Capacity Building

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.

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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.

Technical Career Development at eHealth Africa

Health systems, especially in within Africa, face the challenge of delivering high-quality services to an ever-growing population with limited resources. This has necessitated the development of innovative approaches to expand access to healthcare to larger numbers of people, even in the most difficult-to-reach locations. The role of electronic and mobile technologies, ranging from simple SMS messaging for reporting and complex information and data management systems for studying patterns in disease prevalence, in the transformation of healthcare delivery has become more evident.

eHealth Africa was founded in 2009, on the belief that adapting technology to meet local needs and settings, is the key to delivering better health services. A decade later and with projects such as the Geo-Referenced Infrastructure and Demographic Data for Development (GRID3) and solutions such as LoMIS Suite and Gather under our belt, eHealth Africa is an established leader in the Global Health Informatics (GHI) space.  Our approach to technology is that systems designed in proximity to the environment in which they are needed are stronger, more effective, and help close the gap between design and use.

Our GHI program spans several technical areas including software development, Geographic Information Systems (GIS) & Analytics, Information Technology & Engineering Operations, Business Analysis and DevOps Engineering. We therefore constantly seek to connect and leverage our work across focus areas while attracting and retaining the best employees. Through a more deliberate focus on employee development, we focus on building and keeping an outstanding Africa-based team to execute our work.

There’s always time to laugh when you love your job

There’s always time to laugh when you love your job

Some members of our GHI team share some of the ways that eHA supports the development of careers in tech.

Evance, Senior Software Developer in Software & Solutions Development

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Working at eHealth Africa is by far, the most rewarding career experience I have had. I joined eHA two years ago and before that, I had several years of experience developing software for customer-oriented companies. At eHealth Africa, the focus is on saving lives in the most constrained environments in Africa. Not only have I worked on many projects, all requiring different technical specifications and I have done so in three countries namely, Guinea, Liberia, and Nigeria, using some of the coolest technologies available in our age such as Big/Sensitive data management, Offline- aware apps, Biometric identification). Creating software for various contexts and needs, motivates and challenges me to be more creative and to try new methods. I have grown as a software developer because of the work that I do at eHA. It is an amazing feeling for me to see how the codes I write contribute to improving healthcare among underserved populations.
— Evance

Sandra, Senior Business Analyst in Software & Solutions Development

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As a Senior Business Analyst with the GHI program, I work in the capacity of a project manager, responsible for planning and executing a project. I am also responsible for the requirements analysis and documentation, specifications, development cycle and execution of a variety of GHI projects. eHA has provided me and my colleagues with a platform to excel. I have been given way more opportunities in just 1 year working with eHA, than in the two years I spent working with other organizations. At eHealth Africa, there are a lot of opportunities for career growth within the organization, irrespective of your tech inclination. I joined eHA as a Business Analyst in 2017 and by the end of 2018, I had been promoted twice. I have worked on many projects and last year, I was made the project lead for an eLearning initiative for employees and clients. Thanks to eHealth Africa, I and other colleagues were trained and have received the Projects in Controlled Environments (PRINCE2) certification, which is invaluable for a career in project management. The organization expects great results from their staff but what is most important is that eHA pushes and supports us to achieve our personal development and career goals.
— -Sandra

Oluwafemi, Associate Manager, DevOps Engineering

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DevOps is a growing culture which was born out of the need to roll out incremental changes to software several times daily. In the past, it was not scalable or automated; now with new technologies in cloud computing, automation and deployment, development and operations process are easier and more cost-cutting.
At eHA, we use open source technologies to solve health-related challenges in contexts which are constantly evolving. It is very important for the solutions that we create to move from writing to pushing to production within minutes. DevOps simply eliminates the barrier between the people who develop software and those who operate it, allowing the development of solutions that integrate functionality with enhanced usage and minimal error. I joined eHA about 2 years ago as a DevOps engineer and in that time, I’ve worked with the team on the best and most cost-effective way to evolve and improve our solutions at a faster pace.
The best part of working in eHA, for me, is that there’s always room to learn and grow. I am continuously exchanging knowledge and learning about the latest technology trends to keep up with the ever-growing DevOps culture.
— Oluwafemi

Detan, Associate Manager in Geographic Information Systems

There is a tendency for techies to be somewhat distant from the clients who use their software or solutions. eHA allows members of the GHI team to be seconded to other eHA offices in Berlin, Sierra Leone, and Liberia and to clients in different parts of the continent (Chad, Cameroon, Niger) in order to ensure that the team is fully embedded with clients and fellow technical consultants. This provides a deeper grasp of the context and increases empathy towards the client and the work that we do, making work enjoyable, irrespective of the inherent challenges and risks in implementing a project.
In addition, jobs roles within the organization and division allow for flexibility and adaptability to suit project requirements and career goals. For example, business analysts may double as project managers on a small project, and there are opportunities for project managers and UI/UX designers to transition into product management roles if they are interested in such career paths, while technical leads may also double as technical project managers if need be. Members of the GHI team attend and plan conferences, hackathons and other meetups within the technology industry. This helps our team stay abreast with new trends in our field so they can improve themselves, and deliver better results.
— Detan

eHealth Africa is committed not just to delivering data-driven solutions that address systems-level issues across Africa, but to providing career and learning opportunities to tech enthusiasts. We are passionate about sharing our knowledge, experience, and skills with the next generation in order to inspire positive change. eHealth Africa frequently hosts tech meetups in Kano and Berlin to bring together individuals who are interested in developing technological tools for development.

If you are interested in pursuing a career in tech or global health informatics with an established leader in the field, visit the careers page on our website to keep up with internship or job opportunities.

eLearning - The Journey so far

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At eHealth Africa, one of our strategic objectives is to increase access to high-quality eLearning resources for healthcare workers to achieve proficiency in healthcare delivery, management, and leadership.

In line with this, eHealth Africa collaborated with the Kano State Primary Health Care Management Board (KSPHCMB) and other implementing partners, to deploy its eLearning solution on a pilot scale to health workers in Kano State. The eLearning platform is web and mobile-enabled and can be accessed by participants through their Kano Connect android phones.

Fifty- seven Ward Technical Officers (WTOs) and Health Facility In-charges (HFICs) from facilities across three local government areas of Kano state— Gabasawa, Nassarawa and Fagge LGAs—were selected and trained to utilize the eLearning platform. The aim was to improve the delivery of health services in Kano State by providing health workers with access to texts and audio courses and training modules.

Jibrin Mohammed, a Ward Technical Officer from Nassarawa LGA in Kano State shares his experience with the eLearning modules on routine immunization

After a pilot period of 3 months, the health workers who completed all the modules on the platform were awarded certificates of completion at an award ceremony on November 2, 2018. The ceremony was presided over by the Executive Secretary of Kano State Primary Health Care Management Board (KSPHCMB), Dr. Nasir Mahmoud. During the ceremony, selected participants shared their experiences with the platform and testified that they were better able to provide quality Routine Immunization (RI) services at their respective facilities because of the knowledge they had gained.

Following a successful pilot in Kano State, the RI content currently available on the platform is set to be scaled-up to 18 states in Nigeria, with an estimated number of 3000 health workers per state, to participate. Plans are also underway to expand the curriculum to include content on programs such as Cholera, HIV, Malaria, and Maternal and Child health.




eHealth Africa supports cholera Simulation as part of its Emergency Preparedness

By Umu McCarthy and Sahr Ngaujah

Sierra Leone is known for persistent heavy rains that sometimes lead to public health emergencies including the August 2017 mudslides and cholera outbreaks. As of June 2012, a total of 25,000 people were affected by cholera in Sierra Leone & Guinea, with 399 deaths in Sierra Leone. It was the country's largest outbreak of cholera since the disease was first reported in 1970 and the deadliest since the 1994–1995 cholera outbreak. This has been the largest outbreak in the West Africa region.

eHealth Africa (eHA) partnered with U.S. Centers for Disease Control (CDC), Sierra Leone’s Ministry of Health and Sanitation and the World Health Organization (WHO), in a Cholera Simulation Exercise conducted in the Kambia District, in Northern Sierra Leone. A total of 36 healthcare workers and Health Management Teams  across the country, represented their various Districts in the simulation exercise. The key objectives of the simulation exercise were to:

  • promote awareness of cholera to emergency response staff

  • assess the effectiveness of the surveillance, laboratory and logistics capabilities of the selected districts to respond during outbreaks

  • discuss the roles and responsibilities of Public Health National Emergency Operations Center (PHNEOC) personnel during a potential outbreak activation in accordance with the district and national plans

  • test existing communication and coordination structures  implementation of emergency preparedness and response operations

Usually during the rainy season there is an increase in the trend of diarrhea cases. This puts the country on red alert to heighten its surveillance and preparedness plans. This simulation exercise was a deliberate and proactive step to addressing cholera crisis, should they come up
— Alusine Kamara

Alusine Kamara, the Public Health Operations Coordinator at the Sierra Leone National Emergency Operations Center, was key facilitator of the simulation exercise alongside  Dr. Claudette Amuzu, National Professional Officer, Emergency Preparedness Response, WHO.

CDC is funding eHA’s Emergency Management and Preparedness Project in Sierra Leone. The goal of this project is to enhance the capacity of the Ministry of Health and Sanitation’s ability to prepare, prevent and adequately respond to current and future outbreak of diseases including Ebola Virus Disease.

eHA’s role is to build the capacity of Ministry of Health and Sanitation personnel on key emergency management concepts in line with the Global Health Security Agenda. Scenarios, plenary sessions and presentations were used to test participants’ knowledge on cholera response. After the exercise, participants now have knowledge on how to control the spread of cholera during an outbreak.

Emergency Operation is new to Sierra Leone’s Ministry of Health and Sanitation. Ebola crisis was our very first experience and we are still using the lessons learnt to inform future emergencies . The simulation exercise could not have come at a better time. Partners were able to identify relevant players at the District levels. This makes it easier for response teams during an emergency. If there is a cholera emergency now, I am better placed to mobilize both human and logistical resources to respond to it.
— Sahr Gbandeh, Emergency Operations Center Focal Person for Western Area Urban

The simulation exercise, if properly implemented, goes to also benefit thousands of Sierra Leoneans during an outbreak of cholera.






eHealth Africa supports training for Hepatitis B community-based Serosurvey

eHealth Africa (eHA) and Statistics Sierra Leone are implementing the Hep B Community-based Serosurvey project funded by U.S. Centers for Disease Prevention and Control (CDC). Technical leadership for the survey is being provided by CDC and Dr. Dennis Marke, Program Manager for the Government of Sierra Leone’s Child Health Program. The purpose of the survey is to

  • assess the impact of the current childhood Hepatitis B immunization program in Sierra Leone on the prevalence of chronic hepatitis B infections among children

  • evaluate the need for the Hepatitis B- birth dose in Sierra Leone by determining the burden of chronic hepatitis B virus among mother/child pairs.

In preparation for the survey eHA  supported the training of phlebotomists and surveyors for data and sample collection in the field.

Practical session on processing and tracking of venous blood specimen

Practical session on processing and tracking of venous blood specimen

Strong human resource capacity is crucial to manage a household survey that consists of a detailed questionnaire and a rapid diagnostic test administered to the participant in their home. eHA and CDC trained a team of 50 people (13 surveyors, 13 team supervisors and 3 district coordinators and 20 phlebotomists) from Statistics Sierra Leone and the Ministry of Health and Sanitation. The training took place at Sierra Leone’s Public Health National  Emergency Operations Center (EOC) in Freetown, from 20th - 25th August 2018.

The 5-day training consisted of 3 full classroom days and a 2 days of field work. The following topics were covered:  

  • Overview and relevance of the Hepatitis B Serosurvey

  • Household identification procedure for enrollment

  • Counseling families about Hepatitis B results

  • Conducting Hepatitis B rapid diagnostic test

  • Processing and tracking of venous blood specimens

I have never worked in a survey field. However, this training did not only add to my knowledge about Hepatitis B, it also gave me the opportunity to go out in the field during the training and conduct a phlebotomy exercise on participants.
— Sahr Joseph, Phlebotomist


Key beneficiaries of the project are Sierra Leone’s Expanded Programme on Immunization (EPI), Sierra Leone’s Ministry of Health and Sanitation (MOHS), mothers and children in Sierra Leone and the wider public. Participants testified to the value of the training to facilitate learning valuable information needed for effectively administering the questionnaire and conducting rapid diagnostic tests in the field.

Practical sessions with phlebotomists on the use of the mobile refrigerator to store blood samples

Practical sessions with phlebotomists on the use of the mobile refrigerator to store blood samples

The training was intense. However, I was able to master the purpose of the survey, became conversant with the questions and how to determine the eligibility of participants.
— Tamba Fatorma, Surveyor

eHA provided the phones and internet data for the survey and installed the open data kit (ODK) app (which is used for data collection in the field), the age= app for age calculation, and the  ODK dashboard. eHA’s provision of the android phones for the survey discourages potentials errors via paper-based methods by presenting an automated approach to health data collection. With ODK, data collection will be done easily and survey activities monitored in near real time.

 

Next Steps

The Western Area Urban, Bo and Bombali districts have been identified as target areas for the  survey. After this training, eHA, CDC, Statistics Sierra Leone and the MOHS (including those trained)  will Implement the serosurvey through June 2019, at 14, 200 households in the areas identified. The survey will include infants in the following age categories: 4–24 months; 5-9 year olds and their mothers to evaluate the risk of mother to child transmission (MTCT) of Hepatitis B. Evidence from the survey will be presented to the Sierra Leonean government to inform decision makers on whether to introduce administration of the Hepatitis B vaccine at birth.

MEDSINC Pilot Study Closeout meeting and Certificate Conferment Ceremony

eHealth Africa, THINKMD and Kano State Primary Health Care Management Board (KSPHCMB) collaborated to implement a digital platform called MEDSINC among Community Health Workers (CHWs) in 5 metropolitan Local Government Areas (LGAs). Covering 15 Health facilities, MEDSINC supports the management of illnesses under the Integrated Management of Childhood Illnesses (IMCI) and empowered CHWs with skills to carry out physician-like clinical assessments on sick children within 2 months – 5 yrs of age. The close out meeting which held July 19, 2018 was presided over by the Executive Secretary, KSPHCMB, Dr. Nasir Mahmoud and with the support of Juliet Odogwu, Megan McLaughlin and Dr. Aisha Giwa, he presented certificates of completion to the CHWs. The ceremony consolidated our collaborative efforts in empowering CHWs with training and on-the-job support to improve the quality of care provided at primary health care level in the state. 

Participants with their certificate

Participants with their certificate

The pilot study was completed in 2 months and involved a 6-weeks implementation period (June 4 – July 13) and 3 stages of data collection – Pre, Mid and Post-Implementation IMCI observational data collection. Over the implementation period, CHWs used the platform to assess children in the health facilities. A total of 2,239 children were assessed using MEDSINC and a 41% increase in the number of IMCI observational data points collected at baseline (pre-implementation) was observed after mid-implementation data collection. This indicated an increase in the quality of assessments provided by the CHWs using MEDSINC. The feedback from the CHWs throughout the implementation period was positive and contributed to the ongoing improvements on the MEDSINC platform.

Sustaining impact: Lessons from Kano Connect’s handover

By Fatima Adamu and Abdullahi Halilu Katuka

Kano Connect is a communication and information sharing platform developed by eHealth Africa, with funding from Bill and Melinda Gates Foundation in 2014. It features electronic management tools such as comprehensive directories of all the health facilities and health workers across all levels in Kano State. Using the platform, health workers can submit and review reports on routine immunization from their mobile phones or through a dashboard.  Health workers on the Kano Connect platform can access the contact details of any staff and communicate for free within a closed user group resulting in prompt and quality reporting, improved visibility and effective accountability.

Kano Connect ODK Form

In 2016, eHA officially handed over the Kano connect project to the Kano State Primary Health Care Management Board. However, we continue to provide support and guidance in line with our vision. Prior to the handover, reporting rates through the platform were at an average of 25%. After the handover, reporting rates increased to an average of 95%.
This demonstrates the importance of working hand in hand with the states which we work in to ensure  the sustainability of our projects and our impact.
In this blog post, we share 2 key lessons from eHA’s approach to building state ownership of the Kano Connect platform

Lesson 1: Build capacity
In the course of the Kano Connect project, eHA conducted a total of 21 trainings and workshops for over 1400 health workers across all administrative levels of the Kano state health system. The health workers worked on diverse thematic areas such as Maternal and Child Health, Nutrition, Pharmaceutical Services, Epidemiology and Disease Control and Routine Immunization.
They were trained on how to use an android phone, send Routine Immunization supportive supervision reports using the Open Data Kit (ODK) e-forms, how to use the dashboard for decision making, reporting through the LoMIS Stock applications, using the LoMIS Stock dashboard for decision making ensuring that all the stakeholders understood the platform.

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Lesson 2: Train your Replacement
eHealth Africa trained 5 health workers as the pioneer members of the Kano Connect Operations Unit to manage the day to day running of the Kano Connect project. The unit members were trained on the standard operating procedures of the eHA Kano Connect team and how to execute daily tasks including:  

  • Administrative management of the Kano Connect project

  • Capacity building of Kano Connect users, including onboarding of new users

  • Dashboard management (updating, adding, and deleting user information)

  • Collation of summary reports from dashboards

  • Information and data management through form hub

  • Conducting surveys (paper-based and electronic)

Presently, I’m a data management officer for Kano Connect. eHealth Africa trained me and other Kano Connect operation unit staff to manage Kano Connect dashboard issues like updating, adding, and deleting user information and exporting Information and data management through form hub to populate a report
— Shamsuddeen Muhammad, Kano Connect Data management officer

Presently, Kano Connect is piloting its e- learning mobile application and dashboard  in three local government areas: Fagge, Nassarawa and Gabasawa local government areas in Kano State. Kano Connect eLearning provides access to learning materials and resources that health workers can access on their mobile devices.

Once again, eHealth Africa is partnering with Kano State to ensure that that knowledge gaps are identified and that health workers can gain skills and knowledge for improved health delivery.

The EOC Revolution

By Joshua Ozugbakun & Emerald Awa- Agwu

In line with eHealth Africa’s quest to add more value to the states that we live and work in, the Polio Emergency Operations Centres are being rebranded to provide much more than administrative and coordination functions to the states. 

‘’All the work that eHA does is not for ourselves but to make our partners’ work better’’
— Atef Fawaz, Deputy Director, Program Operations, Nigeria

The Emergency Operating Centres (EOCs) were created by eHealth Africa and other partners such as U.S. Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), and Public Health England to serve as centers for the emergency management and response coordination of Polio and other infectious diseases in Nigeria. The EOCs are located in Abuja, Kano, Katsina, Sokoto, Kaduna, Borno, Bauchi, and Yobe states and during an outbreak, the EOCs serve as a central command and control facility responsible for carrying out the principles of emergency preparedness and emergency management.

After the establishment of the EOCs, eHealth Africa continues to support the center by ensuring that 24-hour electricity and internet access are available and that Technical/ Administrative Coordinators are on hand to ensure connectivity and the maintenance of the EOCs. However, this year, eHA decided that the Technical and Administrative Coordinators could be supporting the states in more ways. Here’s how:

 

Step 1: Capacity Building Workshop

eHealth Africa trained a total of 17 technical and admin coordinators from the 16th to 24th of April, 2018. This was the first step in the transition of eHA’s role in the EOCs from administrative to technical. The T/A Coordinators were trained on Geographical Information Systems (GIS), Analytics and Data Management.       

Photo of Capacity Building Training

Photo of Capacity Building Training

Step 2: 60- day Transition Phase

Following the successful conclusion of the capacity building workshop, the EOC technical support team (formerly the T/A coordinators) are undergoing a transition window during which they are expected to utilise the skills they had gained in their day to day activities at the EOCs. Some of these skills include:

This phase is intended to assess the abilities of the EOC technical support teams will be to use these skills; as well as to identify and address areas of growth or gaps in knowledge.    

Eventually, the EOC technical support teams will be able to act as frontline representatives of eHealth Africa to the states and partners who utilize the EOCs where they are domiciled. They will be able to add more value to eHA as well by identifying more opportunities for business development.

 

Behold the new faces of the EOCs!

Behold the new faces of the EOCs!

Increasing Sierra Leone's efficiency in disease detection with eIDSR

In a continued effort to increase the capacity of  Sierra Leone’s health systems, eHealth Africa (eHA) has partnered with the U.S. Centers for Disease Control and Prevention (CDC)  to support the government of Sierra Leone by increasing the early detection and reporting of government-identified priority diseases using the Electronic Integrated Disease Surveillance Response (eIDSR) framework.

eHA developed a mobile electronic Integrated Disease Surveillance and Response (eIDSR) application in response to requirements stipulated by the Sierra Leone Ministry of Health and Sanitation (MoHS).  This eIDSR app enables the MoHS Surveillance system to accurately record and share health facility-level information from the district to the national level. From health workers in hard-to-reach rural areas up to health officials in the major urban centers, eIDSR connects the health system to generate a clear and accurate picture of the health landscape.

In the first quarter of 2018, eHA introduced two new features to the eIDSR app; data approval and sms compression. These new features align with  Joint External Evaluation (JEE) as stipulated by the International Health Regulations (2005).) Since June 2007, countries—including Sierra Leone, have been making efforts to strengthen their core capacities.

Prior to  the introduction of the electronic data processing system, Sierra Leone’s Integrated Disease Surveillance and Response (IDSR) system relied on a paper based process  where the disease surveillance data summary was compiled in a spreadsheet and then mailed to appropriate authority every Monday. This manual system helped to monitor diseases in Sierra Leone. However the time constraints reduced efficiency. The paper-based method was also prone to human error, resulting in questionable credibility and completeness of information.

Before the introduction of eIDSR, most National health information from the Primary Health Care Unit were written hard copy. It took a lot of time for data staff to capture written hard copy data into the soft health management system. Data processing with the paper based system was time consuming and error prone. Transitioning to eIDSR would improve the quality and timeliness of health information.
— Dr. Tom Sesay, District Medical Officer (DMO), Port Loko - Northern Sierra Leone

One new feature  implemented in the eIDSR app is data approval. In the past, health care workers who were responsible for submitting necessary reports and data would enter the data  and there was no opportunity for superiors 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.

The new data approval feature now prompts the district staff to review and validate all data received from the health facilities before it is seen by other users. eHA also provides daily monitoring of the approval process and quickly resolves any challenges that may arise.

With this new feature in place and the support provided,  the quality of data used for disease surveillance is improved significantly and human errors are minimized.

Training health care workers on the new features in the eIDSR app in Freetown, Sierra Leone

Training health care workers on the new features in the eIDSR app in Freetown, Sierra Leone

One of the biggest challenges experienced during the roll out of eIDSR was internet connectivity. There are many  facilities that do not have internet access to upload their data on site. The initial solution to that challenge was to provide an alternative for the facilities to upload their data into the national server; that alternative was using Short Message Service (sms)  to submit their data.

In the first version of the eIDSR application, seven (7) SMSs were required to upload the eIDSR weekly reporting form by SMS. With this sms compression upgrade the number is now reduced to one.  The introduction of SMS compression has resulted in facility staff saving time needed to find locations in the community where they can have internet access or strong network connection for 7 SMS submissions. It also cuts down on costs as less SMSs are needed to complete the upload into the national server. Through the sms compression, health facility staff are not  likely to leave their facilities to upload their data. The few that might have to leave will not likely have to walk long distances to have their data uploaded.

eIDSR has built the capacities of our health workers most of whom had little experience in the use of smartphones. eIDSR has contributed to improving our interaction with our facility staff.
— Albert Kamara, District Surveillance Officer, Port Loko

eHA has now trained 142 health care workers at the Western Area Urban  District Health Management Team (DHMT) in Freetown, Sierra Leone. This training of trainers session was aimed at cascading the new upgrade to other health workers. These two new features in the eIDSR application are adding immediate value to Sierra Leone’s health systems, by simply automating work.These are best practices for future generations to uphold and retain.

Post-Ebola Liberia: eHealth Africa strengthens laboratories in readiness for future infectious disease outbreak

Prior to the Ebola Virus Disease (EVD) outbreak in 2014, the Liberia public health laboratory system had weak capacity to detect, report and respond to public health emergencies. In order to fulfill our mission to build stronger health systems, eHealth Africa (eHA) supported Liberia’s laboratory system from 2014 - 2018. eHA’s lab support program has improved effectiveness of the laboratory system by providing human capacity support for four years, as well as improved electronic submission of lab reports by providing internet connectivity at priority labs (ELWA, Redemption, LIBR & Bong) since 2014.

Test samples in an eHA supported priority lab in Liberia

Test samples in an eHA supported priority lab in Liberia

The Bong lab is situated at the Phebe Hospital Compound, Bong County. In October 2014, it was one of the regional laboratories selected by Liberia’s Ministry of Health (MOH), the United States Navy (US Navy) and other partners for testing suspected Ebola samples as part of the fight against the 2014 West Africa EVD outbreak. The Bong lab and other identified priority labs faced a few similar capacity challenges, including the lack of skilled staff, lack of adequate equipment and poor internet connectivity. eHA provided lab support by developing technology for capturing of lab data, provided internet connectivity to enable the labs submit the data electronically and also provided human capacity support, including recruitment and training of lab desk officers.

Roberto Koimenee is one of the four lab desk officers that eHA worked with via the laboratory support program. He is deployed at Bong Lab to enter Ebola virus disease (EVD) data and report daily samples test results to the Liberia’s Ministry of Health and eHealth Africa.

From Roberto
‘’I got involved with eHealth Africa-Liberia through an application and CV submission during the Ebola outbreak in September, 2014 in Liberia. I was called by eHA for an interview which was followed by training as a Lab Desk Officer. I was assigned to Bong EVD Lab. I was motivated to work in the lab because I wanted to help in the fight against Ebola in Liberia. Since eHealth is a technology driven company, with my knowledge in data management, I decided to help in this fight against Ebola by entering data from samples tested and submit report for decision making at the National level.

I have more than eight years of experience as an Administrative staff and four years of experience as a data officer at eHealth Africa-Liberia, where I have won some performance awards. I love managing database and solving data issues. I am a person who thrives to work out things when it’s difficult to do and work independently to solve complicated problems”, he explains.  

I participated in a three-day training conducted by eHA and this training impacted my life and work by increasing my knowledge in the following topics: Sample handling storage, and processing; Confidentiality/Document control, Data entry and analysis. Today, I know how to control and secure patient information and report accurate and reliable results to requisite and identified individuals responsible to receive said information or results.

The part of the training I like the most was the off-line tracker although it has not been fully utilized by Bong Lab. The off-line tracker is so unique in that it tracks all data or information in all the four (4) regional labs in the country (Liberia). Each lab can see and access information including reports/results of specimen tested. This system can be used without internet. However, that training especially the off-line tracker needs to be fully utilized for the safety, reliable and secure of lab information/data.

Although I worked with other institutions before eHealth Africa came to Liberia, but life was not too good for me and my family. My salary was too small to cover all my expenses including undertaking house construction project. But after I was employed by eHA, my salary was encouraging that enable me and my family to live better life.’’

Roberto’s wife, Christiana Hne Koimenee, believes her husband made a good decision working for eHA in the fight against Ebola in Liberia, even though she expressed fear over her husband doing one of the riskiest jobs, and comes to the conclusion it was worth it.

‘’It was sad and worrisome for individuals like my husband to be at the frontline to test Ebola specimen. But it was also historical for him and those who stood firm to help in the process of fighting Ebola in Liberia.”
— Christiana Hne Koimenee
Roberto Koimenee and family

Roberto Koimenee and family