Vaccines

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.

Benefits of a Direct Delivery Model

By Adamu Lawan and Emerald Awa- Agwu

eHealth Africa's third- party logistics service, VDD ensures that vaccines are delivered to last mile health facilities in a timely manner

eHealth Africa's third- party logistics service, VDD ensures that vaccines are delivered to last mile health facilities in a timely manner

Vaccination is one of public health’s most cost-effective interventions. According to the World Health Organization1, it prevents between 2 million to 3 million deaths every year. Even though there has been great progress towards achieving universal coverage, there are still 20 million unvaccinated and under-vaccinated children worldwide. To reach these children and to meet global disease elimination targets, all countries must provide an uninterrupted supply of potent vaccines to the most hard-to-reach and conflict-affected areas.

Nigeria has experienced challenges in maintaining functional vaccine cold chains and supply chains, leading to low vaccination coverage rates. Nigeria’s cold chain system consists of five levels: a national cold store which stores all vaccines in the country and supplies six zonal cold stores located in each of Nigeria’s six geopolitical zones. The zonal stores supply vaccines to the state cold stores, which in turn supply the LGA cold stores. The primary health care facilities staff have to visit the LGA cold stores to collect their vaccines on a weekly or daily basis depending on the status of their cold chain equipment.

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This system was inefficient and time- consuming because health workers from over 9,000 health facilities in Nigeria often had to leave work to collect vaccines when they could be treating patients instead. In addition, the system was fraught with high operational costs and poor vaccine stock visibility, especially in transit.

To alleviate this problem, the Nigerian government adopted a direct delivery model called Push Plus in 2013, to transform its supply chain at the state level. A direct delivery model is one which delivers vaccines and dry goods directly from the state cold store to the last mile health facilities according to customized schedules, bypassing the LGA warehouses completely and preventing stock-outs.

The benefits of this model have been enormous. The direct delivery model has freed up an additional 1- 6 hours each week for health workers to attend to patients—time previously spent by health workers in transit to obtain vaccines. In addition, vaccine availability at the last mile health facilities has improved. By increasing the number of health facilities that have functional cold chain equipment, health posts and smaller health facilities can receive vaccines from closer health facilities instead of going to the LGA cold store every day. This has led to a massive drop in the stock-out rate. In Kano state, vaccine stock-out rates dropped from 93% to 3% and in Lagos State, from 43% to none. Not surprisingly, the immunization coverage of Lagos State increased from 57% to 88%. WHO2 lists vaccine shortages and stock-outs as a major cause of missed opportunities to vaccinate.

Nigeria is projected to spend about US$ 450 million by 2020 on vaccines, By increasing vaccine accountability and visibility, the direct delivery model has also reduced the amount of money that could be lost due to wastage and pilfering of vaccines.

eHealth Africa implemented Vaccine Direct Delivery, a third-party logistics service based on the direct delivery model in Kano State from 2014 to 2016 and currently implements it in Bauchi and Sokoto states. We work with the state primary healthcare development agencies to ensure that vaccines and dry goods are delivered safely and in a timely manner to health facilities. Using our LoMIS Deliver solution, eHA plans, schedules, and routes deliveries to enable health delivery officers choose the correct quantity of vaccines and dry goods from the state cold stores and deliver them to health facilities equipped with cold chain equipment. The process of determining what quantities to deliver at the health facility is fully automated to avoid manual errors. The project also incorporates reverse logistics—returning balance stock or waste, if any to the state cold store. VDD provides governments and other stakeholders with accurate, near real-time data for decision making and forecasting.

Through VDD, over 28 million doses of vaccines have been delivered to health facilities in Kano, Bauchi and Sokoto State from 2014 to date, reaching over 13 million children under the age of one. eHealth Africa continues to support governments across Africa with system-level approaches to transforming health service delivery.

Preventing childhood diseases through Vaccine Direct Delivery

By Adamu Lawan

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The Challenge
In Northern Nigeria, vaccines are often unavailable at health facilities due to irregular deliveries. There are no systems in place to track inventory and movement of commodities between facilities and state cold stores. This has led to substantial stock outs of vaccines at last- mile health facilities and consequently, the inability of children under the age of one to access routine immunization services.

eHealth Africa’s solution
In 2013, eHealth Africa developed a logistics platform, LoMIS, to transport vaccines and dry goods from the state cold store to health facilities at the ward level that are equipped with cold chain storage facilities. The project was launched in Kano in 2014 and in Bauchi and Sokoto in 2015.
Following its success in the pilot LGAs of Bauchi State this year, the implementation of Vaccine Direct Delivery was scaled up to include an additional 148 health facilities in the northern clusters of Bauchi State.

The Impact

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Getting Vaccinations on Time

By Hawa Kombian

One of the primary challenges facing routine immunization (RI) in northern Nigeria is a poor vaccine supply chain system which causes consistently high stock out levels. High stock out levels occur when vaccines are not delivered on time and are exacerbated by limited cold chain equipment (CCE) to keep the vaccinations viable. High stock out levels cause low RI coverage because there are fewer vaccines available when needed.

eHealth Africa (eHA) was engaged as a third-party logistics (3PL) supplier to provide a solution for this problem and the Vaccine Direct Delivery (VDD) program was the clear answer to streamline vaccine and dry goods delivery supply chain to CCE equipped health facilities. VDD works by:

One of the terrain challenges encountered by eHA's officers

One of the terrain challenges encountered by eHA's officers

  • Leveraging eHA’s geographic and information systems (GIS) capabilities to optimize delivery routes (including rugged terrain as pictured), reduce cost and maximize efficiency.

  • Collecting, analyzing and reporting data to provide custom delivery workflow support through a near real-time electronic data collection application - Logistics Management Information Systems (LoMIS) for stock level summaries via an integrated reporting dashboard.

VDD is a proven and effective model which enhances the efficiency and quality of Nigeria’s vaccine supply chain network. In collaboration with partners, VDD is implemented by eHA across some of Nigeria’s northern states specifically, Kano, Bauchi, and Sokoto. The program has had a proven and large-scale effect across northern Nigeria. The project has succeeded in improving both access and availability of healthcare for underserved populations, by enhancing the local vaccine supply chain network. It ensures that key and priority antigens are available, as evidenced by the low stock out rates, and are a major contributor to improved RI, especially for children's health. 

 

eHealth Africa Launches Vaccine Direct Service in Sokoto State

By Daniel Ojabo

In partnership with the Sokoto State government, eHealth Africa (eHA) just launched a vaccine delivery and immunization campaign to address supply related gaps in Sokoto State, Nigeria.

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Recently concluded phase of the Vaccine Direct Delivery (VDD) campaign in Kano State saw over 7 million doses of antigens delivered and 4.6 million children immunized. Building on this success, eHA will be engaging Sokoto State as a third party logistics partner to optimize the timely delivery of vaccines and routine immunization supplies across all 23 Local Government Areas (LGAs) in the state.

According to the VDD Project Manager Adamu Lawan, “eHA is contracted to deliver vaccines to health facilities at the wards across all 23 LGAs in the state.”

VDD will be implemented to support demand creation activities and address supply related factors on routine immunization uptake. It will provide a reliable vaccine delivery service for state Primary Health Care (PHCs) facilities in the state, allowing them to run monthly Immunization Plus Days (IPDs) in addition to regular vaccination clinics for children under five.

“eHA is contracted to deliver vaccines to health facilities at the wards across all 23 LGAs in the state.

- Adamu Lawan, Project Manager

The project, which kicked off on 13th December of 2016, is expected to run for 12 months and work with over 80 (PHCs) in Sokoto State. Health facilities will be clustered by Wards/LGAs in order to examine the effect of demand creation against improved supply over a 6-month period.

“Part of the mandate is also to help collect sharp and other wastes from the health facilities we make deliveries to, and deliver back to the cold stores,” Lawan added.

Several immunization programs across all 36 Nigerian states have seen a steady increase in vaccination coverage over the past decade. According to a 2014 report by the National Population Commission (NPC) of Nigeria and ICF Macro, full vaccination coverage of children aged 12-23 months was highest in Imo State (62.4%) and lowest in Sokoto State (1.4%).

The project will monitor and inform eHA, the Sokoto State government, and other stakeholders on the effect of improved vaccine delivery on childhood routine immunization in Sokoto State. The results of these research activities are expected to present an overall picture of the extent to which improving vaccine supply chain affects routine immunization coverage in Sokoto.

eHA will engage the state government through Routine Immunization officers who will track demand creation activities in their health facilities. Current routine immunization coverage information in Sokoto will also be documented using a desk review and analysis of District Health Information System (DHIS2) data. This research will be used to create a benchmark for evaluating the expected outcome of improving vaccine supply chain and delivery in Sokoto.

A Strong Partnership: Kano State and eHealth Africa

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The Kano State Primary Health Care Management Board renovation project provides the right facilities for staff to deliver crucial primary health care interventions across Kano State.

eHealth Africa (eHA) is finalizing a project with the Executive Secretary (ES) of the Kano State Primary Health Care Management Board (KSPHCMB), Dr. Muhammed Nasir Mahmoud, to renovate and upgrade the KSPHCMB’s Offices in Kano, Nigeria.

eHA worked for one month with the KSPHCMB to renovate the building and outside areas. Internet, solar panels, electricity and other facilities were added to provide a better work environment for the Executive Secretary and over 50 staff working for the KSPHCMB. “I believe if one has a conducive environment to work in with the right equipment, tools, and facilities, there should be no reason for people not to work effectively,” said Dr. Mahmoud.

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Dr. Mahmoud, has been in the role for over six months, and has seen a real difference in how stakeholders and visitors now see the board’s work through the building’s renovations. He manages the day to day activities of the KSPHCMB, and also oversees the activities of 1,143 Healthcare Facilities in 44 Local Government Areas of Kano State.

“When I came, the place had a lot of issues and was dilapidated,” said Dr. Mahmoud. “The renovations have built up KSPHCMB’s portfolio and general standing in the community. People come here everyday now, and are always impressed with the changes they see, which makes me proud to head this organisation.”

"Today’s world is a technological world, and without technology people will continue to be disadvantaged. I believe the innovations of eHA will continue to benefit us and other sectors in Kano." - Dr. Muhammed Nasir Mahmoud

The renovation project is one component of the joint work and long term partnership between  eHA and the KSPHCMB to improve primary health care in Kano State. Kano State has many challenges in health care delivery because of security issues and physical challenges in reaching remote locations. This results in the most vulnerable segments of society falling severely ill with preventable and treatable diseases including malaria, tapeworms, ulcers and diarrhea.

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Collaboration projects between eHA and KSPHCMB include the management and coordination of immunizations across the state, a health communication system (Kano Connect), management of Emergency Operation Centers, Geographic Information Systems (GIS) tracking, and the implementation of Health Camps linked to monthly Immunization Plus Day (IPD) campaigns. Another collaboration is Vaccine Direct Delivery, which takes vaccines from KSPHCMB cold stores and directly delivers them to rural health facilities.

“I have been partnering with eHealth Africa for many years,” said Dr. Mahmoud,”and we are currently working on signing a MoU to strengthen communication within the primary health care system. I know there are many areas where we will continue to partner with eHA, and I hope we will continue to explore these other areas. Today’s world is a technological world, and without technology people will continue to be disadvantaged. I believe the innovations of eHA will continue to benefit us and other sectors in Kano.”