Aether

How eHealth Africa supports Universal Health Coverage across Africa

By Emerald Awa- Agwu

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April 7 is World Health Day and this year, the World Health Organization (WHO) is focusing on Universal Health Coverage (UHC).

WHO: Universal Health Coverage - What does it mean?

Good health is crucial for developing economies and reducing poverty. Governments and decision-makers need to strengthen health systems so that people can get the healthcare and services that they need to maintain and improve their health, and stay productive.  However, improving access to health services is incomplete if people plunge further into poverty because of the cost of health care. WHO estimates that over 800 million people spend at least 10% of their household budget on health care which is indicative of catastrophic health expenditure (CHE).  CHE can mean that households have to cut down on or forfeit necessities such as food and clothing, education for their children or even sell household goods.

One of the targets of Sustainable Development Goal 3—Ensure healthy lives and promote wellbeing for all at all ages— is to achieve universal health coverage by 2030. Therefore, achieving UHC has become a major goal for health system reforms in many countries, especially in Africa.

Through our projects and solutions, eHealth Africa supports countries across Africa to strengthen the six pillars of universal health coverage.

1. Health Financing for Universal Health Coverage

WHO recommends that no less than 15% of national budgets should be allocated to health. We believe that accurate and up to date data, can ensure that available health funds are better allocated. In Nigeria,  we worked with several partners to map and collect geospatial data through the Geo-Referenced Infrastructure and Demographic Data for Development (GRID3) program. Data relating to over 22 points of interest categories including health facilities, was collected across 25 states and the Federal Capital Territory in Nigeria. This data helps decision-makers to distribute resources and plan interventions that target the people who need it most.

2. Essential Medicines and Health products

Vaccines are some of the most essential health commodities

Vaccines are some of the most essential health commodities

Countries decide what medicines and health commodities are essential based on the illnesses suffered by the majority or significant sections of their population. They must also ensure that quality, safe and effective medicines, vaccines, diagnostics, and other medical devices are readily available and affordable.

When essential medicines and health products are procured, it is important to maintain proper records and to ensure that health facilities do not run out of stock. eHealth Africa created Logistics Management Information System (LoMIS), a suite of mobile and web applications, LoMIS Stock and LoMIS Deliver that address challenges in the supply of essential medicines and health products such as vaccines and drugs. In Kano State, health workers at the facility level use the LoMIS Stock mobile application to send weekly reports on the vaccine stock levels, essential drug stock levels and the status of cold chain equipment. Supervisors can view the reports in near real-time through the LoMIS Stock Dashboard and plan deliveries of medicines and health products to prevent stockouts of vaccines and essential drugs, using LoMIS Deliver. LoMIS Deliver reduces errors by automating the process of ledger entry to capture the number of vaccines on-hand at the facility and the quantity delivered.

3. Health systems governance

Health system governance according to the WHO is governance undertaken with the aim of protecting and promoting the health of the people. It involves ensuring that a strategic policy framework exists and providing oversight to ensure its implementation. Relevant policies, regulations, and laws must be put in place to ensure accountability across the health system as a whole (public and private health sector actors alike).  Effective health systems governance can only be achieved with the collaboration of stakeholders and partners who will support the government by providing reliable information to inform policy formulation and amendments. Over the years, we have worked with several partners to provide this support.

4. Health workforce

Health systems can only deliver care through the health workforce

Health systems can only deliver care through the health workforce

The attainment of UHC is dependent on the availability, accessibility, acceptability, and quality of health workers1. They must not only be equitably distributed and accessible by the population, but they must also possess the required knowledge and skills to deliver quality health care that marries contextual appropriateness with best practices.

Recognizing this, eHA supports the Kano State Primary Health Care Management Board (KSPHCMB) to improve health service delivery by providing health workers in Kano State with access to texts, audio courses, and training modules through an eLearning solution. Through the eLearning web and mobile-enabled platform, health workers can gain useful skills and knowledge on a wide range of topics. Read about the pilot of the eLearning solution here.

In Sierra Leone, we work with the Ministry of Health and Sanitation (MoHS), U.S. Centers for Disease Control and Prevention (CDC) and the African Field Epidemiology Network (AFENET) to implement the Field Epidemiology Training Program (FETP). Through FETP, public health workers at the district and national level gain knowledge about important epidemiological principles and are equipped with skills in case/ outbreak investigations, data analysis, and surveillance. This positions Sierra Leone to meet the Global Health Security Agenda target of having 1 epidemiologist per 200,000 population. In addition, we support Sierra Leone’s MoHS to build additional capacity in frontline Community Health Officers (CHOs), who are based at the Chiefdom level through the management and leadership training program. CHOs are often the first point of contact for primary care for the local population and the MLTP program equips them to provide better health services and improve health outcomes at their facilities.

5. Health Statistics and Information Systems

In line with our strategy, we create tools and solutions that help health systems across Africa to curate and exchange data and information for informed decision making and future planning.  The Electronic Integrated Disease Surveillance and Response (eIDSR) solution has been used in Sierra Leone and Liberia to transform data collection, reporting, analysis, and storage for a more efficient response and surveillance of priority diseases. Its integration with DHIS2, a health information system used in over 45 countries, makes it easy for health system decision makers to visualize data and gain insight into the state of public health. Read more about our other solutions Aether and VaxTrac. In addition, we also support the Nigeria Center for Disease Control and Prevention (NCDC) by creation and maintenance of a data portal which serves as a repository for all datasets that are relevant to detecting, responding and preventing disease outbreaks in Nigeria.

6. Service delivery and safety

Staff at the Kano Lab

Staff at the Kano Lab

The Service delivery and safety pillar encompasses a large spectrum of issues including patient safety and risk management, quality systems and control, Infection prevention and control, and innovations in service delivery. With our experience working to respond to polio and ebola virus emergencies across Africa, we support health systems to mount prevention and control programs at the national and facility level. We are also committed to creating new technologies and solutions that can help health providers to develop better models of healthcare. We also construct health facilities ranging from clinics to laboratory and diagnostic facilities that utilize state of the art technology to correctly diagnose diseases such as Sickle Cell Disease, Meningitis, and Malaria.

Our Sokoto Meningitis Lab has been at the forefront of meningitis testing and surveillance in Northern Nigeria, offering reliable and prompt diagnoses to support the prevention of future outbreaks.

eHealth Africa continues to work with governments, communities and health workers so that everyone can obtain the quality health care, in a prompt manner and from health workers and facilities within their communities, thus achieving universal health coverage.

Aether 1.0 and Gather 3.0 software releases are out!

Today eHA and the Aether team reached an important development milestone in their contribution to the ehealth open source community -- the release Aether 1.0 and Gather 3.0.

The belief that timely access to accurate data can save lives drives our commitment to create open source software for the development and sustainability of ehealth solutions. We believe that by facilitating the collection, curation, and exchange of relevant health data, we empower decision makers and improve the effectiveness of public health interventions.

With this in mind, last year we started working on Aether, an ambitious project to create a framework for the development of ehealth solutions. We wanted to build a platform that could facilitate developers' work and ensure that ehealth products were built with the highest standards for interoperability, security, and privacy.

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OPEN SOURCE RELEASE

We started transforming that vision into a concrete product in September 2017, and in July the following year, we celebrated the open source release of both Aether and Gather.

Aether is a reliable and secure development platform that enables organizations to build solutions that curate and exchange live information. Aether utilizes “data contracts” between systems, simplifies the movement of data between applications, and helps developers adhere to best practices for ehealth system design.

Gather is the first solution built on top of the Aether platform. Gather is a data collection and curation tool that securely collects data in the field and shares it everywhere it is needed. Thanks to Aether, Gather can perform data curation activities like data masking for privacy requirements and can easily be integrated with other systems and workflows for management, transformation, and analysis purposes.

We were committed to making these projects open source both as a way to give back to the public health community we have been active in for years and so that feedback could be used to quickly improve the solutions. Since their development and release, Aether and Gather have been used by eHA and our partners in a variety of projects.

DEPLOYMENTS

Understanding malaria awareness and practices among young people in Sierra Leone

In July 2018, we partnered with Restless Development and CUAMM Africa in Sierra Leone to provide data collection infrastructure for a malaria prevention campaign called "Youth-Led Malaria Prevention Messaging Survey".
The campaign aims to help public health authorities understand young people’s knowledge, attitude, and behavior towards malaria prevention and treatment. We use Gather for data collection and Aether to connect to a Kibana Dashboard for data analysis visualization. So far, 2,417 survey responses have been submitted.

Building a global high-quality humanitarian health facility database

In July 2018, we were awarded funding for a collaborative global health site mapping project with Healthsites.io. The objective of the initiative is to create a high-quality database that includes information on facility locations, medical staff, and services, which can be used to improve humanitarian crisis response. Data collectors will use Gather in the field to capture health facility data, which will then be connected and shared via Aether to Healthsite.io, Open Street Map, and Humanitarian Data Exchange.

Collecting geodata to gain insight into Nigeria and DRC Health and Demographics

In August 2018 we started implementing Aether and Gather in Kaduna State as part of the the GRID3 project, a multi-country initiative to support underserved communities by collecting and analyzing on points of interest such as settlements, roads, and hospitals. The geodata collected through Gather is automatically published via Aether to a publicly available, customized CKAN instance. As of October 12, 2018, 513,084 points of interest have been submitted through Gather.
Since August, eHA’s involvement in the GRID3 project has expanded into multiple states in Nigeria and to the Democratic Republic of the Congo (DRC). For its use in the DRC, we customized Gather in partnership with UCLA, CIESIN, Oak Ridge and Flowminder. The GatherDRC mobile app was built specifically for microcensus and other mapping tasks.

THE RELEASE AND NEXT STEPS

You can now download Aether 1.0 and Gather 3.0 and start using the software yourself.

Though this is an important milestone in our development process, it is only the beginning of a much longer journey. Currently, we are working toward the development of new features that will allow multi-tenancy, data validation rules, and workflows. In addition, connectors for other ehealth applications will be added, including:

BPMN: Integrate with Workflow processes and tools like Camunda

Zapier: Participate in data exchange with 100’s of existing Apps

DHIS2: Bi-Directional data exchange with DHIS2 API

FHIR: Bi-Directional data exchange via FHIR standard

We look forward to hearing your feedback on our products and hearing from interested organizations and potential partner that are interested in using Aether and Gather for the global good.

Get in touch with us at solutions@ehealthafrica.org

World Development Information Day

The United Nations established World Development Information Day—October 24—to draw global attention to development problems and the need to disseminate information which can stimulate cooperation and partnership.

As the world attempts to attain the Sustainable Development Goals by 2030, the necessity for accurate information and data becomes even more vital. In the face of insufficient resources and competing priorities, governments require data to make decisions about what challenges, interventions, and programs to invest in.

At eHealth Africa, we use the virtuous cycle approach to guide the implementation of all our projects. We believe that collecting, analyzing, and presenting accurate data provides us and our partners with insight to execute our projects. Many of our projects and solutions such as the Geo- Referenced Infrastructure and Demographic Data for Development (GRID3) and LoMIS Suite aim to provide governments and other decision-makers with up-to-date, accurate information that can help them make the best decisions for various populations. We also develop tools and technologies that make the process of data collection and analysis even more efficient.

Geospatial map generated from data collected on the field

Geospatial map generated from data collected on the field

Here are a few examples of how eHA is providing real-time data to aid development through our projects.

  • LoMIS Stock is a component of LoMIS Suite, a solution developed to address vaccine inventory challenges. Health workers at the facility level can enter data on a daily basis and submit weekly reports about vaccine stock levels and the status of cold chain equipment through the mobile application. Supervisors can access this data through the LoMIS Stock dashboard and address issues such as low vaccine stock levels and cold chain equipment faults,  at the health facility promptly. Thanks to this real-time data, vaccine stock-outs can be prevented.

Data gathering in the field

Data gathering in the field

  • Through the Geo-Referenced Infrastructure and Demographic Data for Development (GRID3), eHealth Africa has collected geospatial data for over 500,000 points of interests including schools, farms, water points, health centers etc. across 25 states and the Federal Capital Territory. Using this data, decision makers in various sectors can plan programs and interventions to effectively address key population groups. Currently, the GRID3 team is conducting a data and technology transfer to the Kaduna State Bureau of Statistics (KDBS) to ensure that the state government and relevant ministries, departments and agencies are able to analyze and utilize this data for development.

  • Earlier this year, eHA launched Aether, a reliable and secure development platform that enables organizations to build solutions that curate and exchange live information. Aether was developed to address the recurring challenges we faced when building tailored solutions for individual projects. There was a clear opportunity to solve these challenges with a unique application that made large-scale data collection and curation easier so that informed decisions could be reached faster. Aether facilitates interoperability and addresses the issue of data security and privacy and is available as open source and is freely available to everyone.

At eHealth Africa, we believe in the power of data to transform lives and stimulate development. This World Development Information Day, we are more committed than ever to support our partners and stakeholders by developing tools and technologies that can improve access to accurate data.


Aether and Gather - Open Source Release

By Dave Henry & Benedetta Ludovisi

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Today is a very special day for eHA and the Aether and Gather development teams. Today these two projects are finally being released as open source software!

Aether, the software development platform for data exchange, curation and publication, is available to anyone to be evaluated and used to jump-start the creation of data-driven ehealth solutions.

Gather, the Aether-based solution for large scale data collection is also available, providing an end-to-end pipeline for streaming Open Data Kit survey responses to the CKAN Open Data Portal and other applications.

Read more about the reasons we created these two projects in our interview with the Aether team, and get more information on the Aether and Gather microsites.

If you are eager to get your hands on the software, you can try it yourself by following the step-by-step Gather “getting started” guide.

We look forward to hearing your feedback on our forums, and to seeing the amazing things that you do!!

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Aether - An interview with the team

eHealth Africa developers are active in a number of open source communities. Indeed, many of eHA’s solutions have incorporated open source software such as Open Data Kit (ODK), CKAN, OpenHIE, DHIS2, and Humanitarian OpenStreetMap (HOT).  We are just weeks away from giving back to the community in the form of two new projects - Aether and Gather. We’re excited to support others who are developing solutions for the global good.

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We interviewed the team behind eHA’s Aether to discuss the reasons why they created an open source development platform for data curation, exchange, and publication.

Aether is being developed by a multi-country team working in three different continents, so it was a challenge to sit down with them all in one place. Still, we talked with four people key to its development and asked them what exactly Aether is and why eHA decided to create it. Our conversation included the Director of eHA’s Global Health Informatics Dave Henry, Aether Product Manager Doug Moran, Systems Architect Shawn Sarwar, and Technical Team Lead Adam Butler.

Why is eHA developing Aether?

During our discussion, Shawn Sarwar explained that throughout eHA’s years of experience developing ehealth solutions we faced recurring challenges when scaling the impact of our products within the communities we serve.

Although eHA develops great tailored solutions for specific problems and customers, we were not always leveraging possible synergies between different projects. Shawn gave three reasons why solutions are typically been developed as stand alone projects:

  1. Customization can create maintenance challenges. When multiple customers use a particular solution, a certain level of customization is required. The various codebases can drift apart, making it difficult to apply bug and security fixes across all of them.

  2. There isn’t always a standard set of components across projects. One team may know one technical stack, while another could have a different preference. This leads to the siloing of potentially useful components according to people’s comfort and familiarity.

  3. Almost every project needs to integrate with one or more external systems. Because of this requirement, teams normally plan to write their own integration to exchange data between different applications.

As a consequence, we became very good at creating variations of common solutions. But instead of reinventing the wheel each time, what if we could capitalize on a framework for the development of ehealth solutions? This, Dave Henry explained, is what drove eHA to develop Aether.

He explained that these challenges are not unique to eHA; they point to a broader issue that slows development and deployment of many healthcare systems. Information and Communication Technology (ICT) solutions for global public health use cases rely heavily on open source software, but while individual open source applications have been put to good use, the ability to integrate them into sophisticated solutions has been limited to countries with sufficient funding and visionary, determined leadership. Dave explained that even the most successful solutions leave behind a legacy of isolated data silos. Last September, eHA decided to wrangle these problems by setting twin goals:

  1. Simplify the integration of popular ehealth applications.

  2. Provide a consistent way for data to flow from these applications directly to where it needs to go.

Today the Aether team is pleased to announce the results of this effort: the Aether platform and it’s first companion solution Gather.

What is Aether ?

Aether is a platform for data curation, exchange and publication.
— Dave Henry, Director of Global Health Informatics, eHealth Africa

More precisely, it is an integrated set of tools and services that allows developers to connect to data sources, interpret data structures, and map attributes into a normalized set of entities defined by a formal schema. Aether flows the resulting data in real-time to one or more downstream destinations. The publication process is open and modular – the destinations receive data based on the schema (a de facto contract) and are completely insulated from the source systems. Data can be delivered concurrently to multiple destinations.

In this way, Aether facilitates the flow of data between data-producing and data-consuming applications, enhances data security and privacy, and accelerates the transmission of data between organizations. Basically, Aether allows for faster and more accurate data-driven decision making that helps save lives.

Aether helps organizations exchange health data faster and easier, but most of all it improves the productivity of developers that create ehealth solutions. According to  Doug Moran, Aether is a product built by developers for developers to facilitate their work and free them to focus on the actual solution rather than infrastructure. Solutions become easier to deploy, maintain, and upgrade than traditional one-off projects built from scratch.  By building on a common foundation, the software development process becomes well defined, predictable, and repeatable.

Basically, Aether is a framework of best practices for ehealth systems design. The Aether developers have done much of the dirty grunt work so that the project teams can do the exciting and heroic stuff that solves real problems for real people.

And what about Gather ?

Dave also talked to us about Gather, the first solution and use case built on the Aether platform. Gather leverages Aether and 3rd-party open source software to collect and distribute data collected during large scale field surveys, receives survey data from forms submitted via Open Data Kit (ODK), and ingests it into an Aether pipeline for processing and distribution. The Gather solution includes the ability to flow data into ElasticSearch / Kibana as well as the CKAN Open Data Portal.  The Aether platform services are used to package and operate the ODK components, the Gather user interface, the Aether core modules and the Aether publishers.  Gather is just the first – but arguably the most universal – use case that eHA will address with Aether.

Technical Team Lead Adam Butler elaborated on the implementation of Gather across the countries where eHA’s operates. He explained that in Sierra Leone, the CHAMPS (Child Health and Mortality Prevention Surveillance) network uses Gather to collect data as part of an initiative to identify and prevent child death. In Nigeria, the GRID (Geospatial Reference Information Data) project uses Gather to collect spatial reference data and other points of interest such as health facilities, schools, markets, and post offices to create a geo-database that the government uses for data-driven decision making. In the Democratic Republic of the Congo, the DRC Microcensus project used Gather to conduct a microcensus in the region of Kinshasa and Bandundu in order to predict how many people live in each settlement and estimate the total population for DRC, information that is playing a vital role in the current Ebola outbreak.

What is eHA’s vision for Aether ?

According to the Aether team, eHealth Africa’s goal is to establish and support a vibrant global community around Aether and Aether-enabled solutions. Aether serves three distinct purposes:

  1. A platform for integrating, distributing, and operating sophisticated solutions for specific ehealth industry use cases.

  2. A facility for organizations that are taking their first steps into data governance and (internal) application interoperability.

  3. A controlled “on ramp” for organizations that engage in formal data sharing using international standards.

Aether will be launched as open source software this summer. Stay tuned for the release announcement!

Solutions based on Aether enable faster and more accurate data-driven decision making that helps save lives.