Advancing Public Health: Niger State Set to Inaugurate State-of-the-Art Emergency Operations Center

by Favour Oriaku

Following the successful commissioning of the Emergency Operations Centers (EOCs) in Kebbi and Zamfara states earlier this year, the spotlight now shines on Niger State as they prepare to inaugurate their own EOC, marking the 11th such facility constructed and overseen by eHealth Africa across Nigeria. 

 The inclusion of Niger State in this initiative can be traced to the state being one of the critical regions in Nigeria's fight against the circulating variant of the polio virus and other vaccine-preventable diseases. Aligned with the objectives of the Global Polio Eradication Initiative (GPEI) and its partners, this new EOC aims to enhance coordination and response strategies for Niger State.

Upon its completion, health stakeholders anticipate a state-of-the-art infrastructure that will streamline the planning and execution of public health interventions in Niger State. Through data-driven decision-making processes, the EOC promises to yield improved outcomes, benefiting not only the citizens of Niger State but also its neighboring regions.

During a recent site inspection, discussions with key figures including Eyitayo Samuel, the supervisory site manager, Dr. Abdullahi Usman Imam, Permanent Secretary of the Niger State Ministry of Public Health Care (NSMPHC), and Dr. Samuel Jiya, Director of Disease Control and Immunization at NSMPHC, shed light on the construction progress, and future collaboration prospects.

Eyitayo Samuel, the supervisory site manager, shared insights into the construction progress, affirming the dedication to quality and functionality. He stated, "The progress of the work reflects meticulous planning and execution, indicating a facility that is poised to meet its objectives effectively."

Dr. Ibrahim Ahmed Dangana, the Honourable Commissioner for Primary Health Care Development in Niger State, along with Dr. Abdullahi Usman Imam, Permanent Secretary of NSMPHC, Dr. Samuel Jiya, Director of Disease Control and Immunization, and other essential stakeholders, conducting a site inspection of the ongoing construction of the Niger State Emergency Operation Center.

Dr. Abdullahi Usman Imam commended the meticulous planning evident in the design phase of the EOC, foreseeing its potential to significantly enhance primary healthcare services in Niger State. He affirmed the government's commitment to maintaining the facility at world-class standards, allocating resources for its upkeep and even planning to establish a Data Center to complement its activities. Dr. Abdullahi Usman Imam remarked, "Looking at the progress of the work, it is obvious that a lot of planning has gone into the design phase, as It is already looking like a world class facility that would serve the purpose for which it is being built thereby making very significant impact on Primary Health care services in Niger state."

He further stated, "The government of Niger state will ensure that a budget is set aside to ensure that the facility is maintained to world class standard. The government of Niger state has already set aside in its budget for this year to establish a Data center, this will complement the activities of the EOC."

Dr. Samuel Jiya emphasized the EOC's role in fortifying the state's immunization campaigns, likening them to strategic warfare where planning and execution are paramount. With the EOC as the central hub for coordination, he expressed confidence in the state's ability to combat prevailing diseases effectively. Dr. Samuel Jiya stated, “The campaigns are like a war situation whereby a lot of planning and strategizing goes into play, and this EOC as well equipped would be the hub of that planning and strategizing, ensuring that we efficiently fight the existing variant of polio and other vaccine-preventable diseases, and kick them out of the state.”

The construction and management of the Niger State EOC by eHealth Africa, with support from The Bill and Melinda Gates Foundation and Aliko Dangote Foundation, exemplify the potential for impactful achievements when communities, leaders, and partners unite for public health initiatives.

OutREACH: eHealth Africa, Clinic Collaborate to Tackle Non-Communicable Diseases

by Moshood Isah

Hypertension is a major public health problem in Nigeria, with prevalence of 37.5%. This means that nearly 4 out of 10 Nigerian adults have hypertension. Similarly the prevalence of diabetes is increasing worldwide, and Nigeria is no exception; an estimated 7% of adults in Nigeria have diabetes, making it among the most common cardiovascular diseases in the country.

Unfortunately,  lack of access to quality and affordable hypertension and diabetes services in rural communities and primary health care is a major concern. This is largely due to  disparity in access to quality healthcare, especially between rural and urban areas in Nigeria as a result of  economic, social, geographic, and health workforce factors. For instance, the secondary health facilities where the few drugs are, with the facility for testing and the medical professionals are far from the rural communities, making access difficult. This is exacerbated by the high cost of medications, making it difficult for some clients to afford the treatment they need, resulting in low treatment outcomes.

Thus, adapting and digitizing  the World Health Organisation Package of Essential Noncommunicable (PEN) disease interventions for primary health care, eHealth Africa is collaborating with the EHA Clinic Reaching Everyone with Accessible Community Healthcare (REACH) program to reach out to marginalized communities with healthcare interventions. This, according to the Project Manager Lucy Okoye, is aimed at improving access to quality care and affordable services for persons with hypertension and diabetes and others at risk. 

She said, “Social mobilization activities will increase rural communities' knowledge of hypertension and diabetes”, saying  the identification of risk factors and the signs of hypertension and diabetes will likely result in the adoption of a preventive healthy lifestyle and prompt seeking of treatment. Another potential impact of the intervention according to her is to reduce the prevalence of hypertension and diabetes and improve the health and well-being of the target communities, helping people to live longer and lead healthier lives. 

In February, eHealth Africa supported the free medical outreach conducted in the Kuje community of the Federal Capital Territory and Gyadi-Gyadi community of Kano state. According to Adawiya, Mahmud Ila, Product and Quality Assurance Coordinator at the EHA REACH clinic said the outreach is an opportunity to reach the people accessible and  to provide free healthcare within the community. 

“We are having an outreach where we see hypertension and diabetic patients,we measure the blood pressure and fasten blood sugar.”  If there is a need for us to give hypertensive and glycine medication we give them which is going to be free for 6 months”, she said.

She said, the economic realities in developing countries like Nigeria limits citizens especially the older generation from accessing good medical care.  She said, “You know how the economy is in Nigeria; economically it's hard for them to go to the hospital so we are just trying to make an impact in the community”.

Speaking on community acceptance and mobilization strategy for the outreach, Adawiya said, the partners leveraged on its Community Health Extension Workers (CHEW) to discuss the impact of the intervention  with traditional leaders and community influencers. 

Community Feedback

Zainab Abdullahi is  a resident of Kasuwan Dare area of Gyadi-Gyadi community of Kano state. She heard of the REACH Clinic Outreach through community influencers. “Now they checked our BP,Blood sugar level and from here we will proceed to see the doctor”, she said. 

Zainab lauded the outreach initiative saying the community is receptive to ideas like this. “the hospital environment is clean and welcoming and this is why you can see close to 100 people coming for this outreach”.  “If they can spread their tentacles and establish  this kind of hospital in all areas, we will be happy so that everyone will visit the nearest hospital rather than going far from home to access healthcare”, she said.  There is also a need to have additional doctors to attend to a growing number of patients in a bid to reduce waiting time, she said.

Ahmed Salisu Musa has spent 45 years in the community.  He expressed his excitement saying the outreach has brought good healthcare delivery to his doorstep. “They took my blood samples, gave me some medications and I was told, I am not diabetic”, he said

He said, “as a community leader myself, I am glad to  have witnessed what is happening and will pull  in more people to come and get checked.” Musa called for increased mobilization of citizens and more importantly expansion of the intervention to reach other communities.

Empowering Nigeria’s Healthcare System with EMID App Training

Group photo of eHealth Africa's training team, the National Primary Health Care Development Agency (NPHCDA) training team, State Train the Trainers representatives, and other stakeholders following the EMID cascade training in Ebonyi State.

by Favour Oriaku

Since March 2022, eHealth Africa (eHA) has been instrumental in enhancing the capabilities of the Electronic Management of Immunization Data (EMID) System in Nigeria. This project, funded by the Global Alliance for Vaccines and Immunization (GAVI), is in partnership with the National Primary Healthcare Development Agency (NPHCDA). The goal is to streamline immunization data management at Primary Healthcare Centers (PHCs) across the country, improving vaccination scheduling, real-time data entry, and the overall process of data collation, analysis, and validation.

Dayo Akinleye, a technical Project Manager at eHealth Africa and a member of the EMID project implementation team, shared insights on the progress  made. "The EMID app has been optimized significantly ," he said. "We've introduced several new features, such as the integration of a dedicated Routine Immunization (RI) module, liveness detection, geo-fencing, Frequently Asked Questions (FAQ), real-time help desk support, and overall enhancements to the app's user-friendliness."

Following these improvements, eHealth Africa and NPHCDA, with support from Data-Fi, initiated a comprehensive training for health workers across Nigeria's 36 states, 774 local government areas, and the Federal Capital Territory, Abuja. The series of trainings, recently conducted in several states including Kogi, Nassarawa, and Ebonyi states, were meant  to familiarize healthcare professionals with the updated EMID native app.

James Gambo, a Data Processing Officer with NPHCDA and a member of the training team, emphasized the app's evolution and the significance of the training. "Originally designed for COVID-19 vaccination data, the EMID app now includes a module for routine immunization. It eliminates paper-based records, allowing immediate data access at the NPHCDA headquarters. We're conducting nation-wide training to ensure all users are proficient with the app," he explained. The training strategy involves National Training of Trainers (NTOT), who go on to lead the training at the State level. The State Training of  Trainers (STOT) comprises LGA EMID Focal persons and the State EMID teams. After the STOT, the LGA EMID Focal Persons  then go on to train the recorders at the LGA levels with oversight from both eHealth Africa and NPHCDA/State teams. The hands-on training has received positive feedback, and we've observed participants adeptly navigating the app during the training.

Christopher Nwodom, the Ebonyi State Immunization Officer (SIO), also shared his thoughts. "The EMID native app has revolutionized immunization data collection. It's not just about moving away from paper; it's also about ensuring data accuracy. This training will undoubtedly enhance the skills of EMID focal persons in recording and uploading data in real time," he remarked.

Nwonu Victor Onyedikachi, an EMID recorder who underwent the training, expressed his enthusiasm for the new app. "I find the new EMID native app incredibly user-friendly, efficient, and responsive. The added features have made my experience even more enjoyable," he stated.

Once the training phase is completed, an official launch and deployment date for the new EMID native app will be announced. This marks a significant milestone in the collaborative efforts of GAVI, NPHCDA, and eHealth Africa to enhance health data collection, recording, synchronization, and storage in Nigeria.

Nasarawa SPHCDB set to Sustain Vaccination Progress with User-Friendly EMID Mobile App

by Moshood Isah

The race to  ensure accessibility to  COVID-19 Vaccine and  intensive campaigns to promote the uptake of the vaccines led to its routinization especially in developing countries.   To further ensure the successful implementation of its COVID-19 vaccine deployment plan and address existing challenges of data management, Nigeria developed the Electronic Management of Immunization Data (EMID) system in 2021. By the end of the year,  the National Primary Health Care Development Agency (NPHCDA) revealed that Nasarawa state, located in North Central part of Nigeria has again overtaken other states in the COVID-19 mass vaccination campaign in Nigeria.

However, recent experience has also revealed that manual data collection remains vulnerable to damage or manipulation. Digital solutions remain mostly more recommended as it enables more accurate data capturing and better storage process.  However, the potential challenges that could hamper the progress of development and utilization of digital solutions for management of immunization data are likely technical glitches and capacity limitations of health officials, especially in underserved communities. 

 To Address these challenges, eHealth Africa in partnership with National Primary Health Care Development Agency supported by GAVI developed an optimized version of the EMID mobile application, incorporating routine immunization to further standardize and harmonize data collection and storage. Thus, eHA successfully completed the training of healthcare personnel across the country, in the use of the EMID Native App.

Speaking during the training session for healthcare personnel and immunization recorders across over 300 Primary Health facilities in Nasarawa state, key stakeholders highlighted how the optimum utilization of the EMID application will sustain vaccination progress in the state.

LGA EMID Focal Persons in Nasarawa state after a Training of Trainers on optimised EMID application

Abubakar Alilu Awei, State Primary Healthcare Development Board, (SPHCDB) Immunization Officer (SIO) said the presence of EMID Focal persons at the LGAs ensuring that all recorders upload information of clients on the national server was indeed instrumental in the state progress during the COVID 19 vaccination.  He said, “You may recall that Nasarawa state emerged as the overall best performing state in Nigeria in terms of COVID-19 vaccination and also the best performing state in the North central zone. This may not be unconnected to the good use of our EMID application that we adopted during the COVID 19 vaccination.”

Awei further lauded the incorporation of routine immunization into the application saying, the training is timely as it  will enable the state to have  data on the server to enable adequate tracking of client information. He said, “with the optimized EMID app,  at a glance we can  check on the client that has been vaccinated with the first antigens. So when they come back to the health facilities for the next antigen it's just for the recorder at the health facility to go to the server and update the current antigens that they have received”. It reinforces the prospects for effective management of immunization data.

In a similar vein, Beatrice Samuel, NPHCDA, Zonal technical officer,  Nasarawa state said, “one of the things we really enjoyed is that we could see the accessibility, the user friendly and not much challenge”. While describing the optimization of the EMID app as a milestone for the agency and eHealth Africa, she called for its sustainability. 

“I  want to believe that the excitement we have now would not just go away. It should be something that will not give us challenges when we go to the field.  There should be a sustainable native app for us to enjoy more and more”.

Immunization Recorder in Doma LGA of Nasarawa State

In his words, Ahmed Ibrahim, EMID State Focal Person for Nasarawa State lauded eHealth Africa for leading the optimization of the application saying, “ our recorders at the health facility will now know the value and importance of keeping record”. He said the application guarantees the safety of data in its electronic form saying,  “even if the facility is burnt you can still go to the database and search for the record of any person”, he concluded. 

Celebrating the Handovers of EOCs in Zamfara and Kebbi States

Kazeem Balogun, Senior Programs Manager at eHealth Africa, and Dr. Muyi Aina, Executive Director of the National Primary Health Care Development Agency (NPHCDA), during the handover ceremony for the Zamfara State Emergency Operations Center.

by Favour Oriaku

In the ongoing battle to eradicate the polio type 2 virus, Kebbi and Zamfara states, alongside six others - Borno, Katsina, Kaduna, Niger, Sokoto, and Yobe - have been identified as critical regions in Nigeria's fight against this debilitating disease. These states, collectively referred to as the Axis of Intractable Transmission (AIT), face unique challenges due to areas that are difficult for vaccination teams to access. To bolster the efforts of the Global Polio Eradication Initiative (GPEI) and its partners, the establishment of additional Polio Emergency Operation Centers in Kebbi and Zamfara States became essential. This strategic move aims to accelerate the journey towards the complete eradication of polio in Nigeria and the wider African continent.

January 2024 marked a pivotal period in Nigeria's public health sector with the official handovers of Emergency Operations Centers (EOCs) in both Zamfara and Kebbi States. Held on the 29th and 31st of January respectively, these events signified major advancements in healthcare systems in these regions.

Governor Dauda Lawal, Executive Governor of Zamfara State, cuts the ribbon at the handover ceremony of the Zamfara State Emergency Operations Center.

Zamfara State's EOC Handover

The transfer of the EOC to the state government in Zamfara on January 29th was a celebration of partnership, progress, and a vision for a healthier future. The day included visits to Governor Dauda Lawal and HRH Alh. Ibrahim Muhammad Bello Sarkin Katsinan Gusau, the Emir of Gusau, followed by the official handover ceremony.

This event saw participation from state officials, traditional leaders, and representatives from various organizations. Dr. Muyi Aina, the Executive Director of NPHCDA, stressed the governor's vital role in upkeeping the EOC. In response, Governor Lawal expressed, "I am deeply grateful to all our partners and pledge to ensure the EOC's effective management for the benefit of Zamfara's residents."

Kazeem Balogun, Senior Programs Manager, and Abubakar Shehu, Programs Manager at eHealth Africa, during the courtesy visit to the palace of Alhaji Sama'ila Muhammad Mera, the Emir of Argungu.

Kebbi State's EOC Handover

On January 31st, Kebbi State echoed this progress with its EOC handover in Birnin Kebbi. The day began with a visit to the Emir of Argungu, Alhaji Sama'ila Muhammad Mera. The Emir, emphasizing his commitment to health, said, "80% of the conversation we have around the palace is geared towards health and wellbeing, as I have been a health practitioner for a very long time." He also facilitated a tour of the Argungu war museum for the delegation.

The handover ceremony was attended by state health officials and representatives from supporting organizations. Governor Abubakar Atiku Bagudu, represented by Alhaji Safiyanu Garba Bena, Head of Service, received the EOC keys and new trucks donated by Unicef. Relaying the governor's message, Bena stated, “We deeply appreciate our partners' efforts in supporting Kebbi's health and wellbeing. We assure you of our commitment to not only using this facility effectively but also ensuring its proper maintenance.”

Muyi Aina, handing over the facility, emphasized the need for collaboration. "For this to work, there needs to be a conscious effort towards the judicious use of the facility," he advised. He also called for the swift appointment of an Incident Manager to manage the EOC.

A Testament to Partnership and Progress

The establishment of EOCs in Zamfara and Kebbi, built and managed by eHealth Africa with support from The Bill and Melinda Gates Foundation, Aliko Dangote Foundation symbolizes a renewed commitment to public health. The handover represents more than just new buildings; they are a collective resolve to improve healthcare in both states. Additionally, the events were utilized to hand over maps derived from micro planning and tracking by eHealth Africa. These maps are intended for the state's use in health and other social development planning, providing valuable resources for more effective and targeted initiatives.

As these EOCs commence operations, they stand as testaments to the power of partnership and dedication to improving health outcomes. The handovers in Zamfara and Kebbi are vivid examples of the remarkable achievements possible when communities, leaders, and partners unite for public health.

COP28: Spotlighting the Impact of Climate Change on Public Health - Atef Fawaz

Atef Fawaz, Executive Director, eHealth Africa

Less than a fortnight ago, the  World Health Organisation,  Director-General, Dr Tedros Adhanom Ghebreyesus warned that the impact of climate change may reverse the progress made in the fight against malaria. This according to him is due to “COVID-19-induced public health disruptions, humanitarian crises, drug and insecticide resistance, and global warming impacts”. As contained in the recently released World Malaria report, the changing climate poses a substantial risk to progress against malaria, particularly in vulnerable regions. This may just be another critical reason needed to lift the climate change/health nexus while ensuring effective mainstreaming of  health in the global climate change agenda.

There is no gainsaying that developing countries like Nigeria and others  must be on the alert to prepare for the potential impact of this new development necessitated by climate change. Despite the hysteria that greeted the reported number of Africa’s delegates (especially Nigeria) to the just concluded 28th United Nations Climate Change Conference otherwise referred to as  Conference of Parties (COP28), It is pertinent to reflect on the economic and human resources invested in the event to explore actual opportunities. 

The conference was no doubt a huge platform  where thought leaders and experts across the  world come together to chart pathways  to address the climate crisis, and proffer succor on how  vulnerable communities can adapt to the effects of climate change. This is in a bid to achieve the  overall goal of  net-zero emissions by 2050. With over 70,000 delegates expected to attend this important event every year; from business leaders, young people, climate scientists, Indigenous Peoples, journalists, and various other experts and stakeholders; the opportunities are boundless. 

With the 2023 Intergovernmental Panel on Climate Change report revealing that over 3.5billion people live in areas that are vulnerable to climate change, it's just a matter of time before nations feel the impact if there are no effective measures for early preparedness and response against climate change.  This may have contributed to the call for urgent action on climate change and health by  the Global Health Community.  This is also not a coincidence as similar calls were made before the 2022 Conference as the World Health Organisation reiterated the fact that,  climate crisis continues to make people sick and jeopardizes lives. This yet again buttressed the call to make healthcare delivery amidst climate change  a critical area of discussion during the conference.  Thus it was not surprising when the COP28 Presidency joined with the World Health Organization to announce a new ‘COP28 UAE Declaration on Climate and Health’ (the Declaration) to accelerate actions to protect people’s health from growing climate impacts.

Thus developing countries like Nigeria have a huge opportunity to build on their participation in the conference to explore ways to alleviate the grueling impact of climate change on healthcare delivery and policies.  One of the first signatory to the Declaration on Climate and Health, Malawian President Lazarus Chakwera revealed that  extreme and unfavorable weather events have consistently displaced citizens, causing the spread of infectious diseases that has led to the death of thousands in countries like Malawi. 

Nigeria specifically in recent times witnessed increased flood and rapid desertification. For instance, in the last 18 months, Nigeria experienced massive floods caused by global warming with huge economic and health implications like loss of lives, properties leading to chronic hunger and vulnerability to water-borne diseases.  Also, the potential threat to  livelihoods like agriculture and  fishing is no doubt cause for concern with potential challenges of food security which negatively impact health and nutrition.

While a handful of organizations are taking both intentional and unintentional steps to combat the impending impact of climate change, it is vital to galvanize important stakeholders  across all sectors to discuss their role in supporting the process.  A typical example of such steps is eHealth Africa's deployment of a modular solution that involves the design and implementation of renewable energy solutions for healthcare facilities, especially in low-resource settings. The  Renewable Energy for Public HealthCare (RE4PHC) solar system is designed to be deployed to health facilities with minimal access to power but at the same time reducing the emission of greenhouse gas from generating sets due to lack of electricity. 

However there is need for public and stakeholder sensitization and coordination on the potential impact of climate change in the African region especially in Nigeria. Organisations and government agencies like Nigerian Park service, Great Green Wall, ministries of Agriculture, Marine and Blue economy amongst other Non governmental organizations both within and outside the region must coordinate to ensure effective action against climate change.

This is in a bid to further explore the causes and impact of climate change within and around the African context while educating the people on activities that have consistently escalated the current risk. A basket fund can also be created to pull resources from the public and private sector, especially companies whose activities contribute to emission of greenhouse gasses and global warming with support from international thought leaders and experts in climate change interventions.

The idea of dissecting the nexus between climate change and health is to ensure that Low and Medium Income (LMIC) like Nigeria to advance its aspiration to meet up with acceptable global standards as regards critical actions that aides early preparedness and response. 

Atef Fawaz is the Executive Director of eHealth Africa. He is a Complex operations Management and ICT expert with experience in Humanitarian Response and Digital Health

eHealth Africa's Integration of Digital Solutions for Public Health Impact

By Favour Oriaku

eHealth Africa (eHA) has the strong belief that access to proper healthcare is a right, not just a privilege. Consequently, eHA continues to create innovative solutions that provide underserved communities in Nigeria with the tools to take charge of their health and well-being. Through their digital innovations, eHA is bridging the gap between technology and healthcare. Currently, the organization is improving their offering by merging their two main applications - LoMIS Deliver and  LoMIS Stock - into one, all-encompassing platform: LoMIS Suite. This platform will enhance the management and delivery of vaccines and other health supplies. By doing so, ensuring that essential healthcare services are consistently available. 

LoMIS Deliver alone has successfully delivered over 17 million vaccine doses and 16 million essential goods to their destinations, overcoming logistical challenges to keep healthcare running smoothly. At the same time, LoMIS Stock has provided healthcare workers with a more efficient way to report, offering real-time visibility of stock levels and streamlining the planning process through a mobile app.

The merging of these two applications by eHA, promises to be a powerful tool for improving existing health systems. It will help manage stock levels, track deliveries, and enhance decision-making processes with ease and precision. With these merged applications, every piece of data collected will contribute to better delivery schedules, improved stock availability, and, most importantly, ensuring that every member of the community has access to essential healthcare services. The integration of the LoMIS applications represents not just a technological advancement, but a ray of hope for a society in pursuit of a dependable and efficient healthcare system at the last mile.

Fatimah Howeidy, the project manager, shares her perspective, saying: "Every data point we collect represents real people, families, and their futures. By merging our LoMIS Deliver and LoMIS Stock applications, we're not only improving our technology but also ensuring that vaccines and health supplies are always available when and where they're needed most, and the process is managed using a more improved system."

This initiative is supported  by the Digital Health Innovation Accelerator Program (DHIAP), which was launched in 2021, and is powered by the WFP Innovation Accelerator and BMZ digilab – the innovation lab for digital solutions, initiated by the Federal Ministry for Economic Cooperation and Development (BMZ) in collaboration with GIZ, the German Development Bank KfW, and the Bill and Melinda Gates Foundation. eHA project has been selected as one of 5 finalists for the WFP Sprint Programme, and is supporting the implementation by providing  financial support, as well as access to mentorship, guidance, and a strong network of peers and stakeholders to inspire and share knowledge and best practices. 

Through initiatives like these, eHA is empowered to offer not just technological solutions; they are weaving a future where healthcare is consistent and accessible to all. This future includes mothers who wish to see their children thrive without vaccine-preventable diseases, healthcare workers who rely on dependable data and supply chains, and communities that rightfully deserve equitable healthcare. In the synergy of technology and health facilitated by eHA, each vaccine delivered represents a stride towards improved health outcomes. Every report submitted through the app strengthens the battle against vaccine preventable diseases. And each decision made with precise, real-time data paves the way for equal healthcare accessible to all.

Fatimah encapsulates eHA's spirit by saying, "Our solutions, especially when combined into the LoMIS Suite platform, are more than just applications. They are our commitment, represented in data, ensuring that every child and every family in our communities has reliable healthcare."

In this intricately woven digital solution created by eHA, technology and health are seamlessly interconnected, ensuring that each individual and every community can consistently count on fair and reliable healthcare. It's not just a project; it is a commitment to accessible healthcare through the power of technology and unwavering dedication of our healthcare professionals.

ehealth Africa Commits to promoting early detection of Vaccine Derived Polio Virus through Lab Support

by Moshood Isah

Nigeria may have been declared a polio free nation but the Variant Poliovirus Type 2 strain transmission still lingers. Nigeria reported 168 cases in 2022. This  has made further interventions crucial particularly  around early detection. The growing cases in a  number of African countries require a focused effort to strengthen polio laboratories that can effectively help the affected countries to quickly confirm cVDPV2 cases and launch outbreak responses, including the introduction of novel OPV2.  

In 2018, the World Health Organisation (WHO) introduced a Global Polio Surveillance Action Plan (GPSAP 2018-2020) to support endemic, outbreak, and high-risk countries in evaluating and increasing the sensitivity of their surveillance systems against Polio. The plan also initiated supplemental strategies that may help in closing gaps in detecting polioviruses, including strategies for immunodeficiency-associated vaccine-derived polioviruses (iVDPVs) while also strengthening coordination across surveillance field teams to foster a more effective programme and document zero cases worldwide. 

The new Global Polio Surveillance Action Plan (GPSAP) for 2022-2024. also focuses on increasing the speed of poliovirus detection, improving surveillance quality at the subnational level, fostering the integration of polio surveillance with surveillance for other epidemic-prone vaccine preventable diseases (VPDs), and mainstreaming gender equality in surveillance activities and programming as a key enabling factor.

To achieve parts of the Global Polio Surveillance Action Plan (GPSAP) 2022-2024, ehealth Africa worked with World Health Organisation (WHO)  supported by the Bill and Melinda Gates Foundation (BMGF) to  renovate and upgrade the   Sequencing Laboratory in the Virology department, University College Hospital (UCH) Ibadan, Oyo State. The laboratory was commissioned by Kazadi Walter, Country Representative and Head of Mission; World Health Organisation to Nigeria. This is part of the effort to improve surveillance, rapid detection and response against the spread of Vaccine Derived Polio Virus and other vaccine preventable diseases.  

Speaking during the official commissioning of the Laboratory, Dr. Kazadi Walter reiterated the commitment of WHO towards eradicating polio virus through the provision of facilities and rendering of technical support to Nigeria’s health care. He stated that WHO in collaboration with the government established the Global Polio Laboratory Network of which 16 are currently in Africa, with two located in Nigeria; Ibadan and Maiduguri. According to Walter, the primary objective is to work with WHO in the African Region (AFRO) to equip the global polio laboratory network labs for robust and rapid sample analysis for polio and to provide support in equipping these labs with sequencing capabilities.

Prof. Kayode Adebowale, the university vice chancellor, commended the initiative saying “this laboratory will not only provide vital information for the eradication of polio but also contribute to our university infrastructure, helping us to fulfill our vision and mission in addressing social needs.” The VC said: “The department has played a crucial role in Nigeria’s polio eradication programmes by contributing significantly to the country’s achievements of being declared wild polio-free in 2021.

Speaking on the role of eHealth Africa in the support for Laboratory Supplies across selected countries in Africa, the Project Manager, Tolulope Oginni said, to ensure optimum utility of the laboratory supplies, eHealth Africa leverages previous and current experience in setting up and managing Emergency Operation Centers to strengthen the staff capacity at the Laboratories in operating the installed equipment.

“These interventions  for  the support for laboratory supply and installation with consumables currently ongoing in at least 12 African countries are expected to improve the labs functionality for faster outbreak detection”, he said. With the support of other stakeholders in the region, this intervention will support labs in the African region that are targeted for expansion of sequencing capacity, support to improve existing sequencing capacity, or labs that require support for virus isolation and identification. This intervention has a huge opportunity to explore collaboration with WHO and other global stakeholders to transform the laboratory infrastructure in Africa into world class facilities which in turn will significantly strengthen their capacity and preparedness for disease outbreaks.

Strengthening Blood Management Systems with Digital Tools

By Emmanuel Uko

Every month, eHealth Africa (eHA) convenes stakeholders and subject-matter experts on a fresh episode of the Insights Webinar for topical discussions, solutions and recommendations that improve public health and contribute to the attainment of SDG goal 3: good health and wellbeing for all. The aim is to share lessons learned across different areas of project implementation and to offer recommendations.

The 8th edition of the Insights webinar was focused on how digital tools can strengthen blood management systems. Alluding to the topic, one of the panelists, Dr. Mohammed Farouk (MD, MBA), Managing Director of the Africa Society for Blood Transfusion (AfSBT), said “Incorporation of technology and data-driven solutions makes the blood management value chain more seamless. Recruitment of donors is done with online questionnaires, after which the donor institution determines eligibility of the donor, then invites them to the donation center.” This process saves time and resources as donors are only invited on appointment, based on schedule.

Still on eligibility, Michelle Vermeulen, Head of Marketing & Public Relations at Western Cape Blood Services in South Africa outlines the criteria: “In order to be an eligible donor, criteria differ from country to country. However, generally, one must be between the ages of 16 and 75, weigh more than 50 kg, be healthy on the day of donation, without flu or symptoms of cold, and be leading a healthy sexual lifestyle.”

In addition, Emmanuel Nene Dei, Head of Planning, Monitoring and Evaluation at the National Blood Service, Ghana, further stated that “An eligibility quiz for prospective donors helps to shorten the recruitment process. Those not eligible are, with their consent, linked up with other healthcare facilities for quality healthcare, as necessary.” Francis Ayo, Technical Project Manager in the Informatics Department at eHealth Africa, added that “Integration of data-driven technology creates visibility, accountability and transparency, leading to appropriate decisions about quantity and types of blood products required at specific health facilities, while third-party logistics systems carry out the distribution and ensure supplies where needed.”

The webinar had 160 online participants from Canada, Ethiopia, Germany, Ghana, Guinea, Nigeria, Rwanda and Sierra Leone; and eHA’s live LinkedIn audience (eHealth Africa), had 1,441 viewers at the time of the webinar. eHA’s Strategic Engagement Lead / Senior Manager, in Berlin, Germany, Johanna Roegele, who has worked on the management of the blood supply chain observed that eHA and partners have modelled a system to ensure continual availability of blood products. She recommended that such models be replicated especially in other African countries.

From their vast experience, the panelists shared other lessons for effective blood supply chain management: donors prefer to be contacted with personalized messages (SMS, Whatsapp and emails) rather than general messages sent to everyone. Personalized messages enhance the likelihood of recurrent donations, especially for first-time donors. More so, social media and traditional media help create visibility for institutions and to attract donors. Digital interoperability between digital blood management information systems and testing machines reduces human error, speeds up testing time, increases accuracy, eliminates waste and averts silo functioning. In addition, drone-based delivery to hard-to-reach areas, saves more lives especially in emergencies.

Human-centered project design approach should be applied, taking into consideration inputs and needs of stakeholders and potential beneficiaries. In the data management process, privacy of clients is paramount while keeping appropriate databases updated for tracking and monitoring of trends in blood services.

eHA’s monthly Insights webinar is an opportunity to learn more about how experts are resolving public health issues with the use of digital technology and data-driven solutions, sharing both the solutions and the lessons in creating them for replication.

Help Desk - Optimizing Real-time Response Structure for Digital tools

By Emmanuel Uko

In 2022, eHealth Africa conducted a gap analysis to identify support areas for the Electronic Management of Immunization Data (EMID) system IT infrastructure. The analysis  revealed the weaknesses and strengths of the current issue resolution approaches and the requirements for improving the current system. The help desk operations was identified  to ensure the smooth utilization of the EMID system and increased vaccination coverage data in Nigeria.

Physical and infrastructural constraints were identified: the help desk occupied an open space that was easily accessible, the server room was unrestricted and thus used for other purposes, too. Basic work tools for call agents, like  headsets, and  laptops were either not available or obsolete.

Helpdesk setup at NHPCDA, before and after the optimization.
Photo Credit: eHA

Similarly, operational challenges also existed: downtimes, issues and resolutions were communicated to the leads only through Whatsapp. In addition, a web-based system where users could access resources and information to resolve issues was lacking. More so, information history showing trend of cases and projections was non-existent. There was no existing standard operating procedure for the help desk to guide the team on how to handle issues, especially during off-peak hours. Finally, the support process flow was not fully defined/documented. Thus, the optimization of the help desk support was needed.

“I learnt how to use the native EMID application, as it is more user-friendly than the old one. Specifically, the ability to contact help desk and lodge complaints almost in realtime, whenever issues need to be resolved, is a real advantage that will speed up our work.”
- Ojetade Victoria Oyebimpe, EMID Focal Person, Ede South LGA, Osun State.

eHealth Africa (eHA) software development and help desk teams worked to develop a real-time response structure that caters to users’ needs within the optimized EMID application. As is the universal practice, the structure provides a centralized help to users of the application. The improved EMID help desk at the National Primary Health Care Development Agency (NPHCDA) ensures availability of personnel at every level of troubleshooting, to resolve issues down to zero for both the NPHCDA staff and end users of the EMID app.

Solomon Emmanuel, eHA’s Manager, Helpdesk, anchors training for NPHCDA helpdesk agents.
Photo Credit: eHA

With support from the Global Alliance for Vaccines and Immunization (GAVI), eHealth Africa procured the required IT equipment and facilities for renewable energy to ensure uninterrupted power supply to the IT server rooms, secured furniture and fittings; planned and implemented the setup in collaboration with the NPHCDA. In addition, eHA organized training sessions for the ICT unit at the agency on standard help desk processes and procedures based on the Information Technology Infrastructure Library (ITIL) methodology. They defined, developed and documented standard operating procedures for help desk, operational-level and service-level agreements to guide process flow, from issues escalated by recorders to their resolution stage.

“The native EMID app now helps us determine who, how and where to send complaints to, unlike the old one.”
- Akinyemi Yemi, EMID Focal Person

Jamil Galadanchi, eHA’S Senior Manager, Software Engineering, during a training for NPHCDA, on use of the EMID software.
Photo Credit: eHA

eHA also provided suitable work areas to prevent noise penetration and work tools such as desktops and laptops, display screens with a display/monitor to enable the helpdesk operator to manage multiple screens. This allows for a quick review of the several platforms that may be needed to resolve an issue, or for real time monitoring of the key equipment needed to ensure the EMID system works adequately with limited downtime. eHA also set up the Zendesk application to issue ticket IDs and track issue resolution, an access control system for the help desk main entrance, IT office door leading to the server room, and the server room itself to prevent unnecessary access. Lastly, a solar energy system was also set up at the NPHCDA to power the facilities and ensure a 24-hour electricity supply.

“In addition to its capacity to validate clients’ records in real time, it is now easy to ask questions and access the help desk for support.”
- Egunsola Ayobami Abiodun, EMID Focal Person, Isale-Agbara PHC, Osogbo, Osun State

As a result of the optimization, the help desk can respond to different levels of issues raised. The diagrams below portray mapped help desk support flows according to Tiers 1, 2 and 3 support required. They depict the help desk process flow, from the EMID users, the channels for registering queries, the different levels of helpdesk support system, and the process of resolving issues, the operational phases of response to queries from the end users and the processes involved in using the Interactive Voice Response flow in reporting and resolving EMID issues.

Helpdesk support for pilot training and user assessment test
Image: eHA

Helpdesk support for pilot training and user assessment test
Image: eHA

In addition, below is the Interactive Voice Response (IVR) support flow:

Interactive voice response support flow
Image: eHA

The process of developing the EMID application got all stakeholders working together, each one fulfilling relevant roles for the optimization of the application and realization of the help desk setup. eHA and partners learned important lessons in the course of executing the project. Buy-in and collaboration by relevant stakeholders from the beginning of the project proved necessary for its successful implementation. Setting out deliberate strategies that enable all partners to be carried along especially during important planning and decision making processes, budgeting and procurement, contributed to attaining success. More so, aligning the scope of work with appropriate timelines helped partners to manage the project for successful delivery.

“The new desktop for helpdesk now helps in resolving issues quicker, the monitors and screens help to give a clearer view of the issues presented and there is now a better working environment that enables us to resolve issues more promptly.”
- Nabil Nuhu Bamalli, System Administrator at NPHCDA.

Working as a Recorder is Easier with the Optimized EMID Application

By Farid Suleiman

Opening interface of the EMID Mobile Application

The Electronic Management of Immunization Data (EMID) is Nigeria's homegrown digital platform for the collection, storing, and analysis of covid-19 immunization data. It is domiciled at the National Primary Health Care Development Agency (NPHCDA).

The first version of the app was rolled out by the Nigerian Minister of Health in 2021, as a platform to ensure a smooth COVID-19 vaccination process across the country.

With the rise in the number of unvaccinated adults and unimmunized children in Nigeria, NPHCDA saw the need to scale up the EMID application beyond its regular use for COVID-19 vaccination data to capture and store information on other immunization activities. However, the capacity of the application was below its intended use, with multiple functionality errors, hence the need for an optimized version of the app.

eHealth Africa (eHA), partnered with NPHCDA, to optimize the app for newly defined and broadened functions. They further piloted its use in selected states towards its deployment for use. 
The mobile application provides a gateway for inputting immunization data. This enables the end-user-recorders to work hand in hand with vaccinators across the country to upload data in real-time to the platform. This data enables stakeholders to analyze and monitor the progress of vaccination teams on the field, and where necessary, come up with better strategies to enhance the effectiveness of the immunization program.

Tasiu shehu Jigawa State EMID focal person

Photo Credit: eHA

Abdullahi Muhammad, like other recorders, was quick to spot the changes the new app had come with. He observed: “a lot of features have been simplified on the new EMID application. The data input process and its submission to the server have all been simplified, this will make the work easier.”

Globally, digital tools such as EMID help keep track of information about people vaccinated, types of vaccines they received, doses, location, and other relevant data key to the success of vaccination campaigns. As of January 2023, three years after the commencement of covid-19 vaccination, over 60 million eligible Nigerians have received the vaccine. It is safe to say that Nigeria's immunization strategy, of which EMID is a part, has been successful. The optimization of the EMID app adds value to the overall success, especially on the EMID application’s ease of use, optimized process flow, help desk setup, and renewable power supply.

The optimized EMID application has integrated a client validation tool used to take pictures of the client to validate their presence at the vaccination site. Other validation features such as the geofencing feature ensure that data is only collected by fixed teams when they are within the geographical location assigned for their data entry to be registered on the app, eliminating the possibility of procuring services and the new liveness detection feature which ensures that beyond the still photos of clients, facial feature movements such as blinking are required for verification of client vaccination. This eliminates the possibility of utilizing pictures/static images for data entry. The national team can now have a higher level of confidence in the vaccination data generated using the tool.

The new application also allows recorders to capture data in environments where network connectivity is at its lowest. The specific additional feature is a draft page that prevents the loss of incomplete data. Recorders no longer need to resort to manual synchronization of data when there is internet connectivity as the new application allows automatic data synchronization once internet connectivity is restored. The sort and filter functionality has also been included to allow for ease in identifying previous records via the new native EMID mobile application. Rilwanu Dahiru, another EMID Recorder, describes the use of QR codes for client search as making their work even easier. He says, “if I have the QR code of a client, I search directly for the record without inputting the vaccination number or name.”

Overall, the level of flexibility on the optimized app now allows vaccinators to record and validate client details themselves without having a different validator assigned to them while on duty.

The troubleshooting feature-the FAQs and Help center provides easy access to support questions or challenges that arise while using the application. The help center also has links to the various channels that allow for direct communication with the EMID helpdesk support office.

Optimizing the National Electronic Management of Immunization (EMID) Data Tool for Improved Efficiency

By Emmanuel Uko

The Electronic Management of Immunization Data (EMID) system was designed to facilitate the overall management of immunization data and other programs at Primary Healthcare Centers (PHCs) including vaccination scheduling, real-time entry of clients’ data, and collation, analysis, and validation of such data.

The health sector depends heavily on data for planning. To ascertain how well a country’s immunization plans and implementation are going, adequate information is necessary. The World Health Organization states that immunization data helps to monitor improvements in vaccination trends and identify gaps for its surveillance processes. More so, there is a consensus among vaccination stakeholders that real-time data reporting has allowed decision-makers to follow-up on the unvaccinated and forecast needs for supplies.

Coordinator, Business Application Support at eHA, Diligence Saviour-Albert (left) is confident that users of the native EMID app will use it optimally as she trains them on its different components.
Photo credit: eHA

Since March 2022, eHealth Africa (eHA), has supported the National Primary Healthcare Development Agency (NPHCDA) in Nigeria to optimize the functionality of the Electronic Management of Immunization Data (EMID) System. This optimization is funded by Global Alliance for Vaccines and Immunization (GAVI). They identified the need to fill up the vaccination data gap, after seeing  lapses in the primary data capture tool - the EMID application. Users of the unoptimized app expected more than it was offering. Dr Oyetunde Olasunboye, the Osun State EMID Focal Person said, “the functionality of the system declined noticeably and would sometimes become difficult to input client’s information, search for, or confirm clients’ details. More so, it became increasingly difficult to scan a client’s quick response (QR) code, although this was mostly dependent on the device at the user’s disposal.” These errors adversely affected the application’s functionality.

These inadequacies gave rise to the need for optimization of the EMID application to enable it function at its best for end users at health facilities. “We developed a roadmap for an optimized application that would be scalable country-wide. We built and deployed the optimized application, we conducted training and capacity-building activities for NPHCDA EMID team at national and state levels, and recorders at the PHCs, in preparation to hand over the optimized system to the agency”. Said Stephanie Okpere, eHA’s EMID Project Manager.

Similarly, Kasim Sani, a Network support staff at NPHCDA ICT Unit, said this about the optimized helpdesk: “The new setup has made our work more responsive to clients’ needs. We are able to detect and resolve issues more promptly and applications can now be deployed on the server seamlessly.”

In preparation for the deployment of the optimized app, eHA trained 351 users including recorders, EMID focal persons at State and Local Government levels, and piloted its use across selected states within the six geopolitical zones of Nigeria. From each of the states, eHA selected one rural Local Govermment Area (LGA), one urban LGA and one LGA with poor internet connectivity.

Health Information Recorder, Ife South LGA in Osun State, Tope Oluwatoyin (right), displays a native (optimized) EMID application from his tablet, hopeful that the application would resolve challenges he used to encounter with the old EMID app. 
Photo Credit: eHA

In collaboration with the ICT Unit at NPHCDA, eHA also trained users on help desk use and structure for issue resolution, support process flow, roles and responsibilities of the support tiers, and the use of support channels like email, Whatsapp and phone lines.  Specifically, the training focused on how to download and log into the application, how to conduct online and offline mode check, searching, filtering and updating of records, manual syncing, import and export of records. Participants were also shown how to navigate to the help section and the frequently asked questions (FAQs) on the native application. The optimized application ensures seamless management of vaccination data at national and subnational levels.

In Nigeria, eHealth Africa Optimizes Systems for Seamless Vaccination Data Collection and Retrieval

By Emmanuel Uko

Building and optimizing software applications to improve public health outcomes is at the core of  eHealth Africa’s work. With the Electronic Management of Immunization Data (EMID) application, the organization went beyond optimizing the app to redesigning a new process flow for vaccination data capture. The redesign of an optimized process flow was necessary as research shows that inadequate health data is a challenge in Nigeria due to unintentional duplication, lack of synchronization and dearth of data storage systems.

The quality of data collection tools and the uncoordinated nature of the collection process compounded the data challenges, thus the need for a redesigned data collection process flow. eHA’s Technical Project Manager, Software Engineering, Dayo Akinleye said, “The redesigned process flow was necessary because the new process eliminates the possibility of duplicate records for offline users; utilizes the current quick response (QR) code for easy identification and seamless operation; and eliminates redundant information generated on the Public Registration portal (PubReg). The old process flow used the KoboCollect platform, so it did not have these capabilities. It was also unable to synchronize with the District Health Information Software (DHIS2).”

Former process flow with the old EMID application
Image: eHA

New process flow with the native (optimized) EMID application
Image: eHA

Both process flows allow users to register via the PubReg portal and receive registration ID before visiting the vaccination center to receive the vaccine. At the vaccination site, both processes allow for manual registration of clients into the EMID physical register, and receive a vaccination card with QR code.

eHA’s EMID Project Manager, Stephanie Okpere (right), during a Strategy Group meeting at NPHCDA Headquarters, Abuja.
Photo Credit: eHA

Tope Falodun,  eHA’s Associate Project Manager on the EMID project, affirmed that “the new process departs from the old as it allows for instant validation of clients once registered. Upon successful validation, the optimized EMID system generates a vaccination ID for clients that register at the physical site. For those who register via PubReg, their registration ID is replaced with the vaccination ID, eliminating duplicates, unlike the old system. The new vaccination ID is generated from the QR code for both online and offline clients to avoid duplicate registration. If the registration on the optimized (native) app is unsuccessful, the error message redirects the user to the specific item that needs to be updated or corrected. After correcting the error message the recorder saves the information to complete the registration and validation process.”

EMID Recorder for Isale-Agbara PHC, Egunsola Ayobami (middle), at the pre-deployment training of the native (optimized) EMID application in Osogbo, Osun State
Photo Credit: eHA

End users have found the new process flow more responsive than the old one, and better fit for purpose. As the EMID Recorder at Isale-Agbara Primary Healthcare Centre in Osogbo, Osun State, Egunsola Ayobami, confirmed, “one of the important variations from the old system is the ability to validate a client instantly, making the work easier and faster. It is also easier to use. When in doubt, I now know how to contact helpdesk, and their responses are instant,” he concluded.

Deployment of the native EMID application across Nigeria, with its optimized process flow, guarantees seamless data capture, storage and real-time retrieval. 

eHA’s areas of  expertise are data management, project logistics, infrastructure and ICT services, working in the following focus areas: health delivery, public health emergency management, disease surveillance, laboratory and diagnostics, and nutrition and food security.

Equipping Laboratories for Stronger health systems

By Emmanuel Uko

The journey of supporting and augmenting laboratories in Africa has only started, and evidently, the gap is huge. At the WHO Polio lab in Maiduguri, Borno State, eHA identified cases of damaged, obsolete and inadequate equipment and swung in to supply the needs with support from the World Health Organization (WHO).

As we walked into the office of Professor Marycelin Baba, the Director of the Laboratory, Professor of Medical Virology and lecturer with the University of Maiduguri, we could tell how busy the facility had become on a daily basis. Samples from patients were brought in  on a queue for processing. “Our work here is becoming satisfying”, Prof told us expressively, “especially with partnership from the World Health Organization (WHO) and eHealth Africa (eHA). They have provided various major equipment that enable the center to remain functional”, she said, her passion unwavering for 32 years in the profession.

The lab in Maiduguri, was set up by  Global Polio Laboratory Network (GPLN), to distinguish poliovirus as a cause of acute flaccid paralysis (AFP) from AFP caused by other diseases. It serves the northern part of Nigeria while the one earlier established in Ibadan, Oyo State, serves the southern part of the country. 

Prof. Marycelin Mandu Baba, Director, WHO Polio Laboratory in Maiduguri, is happy to have participated in the polio eradication process in Nigeria.

Photo Credit: eHA

The WHO Polio Laboratory in Maiduguri, like many other labs in developing countries, often  grapples with acute shortage of equipment, reagents, machines, power supply and human resource, which affect its productivity. Research has shown that the number of optimally functional laboratories accredited to international standards were 380, as of 2014; 91% of these were in South Africa. This means that 12 out of 49 countries in the region had one or more laboratories accredited to international quality standards; 37 had none. However, the Global Polio Laboratory Network consists of 146 WHO-accredited polio laboratories, in 92 countries, across the six WHO regions of the world.

Nigeria has 2 of those 146 WHO-accredited polio laboratories. eHA currently provides support to 7 laboratories: 2 in Nigeria, one each in Uganda, Kenya, Ethiopia, Egypt and the Democratic Republic of Congo. The organization is strategizing to commence support to laboratories in Cameroon, Côte d'Ivoire, Ghana, South Africa, Senegal and Central African Republic. This support will improve laboratory and diagnostic services for Africa’s teeming population. “We continue to carry out needs audits and take steps to offer solutions where we identify gaps,”  said eHealth Africa’s Project Manager, Tolulope Oginni. eHA has supported the lab with digitized biosafety cabinets for tissue culture, a Polymerase Chain Reaction (PCR) Workstation, a PCR thermomixer, multi-channel and single-channel pipettes of varied volumes for serology.

Dr Muhammad Talle of the WHO Polio Laboratory in Maiduguri showcases how the new PCR thermomixer donated by eHA works.

Photo Credit: eHA

Dr. Muhammad Talle remains hopeful that the lab will continue to deliver appropriate services according to approved standards.

Photo Credit: eHA

“eHA has brought us relief”, said the Assistant Director for Lab Technical Operations, Dr Bamidele Oderinde, who came in later to the conversation. “The new machines help to reduce technical problems and the functionality complaints we have. We have upgraded our operations, research capabilities and training standards for our students”.

Professor Baba remains keen on contributing her quota towards the eradication of viral diseases, through differential diagnosis of acute flaccid paralysis. According to her, the newly equipped lab benefits people beyond Borno State and extends to other parts of Nigeria. Supporting this lab and other laboratories is part of eHA’s service areas, to build and operate effective laboratories in-country across the globe, and develop the tools and technology needed for effective dissemination and use of public health-related information.

The Director, Prof. Marycelin Baba (3rd right), with eHA delegates and other staff of the laboratory, during eHA’s visit to the lab.

Photo Credit: eHA

Renewable Energy for Improved Healthcare Delivery in Nigeria

By Juliana Okoro

Access to energy is a prerequisite for quality health care and it is fundamental to the achievement of universal health care coverage and the Sustainable Development Goals. Yet, about one in four health facilities in Sub-Saharan Africa lack access to electricity, and three in four facilities lack reliable power. The lack of sufficient and reliable power is jeopardizing the well-being of hundreds of millions of people, especially women and children, who often bear the brunt of inadequate primary healthcare services. According to Dr Julie Yemi-Jonathan. O, Country Manager, We Care Solar, “without a reliable source of electricity, nighttime deliveries are most of the time, attended in near darkness, cancelled or conducted by flashlight, and the outcomes are often tragic.”

Off-grid renewable energy solutions present a key opportunity to provide clean, reliable and cost-effective electricity to rural health centers, which can dramatically transform the quality of healthcare services provided to rural communities.

Harnessing the enormous potential of renewable energy to improve energy access for primary healthcare facilities requires combined action from the health and energy sectors. To this end, the Nigeria Energy Conference, which took place between 20 - 22 September 2022, brought together key energy and health sector stakeholders, including policy-makers, practitioners, financial institutions, development partners, and NGOs that can play a role in enhancing electricity access for primary healthcare facilities.

During a panel session at the conference, eHealth Africa facilitated a discussion about sustainable energy for improved healthcare delivery in Nigeria. The panelists discussed what needs to be done to ensure that Primary Health Centers (PHCs) have access to energy for better health outcomes. Acknowledging the challenges most PHCs face, the panelists elaborated more on how the lack of electricity in primary health centres has led to more medical emergencies and increased mortality rates.

The panel discussion sparked the much-needed, cross-sector thinking around how to deliver energy to health facilities, especially in resource-constrained environments. A resounding takeaway was that distributed solar power and energy-efficient devices hold great potential for creating stronger and more resilient health systems in Africa and beyond.

We Care Solar's deployment of solar suitcases to Primary healthcare centers has had a tremendous impact on reducing child mortality and maternal mortality rates. According to the company’s representative on the panel, “a lot of our health facilities do not have access to a reliable power supply. We have seen cases where surgeries are turned down because of a lack of power. Sometimes surgical operations are suddenly interrupted, leading to the death of the patient, due to power failure”. This she said, “prompted We Care Solar to develop the Solar Suitcase”. 

Another speaker, Mohammed Bello, a project manager at eHealth Africa, identified solar energy as the reliable solution to these challenges. He highlighted some projects implemented by eHealth Africa with support from partners and stakeholders to ensure health facilities across the country have access to a reliable power supply. According to him, eHealth Africa is working with the Nigerian Energy sector and Integration Consulting firm, which are critical players on issues concerning energy.

The panel speakers and moderator after the session hosted by eHealth Africa at the Nigeria Energy Conference 2022

Key lessons from the panel session hosted by eHealth Africa at the Nigeria Energy Conference 2022:

• There is a dire need to increase renewable energy access in primary health centres, especially those in remote areas.

• The use of solar panels as an alternative source of electricity in primary health centers will help mitigate the energy challenges faced by primary health centers.

• Health facilities should be a top priority in electrification plans for both national governments and development partners. Off-grid renewables offer rapidly deployable, reliable, cost-effective solutions.

• In order to address the energy access needs of healthcare facilities, the energy and health sectors must work together. This should happen at all levels, from strategy and planning to policies, budgeting, procurement and implementation.

• Innovation has to be encouraged and promoted, as in the case of the solar-powered suitcases by We Care Solar. Also, in the design of robust, low maintenance, efficient, user-friendly medical devices suited for remote off-grid areas.

• Energy-efficient medical devices, combined with off-grid renewable energy and telecommunications, can expand the services offered by primary health centres in under-served communities. This also reduces the need for patients to travel to larger, more distant facilities.

• There are funding opportunities from donors as long as the organization involved can provide evidence of work done in this field.

How eHealth Africa is implementing the Geolocation Health Facilities Database Initiative (GHFDi) Project in the Republic of Togo

By Friday Daniel, Chinedu Anarado and Munachi Okoro

The public health space has relied on platforms from multilateral agencies and nonprofits to plan interventions. Platforms such as the Humanitarian OpenStreetMap, the WHO Integrated Supportive Supervision (ISS), and electronic surveillance (e-SURV) database, GRID3, and the Global Health mapping platforms were some of the only sources of information on health facility data. But these data sources can be inadequate, rarely reflect the realities on the ground and do not have the imprimatur of relevant government authorities. Equally, Ministries of Health in most WHO countries lack the capacity to curate and manage their health facility data, leaving a critical information gap in the health planning process. 

The WHO conceived the Geolocated Health Facility Data initiative (GHFDi) project as a public good to enhance access to information on the status, location and functionality of health facilities across participating WHO member countries. The overall idea is to deepen capacities in each country to manage this data, ensure its openness and availability in planning public health interventions. 

The GHFD project requires participating countries to grow their capacity to curate and manage their health facility data. But first, an assessment of the existing health facility list or registry is essential. This is expected to provide insight into the efforts required to achieve an ideal scenario which is a database of health facility information, with name, location, unique identifier, geographic coordinates and hosted in an open source platform. Countries may then choose to share this information with a global database managed by the WHO, and then invest in an ongoing process to grow their capacity to ensure the information is updated periodically. 

eHealth Africa is one of the implementing partners of the AFRO region responsible for implementing this project in the Republic of Togo. On the 9th of August 2022, an introductory meeting was held at the headquarters of the Ministry of Health in Togo. This meeting was organized by eHealth Africa in partnership with the Ministry of Health and the WHO country office. 

It brought together various stakeholders responsible for establishing and updating the health facilities database in Togo, including the Ministry of Health (MSPAUS), the National Institute of Statistics and Studies and Demographics (INSEED), as well as the delegate ministry in charge of Territorial Development.

Landscape assessment and data collection session during the workshop in Togo

With an introduction by Dr. Ouedraogo Romain Hilaire, health systems coordinator at the WHO country office, Mr. Compaore Fabris, eHealth Africa representative in Togo and Chinedu Anarado, program manager, eHealth Africa, discussed with the participants on how GHFD seeks to strengthen the capacities of the Ministry of Health to guarantee the availability, quality, accessibility and use of a health facilities master list (HFML) in countries. 

This capacity building should enable the Republic of Togo to have a standardized database open to the public. Participants discussed the seven strategic pathways through which the GHFD initiative will strengthen the Ministry of Health, including governance and policies, partnerships and collaboration, technical capacities, innovation, financial sustainability, communication and advocacy, interoperability, and data management.This introductory meeting led to the conclusion and agreement to hold a participatory landscape analysis workshop on August 30th and September 2nd.

At the end of this workshop, it was discovered that Togo has a unit in charge of the health services mapping, who oversees the health facilities master list (HFML). The Ministry of Health in Togo appreciates the initiative and sees it as an opportunity to strengthen the government's efforts to ensure universal access to care.

Group photograph of the workshop participants

eHealth Africa has since implemented a landscape assessment and is currently developing a report and cost work plan that will itemize the efforts required to bring Togo to the ideal scenario. 

To learn more about the GHFD initiative: https://www.who.int/data/GIS/GHFD 

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. 

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.

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.