We gave back to our communities again!

Giving back to the community is one of the many ways eHealth Africa tries to improve the lives of people in the communities in which we live and work. This June we held two medical outreach events for our community service that served over 1000 people.

Our team members visited  Chirenchi and Dutse-Alhaji communities in Kano and Abuja, FCT., in collaboration with EHA Clinics. We provided free eye exams, basic lab testing, and pharmaceutical counseling to people in those communities. We also offered relevant family planning, water purification, and personal hygiene education.

Here are pictures from the events in Kano and Abuja, FCT.

Work Hard, Play Hard - how we have fun at eHA

By Juliana Jacob

Winning as little as a candy or a bar of chocolate from playing trivia games during a busy day at our workstations makes all the hard work easy. At eHealth Africa, while we believe in working hard, we equally believe in striking a balance. Having fun while working reduces fatigue that may result in burnout.

A study by Ford et al, suggests that an environment is considered fun when it intentionally encourages initiatives and supports a variety of enjoyable and pleasurable activities that positively impact the attitudes and productivity of individuals. Because we prioritize the happiness and well-being of our team, we strive to create an environment where everyone can take a few minutes out of their busy schedules to unwind; no meetings, no scrolling through our task management tool, or not even reading emails.

Here are 3 employee engagement initiatives we introduced to revitalize our workplace to decrease stress and promote fresh creativity and job satisfaction. 

We get everyone involved
Thank God it’s Friday (TGIF) is a favorite of many of our staff because of the rationale behind it. We organize a series of activities every last Friday of the month to allow our team to unpack their month and approach the new month with a relaxed and fresh mindset. While some employees spend the time relaxing and unwinding, others engage in healthy competitions to determine which team wins the title for the month. Different departments take turns hosting the TGIFs.

We go outside
Our mission as an organization is to ensure that people in underserved communities can lead healthier lives through our work. We started our Community Development Initiative (CDI) as part of our efforts to give back to the communities where we work and live in. We identify the needs of these communities and look for ways to support them. These CDI projects also serve as team bonding opportunities outside our work. Recently, to celebrate Earth Day we planted 500 trees in Kano and Abuja. Also, we renovated 22 boreholes across 10 LGAs in Kano State, Borno State, and Abuja.   

The conversation-starter
What started as an informal lunchtime trivia game has since become the norm at eHealth Africa. Some Fridays, a subset of our team gather to play trivia games. You can simply call this learn and play, while everyone involved has a good time, they update their knowledge of projects, programs and solutions.

For us at eHA, fun at work is essential to our employees' happiness. We know fun means different things to different people on our team. From a random joke from a colleague to just gathering around the workstation for trivia games. But whatever their concept of fun is, we are leaving no stone unturned in the pursuit of our team’s happiness.

When GIS and public health experts converged in Geneva

By Chinedu Anarado

On May 9th, the World Health Organization (WHO) formally launched the GIS Centre for Health. The center will manage the production and use of geospatial data and geographic information systems (GIS) towards strengthening public health interventions. Before now, WHO programs and units ran their health data independently. The center will now ensure a dedicated approach to producing and using essential GIS data through the various projects implemented at the center. In addition, it will drive capacity building, partnerships, and collaboration, expansion of GIS infrastructure, and deepening of the geospatial culture within the WHO.

Cross-section of WHO GHFD staff and the GHFD implementing partners (IPs) during the GIS Centre launch in Geneva

eHealth Africa (eHA) participated in this event as a key implementing partner on the Global Health Facility Database (GHFD) project. The GHFD project is one of the projects managed by the GIS Centre. It is also a crucial proof of concept on the value of a center with responsibilities to drive geospatial data generation and usage. The open-access Snakebite and Envenoming Platform is another initiative that leverages support from the GIS Centre, using the latest ArcGIS software. The platform addresses the lack of antivenom in vulnerable communities and improves available information about local snakebite risks.

Screenshot of the Snakebite GIS story map

The database operates as a global reference for anti-venom and snakebite health information. It was established in September 2021 and currently provides snakebite data, risk, nearest health facility for anti-venom etc. The solution is now being expanded to seven countries in East and West Africa, where priority health facilities will be analyzed for accessibility and anti-venom stockpiling. With a GIS-based web mapping, venomous snakes, their distribution ranges, venoms, anti-venoms, and manufacturers of anti-venoms with be available at the click of the button. In the next phase, the database will include data on health facilities and drive time relative to the victim's location. Anyone with internet access can access the platform for information and contribute photos and data to update snake habitats, ranges, and behavior.

The GIS Centre launch was also a gathering of key stakeholders in the GIS, public health, and humanitarian space who identify with the increasing value of geographic information systems (GIS) and the various use cases that will benefit their efforts beyond public health. In addition, we discussed support functions such as data collection tools, GIS usage case studies from the WHO Africa Regional Office, and new GIS features on open data collection kits.

The GIS Centre will leverage WHO's historical experience and knowledge in deploying GIS capabilities in driving public health delivery. Some of these are seen in the distribution of COVID-19, the polio eradication campaign, and the deployment of geospatial maps to support malaria programming.  

eHealth Africa is excited at the prospects of deepening its GIS capacity by partnering with the WHO GIS Centre for Health. Our extensive experience implementing vaccine tracking systems, mapping hard-to-reach localities, supporting immunization campaigns, and microplanning with geospatial maps and data signposts our commitment to using geospatial technologies in public health practice.

Partners’ role towards renewable energy accessibility in rural communities: A case study of 12 selected states in Nigeria

By Mohammed Bello and Tope Falodun

The focus on renewable energy in recent years has been on the rise, this is largely due to the bedeviling problems surrounding nonrenewable energy sources. It has been ascertained that the world will face severe problems related to the depletion of traditional (non-renewable) energy resources (Kahia et al., 2016) as a result of the exhaustive nature of the resources viz a viz growing population and industrial activities. Apart from the finite availability of this energy type, it has environmental issues, the increasing magnitude of global energy consumption and its rapid growth have severe environmental implications (Irandoust, 2016), It is now well established that oil and coal exploitation have ultimately led to forest destruction, biodiversity extinction and natural disasters. (Kahia et al., 2016) the consumption of this energy type also increases carbon dioxide emissions. These emissions are considered the main cause of global warming (Ben et al., 2017). These necessitate the surge of suitable energy for the environment and are inexhaustible.  

Renewable energy forms a key milestone in Africa for social and economic development.  The lack of access to electricity by most people - “600 million in Africa'', and one of the targets of the Sustainable Development Goals (SDG) No. 7 is to expand infrastructure and upgrade technology for supplying modern and sustainable energy services for all in developing countries, brought about the need to improve access to electricity. A common method to assess latent electricity consumption already being applied in Nigeria bringing in existing knowledge from various disciplines to the  Nigerian and West-African context and sharing results and tools openly with all stakeholders from questionnaires and interviews with relevant stakeholders forming partnership with several local (Covenant University, Obafemi Awolowo University,  Université Abdou Moumouni - WASCAL program,  PowerGen Renewable Energy, Creeds Energy,  Clean Technology Hub, Rural Electrification Agency, the Government of Nigeria) and international (Technical University Berlin, Wuppertal Institut,  MicroEnergy International,  Fosera) for the PeopleSuN,  a highly inter- and transdisciplinary project which seeks  to improve on this status quo, having Reiner Lemoine Institut (RLI) an independent non-profit research institution  whose mission is to find paths to a sustainable energy supply based on 100% renewable energy  sources partnering with the Funders - ‘PeopleSuN project funded under “CLIENT II - International  Partnerships for Sustainable Innovation'' in the Framework Program Research for Sustainable  Development towards goal number seven (7) engaged the expertise of eHeath Africa (eHA) a non-governmental organization focused on improving health systems with core technical expertise in Health Delivery Systems, Public Health Emergency Management Systems, Disease Surveillance Systems, Laboratory & Diagnostic Systems, Nutrition, and Food Security Systems, and sustaining program interventions with a mission to build stronger health systems through the design and implementation of data-driven solutions that respond to local needs and provide underserved communities with tools to lead healthier lives.

Scope

eHA as the consultant was ‘responsible for the turn-key implementation of detailed energy surveys of  households and enterprises across 247 non-urban enumeration areas of three geo-political zones in Nigeria’ involving a total of 12 states as follows; 

• Kaduna, Kano, Katsina, and Zamfara within the North-Western zone

• FCT, Nassarawa, Niger, and the Kogi states within the North-Central zone

Akwa-Ibom, Delta, Edo, and the Rivers states within the South-South zone.

Fig 1. Map showing implemented states

Methodology/ Implementation Approach

The methodology used in collecting the data was using a customized Kobo Collect smartphone and a conjoint laminated sheet. eHA conducted detailed energy surveys in Households and Enterprises within these zones.

Field Data Collector administering Household survey in one of the EAs at Malumfashi LGA of Katsina State

From the outset of the survey, one of eHA’s innovative data-driven products, Planfeld was leveraged for planning and monitoring of the survey field activity. A total of 60 enumerators and 12 State supervisors were engaged in the quantitative survey activity. 3,952 Households and 1,235 Enterprises were targeted and data collection started on August 7, 2021. A team comprising 2 enumerators (mostly paired male and female) worked in an EA to cover 16 households and 5 enterprises in each EA. They were to cover 1 EA daily including travel time. Teams set out daily to cover EAs as planned and moved into new EAs to continue coverage, with plans to complete unfinished ones the following day. Gatekeepers, including community leaders and local authorities, were consulted before enumerators’ visits and commencement of activity at the LGA and community levels.

Fig 3. Table showing targeted enumerating areas (EAs)

Data Quality Control and Quality Assurance procedure

To ensure accurate and reliable results from the fieldwork, three categories of validation were used. Attribute validation control, Lineage validation, and spatial validation. All these validations serve as data quality control (QC) for the survey. These controls were checked at three (3) levels of data quality.

Fig 4: Quality Assurance procedure

Three levels of controls:

• Field Enumerator checks: Field enumerators ensured that all Quality Control (QC) checks were completed.

• Supervisor checks: Supervisors ensured that all the enumerators met their daily target, also ensured that all QC checks were passed. The supervisor ‘approved’ the forms from the Kobo toolbox platform after validation

• Data Analyst checks: The Data Analyst runs the quality control check on the forms and is sure that all validations were done. Then the data was released to the partners to ensure the data was valuable, complete, and precise.

The 3 cycles of data validation continue until a desirable result was met.

Data Process and Analysis

The workflow of the data process started from the Open Data Kit (ODK) forms development. We produced the forms in 3 different languages, English, Nigerian Pidgin, and Hausa. This was followed by the deployment of survey tools on the KoBo ToolBox platform. The two survey components- Household and Enterprise- possessed a questionnaire file each. The survey platform was then ready for submissions from the field which were made by the enumerators. After the data collection, the data cleaning exercise commenced which marked the end of data process activities as required by the partner.

Fig 5. A map depicting all implementing states with points collected overlayed

Results

The data were collected in a total of 3,961 Households and 1,232 Enterprises across the 12 states, with 9 EAs that were not visited due to insecurity amongst other issues.

Challenges

There were various challenges encountered during the implementation exercise across the 12 states. Insecurity cuts across the states as some secured areas before implementation became insecure while others are uniquely specific, these challenges are not limited to the following;

• Enumerators' inability to complete targeted H/H and  Ent in specific EAs as a result of security attack while conducting the survey.  The states affected are Akwa-Ibom, Katsina, and Kaduna.

• Torrential rain in Akwa-Ibom, Delta, Edo Rivers, and FCT led to obstruction to daily implementation with re-visit plans rescheduled.

• The bulkiness of the survey led to the refusal to consent or complete the questionnaire in some households across the implemented states.

Lessons Learned

• Communities were reluctant to willingly cooperate with enumerators without the presence of a known local guide at the initial stage. This was later resolved by the collaboration of supervisors and the enumerators who worked hard to engage and onboard local guides, despite the lack of payment factored for local guides.  Provision of incentives (payment)  for local guides should be considered and budgeted for in surveys to get the buy-in of communities.

• Secure enumerating areas (EAs) before implementation become highly insecure after commencement.  information from the security situation reports by the Security Adviser is shared with the team daily in addition to pre-training/instruction to source valid information about the environment locally before moving out daily.

• In this case, the client is the one to provide EAs to be implemented by a consultant, adequate EAs as backup is to be provided for the exchange of inaccessible ones due to whatever reasons. Alternatively, pre-agreement of additional EAs is to be provided by the consultant and agreed upon before the implementation planning phase.

The Program Partners

eHealth Africa planted 500 trees for Earth Day

Last week, just in time for Earth Day 2022, our team in Kano and Abuja embarked on a “plant a tree” campaign. We believe that one of the most significant ways we can help to address the concerns of climate change is to plant trees. As an organization, while we strive to be more energy-efficient to reduce our carbon footprint, we also take other actions to improve the communities we work and live in. For this campaign, we took to some selected communities in Kano and Abuja to plant 500 trees, 300 in Kano, and 200 in Abuja.

About the “plant a tree” campaign, Dr. Kabir İbrahim Getso, Kano State Commissioner for Environment, had this to say, “The essence of Earth Day is to awaken our consciousness to create awareness to protect our environment and engage in practices that will ensure sustainable management of our environment. The very high temperatures we are experiencing and the flooding in Nigeria and around the world are some effects of climate change. Organizations and individuals need to join hands with the government to safeguard the environment and I would like to appreciate eHealth Africa for joining hands with the Kano State Ministry of this environment to carry out this tree planting exercise.”

Here are pictures from the plant a tree campaign in Kano and Abuja

Harnessing Innovation to reduce malaria

By Faridah Tajuddeen

According to the World Health Organization, there were an estimated 241 million cases of malaria worldwide, with an estimated 627,000 deaths in 2020, and 80% of these deaths were children under five years from Sub-Saharan Africa.

The populations with the highest malaria mortality tend to reside in hard-to-reach regions of Africa, with limited access to health facilities. Is there something that needs to be in place to reduce the number of malaria deaths? How do we as an organization use innovation and data to reduce the malaria burden and save lives?

Here are three ways we have harnessed innovation to reduce the malaria burden.

Adequate tracking saves lives

In October 2021, the World Health Organization engaged eHealth Africa to support the Seasonal Malaria Chemoprevention (SMC) Cycle 4 campaign with GIS eTracking across all the 21 Local Government Areas (LGAs) of Adamawa State, and 4 selected LGAs of Yobe State. The campaign was house to house, and we employed the services of Community Drug Distributors (CDD) for drug delivery.

eHA provided technical, equipment, and human resources to support the cycle 4 campaign by collecting and analyzing the passive tracks of the Community Drug Distributor (CDD) teams during SMC Cycle 4 campaign using Vaccinator Tracking System (VTS). We provided VTS for coverage, and this helped with the numbers of houses reached, as the tracker shows any missing location for mop-up. We also tracked the drugs to ensure effective utilization.

Identifying coverage gaps with GIS

We supported the Malaria Consortium in mapping out nine hard-to-reach local government areas in Kaduna and eleven hard-to-reach local government areas in Kano to make them eligible for ICCM (Integrated Community Case Management). ICCM is a strategy that focuses on training, supporting, and supplying community health workers (CHWs) to provide diagnosis and treatments for illnesses such as malaria, pneumonia, and diarrhea for children of families with difficult access to health facilities. Research has shown that ICCM can potentially decrease the child mortality rate of these three illnesses by a whopping 60%.

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 for two weeks.

Access to geospatial data can reduce the malaria burden

We are increasing access to geospatial data in public health planning by opening access to the data we have collected over the years to the public, to allow a wider cross-section of people and organizations access to data that can assist them in decision making and resource planning. We created a tool called the Data Portal, which is a collected catalog of a wide variety of geospatial data and other datasets in the countries and regions eHealth Africa has worked in. We developed this to serve the data access, routine analysis, and informed decision-making needs of government, private sectors, donors, partners, and individuals.

The data is accessible to all for non-commercial use.

With access to this data, the government, non-governmental organizations, relief, and charitable organizations have information on boundaries, settlements, and health facilities; this makes field operations and deployment of resources a lot easier. So when mosquito nets distribution or chemoprevention campaigns are planned, there’s enough data available to serve as a guide, providing information on different settlements and how many health facilities are accessible in those areas.

The fight against malaria is global and still ongoing, and thanks to better prevention and treatment tools, there has been a drop of 44% in the malaria mortality rate in the last two decades in Africa.

Addressing Gender Bias Around Adolescent Girls’ Contraceptive Use

By Sunday James, Fatimah Abdullahi, Hafsat Jafaar and Stephanie Okpere

Adolescent woman receiving counseling and contraceptive from an eHA-ANRiN service provider during routine Adolescent Health Service delivery in Kaduna

Around the world, Gender and other Social norms have had a tremendous impact on the Sexual and Reproductive Health (SRH) of young people, especially Adolescent Girls. Cultural constructs of gender shape expectations related to sexuality and play an essential part in defining what roles and behaviors are considered appropriate for Adolescent Girls and Boys.

Normative expectations embedded in many societies about gender and sexuality create a double standard – which may manifest differently in various settings – that typically encourages sexual liberty for men and demands sexual constraint from women. This values purity and virginity above all else for girls while giving adolescent boys more freedom, including the room to explore, experiment, and engage in sexual relationships. This double standard also places the majority of the burden on females to reject sexual advances from males and to take precautions to avoid pregnancy and sexually transmitted infections (STIs), with females often blamed for STIs and unintended pregnancies. This contributes to the idea that reproductive health is a female responsibility with no role for men. Existing social norms that place men at an advantage with increased access to opportunities also affect young women. Due to these norms, men are more likely to control resources and make decisions for their partners, and may not allow their partners to use contraception. These norms also limit the educational opportunities for young women, marginalizing them from obtaining access to accurate information on sexual and reproductive health.

To make SRH services more accessible to young people, especially adolescent girls and women, eHA ANRiN is addressing gender norms at the community level and building a supportive environment by addressing social and gender norms in addition to increasing individual knowledge that helps in reducing stigma. This effort aims at improving youth-friendly health services at the community level through a more holistic package of interventions that include comprehensive sex education, raising awareness about services to generate more demand among young people for sexual and reproductive health services, and building community support that will decrease stigma and encourage youth to engage in discussions about SRH and seek out services through advocacies, stakeholders engagement, awareness creation at key live events. In addition, eHA ANRiN is providing AHS services and a variety of contraceptive methods to Adolescent Married Women aged 15-19years old to bridge the existing unmet need for contraception. These actions are already having a greater cumulative impact on improving uptake of AHS services, thereby increasing the state’s modern Contraceptive Prevalence Rate (mCPR) and explicitly challenging discriminatory gender norms that put Married Adolescent Girls at a disadvantaged position through awareness creation and balanced counseling services. 

How a Global Health Facility Database can improve the timely delivery of health services

By Chinedu Anarado

The COVID-19 pandemic amplified gaps in global capacity to respond to public health events of such dimension and scale. The world was slow to respond, and when it did, wealth inequalities ensured that some countries had access to life-saving support before others. Poorer countries largely bore the burden of COVID-19 as they grappled with huge infrastructure gaps while trying to ensure their people were safe from COVID-19. At the same time, global health strategists did not have access to the information they needed to deploy appropriate interventions to support developing countries. 

Bamali Nuhu Hospital, Kano Municipal, Kano, Nigeria

The impact of this scenario was predictable. Vulnerable populations were more affected, while those living far from health facilities required more effort to get vaccinated. In Africa, the average readiness rate for vaccine rollout was 40 percent. These issues highlighted the pressing need for improved data that can provide relevant insights into the location of health infrastructures and the distribution of healthcare services. The world needed definitive answers to a straightforward question: where are the health facilities?

Quality data about the location and status of health infrastructures at the local, national and international levels could have improved global efforts to contain COVID-19. With reliable information on health facilities, Governments can improve their vaccine logistics, distribute personal protective equipment (PPE), and expedite vaccine and therapeutics rollout. It became evident that if we want to rapidly reach the needed populations with the necessary support, we must understand their accessibility to health facilities. 

In December of 2021, the World Health Organization (WHO) launched a global campaign to improve access and visibility of health facilities among member states. This global initiative is being implemented across WHO regional offices in Africa (AFRO), South East Asia (SEARO), Eastern Mediterranean (EMRO), and the Western Pacific (WPRO) regions. The goal is to help countries collate and validate their health facility master list and contribute this information to a global database of health facilities. 

“In this age of information, member states need updated database tools to reach the World Health Organization’s triple billion targets for healthier populations, universal health coverage (UHC), and health emergencies protection.”

— Steve Macfeely, Director, Data and Analytics ,World Health Organization

Republic of Tanzania’s Health Facility Registry

We can achieve these challenging targets with robust and authoritative data collection, integrated into a collaborative system that allows citizens and municipalities to identify the locations and services provided by health facilities in their vicinity.

This Global Health Facilities Database (GHFD) will serve as a central repository, providing information such as the health facility’s name, location, and type while assigning a unique identifier to each. In addition to improving aspects of primary care, this data can improve response time, identify gaps in quality, and support advanced health emergency efforts, such as the COVID-19 response.

The public health space has relied on platforms from multilateral agencies and nonprofits to plan interventions. Platforms such as the Humanitarian OpenStreetMap, the WHO ISS, and e-SURV database, GRID3, and the Global Health sites mapping project were some of the only sources of information on health facility data. But these data sources can be inadequate and often do not reflect the realities on the ground. Hence, the WHO has conceived the Global Health Facility Database (GHFD) project as a public good to enhance information access on the location and status of health facilities across all WHO member countries. 

The GHFD project will require participating countries to update their health facility data, participate in an assessment of the existing health facility list or registry, sign an MoU with WHO to share that information with a global database managed by the WHO GIS office, and receive capacity support to ensure the information is updated periodically. A standard health facility list should bear information on the status, location, and capacity. 

Each facility in each country will come with a unique identifier on the GFHD database. Thirty-two countries in Africa are participating in the project’s first phase, which will run for five years. eHealth Africa is implementing this project in five countries: Cameroon, Chad, the Gambia, Seychelles, and Togo. For eHA, this is one of the ways we support the strengthening of health systems and ensure that we can improve access to care for vulnerable populations.

“Supporting WHO member states with establishing and maintaining a master list of health facilities and combining them into a standardized health facility registry will not only strengthen national healthcare delivery systems but also provide a critical resource needed to respond to any public health emergency of international concern (PHEIC).”

— Vince Seaman, Senior Program Manager, Polio, The Bill and Melinda Gates Foundation

We believe that the time has come to support establishing and maintaining a master list of health facilities in each WHO member state and the creation of a global health facility database (GHFD). The availability, quality, and accessibility of the master list of health facilities and the Global health facilities database will transform our capacity to deliver interventions and ensure that wastage of health consumables such as vaccines reduces and health support is prompt and timely. 

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.