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.

World Immunization Week: VaxTrac - helping health workers provide vaccines in Sierra Leone

By Musa Bernard Komeh

Through routine immunization programs, health workers bring life-saving vaccines to people around the world. At eHealth Africa, we work  with our partners to increase vaccination rates in the countries we work in. In Sierra Leone, one of the ways we do this is via VaxTrac.

VaxTrac at work in the Macauley Street Government Hospital, Freetown

VaxTrac at work in the Macauley Street Government Hospital, Freetown

VaxTrac, is a clinic-based vaccination registry system which health workers can use in the field to enroll children and track their immunization records. It eliminates the need for paper-based cohort books, tally sheets, and monthly reporting forms and improves health workers accuracy and efficiency.

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With the introduction of VaxTrac technology into the routine immunizations activity of  Sierra Leone’s Western Area Urban, significant contribution has been made with a view to improving on quality, timely, and useful  immunization data. eHA VaxTrac currently covers 50 health facilities including the biggest and only children’s referral hospital in Sierra Leone.

One of the key features of  VaxTrac is that health workers can easily access information on defaulters which can be used for defaulter tracing activity during their outreach programs within  the communities they serve. Priority areas within the Western Urban Area have been identified which will further strengthen processes and contribute to the success of the project. This was based on lessons learned and data collected from 2016-2017.

eHA further commits to:

  • Working closely with the District Health Management Team of Western Area Urban to ensure regular and more structured outreach programs that will target defaulters

  • Sharing of facility performance to in-charges so they know where improvement should be made to achieve higher coverage

  • Training of more health workers on the use of VaxTrac

  • Modifying of the VaxTrac software to increase user friendliness and usefulness.

In 2017, a total of  39,101 children were registered on VaxTrac. We have plans for more efficient and impactful work in 2018.
— Musa Bernard Komeh, Project Supervisor, VaxTrac

At eHA, we know #VaccinesWork and we look forward to successful outcomes with increased immunization coverage and a reduction in defaulter numbers.

Electronic Immunization Registry and Tracking System in Sierra Leone

Written By Hawa Kombian

In November 2016 we announced the launch of a Child Immunization Initiative in Sierra Leone - an Electronic Vaccination Record and Tracking Project, also known as VaxTrac. The goal of this initiative was to implement an electronic registry for children’s immunizations in order to provide timely and quality data for decision making.

The Immunization Dashboard shows the client's immunization history and upcoming immunization dates. Photo credit: Bryan Gastonguay

The Immunization Dashboard shows the client's immunization history and upcoming immunization dates. Photo credit: Bryan Gastonguay

Funded by the Centers for Disease Control and Prevention (CDC), eHealth Africa (eHA) implemented the project in collaboration with VaxTrac, Africell, and the Child Health Division at the Sierra Leonean Ministry of Health and Sanitation (MoHS). The pilot phase ran from November 2016 to June 2017.

The VaxTrac project has been a thriving success in the Western Area Urban District of Freetown. eHA has led the training of over 110 MoHS health officials and workers from 50 health facilities to conduct electronic registration for children receiving vaccinations via the VaxTrac app. The patient profiles are generated and linked using biometric indicators (i.e. fingerprint scans) from their caregivers or via a QR code sticker on their traditional vaccination cards. Each child’s demographic and vaccination details (i.e. type of vaccine and date of administration) are collected via the VaxTrac mobile app and synced to the VaxTrac monitor analysis system, which the MoHS can access.

“VaxTrac has helped us give accurate return dates [for immunization follow-up] to our patients. ”

— Trained, Freetown Health Care Worker (HCW)

In addition to storing immunization information in a secure and accessible platform, VaxTrac includes features which support the health system proactively addressing child immunizations. The system has a “call-back” feature which tracks follow-up vaccination timelines and calls caregivers with reminder messages encouraging them to bring children back in for their next round of immunization. This friendly and automated reminder helps ensure that vaccine coverage is as high as possible. It further provides a simple and reliable mechanism for healthcare workers to conduct routine follow-ups.

Ultimately, the MoHS will be able to utilize compiled VaxTrac data to make more strategic and informed vaccination decisions via the VaxTrac monitor dashboard which runs data analysis and produces reports.

Following the success of the pilot where over 20,000 patients were registered, the completed end-of-pilot evaluation will provide information on necessary software upgrades to ensure that the app remains user-friendly and is streamlined for data collection and analysis. The project partners plan to expand VaxTrac to the 20 remaining health facilities for 100% coverage within the Western Urban Area District. This activity will include greater engagement of MoHS staff in the process of training health care workers to use the VaxTrac app, monitoring its usage and effectiveness throughout health facilities, and analyzing the data collected for a clearer understanding of immunization trends across the district.

eHA establishes new standards in health delivery through the integration of information, technology, and operations. This supports our mission to improve the quality of healthcare for underserved populations across Africa. To join our team or find out more about the work we do, kindly visit our website.

Using Tech to Save Lives in Sierra Leone

Captivated audience

Captivated audience

eHA SL Senior Software Developer, Jasper Timm

eHA SL Senior Software Developer, Jasper Timm

eHealth Africa (eHA) is often described as an organization which provides technological solutions to strengthen health systems. But what about the “e” in eHA? At the heart of the electronic systems are dynamic software solutions developed and managed by our global health informatics team.

In a quest to highlight achievements, share current projects, and inspire the emerging tech community, eHA’s Sierra Leone’s Information Systems Information Systems team led a “Hacks/Hackers Meetup” in Freetown this November. Hosted by local collective “Sensi Tech Innovation Hub,” the event brought together a mix of technology enthusiasts and software coders with a passion for health.

eHA disease surveillance software

eHA disease surveillance software

Team Manager Manuel Loistl and Senior Software Developer Jasper Timm spoke to a packed house about the Information System team’s role in a variety of eHA activities. This included an overview of: how eHA created mobile applications to track Ebola patients and potential patients during the Ebola outbreak and established the 117 emergency call center’s digital interfaces to connect health workers across all regions of Sierra Leone. Currently, the team is customizing DHIS2 software into a disease surveillance system for Sierra Leone, as well as supporting software modifications in a new partnership with VaxTrac. Additionally, Jasper covered important Information Systems processes and systems necessary to generate high-quality digital solutions to meet Sierra Leone’s unique health needs.

Excitement was in the air as many participants stayed after the presentations to engage with the team and play with demos of various software solutions created for different eHA initiatives.

For future opportunities with eHA Sierra Leone’s Information Systems team, please visit our careers webpage(under Informatics). Follow us for more coverage of similar events via Twitter and Facebook.

Exciting New Partnership to Strengthen Child Immunization in Sierra Leone


Remember eHA’s participation in Sierra Leone's national polio campaign?

More than simply a community exercise, this event served as an important stepping stone toward the launch of an exciting new initiative to strengthen children’s health in Sierra Leone.

eHA is proud to announce its new partnership with VaxTrac, an innovative organization which provides technologies to maximize the effectiveness of vaccination programs in developing countries. Between now and May 2017, partners will collaborate with the Child Health Division at the Ministry of Health and Sanitation (MoHS) to implement an electronic registry for children’s immunization throughout Sierra Leone.  

“eHA is excited to collaborate with MoHS and VaxTrac to implement a biometric immunization record system. We believe this project will lead to a higher number of children finishing their vaccination plans, as well as establish a robust immunization record system for Sierra Leone.” - Evelyn Castle, Executive Director and Co-Founder of eHealth Africa

Read the full announcement on VaxTrac’s website!