, we sampled 596 respondents for our quantitative questionnaire and 21 respondents for our qualitative tool. Their responses are now guiding our analysis and findings. Here are five big lessons we learned while delivering this effort. 

1. Stakeholder engagement is the key to success , and no stakeholder is more important than the other. Any person’s response could be the insight that unlocks the issues you are trying to solve. But they can make or break your ability to reach all your respondents and access all the communities from where you require information. Our approach was first to map out all the stakeholders and their interests in the project. Next, we agreed on a means of communication and what information was important to them before we reached out. Adequate and open communication is the key to successful stakeholder engagement. We ensure we address all their concerns, make them a part of the project, and, where permissible, include them in helping you to get access to the communities you need to study. Ensure to share your collection tools with stakeholders for their input where necessary. Overall, mainstream stakeholder engagement throughout your collection phases if you want to be successful in data collection.

2. Failing to plan is planning to fail. A field plan helps you understand how much time you need to start and end every data collection effort. Because we have a lot of experience implementing data collection, we can estimate the time required to conclude an exercise accurately. To do this, we establish certain parameters such as the number of data collectors available, how many questionnaires are to be administered, the coverage area, and how long it will take to administer a questionnaire to one respondent. With these figures, draw up a field collection plan to estimate the quantity of data one enumerator can collect in a day. This information is vital if you plan to pay data collectors based on performance or measure their effectiveness. Ensure to include a couple more days for mop-up and recollection. This will help address unforeseen delays and disruptions. eHA has designed a tool, Planfeld, that automates planning for field logistics in public health. Planfeld improves efficiency, reduces your turnaround time, and saves valuable resources. It ensures you do not miss any planned collection location since it allows you to input your planned coverage areas. Planfeld uses the data portal, published by eHA, with over 350,000 points of interest and more than 451,000 settlements across Nigeria and it is interoperable with any geodatabase

3. Test your tools. Our best practice at eHA is finding an equivalent to the sample population outside the study area and administering the proposed instrument. In this study, we leveraged the Jigawa State primary healthcare management officials to pilot our tools. The essence of this exercise is to give us real-time information on the issues we could encounter in the field and plan for them. Field testing will also highlight any problem with your survey tools and allow you to correct such problems before you begin data collection. For example, in the Kano State M&E assessment, we discovered challenges regarding the page-to-page transition. We spent the next couple of days reviewing the open data kit forms. We resolved this issue before commencing data collection in the field. Pilot testing is also the platform to test to see if your collection estimates and timelines are realistic. It is best practice to use pilot testing to simulate if your collection plan is workable.

4. Establish and implement quality checks. For example, collection teams must record the geo-coordinates of the collection locations. It is essential to check the time to complete a single form. These are some ideas that could signal the quality of data collection—for instance, spending five minutes on a form that should take 20 minutes to complete signals that an enumerator is doing something wrong. In a GIS collection project, an enumerator collected several points from one location. Our quality checking standards flagged this, and we immediately rectified it. Quality checks ensure you do not return to the field to implement recollection when you have finished data collection because of quality issues.

5. Engage and train experienced data collectors. Over the years, eHA has built up a cadre of enumerators who understand the job and our quality standards. This lessens the time we spend training them. It has also helped us to reduce field errors and ensure the correct information is collected. Pre-collection training is still important, though, and it is an opportunity to introduce new tools, collection modalities, and quality standards to your enumerators. Training also allows you to address respondents' psychography, social and cultural norms. For instance, do not send male enumerators to interview female respondents in a conservative society. If this must happen, it must be in public and under the supervision of another adult.

An assessment is only as good as the data supporting it. If you collect poor-quality information, the analysis will be flawed. Thus, it is vital to align some of your collection approaches, like the outline above.

We took our team bonding outside!

By Juliana Jacob

Nearly 400 million people in sub-Saharan Africa are denied basic drinking water supply. Access to water and sanitation are recognized by the United Nations as human rights, reflecting the fundamental nature of these basics in every person’s life.

One of the strategies we put in place to impact the communities we live and work in is our Community Development Initiative. Recently, we partnered with the REACH community health program of EHA Clinics to renovate 20 Boreholes across 10 LGAs of Kano state. While the project aims to make water available for the communities, we also strive to achieve Sustainable Development Goals (SDGs) number 6 “Clean water and sanitation”

We were excited to visit Sharifawa and Zangon Dakata communities in Gazewa and Ungogo LGAs respectively to launch the boreholes and spend time with the people of the host communities.

Departure time

The eHA and REACH team about to depart for the communities. Everyone was super excited and couldn’t wait to meet our hosts for the day.

Muhammed Mairogo, Community Head, Sharifawa Community, Gazawa giving a welcome address.

Mohammed Bello telling the community the reason for our visit.

L-R Bolanle, Ibrahim, Ayodeji, Ebi, Babatunde and Francisca at Sharifawa community

Group photo of the eHA and REACH team at Sharifawa community.

Photo with Bilyaminu M. Abubakar, Ward Head, Zango Dakata, Ungogo LGA, Kano.

Applications open for eHA Academy!

Applications are now open for the January 2022 cohort of eHA Academy! This cohort is the first all-female cohort of eHA Academy and aims to increase the number of homegrown tech talent in Nigeria!

eHA Academy is an intensive 10-week program that will teach participants basic web development skills in HTML, CSS, and Javascript. The academy uses a combination of coursework, workshops, mentoring, and a capstone project to train participants and help jumpstart their careers. We will place participants who successfully complete their training in internships in software development, quality assurance engineering, business analysis of UI/UX design.

Donations (cash and in-kind) from our supporters and partners will cover the costs of the program and will be free for participants.

Eligibility

The Academy is 100% free, but to be successful, you must meet the following requirements:

• Basic computer knowledge

• Access to a laptop.

• Access to an internet connection.

The cohort will be selected from applicants who successfully complete assessments and interviews with the selection panel and will start their coursework in January 2022.

This cohort will be implemented with support from our partners

Afrilabs

First Founders

Start Up Kano

Tech4Dev

Women Who Code

The centrality of data in outbreak detection and response: the Data for Action intervention in Kano and Kebbi states

By Chinedu Anarado and Tope Falodun

The world is recovering from the disruptions and losses caused by COVID-19. Nigeria was heavily affected and worked hard to manage the fallout from the outbreak. Using quality data and information was central to these efforts. Daily, the Nigeria Centre for Disease Control (NCDC) published data on those infected and the attendant mortalities. It harvested information from various sources as it worked to control the outbreak. But what if Nigeria had access to quality data at all levels on disease outbreaks? Could it have done better with the COVID-19 outbreak, despite its global dimensions? Perhaps it will have enough information to plan outbreak response and keep people safe.

One of the critical challenges confronting public health management officials is access to quality data to identify, prepare, and respond promptly to potential public health events. This challenge manifests in data illiteracy among relevant officials, inability to aggregate and analyze data, and leveraging analyzed information to take action. There are also data quality issues and the political will to act on the information.  

Participants reviewing data during the Disease Identification USSD training session in Kebbi State

There are many challenges that prevent the regular use of data In Nigeria’s public health sector. For instance, data sources are stored in silos, especially at the generation points. There is no upward information flow where decision-makers can understand what is happening and prepare a response strategy for such an outbreak. For instance, the NCDC has set up Public Health Emergency Operation Centers (PHEOCs) in 23 states. But they are not staffed with the right personnel and tools to analyze information, detect and flag disease outbreaks early enough. They are also not integrated in a manner that gives the NCDC some visibility into what is happening, allowing for easy monitoring and timely response. There aren't enough skills at the generation and perhaps usage points at the local level to clean up, analyze and interpret the data at the primary source.  

Fortunately, eHealth Africa is implementing the Data for Action project to address these issues. The Data for Action effort is a component of the Subnational Emergency Preparedness and Response Capacity Building (SERCB) program, an initiative of the NCDC. The SERCB effort provides an overall emergency preparedness capacity at the state level. Its Data for Action component provides data and information for prompt response action that underpins emergency preparedness. Resolve to Save Lives (RTSL) funds this intervention, which involves delivering solutions for the benefit of the NCDC and state-based Public Health Emergency Operations Center (PHEOCs). Successfully implementing Data for Action will provide data that will support an early warning system, allowing stakeholders to detect and respond to potential disease outbreaks before they assume challenging proportions. The states will also have the critical capacity and resources to sustain the use of data for decision making at the local and sub-national levels. 

eHA has conceived an early warning system that should involve the aggregation and analysis of data. This will cause periodic reporting of identified diseases from the ward unit up to the state level, with a mechanism that shows the reported disease and the frequency of occurrence. It should also define what level of spread and actions to be taken if an outbreak is imminent. 

To arrive at these solutions, we implemented a bottleneck assessment in Kano and Kebbi states that helped us identify the critical challenges preventing the seamless flow of data from the various ward units right up to the state and the center. eHA’s findings from the assessment were addressed by investing in creating data products, building the capacity of disease surveillance and notification officers on data clean up, analysis and presentation. We also trained community informants on disease identification to help improve the sensitivity of surveillance systems. If they can accurately identify diseases, we can report more and ensure that relevant public health actors do not miss potential outbreaks. 

eHA also provided infrastructure and equipment support to ensure the conducive functioning of the PHEOCs. For instance, we operationalized a power generating set in Kano and provided a six-month diesel supply and internet connectivity to support data analysis. In Kebbi state, we provided additional equipment to support communication and visualization, including projectors and screens, public address systems, internet connectivity, air conditioners and water dispensers. Kebbi PHEOC, still at its nascent stage, requires these pieces of equipment to improve their work, and we are glad they are being put to good use.  

In the coming days, we will implement additional training on data use and ensure beneficiaries can produce data products or reports that give insights on the prevalence rate of six priority infections. These include Cholera, COVID-19, Lassa Fever, Measles, Meningitis and Yellow Fever. These diseases are the most prevalent in Kano and Kebbi states. Hence, tracking them will help reduce the prevalence of these outbreaks and the safety of Children. We will back up this effort with periodic supportive supervision to ensure that valuable data is available to ensure decision-makers keep their citizens safe and prevent more disease outbreaks.

Taking A Bite Out of Malnutrition

By Hafsat Jaafar

In less than a decade, the number of acutely malnourished children receiving treatment globally has quintupled: increasing from just over one million in 2011 to over 14 million in 2020. Nigeria has the second-highest number of under-five child undernutrition in the world, with about 2 million children suffering from severe acute malnutrition. A major challenge directly impeding child nutrition is the reduced access and utilization of maternal and youth-friendly sexual and reproductive health services. 

In 2016, the United Nations (UN) declared the Decade of Action on Nutrition and stakeholders have made more efforts to contribute to Nutrition improvement globally.  The World Bank is taking a double-pronged approach to address malnutrition through the Accelerating Nutrition Results in Nigeria (ANRiN) project. ANRiN focuses on reaching pregnant women, adolescent girls, and children under the age of 5 years. The project aims to abate the surging rate of malnutrition through appropriate maternal care, counseling,  infant and young child feeding, healthy sanitation behaviors, prevention and, when necessary, appropriate treatment of diarrhea, and ensuring adequate intake of essential vitamins and minerals through food fortification and supplementation.

eHealth Africa as a lead consortium member has begun the implementation of the ANRiN project in 12 LGAs of Kaduna State; Kaduna South, Chikun, Kajuru, Kagarko, Jaba, Zangon Kataf, Jema’a, Sanga, Kaduna North, and Ikara. The eHA- ANRiN team delivers the Basic Package of Nutrition Services (BPNS) and Adolescent Health Services (AHS) to beneficiaries of the project. This includes; behavior change communication to improve infant and young child feeding behaviors, namely early and exclusive breastfeeding (0-6 months) and appropriate complementary feeding (6-23 months); micronutrient powders to children 6-23 months to improve the quality of food provided for complementary feeding; iron/folic acid supplementation for pregnant women with counseling to improve compliance; intermittent preventive treatment for malaria to pregnant women; zinc and ORS for treatment of diarrhea in children 6-59 months; vitamin A supplementation twice a year for children 6-59 months; deworming twice a year for children 12-59 months; and counseling and provision of commodities to married adolescents in Kaduna for increasing birth spacing.

eHealth Africa among winners in 2021 edition of the Wiki Loves Africa Photo Contest

By Oladipo Olurishe

2nd Place Winner Wiki Loves Africa Photo Contest 2021

Our submission to the Wiki Loves Africa 2021 Photographic Competition came 2nd place out of over 8000 entries.

Wiki In Africa, the international organizers of the Wiki Loves Africa challenges the global photographic community each year to respond to a call for photographs of life in Africa along a specific theme. This year, the competition called for photographers to contribute images that visually interrogated the theme of Health + Wellness within the African context but looking at the positive aspects within that sector of African life.

The image which emerged as a global winner was shot at the Kano head office of eHealth Africa during a Malaria Microscopy Training conducted by our Laboratory team. The image was uploaded by Dr. Nirmal Ravi who leads the team and was present during the session.

Need for Stable and Sustainable Energy for better Healthcare Delivery in Nigeria: A case study of Kano and Osun State Health facilities

By Mohammed Bello

A recent publication by International Renewable Energy Agency (IRENA) stated that around a billion people today rely on health facilities without electricity supply. While most large hospitals may have round-the-clock access to power, electrification rates drop significantly for rural clinics. In the absence of reliable power, many of the basic life-saving interventions cannot be undertaken safely or at all.

Also, a recent study analyzing over 121,000 health facilities, in 46 low and middle-income countries, found that almost 60% of them lacked access to reliable electricity. Even facilities with electricity access can often suffer from an unreliable supply – negatively affecting the ability of medical professionals in rural communities to deliver modern health services.

Renewable energy is at the forefront of solving this issue. Off-grid (stand-alone and mini-grid) renewable energy solutions represent a cost-effective, rapidly deployable, and reliable option to electrify healthcare centers, transforming lives whilst bolstering global efforts to achieve Sustainable Development Goal 3 – good health and wellbeing.

Lack of sufficient and reliable power is jeopardizing the well-being of millions of people, especially women and children, who often bear the brunt of inadequate primary healthcare services. In fact, worldwide, more than 289,000 women die every year from pregnancy- and childbirth-related complications, many of which could be averted with the provision of better lighting and other electricity-dependent medical services (Sustainable Energy For All, 2019).

Like the pilot Energy survey from 10 selected health facilities across seven (7) Local Government Areas (LGAs) of Kano state in August 2020, the expanded phase was also carried out by the Nigerian Energy Support Programme (NESP), a technical assistance programme co-funded by the European Union and the German Government and implemented by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH in collaboration with the Federal Ministry of Power (FMP), in partnership with eHealth Africa. It was conducted in close cooperation with geospatial data experts from INTEGRATION Environment & Energy GmbH (INTee) and Reiner Lemoine Institut (RLI) in Germany. This is part of the effort of the NigeriaSE4ALL Initiative to offer the most up-to-date, ground-truth, electrification data available in Nigeria.

The expanded survey was also carried out using a remote interview method for conducting interviews with the health facility in-charges in selected health facilities across 43 out of 44 LGAs of Kano, and 27 out of 30 LGAs of Osun state.

The findings from the result of the earlier concluded pilot survey necessitated the expansion in the scope of the survey, to gather sufficient information that would help provide a bigger picture of the energy needs, current situation, and guidance for the planning of possible implementation of suitable energy solutions for communities. The expanded scope covered a total of 291 health facilities - 173 health facilities in Kano state and 118 health facilities in Osun state.

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Helpdesk Agents administering questionnaires remotely to Health Facility In-charges in Kano and Osun State

The methodology used in collecting the data is through remote administration of survey questionnaires via phone calls, to ensure adherence to and support the COVID-19 response efforts in Nigeria and minimize the risk of infection through physical contact.

The primary aim is to assess energy gaps and identify the potentials for connection to an off-grid power source (renewable energy) and at the same time, determine the readiness for Covid-19 response at the Primary Health facility level.

The diagram below presents a summary of the implementation approach adopted for the survey.

Figure: Summary of the implementation approach adopted for the survey.

• The following four major data sources were utilized; 

  • list of health facilities extracted from the eHA data portal, 

  • Grid Clusters (potential location for off-grid infrastructure),

  • Senatorial administrative boundary

  • Contact list for Health Facility representatives

Health facility data and senatorial administrative boundaries were downloaded from the eHA Data portal/ GRID3 as shapefile format, power grid location was downloaded from Nigeria SE4ALL Webmap; in Geojson format, containing the KEDCO - Grid Data MV Lines (2016) and Osun state MV power lines. 

Finally, a structured survey was designed to capture the energy required capabilities and capacity of the health facilities.

Fig 2. Map showing the distribution of Primary health facilities in Osun state(Left) and Kano state(Right)

Activities

Remote administration of questionnaires to the health facilities in-charges via phone calls to identify the following:

• the health centers’ current electricity supply status

• general services provided by the health centers, 

• their current ability to cope with the COVID-19 response

• available infrastructure at the health center that would impact considerations around power requirements

Key Findings

• The survey findings indicate that all infrastructures do not meet up the minimal requirement stated by NPHCDA and some health services needed to be upgraded

• Power shortages affect the functionality of many types of equipment at the health centers across all assessed facilities thereby, affecting the output and overall performance of the facilities in terms of service delivery.

Benefits of the survey

The outcome of the survey provides visibility on areas and health facilities that require urgent intervention, such as the provision of PPEs to the health facilities and other equipment/infrastructures. Also, the data collected were subsequently published with updated health facilities infrastructure and services information on the eHA data portal for public access and to all for non-commercial use.

Finally, the survey makes readily available information relating to health facilities and the preventive measures taken during the COVID-19 crisis.

Future Survey Use Case Potential:

The remote survey showcased the capacity to effectively gather information on energy sources and requirements whilst supporting efforts in preventing the spread of the COVID-19 virus, without requiring a face-to-face engagement. 

Considering the necessity for energy supply, especially at health facilities, these surveys present a clear understanding of current energy systems that may not be sustainable and the need to consider alternative sustainable energy systems that would have minimal impact on climate change and make lives better.

Ultimately, surveys can be conducted nationwide to establish a baseline for the energy requirements of Primary Healthcare facilities.

It is evident that the functionality and efficiency of the Nigerian health systems especially in rural settings, can not be optimized with the use of on-grid electricity, some components of which are affected by unstable weather due to climate change. As such, harnessing renewable energy will be an alternative way of addressing the persistent power challenges in the health sector.

The Program Partners

eHealth Africa’s Ifeanyi Franklin Ike, named one of the 50 rising stars in the geospatial Industry

By Oladipo O. Olurishe

Franklin, a GIS Coordinator here at eHealth Africa (eHA) has been recognized as a rising star to look out for in the geospatial industry the inaugural Geospatial World 50 Rising Star list published by Geospatial Media. We are excited to congratulate Ifeanyi Franklin Ike on this accomplishment. We had a brief chat with Ifeanyi about this accomplishment.

Ifeanyi Franklin Ike

You were recently listed among the 50 rising stars to look out for in 2021 on the geospatial media, how does that make you feel?

This recognition comes as a bit of a surprise to me that out of all nominated young persons in the geospatial world, my contribution to the geospatial industry in Nigeria has been appreciated. It makes me feel excited and zealous to do even more. This could have come at no better time than now, when fatigue was already setting in for the work done for Nigeria’s COVID-19 response. I feel more energized to contribute more. 

Since last year, Ifeanyi has been working closely with the Nigeria Centre for Disease Control (NCDC)  to provide geospatial and data solutions to support the country’s response to the COVID-19 pandemic. He is a member of the multi-partner team that developed an assessment tool for checking health care workers' preparedness for COVID-19 response. Ifeanyi also designed the web and mobile geospatial analytics tools for tracking COVID-19 outbreak in the country. He also designed the data collection platform for the First Few Cases of COVID-19 (FFX) study in Nigeria and the dashboard for the COVID-19 Personal Protective Equipment (PPE) distribution in Nigeria.,

Can you tell us what geospatial data is and what the geospatial industry is all about?

In the first place, data is a set of information that has been translated into a form that can be processed. Geospatial data can then be said to represent the sets of data that are linked to specific/known locations in space (the world). 

Over the recent years, the geospatial industry has grown beyond imagination with potential for more growth. In our world of today, the application of location-intelligent (geospatial) algorithms in our daily engagements have developed drastically. So it is safe to say that the geospatial world is the backbone of most modern technological developments and will continue to do so in the unforeseeable future.

Can you tell us about your work, what you do around geospatial data?

I’m a data scientist with a special interest in geospatial data analysis, especially as it relates to the Global Health Informatics Strategy (GHIS). I employ insightful location-based analysis in creating solutions that help to support effective data-driven decision-making, especially in the public health sector. This passion for creating public health solutions using geospatial data was and remains my motivation for joining eHA.

What impact can you say your work has had by using geospatial data?

My work using geospatial data has positively impacted the Public Health space.  My use of geospatial data has supported the design of solutions that are geolocation-centric, bringing out varieties of insightful information which have supported public health decision-making across different organizations.

Some examples include contributing to the designing of the following tools:

• eHA's PlanFeld application geodatabase

• The vaccine delivery optimization tool for eHA

• Sampling scripts for the National Micronutrient and Food Consumption survey in Nigeria

• M&E tools for the tracking of World Bank COVID-19 grants to support IAP implementation in States

What is the future of geospatial data? How will it help the world solve problems?

As I mentioned earlier, geospatial data, geospatial technologies, and geospatial skillset forms the backbone of modern technological developments and will continue to do so in the next unforeseeable part of the future. With the global shift away from the era of the industrial revolution to the information age and the continuous increase in the need for location intelligent applications in our day-to-day endeavors, the future is very bright for the geospatial industry. I’m therefore excited to belong to the geospatial family of this generation and thankful to all my colleagues at eHA for the wonderful geospatial work we are doing together.

Let’s keep pushing. Thank you

Congratulations once again to Franklin,  continue the outstanding work you are doing in the geospatial industry.

Remote Data Collection as a First Step for Developing a Digital Information System to Guarantee the Supply of Quality-Assured Blood to the South African Population

By Dr. Alexander Pinz

The project    

The provision of safe and high-quality blood and blood products is a significant challenge for blood establishments in times of crisis. Depending on the crisis at stake, blood demand may suddenly explode, e.g. with mass casualty events; or there will be shortages in blood supply because of infectious diseases (epidemics, pandemics), and environmental catastrophes (e.g. floods, droughts). In these situations, it is important that blood establishments can rely on adequate information and emergency plans, enabling them to ensure the continuous supply of blood and blood products to both the entire population, and the persons severely hit by the crisis. However, currently, blood establishments are rarely included in national or regional emergency management plans. They often lack adequate information technology, enabling them to foresee slowly emerging crises or to react appropriately to catastrophic events that suddenly happen. According to the participants in the CoordinatedBlood-Workshop, which took place in Berlin in September 2018, these challenges apply to the South African blood supply system, too.

To better prepare blood establishments for crises, the BISKIT-consortium—comprising eHealth & Information Systems Africa, the Paul-Ehrlich-Institut (German Federal Institute for Vaccines and Biomedicines), and the Working Group Inter-disciplinary Security Research (Free University Berlin), the European Research Center for Information Systems (University of Münster), and the Chair for Software & Digital Business (Technical University of Darmstadt)—has started the project Blood Information System for Crisis Intervention and Management, funded by the German Federal Ministry of Education and Research. The aim of this research project is to improve the supply of safe and quality-assured blood and blood products before, during, and after a crisis to the South African population. To achieve this objective, the consortium is going to 

• develop an information-system including a user-interface (demonstrator) for data-based decision-making, 

• develop crisis management plans and recommendations for crisis communication, and

• organize and implement capacity building training on the use of the demonstrator.

The challenge

To accomplish these objectives, we need an enormous amount of data. First, we have to map the South African blood transfusion as well as crisis management systems, including their major stakeholders. Second, we have to visualize the entire blood supply chain from vein to vein. Thus, we have to assess every single process step such as donor recruitment, donation, processing, and testing, transportation, and storage, as well as issuing of blood products. Also, we need GIS data on the locations of the relevant facilities like blood establishments, mobile clinics, hospitals, etc. Finally, we need quantitative data on the duration of each process step, the number of donors/donations, number of products, etc. However, due to the COVID-19 pandemic, we are not allowed to fly to South Africa to start our data collection process. So what can we do?

The solution

We exploited the digital tools available to us to start a virtual data collection process. Thus, we use video conference systems to implement key-informant interviews with relevant stakeholders of the South African blood transfusion and crisis management system. We store the data in a CKAN-portal that only members of the BISKIT consortium can access. To make the information obtained via these interviews available to the entire consortium, we transcribe the interviews with artificial intelligence software. We then analyze the anonymized transcripts with cloud-based as well as standard qualitative analysis software.

Having, so far, conducted 20 key informant interviews with persons responsible for different parts in the blood supply chain, and the crisis management system, we have t great insights into how the South African blood transfusion and crisis management systems work. We can use these insights to map the relevant actors and processes of the respective systems. In addition, we now have a notion of the different data available for upload. With this information, we start modeling the blood supply chain from a logistical perspective, and, thus, get the project started.

The world saw more video calls this year due to the COVID-19 pandemic.

Sure, virtual data collection differs from data collection on-site. The social aspects of collaboration are missing. Nevertheless, in the interviews, we created a good atmosphere with the project partners in South Africa. Using video calls enabled us to at least see each other and get the relationship-building process started. This adaptation to the travel restrictions resulting from the COVID-19 pandemic has shown us we can collect data with digital technology. This approach enables us to better focus on the travels that are relevant for project success. It helps us to reduce our carbon footprint of development cooperation work. However, we are also looking forward to getting to know our project partners in person. Because in the end, this will further improve the quality of the data we can collect, and, thus, contribute to the aim of increasing the resilience of the South African blood supply system by using digital technology.

Dr. Alexander Pinz is the Project Manager for the Blood Information System for Crisis Intervention and Management (BISKIT) project at Paul-Ehrlich-Institut (PEI). PEI is the leading organization within the BISKIT consortium and responsible for coordinating the project implementation.

Remote Assessment of Energy Gaps in Selected Health Facilities in Kano State: Identifying Potential for Alternative Energy Sources

By Mohammed Bello

In accordance with the standard for operations in most health centers, The World Health Organization (WHO)¹ states that the majority of health centers require energy for water supply, temperature control, lighting, ventilation, and clinical processes. In terms of electricity, Nigeria is ranked by the World Bank as the second country in the world and the first in Sub-Saharan Africa with more of her population not having access to electricity. With a population of about 200 million Nigerians, over 80 million representing 40% of the country’s population, lack access to grid electricity². Presently, power generation, transmission, and distribution rates are not commensurate with the energy demands of the population, giving rise to consumers depending on dirty and outdated energy sources that have adverse health and economic consequences on them and the society at large. Nigeria’s energy demand was estimated to rise to 88,282MW by 2020 from 15,730MW in 2016³ . Despite the country’s current installed generation capacity of 12,522MW, it generates an average of 4,500 MW, which is transmitted through its fragile National Grid and is grossly insufficient to meet the electricity demand of its 190 million population not excluding demands at health facilities.

Sadly, only an estimated 30% of Nigerians are connected to the national grid. This low and erratic power supply affects the community’s primary health centers forcing the management to rely on kerosene lanterns as a source of lighting and petrol generator as their primary source of electricity (UNDP Nigeria., 2015)⁴. As a result, this hinders the efficiency of health services and amenities for optimal operation.

To improve service delivery dependent on energy supply, there is a need to identify the gaps in energy sources of primary health centers in relation to needs/consumption. To this end, a pilot survey was carried out by Nigerian Energy Support Programme (NESP), a technical assistance programme co-funded by the European Union and the German Government and implemented by the Deutsche Gesellschaft fürInternationaleZusammenarbeit (GIZ) GmbH in collaboration with the Federal Ministry of Power (FMP), in partnership with eHealth Africa. It was conducted in close cooperation with geospatial data experts from INTEGRATION Environment & Energy GmbH (INTee) and Reiner Lemoine Institut (RLI) in Germany. This is in line with the objectives of the SE4ALL initiative that are working globally to ensure universal access to modern energy services; doubling the global rate of improvement in energy efficiency, and doubling the share of renewable energy in the global energy mix by 2030 compared to 2010.

Due to the current pandemic (COVID-19) situation of the world and the country Nigeria, the pilot was geared at finding out how effective remote surveys can be applied to gather data required to understand and make decisions on energy challenges at health facilities. It was pertinent to adhere to all precautionary measures to prevent the further spread of the virus during an actual physical face-to-face survey. Hence, this survey employs a remote data collection approach in administering questionnaires, as an alternative to the conventional physical data collection.

Helpdesk Agent administering questionnaires remotely to Health Facility In-charges in Kano State

In this respect, eHealth Africa (eHA), a leader in the use of technology, data-driven approach plus in-country expertise in public health-focused activities in partnership with NESP having expertise in alternative energy research, conducted a Pilot Survey on selected Primary Health Centers in Kano State with the aim of assessing energy gaps and identifying potentials for connecting to an off-grid power source (renewable energy) and at the same time, their readiness for Covid-19 response at the primary facility level. 

For the purpose of this survey, five major sources of data have been employed which include; health facilities extracted from the eHA data portal, Grid Clusters (potential location for off-grid infrastructure), population figures, senatorial administrative locations, and structural survey questionnaires. Health facility data and senatorial administrative boundaries were downloaded in shapefile format from the data portal published by eHealth Africa, grid cluster was provided by NESP  (containing the cluster of buildings), population information was downloaded from VTS portal in raster format. Finally, a structure of the survey was designed to capture the energy required capabilities and capacity of the health facilities.

A four grouped structure survey form was designed. The first group was basic information from the respondent (8 questions), the second group was infrastructure equipment at the health center (6 questions), the third group was about services rendered by the health facilities (5 questions) and the fourth group was on energy sources at the health facility (12 questions).

Figure: 2.1Map showing the distribution of sample clusters and health facilities

A systematic snowball sampling survey technique was used through a phone call to the health facilities. Since the health facilities were predetermined and a focal person was also identified at each of the health facilities, which made the survey straight forward. Also, the collection process was digitized to an ODK web form.

Key Activities

eHA’s Program and GIS team worked with INTee to analyze remotely mapped clusters for suitability with mini-grid. At the initial phase, INTee shortlisted 30 locations for the survey and handed over the longlist to eHA, to come up with a shortlist of 10 health facilities preferably PHCs, using agreed criteria as highlighted below. The LGAs selected fell within the 3 senatorial zones of Kano  (Sumaila, Bagwai, Gabasawa, Kibiya, Karaye, Minjibir, and Tudun Wada).

• Their electrification status (off-grid and on-grid) and already mapped in OpenStreetMap by NESP

• The health center should be close to a settlement

• The health center should be located where there are nearby  buildings

• The locations and health centers should be within Kano state

  After shortlisting the facilities, a list of community leaders and health facilities in charge were generated along with their contacts for the purpose of conducting a remote interview with them. This is aimed at identifying the gaps within the community and the health facility with respect to their electrification status. 

  The survey sought to assess general information on the health center services and equipment,  and how this relates to their power requirements and current electrification status.  Their current ability to cope with the COVID-19 response were also accessed. eHA administered questionnaires to each of the shortlisted health facilities to identify their current energy needs. Daily calls were made from the call helpdesk to administer the questionnaire and individual responses were captured accordingly. The completed questionnaires were then uploaded to the KoBo Toolbox platform for analysis. NESP was responsible for conducting the analysis.

  To ensure a community-based perspective was covered, community leaders where the health centers were located were also interviewed. Questionnaires were also administered in a similar remote fashion. To capture the appropriate responses,  the local language was used to administer these questionnaires, and the feedback generated were also uploaded to the KoBo Toolbox for analysis purposes.

  Key success

  The remote survey showcased the capacity to effectively gather information on energy sources and requirements whilst supporting efforts in preventing the spread of the COVID-19 virus.

  It also increased the availability of information related to health facilities and the preventive measures taken during the COVID-19 crisis.

  Beyond the energy needs, the analysis from data gathered during the survey showed that available infrastructures at the facilities do not meet up with the minimum requirements stated by NPHCDA. Some gaps in health services provision were identified and needed to be bridged. Furthermore, power shortages at the health centers across all primary health facilities were a common occurrence. All these were achieved via a remote survey which ensures a zero level of risk faced by data collectors.

The Program Partners

Our Path to Polio Eradication in Nigeria

By Uche O. Ajene

The eHealth Africa (eHA) story began when we were founded in 2009 to provide northern Nigeria’s health infrastructure with customized technology solutions for data-driven decision-making to improve public health. In 2012, we joined the Nigerian government, international philanthropy and development partners, regional and national NGOs, and implementing partners in the fight for polio eradication in the country. All partners brought different yet complementary expertise and experience to the fight, from grassroots community organizing to funding to policy advisory; each partner played a critical role in eradicating polio in Nigeria.  

In 2012, we were a very young and focused team. Our expertise was (and remains) providing technology solutions and operational and technical support. We focus on developing user-centric technology-driven solutions to collect, manage, and analyze data that is still being used today to enhance large-scale public health interventions. We also provide operational and technical support to bridge the gap in access to health delivery services. Through the years, we have worked as part of larger consortiums to implement various programs to address polio in Nigeria, from ensuring vaccine delivery to last-mile health facilities to implementing one of the most extensive community-involved disease surveillance programs in the region. 

On June 18, 2020, the World Health Organization (WHO) declared Nigeria polio-free, and here we revisit some of the steps we took on our path to polio eradication.

2012

Nigeria accounted for more than half of polio cases worldwide in 20121. It was an emergency that needed an immediate response.

Walking into the Kano EOC

Enter the Polio Emergency Operations Centers (EOCs)
The EOCs are a linchpin in Nigeria’s fight against polio. In 2012, we built the first of 8 EOCs, which act as command centers for decision-makers, partner organizations, and relevant stakeholders in the health sector to meet, review data, and take prompt actions to mount a coordinated response during emergencies. They are a government-led initiative to improve information sharing and joint programming (planning, implementation, monitoring, and evaluation) for improved polio (now other public health) emergency management. eHA built and currently manages the National EOC in Nigeria’s capital, Abuja, and seven state-level EOCs, located in Bauchi, Borno, Kaduna, Kano, Katsina, Sokoto, and Yobe.

Increasing Accuracy and Accountability through Tracking
Immunization Plus Days (IPDs) are supplementary immunization activities (SIAs), and mass campaigns complement routine immunization. All children under 5 receive two oral polio vaccine (OPV) doses during these campaigns to boost herd immunity. Polio eradication partners introduced Vaccinator Tracking System (VTS) to increase the accountability of vaccinators.

Under the Global Polio Eradication Programme, eHA mapped all 11 of Nigeria’s northern states in 2012. We collected geospatial data relating to points of interest, including settlements' names and locations and habitation status. Using this data, we supported states in developing accurate, comprehensive maps and micro-plans for planning SIAs, including IPDs. During each campaign, VTS uses Geographic Information Systems (GIS) technology to track, collect and store location data to identify missed or partially covered settlements. The data is downloaded, reviewed, and analyzed at the end of each day during the campaign. Decision-makers identify challenges, take evidence-based actions, and ultimately improve vaccination geo-coverage in high-risk states. Since 2012, over 88% of states in Nigeria have used VTS to increase accountability during campaigns.

Assembling Health Camp boxes in our warehouse

2014 - 2016: In all the nooks and crannies
Nigeria employed many strategies and implemented many programs to eradicate polio. Under the guidance of the National Polio Eradication Program, states created and adapted programs to suit their local contexts. Kano state Health Camps, a targeted mop-up campaign, were free health outreach events where members of each community got access to essential health checkups and free medications. They also provided another avenue for immunization against polio.

WHO procured the necessary medicine and equipment and packaged and distributed these essential medicines to health facilities across the state. Health Camps were a massive success; communities needed vital services and medications and attended these outreach events en masse. Using lessons learned from the implementation in Kano state, eHA supported Borno state in running health camps in seven Local Government Areas (LGAs) in 2016.

Child receiving OPV dose during house to house campaign

End Game Strategy
Despite best efforts during supplementary immunization activities, all eligible children did not receive the polio vaccine. In 2016, eHA supported the End Game Strategy (EGS) project in Kano state by tracking down all the missed children during the state’s IPDs so that they could be followed up and immunized before the next immunization campaign round. 

EGS was coordinated by the Kano State EOC, partner agencies (including UNICEF), and the invaluable support of the Kano Emirate council. The project line-listed all the children missed and categorized them based on the following reasons: Noncompliance (NC), child absent (CA), and block rejection (BR). Households reported by the house-to-house teams as having “no eligible children under 5” were tracked and verified to ensure vaccinators missed no children in those households. Working closely with the Kano Emirate council, Polio eradication partners addressed noncompliance and block rejection cases. Vaccinators revisited houses with absent children and vaccinated them immediately after their return from travels. eHA provided logistics support to District Heads, Ward Heads, Ward Focal Persons, Health Educators, and Senior team Supervisors to support the follow-up and vaccination of children missed during IPD campaigns.

2016: A setback

On August 11, 2016, after two years without a case of wild poliovirus, the Nigerian government reported that the disease paralyzed two children in security-challenged Borno state.  The almost decade-long insurgency in Northeast Nigeria presented a challenge for government and health partners. 

Nigerian Polio Eradication partners developed a more context-specific strategy to reach children in all parts of the state. The  Borno State Primary Health Care Development Agency (BSPHCDA), in close collaboration with WHO, the Bill and Melinda Gates Foundation, U.S Centers for Disease Control and Prevention (CDC), United Nations Children’s Fund (UNICEF), and other partners, launched a series of strategies to interrupt the transmission of the virus and reach all eligible children under the age of 5 in security-compromised, partially Hard to Reach (HTR) and HTR settlements.  We leveraged our GIS, field operations, and logistics expertise to collect and analyze geospatial data. The data helped real-time program monitoring and decision-making by the state and relevant key stakeholders. 396,607 children have been immunized in security-challenged areas of Borno state. An additional 2,195,369 children have been vaccinated in non-security-challenged areas.

Mapping Nigeria takes you through hills and streams

Our path to polio eradication in Nigeria has helped us live our mission of building stronger health systems and ultimately improving people's lives in our communities. We have traveled rugged terrain, surmounted obstacles, and developed incredible partnerships along the way. It has been challenging and adventure-filled, but each step taken on this path has been ultimately rewarding.

Improving Emergency Response by Upgrading Information Technology Systems to Better Respond to COVID-19

By AbdulHamid Yahaya and Emerald Awa-Agwu

The Kano State Polio Emergency Operations Center

When designing technology and data solutions, we take the unique needs and contexts of our partners into account. We are then able to give them custom solutions that integrate seamlessly with their systems and that can be deployed easily to respond to active and potential public health emergencies. We provide operational support to Nigeria’s Polio Emergency Operations Centers (PEOCs). Initially designed to coordinate the country’s response to Polio, the EOCs now serve as a command center for decision-makers, program planners, and partners in the health space to plan and mount a coordinated response to all public health emergencies and outbreaks.

In Kano State, the EOC has been instrumental for Routine Immunization (RI) and Supplementary Immunization Activities (SIAs). The State Emergency Routine Immunization Coordination Center (SERICC) uses the well-equipped data infrastructure at the EOC to easily visualize health facility immunization data and immunization coverage data from campaigns on a weekly basis in order to monitor thresholds of priority infectious diseases. This helps them proactively identify patterns and trends in disease occurrence and respond more promptly to forestall outbreaks or epidemics.

On April 11, 2020, when Kano State recorded its first COVID-19 case, we quickly needed to upgrade the phone system so that the state EOC could better respond to the outbreak. Kano state needed a call center where community members could report cases and persons of interest could be followed up. While we set up the call center, we needed to switch the Private Branch Exchange (PBX) from Elastix 2.5 to 3CX. A PBX phone system is a private telephone network used within an organization that allows users to communicate internally (within their company) and externally (with the outside world), using different communication channels. It is ideal for call centers because it also allows for more calls than physical phone lines and free calls between users.

The Kano State COVID-19 call center

This became relevant because it shortened our turnaround time so that we could set up any additional support queues and lines faster. The upgrade also supported an unlimited number of agents to be added to the phone system at no additional cost and even allow agents to work remotely. This was vital for the response in Kano State to keep track of the large number of calls that they received and the persons of interest that were identified in a short time. 

The call center agents do not need to be in a physical location to operate the lines which aligned well with the state’s movement restrictions and social distancing guidelines. Our partners and stakeholders were still able to collaborate, discuss, and resolve issues quickly using the 3CX WebMeeting feature for video conferencing calls. The call center logs over 500 calls on a weekly basis.

Because of our experience with Kano state, we were also able to support Nigeria’s COVID-19 response led by the Nigeria Centre for Disease Control and Prevention (NCDC) by developing an automated system for tracking and following up persons of interest who have been exposed to COVID-19 for a period of 14 days. The system can call thousands of contacts on a daily basis to verify whether or not they have developed symptoms.

Members of our Helpdesk team monitoring the PBX system

Thanks to 3CX technology, we currently support more than 3,000 dashboard users across 12 states with the potential for an unlimited number. We believe that technology is the key to developing sustainable and scalable solutions that can strengthen health systems.

Sustaining the Push: Essentials for Attaining a Polio-free Nigeria

By Mustapha Hadi Mustapha and Emerald Awa-Agwu

Children at a school in Kogi State receive the Oral Polio Vaccine during an Immunization Plus Days (IPD) activity

Today, June 19, 2020, the World Health Organization (WHO) declared Nigeria, polio-free.

The first requirement for attaining the polio-free certification—no wild poliovirus transmission for three consecutive years—was attained on August 21, 2019  1.

The Africa Regional Certification Committee’s visit to Borno State in March 2020 as part of the process for certifying Nigeria polio-free

This success is the result of several sustained efforts, including domestic and international financing, the commitment of thousands of health workers and the switch to electronic, technology-driven data collection and management systems which have given decision-makers and polio eradication partners the accurate data needed to develop plans and strategies for reaching every eligible child, even in hard-to-reach and security-challenged areas 2.

“Having achieved the milestones of primary requirements, the ARCC will first review the complete documentation report of the interruption of wild poliovirus type 1 and then proceed to conduct field verification visits to select states in the south of Nigeria. If the ARCC is satisfied with the national documentation and field verification after both visits in December 2019 and March 2020, the WHO African Region could be certified to have eradicated polio by mid-2020.”

— Dr. Fiona Braka, WHO Nigeria Team Lead, Expanded Programme on Immunization (EPI)

eHealth Africa supported these efforts by providing Geographic Information Systems-based solutions and services including the Vaccination Tracking System (VTS). Here is how states benefited :

• eHA supported states to develop a comprehensive, up-to-date list of settlements. 

In 2014 and 2015, eHA mapped the eleven northern states under the Global Polio Eradication Initiative (GPEI). The data proved so useful to decision-makers that eHA received funding from the Bill and Melinda Gates Foundation (BMGF) teamed up with the National Primary Health Care Development Agency (NPHCDA), the UK Department for International Development (DFID), Flowminder, the United Nations Population Fund (UNFPA) and the Center for International Earth Science Information Network (CIESIN) to map the rest of Nigeria during the Geo-Referenced Infrastructure and Demographic Data for Development (GRID3) project which lasted from 2017 to 2019. We also frequently execute data collection and campaign activities across the country during which we gather spatial and non-spatial data relating to several points of interest including settlements and health facilities. These data are housed in what we call the eHA Geodatabase (GDB). 

Using the datasets in the GDB, we have helped states in Nigeria to identify previously unknown settlements and update their master list of settlements. eHA developed and provided the states updated LGA and ward level maps. The maps include the geocoordinates, names, and delineated boundaries of known and newly identified settlements. These updated master list of settlements and the new maps allow health planners to develop accurate, comprehensive micro plans for Routine and Supplementary Immunization Activities and reach eligible children in the remotest communities.

The Vaccinator Tracking System dashboard

• eHA built the capacity of health teams at the state and local government levels to visualize and analyze vaccination coverage data for decision making during campaigns.

Through the VTS dashboard decision-makers, partners, and other stakeholders can access near real-time information about ongoing and concluded immunization campaigns such as the immunization coverage and missed settlements. eHA trained health teams at the state and LGA levels to easily access, visualize and analyze the data on the dashboard, and use it to promptly identify and address challenges that may affect the immunization coverage levels in the state. 

The milestones recorded by Nigeria’s Polio Eradication program prove without a doubt, the positive outcomes that are possible when decision-makers use quality data as the basis for planning and implementing projects. eHealth Africa is proud to be a part of Nigeria’s Polio success story. We thank and congratulate our partner organizations and governments at the national and sub-national levels, who were all instrumental in this achievement.

Going forward, we know that a strong immunization program is essential to sustain this success so, we continue to support immunization programs at the state and national levels through projects such as Vaccine Direct Delivery, LoMIS Stock, and Kano Connect.

Supporting Vaccine Logistics and Maintaining the Cold Chain in Northern Nigeria

By Sadiq Haruna Hassan

A child in Kano State getting vaccinated

Every year, Nigeria spends millions of dollars to procure vaccines. The amount has grown from over US$ 302 million in 2015 to an estimated US$ 426.3 million in 2020. 1 Once the vaccines have been procured, a major challenge is maintaining the cold chain in transit to and on-site at last-mile health facilities. The cold chain is the system of storing and transporting vaccines at recommended temperatures—ideally between 2°C and 8°C—from the point of manufacture to the health facilities where they are used.2 If the cold chain is broken at any point between manufacture and usage, it could result in:3

• Loss of vaccine potency

• High vaccine wastage rates

• Loss of funds spent on procuring vaccines

• Need for re-immunization

To maintain the cold chain, health facility workers, and cold chain officers at local government and state levels in Nigeria must monitor and track the performance of cold chain equipment (CCE) regularly. Health workers record data on daily temperatures of CCE and the functionality of the equipment at health facilities across the country ( i.e. whether the equipment is working or not) using paper-based charts and forms, and cold chain officers visit health facilities routinely to collect this data.

A vaccinator in Kogi State shows us the vaccine to be used in her House-to-House Immunization Plus Days visit

As a result of insecurity, the location of the health facilities, and now, the COVID-19 pandemic, conducting this process in Northern Nigeria has been challenging. 

Vaccine Direct Delivery is a third-party logistics (3PL) service offered by eHealth Africa to the Sokoto and Zamfara State Primary Health Care Management Boards. Through this service, eHA picks up the required amount of vaccines from the state cold stores, transports them at the appropriate temperatures, and delivers directly to health facilities that are equipped with functional CCEs, ensuring that the cold chain is maintained and that the vaccines remain potent even in transit. In addition, using the VARO application, eHA helps decision-makers and key stakeholders to remotely monitor the performance of CCEs at 393 apex health facilities in both states.

A Health Delivery Officer in Zamfara State downloads the temperature records of Cold Chain Equipment

In Kano state where VDD is not operational, the apex health facilities, LG, zonal, and state cold stores keep track of CCE performance using LoMIS Stock, a solution developed by eHealth Africa. The solution allows health workers to send reports about vaccine stock data including vaccine utilization, wastage, and cold chain equipment functionality, using their mobile phones. These reports can be accessed in near-real-time by cold chain officers and decision-makers so that the faulty cold chain equipment can be fixed and back-up protocol for maintaining the cold chain can be followed.

Vaccines save lives. At eHA, our goal is to provide our partners with accurate data and technological tools so that they can better reach underserved populations with potent life-saving vaccines.

The Strides of Polio Vaccination in Hard to Reach Areas (HTRs) in Borno State

By John Momoh

As Nigeria marks 3 years and 10 months without a new wild poliovirus case, here is how the program has contributed to the Polio Eradication initiative in Borno State since 2016:

Inaccessibility to some settlements in  North East, Nigeria presents a great challenge to the immunization program in states like Adamawa, Borno, and Yobe states where the ongoing conflict is most severe. Health facilities in these states have been destroyed leading to a reduced number of eligible children being reached with Routine Immunization (RI) services. The mass displacement of people, migration from settlements, and insecurity have all hindered the planning and execution of Supplementary Immunization Activities (SIAs) such as Immunization Plus Days (IPDs) and Outbreak Response (OBR) campaigns in the region.

A child receives his vaccination at a settlement in Maiduguri, Borno state during an IPD campaign

In 2016, after a wild poliovirus outbreak in Borno, the  Borno State Primary Health Care Development Agency (BSPHCDA), in close collaboration with World Health Organization (WHO), the Bill and Melinda Gates Foundation (BMGF), U.S Centers for Disease Control and Prevention (CDC), United Nations Children’s Fund (UNICEF), eHealth Africa (eHA), Solina Health and other partners, launched the Reach Every Settlement (RES) and the Reaching Inaccessible Children (RIC) to access under-5 children in partially Hard to Reach (HTR) and HTR settlements respectively in order to interrupt the transmission of the virus.

Polio eradication partners at a working group meeting

eHealth Africa has been supporting the projects by leveraging our expertise in Geographic Information Systems, field operations, and logistics to collect and analyze geospatial data to aid near real-time monitoring of the program and decision-making by the state and relevant key stakeholders.

Pushing the Boundaries of Routine Immunization coverage

By John Momoh & Emerald Awa-Agwu

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

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

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

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

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

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

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

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

The Progress So Far

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

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

Reducing eHealth Africa’s Carbon Footprint

By Onche Ogbole

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

What We Did and How It’s Working

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

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

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

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

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

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

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

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

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