elearning

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.

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.




FIND Visits Kano State

During the month of August, eHealth Systems Africa in collaboration with THINKMD, FIND and Kano State Primary Health Care Management Board (KSPHCMB) implemented the second phase of the pilot study of the eHealth platform MEDSINC. In the first phase of the pilot, Community Health Workers (CHWs) in 15 health facilities across Kano state had been trained to use the platform and carry out physician like clinical assessments on ill children between the age of 2 months and 5 years of age. At the completion of their training the CHWs received a training certificate during a conferment ceremony. Taking from the success of the first phase, a new version of MEDSINC was developed and combined with malaria rapid diagnostic tests to guide CHWs through clinical assessment, malaria diagnosis and management. This phase of the pilot was implemented in 5 health facilities across five metropolitan Local Government Areas.

Last week, FIND representative, Dr. Karell Pellé, visited eHealth Systems Africa and met with the Executive Secretary of Kano State Primary Health Care Management Board (KSPHCMB), Dr. Nasir Mahmoud, to discuss ongoing plans for scaling up the use of mHealth tools to improve clinical diagnosis of childhood illnesses. She also visited some of the pilot health facilities in Kano State to interact with the CHWs and observe first-hand how quality of care and health delivery had been improved in those facilities.

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.