Supporting Access to Immunization through Supplementary Immunization Activities

By Abubakar Shehu and Emerald Awa- Agwu

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

A child receiving the Oral Polio Vaccine

A child receiving the Oral Polio Vaccine

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Increase in vaccination coverage rates

Increase in vaccination coverage rates

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

Meet The Team - Sally Williams

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

meet the team Sally.jpg

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

Sally receiving her Team of the Quarter certificate

Sally receiving her Team of the Quarter certificate

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

My role is a challenging but thrilling one. I have an affinity for teamwork. The favorite part of my job is interacting with my team in the districts because they are the ones in the field that go day-to-day out in the community spreading the message of 117. Their dedication is priceless.
— Sally Williams
When Sally is around us, you would hardly tell who is the boss. She mixes well but knows how to get us to do a good job. Her positive attitude towards us motivates us to work harder for best results.
— Maseray Sesay, Project Assistant, 117 Call Center project

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

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

Sally with some members of her team

Sally with some members of her team

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

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

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

Lessons from the eHealth Africa-Emory University Schistosomiasis Study

By Tolulope Oginni and Emerald Awa-Agwu

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

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

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

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

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

Training of Community Health Workers

Training of Community Health Workers

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

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

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

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

Meet the Team - Maryam Haruna

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

We don’t know but Maryam Haruna does.

meet the_team Maryam.jpg

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

1. Be prepared, even in your sleep

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

2. Think fast but pay attention to detail

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

Maryam at work

Maryam at work

3. Communicate frequently and clearly

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

4. Reward yourself

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

Internship Spotlight: Lessons from my eHA internship

By Hassan Cecil Bangura

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

IMG_0185.JPG

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

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

IMG_0136.JPG

The eHA finance team is a mentoring team.

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

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

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

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

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

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

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

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

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

See photos from the event below.

Meet the Team - Masud Abdullahi

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

meet the_team- Masud.jpg

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

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

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

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

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

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

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

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

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

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

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

Why Schistosomiasis? What inspired this project?

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

What's the purpose of this research study?

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

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

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

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

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

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

Going digital improves Disease Surveillance in Sierra Leone

By Sahr Ngaujah and Nelson Clemens

DSC_1239.JPG

According to WHO, Sierra Leone is the first country in the Africa region to fully transform its national disease surveillance system from a paper-based system to a  web-based electronic platform. This is due to the introduction of the electronic Integrated Disease Surveillance and Response solution.

Sierra Leone was one of the hardest-hit countries during the 2014 EVD outbreak in West Africa. The country’s poor disease surveillance infrastructure highlighted the need for a robust disease surveillance mechanism. Introducing an electronic method for disease surveillance reporting became one identified remedy for improving disease surveillance in a country that was still trying to catch up with the rest of the world in terms of digital technology. 

Paper-based health data recording and reporting from across Sierra Leone’s 1300 health facilities became increasingly inadequate and inaccurate and was also characterized by late reporting, incomplete district-level reports, multiple data entry errors, and difficulty storing and retrieving data.

With an expertise in health informatics, eHealth Africa (eHA) designed the electronic Integrated Disease Surveillance and Response (eIDSR) solution and has been implementing the solution in collaboration with Sierra Leone’s Ministry of Health and Sanitation (MoHS), the U.S. Centers for Disease Control and Prevention (CDC), the World Health Organization, Focus 1000, and GIZ since 2016, with  the objective to enhance disease prevention and control through the digital capture and submission of data on epidemiologically-important diseases. The eIDSR project was funded by the CDC. 

eHA customized an open source health information tool from DHIS2 for the purpose-built digital data collection and reporting. The eIDSR tool is integrated into the national health system through its compatibility with the health information systemDHIS2, which is used in over 45 countries, especially those with vulnerable health systems like Sierra Leone. eHA developed the web form and custom mobile application, piloted both, and created a Short Message Service (SMS) submission solution for health workers to submit their weekly surveillance reports in locations where internet access is weak.

Nwanyibuife Obiako, Senior Programs Manager, eHA Sierra Leone, making a statement during the eIDSR rollout closing ceremony

Nwanyibuife Obiako, Senior Programs Manager, eHA Sierra Leone, making a statement during the eIDSR rollout closing ceremony

As of June 2019, 2758 health care workers at the health facility and district level were trained by eHA on the use of eIDSR across Sierra Leone. These health care workers now monitor 26 disease categories digitally. Digitizing health-related data has yielded positive outcomes in Sierra Leone. eHA has supported the rollout of eIDSR to all 14 administrative districts in Sierra Leone and a ceremony was held on June 6th in Tonkolili district, with participants from the MoHS and other implementing partners, to celebrate the milestone achieved.

Thanks to eIDSR, we have seen an improvement of multiple surveillance indicators, such as reporting completeness and timeliness. It’s evident that a critical part of this success is partnership and collaboration.
— Nwanyibuife Obiako, Senior Programs Manager, eHA Sierra Leone
Nelson Clemens, eHA’s eIDSR Project Coordinator presenting during the eIDSR rollout closing event

Nelson Clemens, eHA’s eIDSR Project Coordinator presenting during the eIDSR rollout closing event

The eIDSR system has also enhanced:

  •  Reduced data entry errors

  •  Reporting completeness, timeliness, and efficiency

Reducing data entry error

Optimal data management and quality are crucial to the delivery of high-quality healthcare services. Accurate data is essential to informed decision making and appropriate public health action. In the past, when health care workers submitted their reports, there was no opportunity for their superiors to perform data quality assurance. This sometimes resulted in erroneous data being sent to the national level, reducing the quality of data used for disease surveillance in Sierra Leone. With eIDSR, digital data is now managed in an efficient manner at District and National levels and made available to all relevant parties in the quickest way possible.

The electronic system has reduced the number of data entry errors in half, and is capturing and verifying data 60% faster than the paper-based IDSR system.
— CDC

Reporting completeness, timeliness, and efficiency 

The eIDSR tool was created to improve the speed of the flow of information within health systems. Through the electronic Integrated Disease Surveillance Response (eIDSR) solution, disease prevention, and control is enhanced through timely electronic capture and submission of data on epidemiologically-important diseases as data can now be submitted, reviewed and acted upon near real-time.

...My colleague Surveillance Officers would agree with me that eIDSR has relieved our stress. eIDSR roll-out commenced in the Kambia district in November 2018. A week following the roll-out, we achieved 98% of timeliness of reporting and has not gone below 90% since.
— Usman Barrie, District Surveillance Officer, MoHS, Kambia district.

Disease surveillance plays an important role in disease prevention, control and elimination. 

eHA continues to work with its partners to ensure eIDSR is sustainable in Sierra Leone.

Modelling Disease Surveillance Systems that work in Chad and Niger

By Tope Falodun and Emerald Awa-Agwu

Participants in Maradi, Niger after the training

Participants in Maradi, Niger after the training

Functional disease surveillance systems provide data that can be analyzed to yield insight for planning, project execution, monitoring, and evaluation of public health interventions. For a priority disease like Polio, surveillance systems are important because they monitor the burden of the disease and alert health systems of any increase in the occurrence of the disease in any location of implementation, ahead of time.

A key element that is often missing in disease surveillance systems is intersectoral action. In the past, the responsibility of finding, investigating, reporting and monitoring AFP cases rested solely on the disease surveillance officers (DSOs). This resulted in incomplete data because the DSOs could not cover every single community, and also manual errors as DSOs had to enter reports using paper-based tools.  Recognizing this, eHealth Africa (eHA) partnered with the World Health Organization (WHO), Novel-T, the Bill & Melinda Gates Foundation (BMGF) and the Ministries of Health in eight countries including Chad and Niger to develop the Auto- Visual AFP Detection and Reporting (AVADAR) system for improving AFP case identification and reporting. The goal of the project was to support health systems in polio-endemic and high-risk countries to find, report and investigate AFP cases using available, context-appropriate resources, in this case, community members. 

By partnering with local communities and enlisting members to serve as informants and investigators, some of the pressure on disease surveillance officers who performed all three functions of finding, investigating, reporting and monitoring suspected AFP cases were relieved. In addition, AVADAR infused digital data management and reporting innovations through the mobile application. With this, community informants report cases of suspected AFP via the AVADAR  mobile application. The investigators receive alerts of these reports on their mobile devices, locate the cases, investigate and collect stool samples for further laboratory tests in cases of true AFPs.  

In 2017, AVADAR was launched in 6 pilot districts in Chad and three pilot districts in Niger. By 2018, the project expanded to an additional three districts in both Chad and Niger. In total, eHA trained 849 and 509 community informants in Chad and Niger respectively. eHA also supported the training of 177 investigators by the WHO in Chad and 178 investigators in Niger. Within these periods, eHA supervised the activities of the informants, investigators, and technical officers, and also resolved technical issues relating to the mobile application, telecommunication, and network access on Android phones.

Chad 1st level supports going through pre-test during the transition training in Bokoro, Chad

Chad 1st level supports going through pre-test during the transition training in Bokoro, Chad

AVADAR has had a great impact on AFP surveillance, directly and disease surveillance as a whole by improving communication and information transfer.
— Mbaielde Felix, Head of Abirebi Health Area, Bokoro District, Chad

After almost three years of supporting the health systems in Chad and Niger through AVADAR, it was evident that the model worked. eHA successfully handed over the continuation of the project in the pilot districts to the Ministries of Health and the World Health Organization in Chad and Niger. A total of 109 first and second line technical support officers in the two countries, were trained to continue to handle and resolve any technical issues that may arise. 

At eHA, we support health systems to effectively monitor and eradicate communicable diseases like polio by developing and supporting the development of creative surveillance methods and innovative data management solutions.

AVADAR has allowed us to communicate with the informants, the district management team and the health delegation on the report of other diseases other than the AFP.
— Abakar Mahamat Kalbassou, Head of Abgode Health Area, Bokoro District, Chad

Innovations in Newborn Sickle Cell Screening

By ZIllah Waminaje

In Africa, 50% to 90% of children who have sickle cell die before their fifth birthday1. To improve their chances of survival, health systems must integrate Newborn Screening (NBS) for Sickle Cell Disease (SCD) with comprehensive treatment and management plans.

For almost five decades, newborn screening for SCD has been conducted using conventional procedures such as electrophoretic techniques, isoelectric focusing (IEF), high-performance liquid chromatography (HPLC) and DNA analysis, which require specialized laboratories with stable electricity, long sample processing times, expensive equipment and reagents, and highly skilled personnel. These methods, while ideal and feasible for developed countries, are inappropriate for low-resource settings like sub-Saharan Africa where 70% of SCD sufferers reside.

Screening with Sickle SCAN Device

Screening with Sickle SCAN Device

Sickle SCAN is an innovative, cost-effective point-of-care (POC) device that has been developed by Biomedics Inc. to address the challenges of SCD diagnostics in low-resource settings. It is a simple rapid point-of-care test kit that can detect the presence of Hemoglobin A, S, and C and yield results within 5 minutes using blood from a heel/ finger prick or vein. In addition to newborn screening, the Sickle SCAN device can be used for premarital/preconception genetic counseling, blood donor screening, and general screening.

Sickle SCAN

Sickle SCAN

Several features make the Sickle SCAN ideal for low-resource settings and large-scale mass screening programs. The first is that it does not require specialized technical knowledge to administer or read the test results. Anyone can be trained to use the device. The device does not require any special equipment or electricity and thus, eliminates the time, resources and logistics needed to transport samples to a laboratory. Finally, the short result turnaround time allows for the prompt identification of SC-positive babies so that early treatment can commence and survival rates can improve.

Since December 2018, eHealth Africa has partnered with Sickle Cell Well Africa Foundation (SCWAF), Pro-Health International and the Presidential Committee on the North- East Initiative (PCNI) to hold Sickle Cell awareness and testing outreaches in Adamawa, Bauchi, and Gombe states. Over 1000 people in all three states were screened using Sickle SCAN rapid diagnostic test kits. Patients who tested positive for sickle cell disease were immediately given routine medication and referred to sickle cell clinics.

Sickle Cell Outreach in Hong LGA, Adamawa

Sickle Cell Outreach in Hong LGA, Adamawa

Since healthcare in many African countries is community-based, rapid POC test kits like the Sickle SCAN can be easily integrated into existing health programs like routine immunization at primary health care centers or health insurance schemes to facilitate universal screening and ensure sustainability. This will ensure that relevant data on SCD births, morbidity and mortality rates and long term outcomes are captured.

Sickle Cell Awareness and Testing Outreach in Toro LGA, Bauchi

Sickle Cell Awareness and Testing Outreach in Toro LGA, Bauchi

eHealth Africa continues to work with partners to address health inequalities by ensuring equal access to quality and effective diagnostic tools to achieve universal health coverage.

Expanding Cornbot to fight food insecurity

Chinedu Anarodo and Cornelius Adewale at the award ceremony

Chinedu Anarodo and Cornelius Adewale at the award ceremony

Last year, eHealth Africa’s CornBot Application was one of the finalists for the Fall Army Worm Tech Prize. The application received the Frontier Innovation Award for its ease of use and human-centric design. CornBot also received $50,000 in prize money. Six months later, CornBot’s, Chinedu Anarado and Cornelius Adewale share their progress and how they are using the prize money to expand CornBot so that the solution addresses more challenges in nutrition and food security.

Why did you develop CornBot?

One of eHA’s focus areas is Nutrition and Food Security Systems. Our goal with this program is to provide nutrition stakeholders at all levels of the value chain, with technological tools and data so that vulnerable populations in West Africa can have access to nutritious food.

When USAID called for innovations to address Fall Armyworm (FAW), a major pest that destroys various crops worth $2.4bn – $6bn annually, predisposing communities to food insecurity, we knew we had to respond. We partnered with the Washington State University (WSU) to design and build CornBot, a mobile application, that interacts with farmers in their local dialect and guides them through the process of detecting, preventing and treating FAW infestation on their farms. The application is synced to a dashboard to enable us and other stakeholders to easily aggregate data on FAW infestation and make informed decisions.

What scenario mapped the transition from CornBot to FMT?

After we received the Frontier Innovation Award and the prize money, we started thinking about what we could do to expand CornBot. During the field testing phase as well as during other field research carried out by WSU, we realized that smallholder farmers needed more than just a pest detection tool—they needed a platform where they could exchange and receive guidance and knowledge to increase their productivity. We then decided to invest the prize money in building a platform where farmers can gain additional information to enable them to yield as much as possible from their farms, in line with the Good Agricultural Practices (GAP) put forward by the Food and Agriculture Organization (FAO). So, CornBot went from an idea that helps in combating farm pests, to a platform for providing guidance on farming practices as a whole. For now, we call it the Farm Management Tool.

What do you hope to accomplish with the Farm Management Tool?

Farmers in Kano using Cornbot to identify FallArmy Worm

Farmers in Kano using Cornbot to identify FallArmy Worm

Overall, we want to improve the quality of livelihood among smallholder farmers and strengthen the resilience of communities against food insecurity. We know that by making small changes in their farming processes and decisions, and by adopting good agricultural practices, farmers can increase the crop yield from the same plot of land. They just do not know how to. Many of these farmers have been doing things the same way for years without ever knowing why. Our goal is to arm them with relevant information and ensure that they can produce more crops. If we can achieve this, it will be a huge success and it means that our solution is viable.  

What first steps have you taken?

We are currently working to build a mobile application. However, we held a workshop with 40 smallholder farmers in April to glean baseline data about their current agricultural practices, their level of knowledge, and current challenges, and to introduce them to our project and the concept of good agricultural practices. They have agreed to work with us for the pilot scheme and testing, as well as map out portions of their farmlands to test our concepts. We have also commenced field operations such as soil sample testing to understand the existing soil composition and what kinds of fertilizers will be needed.

The idea is to “hand-hold” the farmers throughout the planting season and see if there are significant differences from their previous outputs.

We are very excited about this platform and the possibilities that it presents for addressing food insecurity in communities across West Africa.



Meet the Team - Mohamed Sulaiman Kamara

Meet Mohamed Sulaiman Kamara, a die-hard Arsenal fan and the Chief Accountant in our Sierra Leone office!

meet the_team - mohammed kamara.jpg

Mohamed joined eHealth Africa (eHA) as a Project Accountant in 2017 and was promoted to this current position after consistent hard work and excellent performance. Mohamed has always worked closely with his team to ensure that they are working towards their team goals and the organization’s overall goals.

Mohamed’s role is a challenging but exciting one, he and his team primarily support all projects by ensuring their accounting and finance processes and procedures are in line with best practices. He ensures the books are closed on a monthly basis in compliance with regulatory standards and makes sure that all the i’s are dotted and t’s crossed for audits. Mohammed also guides and mentors the project accountants, he provides technical support to them when needed and ensures his team remains high performing.

For him, the most rewarding part of his job is the challenges. These challenges help him think critically and innovatively to come up with solutions. Mohammed also enjoys working with diverse teams that include partners and stakeholders, they ensure that no two days are the same at eHA.

In addition to his love and passion for Accounting and Arsenal, Mohammed loves reading motivational books and listening to business news.

Our Iftar Celebration

eHealth Africa is a team of people from diverse cultures, educational backgrounds, and experiences, united by the desire to build stronger health systems across Africa.

One of our values at eHealth Africa is ownership—we work hard to become embedded in the fabric of the communities which we work in and we invest our time, ideas and resources to ensure that the quality of life in those communities is improved.

This week, our staff in Kano and Abuja hosted an Iftar celebration for members of neighboring communities. Iftar breaks the daylong fast that Muslims must observe during the month of Ramadan. eHA staff came together to distribute food packs and clothes to over 500 people in Kano and 200 people in Abuja. Our aim was to give back to the communities that we live and work in.

Here are pictures from the event in Kano. Ramadan Kareem!

My Internship at eHealth Africa Helped me Find my Path

My name is Juliana Jacob and I am a Helpdesk associate with the IT Engineering and Operations team.  I studied Mass Communication at Kogi State University and I am currently studying to earn my Masters in Public Relations at Bayero University, Kano. Up until January 2018 when I became an intern with the Helpdesk/ Network Operating Center at eHealth Africa, all I could think about was pursuing a career that would put me in the limelight and make me a household name.

Everything changed during my National Youth Service year in 2016. I worked at the Nassarawa Broadcasting Service (NBS) as a Radio/TV presenter but I had the opportunity to participate in a project as a data collector/ enumerator. I visited settlements in very remote and hard-to-reach locations and saw first-hand the deplorable state of health care in those communities. Many health facilities were dilapidated and had no vaccines or medicines. I decided there and then that I had to play my own part to improve healthcare for the people in such communities.

Someone told me about an eHealth Africa internship placement. I was immediately interested because eHA was a NGO and I knew it would give me the opportunity to touch lives in some way. I am not sure what I expected but when I found out that I would be placed with the Helpdesk/ Network Operating Center, I was worried. I didn’t see any similarities between my background in Mass Communications or my prior experience as an on-air person and working in Information Technology (IT). I had very little knowledge about IT or what it entailed, prior to this internship. My only experience with IT was a course that I took as an undergraduate student.

DSC2_6507 (1).jpg

My time as an intern was the most challenging experience of my adult life but it was also the most enlightening. The Helpdesk is perhaps the busiest unit in the entire organization because it supports the delivery of all the projects in some capacity. We make sure that every team member has all the digital tools that they need to deliver their results. The helpdesk also functions as a customer call center and provides support, information, and solutions to eHA staff and partners. Working at the helpdesk helped me to internalize and exhibit the eHA values especially innovative problem-solving. In no time, I found that I had gained valuable skills such as interpersonal communications, and time and task management.

DSC2_6689 (1).jpg

I have become familiar with IT terms and concepts—that I never thought I would encounter. I have fallen in love with IT and what is so amazing that I did not have an IT or tech background. Everything I know about IT and network operations, I learned from my team at eHealth Africa. Not only were they patient with me, but they also recommended several courses and seminars for my own personal development.

At first, I didn’t think that I could really be of any help to the communities with poor healthcare if I was not on the field or if I was not in the medical profession but my internship with the Helpdesk proved to me that everyone can do something to improve the quality of healthcare for vulnerable populations or communities. At eHealth Africa, everyone brings their strengths to the table and contributes their quota to achieve our mission and vision. We have staff who are not medical doctors or nurses but contribute to the improvement of health service delivery through their expertise in software development, logistics, construction or communications.

In February 2018, I became a full-time staff at eHA. One of the things I love most about eHealth Africa is that it focuses on applied knowledge rather than theoretical knowledge. To a large extent, what matters is getting the job done and not what you studied in school. This is why an intern with a Mass Communications background can become a full-time staff in one of the most technical fields in the organization.

My internship experience helped me to discover what I truly want to do career-wise. Even though my masters is in Public Relations, I have decided to pursue a career in IT. I am currently taking several online courses to attain some certifications in Information and Communications Technology (ICT). There are so many intersections between PR and ICT and I cannot wait to explore them.

I am truly grateful to my team and to eHA for this opportunity. If you are looking for an organization with bright, progressive people who are passionate about transforming health systems in Africa, eHA is definitely the place for you.

Meet the Team - Gift Ogbaje

Meet Gift Ogbaje, our “Director of First Impressions”. She is a security associate/ receptionist with the Operations unit at our Kano office in Nigeria.

meet the_team-Gift.jpg

She joined eHealth Africa 2 years ago. Gift’s primary responsibility is visitor management and she is the first person that our visitors meet when they walk through our doors. Gift takes this responsibility very seriously and has made a conscious effort to improve her interpersonal skills so that guests can feel welcome.

At eHA, our strongest asset is our people. Gift embodies our values here at eHA and has shown a remarkable aptitude for innovative problem solving by creating unique and workable solutions to problems within her team. One of her major successes was her simple solution to the traffic during on-site events with external participants. In place of the cumbersome process of generating and printing individual visitors tags, Gift created tags for the training which she could print ahead of time; as well as a register where each participant could enter their details. Her solution reduced the traffic by over 85% and made work much faster.

At eHealth Africa, I am able to utilize my strengths such as accuracy and attention to detail, optimally. I collect and handle invoices from vendors, which I forward to the finance team for payments. My attention to detail aided by proper documentation has helped to reduce errors and delays in processing payments. I have also gained new skills in time management and multitasking which enable me to perform multiple tasks efficiently, without getting flustered.
— Gift Ogbaje
DSC_6901.jpg

We are proud to have Gift as part of our team, if you’re ever visiting our office in Kano, be sure to say a warm hello.

Much Ado about Monitoring & Evaluation?

By Emerald Awa- Agwu and Olayinka Orefunwa

Case Study

Thomas* has just received some feedback from donors to suggest that his organization may need to refund some of the funding it received. The donors feel that there is insufficient evidence to demonstrate that the project achieved its outcomes and overall objectives.

Thomas managed a three-year nutrition project, which aimed to combat malnutrition in children under the age of 5 by training local women and caregivers to produce nutritious meals for children from 6 months to 5 years using indigenous, locally available foods. He and his team conducted several activities including producing recipe manuals, organizing food demonstration classes, developing communication materials, and educating women on nutrition and hygiene issues.

Thomas believed that the project had achieved great results. Malnutrition rates had dropped and mothers in the community had a better knowledge of how to create nutritious, balanced meals with local foods in order to support the optimal growth and development of their children. He simply could not understand why the donors could not understand this. After a lot of back-and-forth conversations, the donors asked to see the Monitoring & Evaluation Framework for the project. Thomas and his team had never created one.

What is Monitoring & Evaluation?

Over the last decade, monitoring and evaluation (M&E) processes have become an important source of knowledge management and organizational learning in the development sector. Monitoring and Evaluation (M&E) are processes that help project managers like Thomas as well as donors and relevant partners to assess the performance of a project or organization. Monitoring is a systematic, continuous and long-term process of gathering information about a project’s progress towards its set objectives. Evaluation helps to determine if the project has, in fact, achieved its goals and delivered the expected outputs as planned.

DSC00767.JPG

Why is Monitoring & Evaluation Important?

As we saw from the case study, neglecting M &E can have dire consequences. It is important to factor it in from the inception of the project. Best practices in programming and project management suggest that an equivalent of 5% - 15% of the overall project budget should be allocated to M &E.  Here are a few reasons why organizations and project managers should have a strong M & E framework in place.

1. M & E is relevant for donors to assess the quality of project implementation. In the development sector, an M &E framework is required by donors for them to gauge how reliable an organization is as a partner, before considering them for future collaborations and opportunities.

2. Together, M&E help to keep track of how efficiently projects are implemented (with regards to using resources and inputs) or how effective the programs are. This is extremely valuable for project managers like Thomas because it helps them ensure that donor funds are being used judiciously to get the best value for money.

3. M&E is also important for identifying challenges and gaps so that changes can be made as needed.

4. It allows teams to learn from each other’s experiences, and to build on expertise and knowledge.

At eHealth Africa, M & E is led by our Monitoring, Evaluation, and Research (MER) team and is built into projects from the inception to close out. The MER team supports project managers across the organization to develop solid M & E frameworks that guide project delivery according to laid down standard operating procedures. Apart from their internal quality assurance functions within projects, our MER team supports eHA’s efforts to contribute to public health research.

The team provides research services to organizations including universities and implementing partners to conduct qualitative and quantitative studies on a wide range of areas.  In addition, eHA’s MER team provides third-party monitoring services for humanitarian organizations so that they can have a true picture of the quality and impact of their interventions. Recently, our MER team provided technical leadership in a baseline data survey for the Clinton Health Access Initiative (CHAI). The survey aimed to gather data relating to perceptions and practices relating to sexual and reproductive health among males and females of reproductive age in Kaduna, Katsina and Kano states.  Over the course of three years, CHAI will support the state governments of Kaduna, Kano, and Katsina to increase contraceptive prevalence rates and utilization of reproductive health services, which should lead to reduced rates of unintended pregnancies and unsafe abortions. The increased use of family planning, in addition to sustained gains in the provision of quality emergency obstetric services, should lead to a further reduction in the number of maternal deaths in the same time period.

To effectively achieve this goal, a clear understanding of current levels of knowledge on reproductive health was required. First, as a baseline against which program outcomes can be measured at the end of the project, but more importantly, as a basis for which strategies for program intervention can be designed and delivered. eHealth Africa trained the data collectors to use Android-based digital applications such as ODK to collect data across 70 LGAs and supervised the data collection process.

eHealth Africa staff including MER lead, Yinka Orefunwa visit Soba LGA in Kaduna State to conduct data quality assessments for the CHAI survey

eHealth Africa staff including MER lead, Yinka Orefunwa visit Soba LGA in Kaduna State to conduct data quality assessments for the CHAI survey

Overall, to avoid scenarios like the one in our case study, organizations need to recognize Monitoring and Evaluation as a necessary component to ensure the quality of their project execution and the accuracy of their outcomes. M&E ensures visibility and accountability as donors, implementing partners and relevant stakeholders will have adequate information about successes, challenges and even changes made in the course of the project.

Meet The Team - Abdulai Dumbuya

Meet Abdulai Dumbuya, Senior Network Administrator,  in our Sierra Leone office.

meet the_team - Abdulai.jpg

Abdulai has been part of the eHealth Africa (eHA) team for approximately 4 years. He is a team lead and go-to person for issues relating to networking, troubleshooting,  systems backups, the configuration of network application systems, maintenance and administration of Wide Area Network (WAN) technologies and the execution of network disaster recovery plan.

He also the deputy to the ICT Manager and performs administrative duties for the ICT team, including assisting with the preparation of annual ICT budget and procurement for the department.

eHA’s approach to serving underserved communities in Africa is one of my motivations for working with the organization.
— Abdulai Dumbuya

One of Abdulai’s biggest contributions to eHA is reducing the operational cost of the 117 Call Center by over 50%. He achieved this by moving the 117 call center ICT infrastructure from an external provider to the Emergency Operations Center  (EOC), under the Ministry of Health and Sanitation (MoHS).

We are glad to have Abdulai on our team!

Strengthening Routine Immunization using Lessons learned from Polio Emergency Support

By Joshua Ozugbakun & Emerald Awa-Agwu

In July 2016, after over two years of being polio-free, two wild poliovirus cases were discovered in Borno State, Nigeria. This launched fresh efforts to strengthen the four pillars of polio eradication including Routine Immunization (RI), Supplementary immunization activities (SIAs) (including national Immunization Plus Days (IPDs)), Surveillance and targeted mop-up campaigns.

A health worker vaccinates a child with the Oral Polio Vaccine

A health worker vaccinates a child with the Oral Polio Vaccine

Partners, both local and international, collaborated with the Nigerian government at state and national level, through various interventions and projects to increase the coverage and effectiveness of IPDs and mop-up campaigns in order to increase herd immunity and stop polio transmission, especially in high-risk states like Adamawa, Borno and Yobe states. These interventions were coordinated by the State Emergency Routine Immunization Coordination Centers (SERICCs). Each SERICC is led by individual state governments and help to improve information sharing, joint programming of public health emergency management activities (planning, implementation, monitoring, and evaluation) with partners. The National Emergency Routine Immunization Coordination Center (NERICC) is responsible for strategy development and oversees the activities of all the SERICCs. With this coordination mechanism in place, the menace of polio is being tackled collaboratively and Nigeria is well underway to being declared ‘Polio Free’, a major milestone in its vaccine-preventable disease management efforts.
A major takeaway for Nigerian polio eradication stakeholders after years of battling polio is the need for data collection, management and storage systems to be upgraded. As the need to halt poliovirus transmission increased, it became increasingly obvious that paper-based data management systems were incapable of providing decision makers with the reliable, actionable data which they needed for effective programming. eHealth Africa responded to this challenge by supporting states across Nigeria to develop comprehensive, digital maps using our expertise in Geographic Information Systems (GIS). The accuracy of these maps improves the microplanning process and guarantees a greater coverage of settlements during campaigns.

Our GIS technology has improved the quality of maps used for polio campaign planning

Our GIS technology has improved the quality of maps used for polio campaign planning

In addition, through our Vaccinator Tracking Systems (VTS) project, GIS-encoded Android phones are used to record and store passive tracks of vaccinators as they conduct their house-to-house visits; allowing decision-makers to have an accurate picture of the settlements that have been covered during IPDS and mop-up campaigns. This data can easily be accessed through dashboards for a more detailed analysis and breakdown of coverage information.


Supporting polio emergency response activities also highlighted the need for the Nigerian health system to move from an emphasis on SIAs and campaigns to strengthening the RI and disease surveillance systems. Sound routine immunization and disease surveillance systems are necessary to sustain the herd immunity built through polio campaigns.

In Kano state, the LoMIS Stock solution helps the State Primary Health Care Management Board to ensure that the vaccine supply chain is maintained. Health workers at the facility level use the LoMIS Stock application to send reports on a variety of vaccine stock indicators including vaccine utilization, vaccine potency, stock levels, wastage rates, and cold chain equipment status. Supervisors access the reports through the LoMIS Stock dashboard and are able to respond appropriately. This ensures that the RI system is maintained and that health facilities are never out of stock.

In the past, Acute Flaccid Paralysis (AFP) surveillance in health systems across Africa was passive. This meant that disease surveillance and notification officers (DSNOs) only reported or investigated suspected AFP cases that were presented at the health facility. According to the U.S Centers for Disease Control and Prevention (CDC)1, over 72% of polio cases are asymptomatic and as such, will not present at the health facility. In addition, DSNOs are unable to visit every single community to actively search for AFP cases due to logistics and security challenges. Relying on data from passive AFP surveillance causes programs to be designed based on data that excludes the asymptomatic polio cases. Auto-Visual AFP Detection and Reporting (AVADAR) reduces the burden on the DSNOs by enlisting members of the community to actively find AFP cases and report using a mobile application on a weekly basis; thus, providing accurate real-time surveillance data that can be used for program planning and implementation.

An often overlooked factor that promoted the transmission of the poliovirus was the rejection of the polio vaccine by mothers and households due to various myths and socio-cultural barriers. By engaging traditional and religious leaders as ambassadors of vaccination, more mothers and households are accepting the polio virus.

The central lesson in Nigeria’s journey so far towards polio eradication is the importance of collaboration and engagement at all levels including communities. eHealth Africa is proud to be supporting governments and health systems across Africa to respond to the polio emergency.