September 2024 - eHealth Africa

Polio in Nigeria: A Milestone Achieved, but the Fight Continues

Posted on September 30, 2024October 3, 2024 by Favour Oriaku

In August 2020, Nigeria achieved what many had once thought impossible. The country was declared free of wild poliovirus by the World Health Organization (WHO), a moment that marked the end of a long, hard-fought battle against a virus that had paralyzed children and devastated families. For us at eHealth Africa, it was a moment of immense pride and hope. This victory proved that even the most persistent challenges can be overcome through commitment, collaboration, and tireless effort.

This success did not come easily. It was the result of years of determined action by local communities, government bodies, international/indigenous organizations, and healthcare workers who ensured that even the most remote and conflict-prone areas were reached. Through routine immunization, community engagement, and continuous surveillance, Nigeria’s wild poliovirus transmission was halted. For us at eHealth Africa, it was more than just a victory against a disease; it was a testament to the power of partnership and resilience.

However, even as we celebrate the elimination of the wild poliovirus, we face a new and evolving challenge: the emergence of the circulating variant poliovirus type 2 (cVPV2). This variant strain, which can mutate from the oral polio vaccine (OPV) in under-immunized communities, poses a serious threat to children in northern Nigeria, particularly in areas where immunization coverage remains low.

In response to the rise of cVPV2 cases, eHealth Africa, alongside other partners, has intensified efforts to ensure that this new strain is swiftly and effectively contained. One such effort is the Outbreak Response 3 (OBR3) campaign, recently flagged off simultaneously in Kano State and several high-risk northern states.

The flag-off ceremony was a powerful reminder of the collective effort required to defeat this virus. The Executive Governor of Kano State, His Excellency Alh. Abba Kabir Yusuf, along with key figures including Deputy Governor Aminu Abdussalam Gwarzo who doubles as the chairman of the state task force on routine immunization and polio, representatives from international and indigenous organizations like UNICEF, WHO, SOLINA, AFENET, Sultan and Chigari Foundation, and eHealth Africa, called on parents to allow their children to be vaccinated to prevent the spread of this devastating disease.

Speaking at the event, the Deputy Governor reassured the public of the government’s commitment, stating, “We are putting everything in place to ensure that polio is eradicated within the next 3 to 4 months, God willing.” The urgency of the situation was further underscored by Governor Yusuf’s sharing of statistics, revealing that Kano State accounted for 36 of the 272 cases of cVPV2 recorded in Nigeria between 2023 till date. This accounted for 13% of the total.

As we continue our work, we know that vaccines alone are not enough. Addressing polio in Nigeria requires a holistic approach—one that includes house-to-house tracking to ensure no child is missed, even in the most remote or resistant communities. We must engage with families, dispel myths, and break down cultural barriers to vaccination.

At eHealth Africa, we are implementing innovative solutions to support these efforts. Through projects like the Geospatial Tracking System (GTS), we are ensuring that vaccination teams reach every household, no matter how far or difficult to access. The 11 Polio Emergency Operation Centers we manage serve as hubs for coordination and planning, allowing partners and stakeholders to track progress and adjust strategies in real-time. We are also working closely with traditional leaders, whose influence within communities is critical to promoting the benefits of vaccination and overcoming resistance.

As Abubakar Shehu, Program Manager at eHealth Africa, emphasized during the flag-off, “eHealth Africa is simultaneously implementing several projects to support the mass OPV vaccination campaign. These include the Geospatial Tracking Project (GTS) that tracks the vaccination teams, ensuring no household is missed.” He went on to add, “We also manage the Polio Emergency Operation Centers and engage traditional leaders to ensure their involvement in the campaign, as well as the fight against cVPV2 and other vaccine-preventable diseases.”

The journey to a polio-free Nigeria has not ended with the eradication of wild poliovirus, it has only shifted focus. The fight against cVPV2 requires the same level of determination, vigilance, and collaboration that got us this far. Each child vaccinated brings us one step closer to ensuring that no child ever suffers from the paralysis caused by polio again.

As we move forward, we call on communities, leaders, and international partners to remain steadfast in their support. Together, we will protect the children of Nigeria and ensure a future free from the crippling effects of polio.

How Planfeld Can Eradicate Perennial Vaccination Campaign Challenges – Primary Healthcare Workers

Posted on September 13, 2024September 13, 2024 by Moshood Isah

By Moshood Isah

*Primary Healthcare workers during Planfeld workshop in Zamfara*

Vaccination campaigns, especially in Nigeria, are a Herculean task, particularly when navigating complex and hard-to-reach terrains. From the planning stage, where primary healthcare workers identify households and calculate target populations for vaccination, the challenges are immense.

Khadija Ibrahim, a Ward Focal Person from Bagama A in Suleja Local Government Area (LGA), often braves rain and harsh weather conditions while moving from one community to another to identify households and target populations for vaccination. According to Khadija, although community leaders play crucial roles in identifying target populations, some gatekeepers can be reluctant due to a lack of incentives.

While community leaders need to support public health campaigns, Khadija lamented that “sometimes, your community leader does not want to accompany you, and you cannot enter without them.” This sometimes leads to inaccurate information and, in many cases, missed settlements during the vaccination campaign, which affects the spread of the Circulating Variant of Poliovirus and other vaccine-preventable diseases.

Due to the challenging terrain in rural areas, Ward Focal Persons often rely on motorcycles for transportation. “There was a year when I had an accident and dislocated my left wrist while distributing vaccines as early as 6 a.m.,” Khadija recalled. Given that all documentation for planning and implementing public health campaigns is done manually on paper, these documents are vulnerable to destruction by rain, accidents, or human errors.

“This manual method is difficult because sometimes you may go to a community and find that the number of children is not as high as the numbers given to us,” Abdullahi Muhammad, another Ward Focal Person, said. This affects reporting and vaccine management.

Muhammad supervises 14 vaccination teams, each visiting over 100 households for daily immunization rounds. He noted that “because the profiles of the settlements are captured manually, it’s difficult to understand the accessibility of these settlements, whether they are rural, urban, nomadic, or scattered.” These complications also impact the identification of starting points, midpoints, and endpoints during implementation.

The challenges in developing an effective microplan sometimes lead to the postponement of vaccination campaigns. Thus, the introduction of Planfeld—designed to enhance the planning of vaccination campaigns and ensure every child has access to the polio vaccine and other routine immunization services—comes at an opportune time.

Muhammad is among the first healthcare workers to express excitement about the Planfeld pilot. “Planfeld saves time; rather than spending four to five days developing a microplan, we can achieve it in just a few minutes,” he said.

Echoing this sentiment, Usman Abubakar, the Niger State Immunization Officer (SIO), remarked that the Planfeld pilot workshop is timely. He noted that digitizing micro plans will significantly address the issue of resource allocation, which he considers one of the most challenging tasks in his 20 years in the health sector.

Having spent nearly two decades leading and supporting vaccination campaigns across the state, Khadija, Umar, Usman, and other unsung heroes of public health interventions share one common aspiration.

eHealth Africa is dedicated to advancing digital health innovations through a user-centered approach, aiming to meet the needs and aspirations of underserved communities.

5 Lessons from the Planfeld Pilot Workshop Across Six States in Nigeria

Posted on September 13, 2024September 13, 2024 by Moshood Isah

By Moshood Isah

eHealth Africa team, partners and Stakeholders from the Kaduna State Primary Healthcare

Between August and September 2024, eHealth Africa’s Disease Prevention and Monitoring team conducted a comprehensive pilot workshop for its innovative digital solution, Planfeld. The tool is designed to enhance the planning of vaccination campaigns and ensure that every child has access to the polio vaccine and other routine immunization services. During the workshop, held in Kaduna, Niger, Katsina, Zamfara, Sokoto, and Kebbi States, eHealth Africa exposed over 350 primary healthcare workers, partners, and stakeholders to the efficacy of Planfeld in planning vaccination campaigns with greater speed and accuracy.

The impactful workshop, funded by the Gates Foundation, provided stakeholders with the opportunity to give insightful feedback during the tool’s demonstration. Here are some key lessons learned:

1. Time Management: Reducing Vaccination Plan Development from 5 Days to 10 Minutes

In all six states where Planfeld was piloted, Ward Focal Persons managing vaccination campaigns reported that developing a micro plan typically took between three to five days. This process involved manually collecting data from communities and engaging with local gatekeepers to identify target households and populations (children aged 0-59 months). However, with Planfeld, an updated Master List of Settlements, and input from primary healthcare providers, a near-accurate micro plan could be generated in just five minutes. Umar Muhammed, a Ward Focal Person in Niger State, noted, “If Planfeld works perfectly, it will solve all our challenges, as it can generate micro plans within a few minutes.”

Similarly, Victor Obagunlu from Solina, who attended the workshop in Kaduna State, said, “Planfeld is beneficial because it significantly reduces the time and energy spent on developing micro plans.”

2. Effective Resource Management and Allocation for Vaccination Campaigns

The workshop highlighted that with an accurate Master List of Settlements (MLoS) uploaded into Planfeld, the right number of vaccination teams can be effectively assigned to households. According to Friday Daniel, eHealth Africa’s Associate Manager supporting this intervention, “Accurately assigning vaccination teams to the right number of settlements will reduce undue burden and ensure every household is reached within the vaccination period.” Like many digital innovations, Planfeld relies on data for better decision-making, ensuring both financial and human resources are effectively utilized.

3. State Primary Healthcare Leaders Are Open to New Innovations

Dr. Larai Aliyu Tambuwal, Executive Secretary of the Sokoto State Primary Healthcare Development Agency (NPHCDA), summarized the views of other agency leaders by stating, “The integration of digital innovation in primary healthcare services will significantly improve precision in delivering vaccines to every settlement, ensuring comprehensive coverage.”

Key stakeholders at the state level were generally receptive to digitizing the microplanning process to enhance its quality. Mustapha Aliyu Alinkilo, Director of Disease Prevention and Control in Zamfara State, commented, “Technology will enhance the quality of microplanning in the state, and deploying the monitoring aspect of Planfeld will ensure a near-perfect vaccination campaign.”

4. User-Centric Approach Is Key to Success of Digital Innovations

To ensure an effective transition from manual to digital microplanning, eHealth Africa’s Program Manager Abubakar Shehu emphasized the importance of involving all relevant parties during the planning phase. “We brought in key players in the generation of micro plans at the state level, led by the Incident Manager and the State Immunization Officer for both Polio and routine immunization,” Abubakar said. Key partners, including the World Health Organization (WHO), United Nations International Children’s Emergency Fund (UNICEF), African Field Epidemiology Network (AFENET), and SOLINA, participated in the pilot workshop.

A crucial lesson learned from the Planfeld demonstrations is that understanding and prioritizing the needs, preferences, and behaviors of users is essential when developing digital innovations. Feedback from over 350 prospective end-users has highlighted areas for optimization to ensure that the Planfeld application resonates with its target audience.

5. Opportunity for Optimization of Planfeld

As with any digital solution, Planfeld has room for optimization. After the workshop in Niger State, the State Immunization Officer (SIO) Usman Abubakar Kpantu suggested that Planfeld be optimized to include the allocation of accurate resources and commodities, especially vaccines, to various settlements. Abubakar recommended, “Micro plan structures should accommodate advocacy, communication, and social mobilization tools to promote ownership of vaccination campaigns across communities.”

Other stakeholders advised that Planfeld should identify the exact number of households and children a vaccination team should expect to cover during daily activities. This, they believe, will further enhance planning accuracy and ensure that no child is left unvaccinated.

Overall, as agreed by all stakeholders during the Planfeld pilot workshop across the six states, an accurate Master List of Settlements is crucial for developing effective micro plans. An accurate micro plan remains vital for reaching every household and target population with the appropriate vaccines. Therefore, primary healthcare providers and community gatekeepers play essential roles in collecting and disseminating accurate information. This will help ensure that technical partners like eHealth Africa use the right information to support vaccination campaigns, as efforts continue to eliminate the Circulating Variant Poliovirus and other vaccine-preventable diseases.

Building Resilience: How eHealth Africa Sets Up Emergency Operations Centers in Conflict Zones

Posted on September 3, 2024October 30, 2024 by Favour Oriaku

By Favour Oriaku

In today’s world, robust health systems are essential in ensuring the health and safety of populations, particularly in regions prone to disease outbreaks. According to the World Health Organization (WHO), a strong health system is key to achieving universal health coverage, and one of the pillars of such systems is the ability to manage health emergencies effectively. This is where Emergency Operations Centers (EOCs) come in, acting as crucial hubs for coordinating responses to health crises. In countries like Somalia and the Democratic Republic of Congo (DRC), where security challenges and infrastructure deficiencies are prevalent, setting up these centers is not just about logistics—it’s a herculean task that requires resilience, resourcefulness, and a deep understanding of local dynamics.

eHealth Africa is at the frontline of strengthening health systems through its Polio Outbreak Control Rooms (POCR) project. This initiative, supported by the Bill and Melinda Gates Foundation (BMGF), aims to equip governments across Africa with the tools needed to combat polio and other vaccine-preventable diseases. Over the past two and a half years (March 2022 – June 2024), eHealth Africa has successfully set up more than 24 POCRs across countries like Cameroon, Somalia, the DRC, and Niger, Tanzania among others. The scope of the project includes constructing or renovating facilities to become POCR, training government-assigned staff on basic EOC operations management, providing IT and GIS/mapping support, and offering assistance for high-level national meetings and public health campaigns. While this work is essential in peaceful nations, it takes on an entirely new dimension in fragile and conflict-affected regions like Somalia and the DRC, where insecurity and logistical difficulties have become part of the daily routine.

For eHealth Africa’s Operations Leads (OLs), setting up these centers in Somalia and the DRC meant facing these difficulties head-on. Abukhasim Salisu, who was part of the operations in these countries, highlighted how complex the process was: “The major challenge was security-wise because Somalia is a very fragile country with regard to security. We had to be extremely careful when dealing with vendors… We were very cautious to ensure we were not dealing with insurgent groups.”

In the DRC, the vastness of the country compounded logistical issues. “DR Congo is about two and a half times the size of Nigeria. Sometimes it could take two to three days just to get from one location to another. The logistical challenges, combined with the limited number of operational airlines, made transportation very difficult,” said Abukhasim.
Security issues in these regions inevitably impacted the timelines for project completion. In Somalia, movement restrictions delayed progress. “In Somalia, movement restrictions delayed the project. In the DRC, it was the logistics. Items could take up to two to three months to arrive, and some arrived damaged, which impacted our delivery timelines,” Abukhasim noted.

Atiku Haruna, another Operations Lead, echoed similar sentiments: “In Somalia, movement across cities requires a security clearance every time we go from point A to point B, always with a well-armored escort. The movement of services and goods to the sites is equally challenging.”

In regions of high-security risks, resilience is not just a desirable quality, it’s a necessity. Both OLs recounted incidents that tested their resolve and commitment to the project. Abukhasim shared a harrowing experience during a flight: “We crash-landed, and the aircraft stopped right on the runway. That incident made me think deeply about my life, my job, and the risks we face. But despite these dangers, the work had to continue.” Atiku, too, faced life-threatening situations: “One of the incidents that tested me was when our aircraft refused to fly after landing, and I had to witness the repair in my presence.”

While security was a major obstacle, engaging with local communities and authorities was equally crucial to the success of these projects. Both OLs emphasized the importance of cultural adaptation. “In DR Congo, my ability to speak the local language gave me a big advantage. I could identify as Congolese, which made it easier to navigate and gain trust from the local authorities and communities,” said Abukhasim. Atiku added: “Learning the basics of the Somali language was key. This language unlocks societal freedom and helps build rapport.”

Despite the daunting challenges, the rewards of setting up these EOCs are immeasurable. The OLs took immense pride in their work, knowing they were making a difference in regions that desperately needed health system support. Abukhasim reflected on the scale of his accomplishments: “Being able to lead the set up of 11 EOCs across different countries is a huge achievement for me. It’s something I’ll always look back on with pride, even after my time at eHealth Africa.” For Atiku, the most rewarding aspect was seeing the tangible results of his efforts: “The most rewarding part is seeing my achievements across locations that have proven to be difficult.”

Atiku also shared how significant the EOC project has been for Somalia: “In Somalia, it may seem like just a mere building, but it’s a turnaround, a whole ministry, and its staff were in a rented location with no idea how to develop their building. Shortly after, through eHA’s technical expertise and funding from the BMGF, we were able to build seven EOCs that can comfortably accommodate both the EOCs staff and the Ministry, strengthening coordination of public health interventions.”

Both OLs have valuable advice for those embarking on similar projects in security-challenged regions. Abukhasim advised: “My advice is to always develop security consciousness. No matter how much you prepare, the actual scenario can be very different. You have to be aware of your environment, and security must always be a top priority.” Atiku’s advice was simpler but no less critical: “Stay out of any form of trouble.”

Setting up Emergency Operations Centers in security-challenged regions is a task filled with complexities, risks, and challenges, but it’s a mission that eHealth Africa undertakes with commitment and resilience. The success of the POCR project in countries like Somalia and the DRC is a testament to the dedication of the teams involved, who continue to strengthen the health systems of these countries under some of the most difficult conditions imaginable. Through their efforts, eHealth Africa is helping governments build lasting public health infrastructure that can save lives and manage health crises more effectively.

Jacaranda partners with eHealth Africa to expand lifesaving PROMPTS support for Nigerian mothers

Posted on September 2, 2024September 3, 2024 by Favour Oriaku

Nigeria has Africa’s largest and fastest-growing population, and contributes 20% of the world’s maternal deaths annually (1,047 deaths per 100,000 live births). In June this year, we secured a partnership with African nonprofit eHealth Africa (eHA) to test our SMS-based digital health tool PROMPTS as a cost-effective and quickly scalable tool to support Nigerian mothers through their pregnancy journey.

The aim of the pilot is to adapt the platform for the Nigerian context and assess its uptake and engagement with 25,000 mothers in Kano State, located in the country’s northern region. Similar to our approach in Kenya, mothers will be consensually enrolled to PROMPTS at health facilities – specifically within the network of public hospitals, health centers, and outreach clinics under EHA Clinics, eHA’s sister organization.

Over the last few months, Jacaranda has been working to prime PROMPTS for the expansion. We have recently extended our customized Large Language Model (the technology that underpins the PROMPTS helpdesk) to converse in Hausa and Yoruba, ensuring that Nigerian mothers are supported in a language they can understand and act on. We are working to customize the PROMPTS helpdesk to better classify language and context-specific questions from mothers, as well as collect specific data (via SMS surveys) on their experience of care in the facilities they visit.

Meanwhile, we have been adding and adapting messaging content within the platform to align with the local context and increase relevance for mothers in Kano State. Alongside the standard suite gestation stage-specific messaging and appointment reminders, we are introducing content to address specific, yet widespread pregnancy-related myths and misconceptions, alongside malaria-focused content, given the disease’s high prevalence (32.4%) in Kano State. eHA will be gathering further information from Community Health Extension Workers on the needs and experiences of mothers in this setting to inform further messaging adaptations over the coming weeks.

With a successful pilot, our goal is to expand PROMPTS to reach an additional 100,000 Nigerian mothers in the following year and over 1.5 million mothers in the next three years, leveraging eHA’s extensive connections within the Nigerian public health sector to drive sustainable growth for the platform.

“The collaboration between eHealth Africa and Jacaranda in Nigeria has immense potential to further the work already being done to improve maternal and child healthcare in Kano State. By combining Jacaranda’s expertise in digital engagement of moms with EHA’s robust infrastructure and deep understanding of the local landscape, we can create and scale solutions to improve healthcare outcomes for mothers and babies, as well as amplifying women’s voices. This partnership is not just about expanding reach but also about sharing knowledge, fostering innovation, and ultimately, improving health outcomes for moms and babies across Nigeria.” – Rachael Alldian, Director of Global Programs & Product, Jacaranda Health

“At eHealth Africa, we are committed to leveraging technology to bridge healthcare gaps in underserved communities. Our partnership with Jacaranda to implement the PROMPTS platform in Nigeria is a significant step towards achieving this goal. Leveraging our indigenous knowledge and Jacaranda’s digital expertise, we are well-positioned to significantly improve maternal and child health outcomes in Kano State and beyond. We are excited to see how this initiative will improve the lives of countless mothers and their families.” — Atef Fawaz, Executive Director, eHealth Africa

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