OutREACH: eHealth Africa, Clinic Collaborate to Tackle Non-Communicable Diseases

by Moshood Isah

Hypertension is a major public health problem in Nigeria, with prevalence of 37.5%. This means that nearly 4 out of 10 Nigerian adults have hypertension. Similarly the prevalence of diabetes is increasing worldwide, and Nigeria is no exception; an estimated 7% of adults in Nigeria have diabetes, making it among the most common cardiovascular diseases in the country.

Unfortunately,  lack of access to quality and affordable hypertension and diabetes services in rural communities and primary health care is a major concern. This is largely due to  disparity in access to quality healthcare, especially between rural and urban areas in Nigeria as a result of  economic, social, geographic, and health workforce factors. For instance, the secondary health facilities where the few drugs are, with the facility for testing and the medical professionals are far from the rural communities, making access difficult. This is exacerbated by the high cost of medications, making it difficult for some clients to afford the treatment they need, resulting in low treatment outcomes.

Thus, adapting and digitizing  the World Health Organisation Package of Essential Noncommunicable (PEN) disease interventions for primary health care, eHealth Africa is collaborating with the EHA Clinic Reaching Everyone with Accessible Community Healthcare (REACH) program to reach out to marginalized communities with healthcare interventions. This, according to the Project Manager Lucy Okoye, is aimed at improving access to quality care and affordable services for persons with hypertension and diabetes and others at risk. 

She said, “Social mobilization activities will increase rural communities' knowledge of hypertension and diabetes”, saying  the identification of risk factors and the signs of hypertension and diabetes will likely result in the adoption of a preventive healthy lifestyle and prompt seeking of treatment. Another potential impact of the intervention according to her is to reduce the prevalence of hypertension and diabetes and improve the health and well-being of the target communities, helping people to live longer and lead healthier lives. 

In February, eHealth Africa supported the free medical outreach conducted in the Kuje community of the Federal Capital Territory and Gyadi-Gyadi community of Kano state. According to Adawiya, Mahmud Ila, Product and Quality Assurance Coordinator at the EHA REACH clinic said the outreach is an opportunity to reach the people accessible and  to provide free healthcare within the community. 

“We are having an outreach where we see hypertension and diabetic patients,we measure the blood pressure and fasten blood sugar.”  If there is a need for us to give hypertensive and glycine medication we give them which is going to be free for 6 months”, she said.

She said, the economic realities in developing countries like Nigeria limits citizens especially the older generation from accessing good medical care.  She said, “You know how the economy is in Nigeria; economically it's hard for them to go to the hospital so we are just trying to make an impact in the community”.

Speaking on community acceptance and mobilization strategy for the outreach, Adawiya said, the partners leveraged on its Community Health Extension Workers (CHEW) to discuss the impact of the intervention  with traditional leaders and community influencers. 

Community Feedback

Zainab Abdullahi is  a resident of Kasuwan Dare area of Gyadi-Gyadi community of Kano state. She heard of the REACH Clinic Outreach through community influencers. “Now they checked our BP,Blood sugar level and from here we will proceed to see the doctor”, she said. 

Zainab lauded the outreach initiative saying the community is receptive to ideas like this. “the hospital environment is clean and welcoming and this is why you can see close to 100 people coming for this outreach”.  “If they can spread their tentacles and establish  this kind of hospital in all areas, we will be happy so that everyone will visit the nearest hospital rather than going far from home to access healthcare”, she said.  There is also a need to have additional doctors to attend to a growing number of patients in a bid to reduce waiting time, she said.

Ahmed Salisu Musa has spent 45 years in the community.  He expressed his excitement saying the outreach has brought good healthcare delivery to his doorstep. “They took my blood samples, gave me some medications and I was told, I am not diabetic”, he said

He said, “as a community leader myself, I am glad to  have witnessed what is happening and will pull  in more people to come and get checked.” Musa called for increased mobilization of citizens and more importantly expansion of the intervention to reach other communities.

Nasarawa SPHCDB set to Sustain Vaccination Progress with User-Friendly EMID Mobile App

by Moshood Isah

The race to  ensure accessibility to  COVID-19 Vaccine and  intensive campaigns to promote the uptake of the vaccines led to its routinization especially in developing countries.   To further ensure the successful implementation of its COVID-19 vaccine deployment plan and address existing challenges of data management, Nigeria developed the Electronic Management of Immunization Data (EMID) system in 2021. By the end of the year,  the National Primary Health Care Development Agency (NPHCDA) revealed that Nasarawa state, located in North Central part of Nigeria has again overtaken other states in the COVID-19 mass vaccination campaign in Nigeria.

However, recent experience has also revealed that manual data collection remains vulnerable to damage or manipulation. Digital solutions remain mostly more recommended as it enables more accurate data capturing and better storage process.  However, the potential challenges that could hamper the progress of development and utilization of digital solutions for management of immunization data are likely technical glitches and capacity limitations of health officials, especially in underserved communities. 

 To Address these challenges, eHealth Africa in partnership with National Primary Health Care Development Agency supported by GAVI developed an optimized version of the EMID mobile application, incorporating routine immunization to further standardize and harmonize data collection and storage. Thus, eHA successfully completed the training of healthcare personnel across the country, in the use of the EMID Native App.

Speaking during the training session for healthcare personnel and immunization recorders across over 300 Primary Health facilities in Nasarawa state, key stakeholders highlighted how the optimum utilization of the EMID application will sustain vaccination progress in the state.

LGA EMID Focal Persons in Nasarawa state after a Training of Trainers on optimised EMID application

Abubakar Alilu Awei, State Primary Healthcare Development Board, (SPHCDB) Immunization Officer (SIO) said the presence of EMID Focal persons at the LGAs ensuring that all recorders upload information of clients on the national server was indeed instrumental in the state progress during the COVID 19 vaccination.  He said, “You may recall that Nasarawa state emerged as the overall best performing state in Nigeria in terms of COVID-19 vaccination and also the best performing state in the North central zone. This may not be unconnected to the good use of our EMID application that we adopted during the COVID 19 vaccination.”

Awei further lauded the incorporation of routine immunization into the application saying, the training is timely as it  will enable the state to have  data on the server to enable adequate tracking of client information. He said, “with the optimized EMID app,  at a glance we can  check on the client that has been vaccinated with the first antigens. So when they come back to the health facilities for the next antigen it's just for the recorder at the health facility to go to the server and update the current antigens that they have received”. It reinforces the prospects for effective management of immunization data.

In a similar vein, Beatrice Samuel, NPHCDA, Zonal technical officer,  Nasarawa state said, “one of the things we really enjoyed is that we could see the accessibility, the user friendly and not much challenge”. While describing the optimization of the EMID app as a milestone for the agency and eHealth Africa, she called for its sustainability. 

“I  want to believe that the excitement we have now would not just go away. It should be something that will not give us challenges when we go to the field.  There should be a sustainable native app for us to enjoy more and more”.

Immunization Recorder in Doma LGA of Nasarawa State

In his words, Ahmed Ibrahim, EMID State Focal Person for Nasarawa State lauded eHealth Africa for leading the optimization of the application saying, “ our recorders at the health facility will now know the value and importance of keeping record”. He said the application guarantees the safety of data in its electronic form saying,  “even if the facility is burnt you can still go to the database and search for the record of any person”, he concluded. 

COP28: Spotlighting the Impact of Climate Change on Public Health - Atef Fawaz

Atef Fawaz, Executive Director, eHealth Africa

Less than a fortnight ago, the  World Health Organisation,  Director-General, Dr Tedros Adhanom Ghebreyesus warned that the impact of climate change may reverse the progress made in the fight against malaria. This according to him is due to “COVID-19-induced public health disruptions, humanitarian crises, drug and insecticide resistance, and global warming impacts”. As contained in the recently released World Malaria report, the changing climate poses a substantial risk to progress against malaria, particularly in vulnerable regions. This may just be another critical reason needed to lift the climate change/health nexus while ensuring effective mainstreaming of  health in the global climate change agenda.

There is no gainsaying that developing countries like Nigeria and others  must be on the alert to prepare for the potential impact of this new development necessitated by climate change. Despite the hysteria that greeted the reported number of Africa’s delegates (especially Nigeria) to the just concluded 28th United Nations Climate Change Conference otherwise referred to as  Conference of Parties (COP28), It is pertinent to reflect on the economic and human resources invested in the event to explore actual opportunities. 

The conference was no doubt a huge platform  where thought leaders and experts across the  world come together to chart pathways  to address the climate crisis, and proffer succor on how  vulnerable communities can adapt to the effects of climate change. This is in a bid to achieve the  overall goal of  net-zero emissions by 2050. With over 70,000 delegates expected to attend this important event every year; from business leaders, young people, climate scientists, Indigenous Peoples, journalists, and various other experts and stakeholders; the opportunities are boundless. 

With the 2023 Intergovernmental Panel on Climate Change report revealing that over 3.5billion people live in areas that are vulnerable to climate change, it's just a matter of time before nations feel the impact if there are no effective measures for early preparedness and response against climate change.  This may have contributed to the call for urgent action on climate change and health by  the Global Health Community.  This is also not a coincidence as similar calls were made before the 2022 Conference as the World Health Organisation reiterated the fact that,  climate crisis continues to make people sick and jeopardizes lives. This yet again buttressed the call to make healthcare delivery amidst climate change  a critical area of discussion during the conference.  Thus it was not surprising when the COP28 Presidency joined with the World Health Organization to announce a new ‘COP28 UAE Declaration on Climate and Health’ (the Declaration) to accelerate actions to protect people’s health from growing climate impacts.

Thus developing countries like Nigeria have a huge opportunity to build on their participation in the conference to explore ways to alleviate the grueling impact of climate change on healthcare delivery and policies.  One of the first signatory to the Declaration on Climate and Health, Malawian President Lazarus Chakwera revealed that  extreme and unfavorable weather events have consistently displaced citizens, causing the spread of infectious diseases that has led to the death of thousands in countries like Malawi. 

Nigeria specifically in recent times witnessed increased flood and rapid desertification. For instance, in the last 18 months, Nigeria experienced massive floods caused by global warming with huge economic and health implications like loss of lives, properties leading to chronic hunger and vulnerability to water-borne diseases.  Also, the potential threat to  livelihoods like agriculture and  fishing is no doubt cause for concern with potential challenges of food security which negatively impact health and nutrition.

While a handful of organizations are taking both intentional and unintentional steps to combat the impending impact of climate change, it is vital to galvanize important stakeholders  across all sectors to discuss their role in supporting the process.  A typical example of such steps is eHealth Africa's deployment of a modular solution that involves the design and implementation of renewable energy solutions for healthcare facilities, especially in low-resource settings. The  Renewable Energy for Public HealthCare (RE4PHC) solar system is designed to be deployed to health facilities with minimal access to power but at the same time reducing the emission of greenhouse gas from generating sets due to lack of electricity. 

However there is need for public and stakeholder sensitization and coordination on the potential impact of climate change in the African region especially in Nigeria. Organisations and government agencies like Nigerian Park service, Great Green Wall, ministries of Agriculture, Marine and Blue economy amongst other Non governmental organizations both within and outside the region must coordinate to ensure effective action against climate change.

This is in a bid to further explore the causes and impact of climate change within and around the African context while educating the people on activities that have consistently escalated the current risk. A basket fund can also be created to pull resources from the public and private sector, especially companies whose activities contribute to emission of greenhouse gasses and global warming with support from international thought leaders and experts in climate change interventions.

The idea of dissecting the nexus between climate change and health is to ensure that Low and Medium Income (LMIC) like Nigeria to advance its aspiration to meet up with acceptable global standards as regards critical actions that aides early preparedness and response. 

Atef Fawaz is the Executive Director of eHealth Africa. He is a Complex operations Management and ICT expert with experience in Humanitarian Response and Digital Health

eHealth Africa's Integration of Digital Solutions for Public Health Impact

By Favour Oriaku

eHealth Africa (eHA) has the strong belief that access to proper healthcare is a right, not just a privilege. Consequently, eHA continues to create innovative solutions that provide underserved communities in Nigeria with the tools to take charge of their health and well-being. Through their digital innovations, eHA is bridging the gap between technology and healthcare. Currently, the organization is improving their offering by merging their two main applications - LoMIS Deliver and  LoMIS Stock - into one, all-encompassing platform: LoMIS Suite. This platform will enhance the management and delivery of vaccines and other health supplies. By doing so, ensuring that essential healthcare services are consistently available. 

LoMIS Deliver alone has successfully delivered over 17 million vaccine doses and 16 million essential goods to their destinations, overcoming logistical challenges to keep healthcare running smoothly. At the same time, LoMIS Stock has provided healthcare workers with a more efficient way to report, offering real-time visibility of stock levels and streamlining the planning process through a mobile app.

The merging of these two applications by eHA, promises to be a powerful tool for improving existing health systems. It will help manage stock levels, track deliveries, and enhance decision-making processes with ease and precision. With these merged applications, every piece of data collected will contribute to better delivery schedules, improved stock availability, and, most importantly, ensuring that every member of the community has access to essential healthcare services. The integration of the LoMIS applications represents not just a technological advancement, but a ray of hope for a society in pursuit of a dependable and efficient healthcare system at the last mile.

Fatimah Howeidy, the project manager, shares her perspective, saying: "Every data point we collect represents real people, families, and their futures. By merging our LoMIS Deliver and LoMIS Stock applications, we're not only improving our technology but also ensuring that vaccines and health supplies are always available when and where they're needed most, and the process is managed using a more improved system."

This initiative is supported  by the Digital Health Innovation Accelerator Program (DHIAP), which was launched in 2021, and is powered by the WFP Innovation Accelerator and BMZ digilab – the innovation lab for digital solutions, initiated by the Federal Ministry for Economic Cooperation and Development (BMZ) in collaboration with GIZ, the German Development Bank KfW, and the Bill and Melinda Gates Foundation. eHA project has been selected as one of 5 finalists for the WFP Sprint Programme, and is supporting the implementation by providing  financial support, as well as access to mentorship, guidance, and a strong network of peers and stakeholders to inspire and share knowledge and best practices. 

Through initiatives like these, eHA is empowered to offer not just technological solutions; they are weaving a future where healthcare is consistent and accessible to all. This future includes mothers who wish to see their children thrive without vaccine-preventable diseases, healthcare workers who rely on dependable data and supply chains, and communities that rightfully deserve equitable healthcare. In the synergy of technology and health facilitated by eHA, each vaccine delivered represents a stride towards improved health outcomes. Every report submitted through the app strengthens the battle against vaccine preventable diseases. And each decision made with precise, real-time data paves the way for equal healthcare accessible to all.

Fatimah encapsulates eHA's spirit by saying, "Our solutions, especially when combined into the LoMIS Suite platform, are more than just applications. They are our commitment, represented in data, ensuring that every child and every family in our communities has reliable healthcare."

In this intricately woven digital solution created by eHA, technology and health are seamlessly interconnected, ensuring that each individual and every community can consistently count on fair and reliable healthcare. It's not just a project; it is a commitment to accessible healthcare through the power of technology and unwavering dedication of our healthcare professionals.

ehealth Africa Commits to promoting early detection of Vaccine Derived Polio Virus through Lab Support

by Moshood Isah

Nigeria may have been declared a polio free nation but the Variant Poliovirus Type 2 strain transmission still lingers. Nigeria reported 168 cases in 2022. This  has made further interventions crucial particularly  around early detection. The growing cases in a  number of African countries require a focused effort to strengthen polio laboratories that can effectively help the affected countries to quickly confirm cVDPV2 cases and launch outbreak responses, including the introduction of novel OPV2.  

In 2018, the World Health Organisation (WHO) introduced a Global Polio Surveillance Action Plan (GPSAP 2018-2020) to support endemic, outbreak, and high-risk countries in evaluating and increasing the sensitivity of their surveillance systems against Polio. The plan also initiated supplemental strategies that may help in closing gaps in detecting polioviruses, including strategies for immunodeficiency-associated vaccine-derived polioviruses (iVDPVs) while also strengthening coordination across surveillance field teams to foster a more effective programme and document zero cases worldwide. 

The new Global Polio Surveillance Action Plan (GPSAP) for 2022-2024. also focuses on increasing the speed of poliovirus detection, improving surveillance quality at the subnational level, fostering the integration of polio surveillance with surveillance for other epidemic-prone vaccine preventable diseases (VPDs), and mainstreaming gender equality in surveillance activities and programming as a key enabling factor.

To achieve parts of the Global Polio Surveillance Action Plan (GPSAP) 2022-2024, ehealth Africa worked with World Health Organisation (WHO)  supported by the Bill and Melinda Gates Foundation (BMGF) to  renovate and upgrade the   Sequencing Laboratory in the Virology department, University College Hospital (UCH) Ibadan, Oyo State. The laboratory was commissioned by Kazadi Walter, Country Representative and Head of Mission; World Health Organisation to Nigeria. This is part of the effort to improve surveillance, rapid detection and response against the spread of Vaccine Derived Polio Virus and other vaccine preventable diseases.  

Speaking during the official commissioning of the Laboratory, Dr. Kazadi Walter reiterated the commitment of WHO towards eradicating polio virus through the provision of facilities and rendering of technical support to Nigeria’s health care. He stated that WHO in collaboration with the government established the Global Polio Laboratory Network of which 16 are currently in Africa, with two located in Nigeria; Ibadan and Maiduguri. According to Walter, the primary objective is to work with WHO in the African Region (AFRO) to equip the global polio laboratory network labs for robust and rapid sample analysis for polio and to provide support in equipping these labs with sequencing capabilities.

Prof. Kayode Adebowale, the university vice chancellor, commended the initiative saying “this laboratory will not only provide vital information for the eradication of polio but also contribute to our university infrastructure, helping us to fulfill our vision and mission in addressing social needs.” The VC said: “The department has played a crucial role in Nigeria’s polio eradication programmes by contributing significantly to the country’s achievements of being declared wild polio-free in 2021.

Speaking on the role of eHealth Africa in the support for Laboratory Supplies across selected countries in Africa, the Project Manager, Tolulope Oginni said, to ensure optimum utility of the laboratory supplies, eHealth Africa leverages previous and current experience in setting up and managing Emergency Operation Centers to strengthen the staff capacity at the Laboratories in operating the installed equipment.

“These interventions  for  the support for laboratory supply and installation with consumables currently ongoing in at least 12 African countries are expected to improve the labs functionality for faster outbreak detection”, he said. With the support of other stakeholders in the region, this intervention will support labs in the African region that are targeted for expansion of sequencing capacity, support to improve existing sequencing capacity, or labs that require support for virus isolation and identification. This intervention has a huge opportunity to explore collaboration with WHO and other global stakeholders to transform the laboratory infrastructure in Africa into world class facilities which in turn will significantly strengthen their capacity and preparedness for disease outbreaks.

Strengthening Blood Management Systems with Digital Tools

By Emmanuel Uko

Every month, eHealth Africa (eHA) convenes stakeholders and subject-matter experts on a fresh episode of the Insights Webinar for topical discussions, solutions and recommendations that improve public health and contribute to the attainment of SDG goal 3: good health and wellbeing for all. The aim is to share lessons learned across different areas of project implementation and to offer recommendations.

The 8th edition of the Insights webinar was focused on how digital tools can strengthen blood management systems. Alluding to the topic, one of the panelists, Dr. Mohammed Farouk (MD, MBA), Managing Director of the Africa Society for Blood Transfusion (AfSBT), said “Incorporation of technology and data-driven solutions makes the blood management value chain more seamless. Recruitment of donors is done with online questionnaires, after which the donor institution determines eligibility of the donor, then invites them to the donation center.” This process saves time and resources as donors are only invited on appointment, based on schedule.

Still on eligibility, Michelle Vermeulen, Head of Marketing & Public Relations at Western Cape Blood Services in South Africa outlines the criteria: “In order to be an eligible donor, criteria differ from country to country. However, generally, one must be between the ages of 16 and 75, weigh more than 50 kg, be healthy on the day of donation, without flu or symptoms of cold, and be leading a healthy sexual lifestyle.”

In addition, Emmanuel Nene Dei, Head of Planning, Monitoring and Evaluation at the National Blood Service, Ghana, further stated that “An eligibility quiz for prospective donors helps to shorten the recruitment process. Those not eligible are, with their consent, linked up with other healthcare facilities for quality healthcare, as necessary.” Francis Ayo, Technical Project Manager in the Informatics Department at eHealth Africa, added that “Integration of data-driven technology creates visibility, accountability and transparency, leading to appropriate decisions about quantity and types of blood products required at specific health facilities, while third-party logistics systems carry out the distribution and ensure supplies where needed.”

The webinar had 160 online participants from Canada, Ethiopia, Germany, Ghana, Guinea, Nigeria, Rwanda and Sierra Leone; and eHA’s live LinkedIn audience (eHealth Africa), had 1,441 viewers at the time of the webinar. eHA’s Strategic Engagement Lead / Senior Manager, in Berlin, Germany, Johanna Roegele, who has worked on the management of the blood supply chain observed that eHA and partners have modelled a system to ensure continual availability of blood products. She recommended that such models be replicated especially in other African countries.

From their vast experience, the panelists shared other lessons for effective blood supply chain management: donors prefer to be contacted with personalized messages (SMS, Whatsapp and emails) rather than general messages sent to everyone. Personalized messages enhance the likelihood of recurrent donations, especially for first-time donors. More so, social media and traditional media help create visibility for institutions and to attract donors. Digital interoperability between digital blood management information systems and testing machines reduces human error, speeds up testing time, increases accuracy, eliminates waste and averts silo functioning. In addition, drone-based delivery to hard-to-reach areas, saves more lives especially in emergencies.

Human-centered project design approach should be applied, taking into consideration inputs and needs of stakeholders and potential beneficiaries. In the data management process, privacy of clients is paramount while keeping appropriate databases updated for tracking and monitoring of trends in blood services.

eHA’s monthly Insights webinar is an opportunity to learn more about how experts are resolving public health issues with the use of digital technology and data-driven solutions, sharing both the solutions and the lessons in creating them for replication.

Help Desk - Optimizing Real-time Response Structure for Digital tools

By Emmanuel Uko

In 2022, eHealth Africa conducted a gap analysis to identify support areas for the Electronic Management of Immunization Data (EMID) system IT infrastructure. The analysis  revealed the weaknesses and strengths of the current issue resolution approaches and the requirements for improving the current system. The help desk operations was identified  to ensure the smooth utilization of the EMID system and increased vaccination coverage data in Nigeria.

Physical and infrastructural constraints were identified: the help desk occupied an open space that was easily accessible, the server room was unrestricted and thus used for other purposes, too. Basic work tools for call agents, like  headsets, and  laptops were either not available or obsolete.

Helpdesk setup at NHPCDA, before and after the optimization.
Photo Credit: eHA

Similarly, operational challenges also existed: downtimes, issues and resolutions were communicated to the leads only through Whatsapp. In addition, a web-based system where users could access resources and information to resolve issues was lacking. More so, information history showing trend of cases and projections was non-existent. There was no existing standard operating procedure for the help desk to guide the team on how to handle issues, especially during off-peak hours. Finally, the support process flow was not fully defined/documented. Thus, the optimization of the help desk support was needed.

“I learnt how to use the native EMID application, as it is more user-friendly than the old one. Specifically, the ability to contact help desk and lodge complaints almost in realtime, whenever issues need to be resolved, is a real advantage that will speed up our work.”
- Ojetade Victoria Oyebimpe, EMID Focal Person, Ede South LGA, Osun State.

eHealth Africa (eHA) software development and help desk teams worked to develop a real-time response structure that caters to users’ needs within the optimized EMID application. As is the universal practice, the structure provides a centralized help to users of the application. The improved EMID help desk at the National Primary Health Care Development Agency (NPHCDA) ensures availability of personnel at every level of troubleshooting, to resolve issues down to zero for both the NPHCDA staff and end users of the EMID app.

Solomon Emmanuel, eHA’s Manager, Helpdesk, anchors training for NPHCDA helpdesk agents.
Photo Credit: eHA

With support from the Global Alliance for Vaccines and Immunization (GAVI), eHealth Africa procured the required IT equipment and facilities for renewable energy to ensure uninterrupted power supply to the IT server rooms, secured furniture and fittings; planned and implemented the setup in collaboration with the NPHCDA. In addition, eHA organized training sessions for the ICT unit at the agency on standard help desk processes and procedures based on the Information Technology Infrastructure Library (ITIL) methodology. They defined, developed and documented standard operating procedures for help desk, operational-level and service-level agreements to guide process flow, from issues escalated by recorders to their resolution stage.

“The native EMID app now helps us determine who, how and where to send complaints to, unlike the old one.”
- Akinyemi Yemi, EMID Focal Person

Jamil Galadanchi, eHA’S Senior Manager, Software Engineering, during a training for NPHCDA, on use of the EMID software.
Photo Credit: eHA

eHA also provided suitable work areas to prevent noise penetration and work tools such as desktops and laptops, display screens with a display/monitor to enable the helpdesk operator to manage multiple screens. This allows for a quick review of the several platforms that may be needed to resolve an issue, or for real time monitoring of the key equipment needed to ensure the EMID system works adequately with limited downtime. eHA also set up the Zendesk application to issue ticket IDs and track issue resolution, an access control system for the help desk main entrance, IT office door leading to the server room, and the server room itself to prevent unnecessary access. Lastly, a solar energy system was also set up at the NPHCDA to power the facilities and ensure a 24-hour electricity supply.

“In addition to its capacity to validate clients’ records in real time, it is now easy to ask questions and access the help desk for support.”
- Egunsola Ayobami Abiodun, EMID Focal Person, Isale-Agbara PHC, Osogbo, Osun State

As a result of the optimization, the help desk can respond to different levels of issues raised. The diagrams below portray mapped help desk support flows according to Tiers 1, 2 and 3 support required. They depict the help desk process flow, from the EMID users, the channels for registering queries, the different levels of helpdesk support system, and the process of resolving issues, the operational phases of response to queries from the end users and the processes involved in using the Interactive Voice Response flow in reporting and resolving EMID issues.

Helpdesk support for pilot training and user assessment test
Image: eHA

Helpdesk support for pilot training and user assessment test
Image: eHA

In addition, below is the Interactive Voice Response (IVR) support flow:

Interactive voice response support flow
Image: eHA

The process of developing the EMID application got all stakeholders working together, each one fulfilling relevant roles for the optimization of the application and realization of the help desk setup. eHA and partners learned important lessons in the course of executing the project. Buy-in and collaboration by relevant stakeholders from the beginning of the project proved necessary for its successful implementation. Setting out deliberate strategies that enable all partners to be carried along especially during important planning and decision making processes, budgeting and procurement, contributed to attaining success. More so, aligning the scope of work with appropriate timelines helped partners to manage the project for successful delivery.

“The new desktop for helpdesk now helps in resolving issues quicker, the monitors and screens help to give a clearer view of the issues presented and there is now a better working environment that enables us to resolve issues more promptly.”
- Nabil Nuhu Bamalli, System Administrator at NPHCDA.

Working as a Recorder is Easier with the Optimized EMID Application

By Farid Suleiman

Opening interface of the EMID Mobile Application

The Electronic Management of Immunization Data (EMID) is Nigeria's homegrown digital platform for the collection, storing, and analysis of covid-19 immunization data. It is domiciled at the National Primary Health Care Development Agency (NPHCDA).

The first version of the app was rolled out by the Nigerian Minister of Health in 2021, as a platform to ensure a smooth COVID-19 vaccination process across the country.

With the rise in the number of unvaccinated adults and unimmunized children in Nigeria, NPHCDA saw the need to scale up the EMID application beyond its regular use for COVID-19 vaccination data to capture and store information on other immunization activities. However, the capacity of the application was below its intended use, with multiple functionality errors, hence the need for an optimized version of the app.

eHealth Africa (eHA), partnered with NPHCDA, to optimize the app for newly defined and broadened functions. They further piloted its use in selected states towards its deployment for use. 
The mobile application provides a gateway for inputting immunization data. This enables the end-user-recorders to work hand in hand with vaccinators across the country to upload data in real-time to the platform. This data enables stakeholders to analyze and monitor the progress of vaccination teams on the field, and where necessary, come up with better strategies to enhance the effectiveness of the immunization program.

Tasiu shehu Jigawa State EMID focal person

Photo Credit: eHA

Abdullahi Muhammad, like other recorders, was quick to spot the changes the new app had come with. He observed: “a lot of features have been simplified on the new EMID application. The data input process and its submission to the server have all been simplified, this will make the work easier.”

Globally, digital tools such as EMID help keep track of information about people vaccinated, types of vaccines they received, doses, location, and other relevant data key to the success of vaccination campaigns. As of January 2023, three years after the commencement of covid-19 vaccination, over 60 million eligible Nigerians have received the vaccine. It is safe to say that Nigeria's immunization strategy, of which EMID is a part, has been successful. The optimization of the EMID app adds value to the overall success, especially on the EMID application’s ease of use, optimized process flow, help desk setup, and renewable power supply.

The optimized EMID application has integrated a client validation tool used to take pictures of the client to validate their presence at the vaccination site. Other validation features such as the geofencing feature ensure that data is only collected by fixed teams when they are within the geographical location assigned for their data entry to be registered on the app, eliminating the possibility of procuring services and the new liveness detection feature which ensures that beyond the still photos of clients, facial feature movements such as blinking are required for verification of client vaccination. This eliminates the possibility of utilizing pictures/static images for data entry. The national team can now have a higher level of confidence in the vaccination data generated using the tool.

The new application also allows recorders to capture data in environments where network connectivity is at its lowest. The specific additional feature is a draft page that prevents the loss of incomplete data. Recorders no longer need to resort to manual synchronization of data when there is internet connectivity as the new application allows automatic data synchronization once internet connectivity is restored. The sort and filter functionality has also been included to allow for ease in identifying previous records via the new native EMID mobile application. Rilwanu Dahiru, another EMID Recorder, describes the use of QR codes for client search as making their work even easier. He says, “if I have the QR code of a client, I search directly for the record without inputting the vaccination number or name.”

Overall, the level of flexibility on the optimized app now allows vaccinators to record and validate client details themselves without having a different validator assigned to them while on duty.

The troubleshooting feature-the FAQs and Help center provides easy access to support questions or challenges that arise while using the application. The help center also has links to the various channels that allow for direct communication with the EMID helpdesk support office.

Optimizing the National Electronic Management of Immunization (EMID) Data Tool for Improved Efficiency

By Emmanuel Uko

The Electronic Management of Immunization Data (EMID) system was designed to facilitate the overall management of immunization data and other programs at Primary Healthcare Centers (PHCs) including vaccination scheduling, real-time entry of clients’ data, and collation, analysis, and validation of such data.

The health sector depends heavily on data for planning. To ascertain how well a country’s immunization plans and implementation are going, adequate information is necessary. The World Health Organization states that immunization data helps to monitor improvements in vaccination trends and identify gaps for its surveillance processes. More so, there is a consensus among vaccination stakeholders that real-time data reporting has allowed decision-makers to follow-up on the unvaccinated and forecast needs for supplies.

Coordinator, Business Application Support at eHA, Diligence Saviour-Albert (left) is confident that users of the native EMID app will use it optimally as she trains them on its different components.
Photo credit: eHA

Since March 2022, eHealth Africa (eHA), has supported the National Primary Healthcare Development Agency (NPHCDA) in Nigeria to optimize the functionality of the Electronic Management of Immunization Data (EMID) System. This optimization is funded by Global Alliance for Vaccines and Immunization (GAVI). They identified the need to fill up the vaccination data gap, after seeing  lapses in the primary data capture tool - the EMID application. Users of the unoptimized app expected more than it was offering. Dr Oyetunde Olasunboye, the Osun State EMID Focal Person said, “the functionality of the system declined noticeably and would sometimes become difficult to input client’s information, search for, or confirm clients’ details. More so, it became increasingly difficult to scan a client’s quick response (QR) code, although this was mostly dependent on the device at the user’s disposal.” These errors adversely affected the application’s functionality.

These inadequacies gave rise to the need for optimization of the EMID application to enable it function at its best for end users at health facilities. “We developed a roadmap for an optimized application that would be scalable country-wide. We built and deployed the optimized application, we conducted training and capacity-building activities for NPHCDA EMID team at national and state levels, and recorders at the PHCs, in preparation to hand over the optimized system to the agency”. Said Stephanie Okpere, eHA’s EMID Project Manager.

Similarly, Kasim Sani, a Network support staff at NPHCDA ICT Unit, said this about the optimized helpdesk: “The new setup has made our work more responsive to clients’ needs. We are able to detect and resolve issues more promptly and applications can now be deployed on the server seamlessly.”

In preparation for the deployment of the optimized app, eHA trained 351 users including recorders, EMID focal persons at State and Local Government levels, and piloted its use across selected states within the six geopolitical zones of Nigeria. From each of the states, eHA selected one rural Local Govermment Area (LGA), one urban LGA and one LGA with poor internet connectivity.

Health Information Recorder, Ife South LGA in Osun State, Tope Oluwatoyin (right), displays a native (optimized) EMID application from his tablet, hopeful that the application would resolve challenges he used to encounter with the old EMID app. 
Photo Credit: eHA

In collaboration with the ICT Unit at NPHCDA, eHA also trained users on help desk use and structure for issue resolution, support process flow, roles and responsibilities of the support tiers, and the use of support channels like email, Whatsapp and phone lines.  Specifically, the training focused on how to download and log into the application, how to conduct online and offline mode check, searching, filtering and updating of records, manual syncing, import and export of records. Participants were also shown how to navigate to the help section and the frequently asked questions (FAQs) on the native application. The optimized application ensures seamless management of vaccination data at national and subnational levels.

In Nigeria, eHealth Africa Optimizes Systems for Seamless Vaccination Data Collection and Retrieval

By Emmanuel Uko

Building and optimizing software applications to improve public health outcomes is at the core of  eHealth Africa’s work. With the Electronic Management of Immunization Data (EMID) application, the organization went beyond optimizing the app to redesigning a new process flow for vaccination data capture. The redesign of an optimized process flow was necessary as research shows that inadequate health data is a challenge in Nigeria due to unintentional duplication, lack of synchronization and dearth of data storage systems.

The quality of data collection tools and the uncoordinated nature of the collection process compounded the data challenges, thus the need for a redesigned data collection process flow. eHA’s Technical Project Manager, Software Engineering, Dayo Akinleye said, “The redesigned process flow was necessary because the new process eliminates the possibility of duplicate records for offline users; utilizes the current quick response (QR) code for easy identification and seamless operation; and eliminates redundant information generated on the Public Registration portal (PubReg). The old process flow used the KoboCollect platform, so it did not have these capabilities. It was also unable to synchronize with the District Health Information Software (DHIS2).”

Former process flow with the old EMID application
Image: eHA

New process flow with the native (optimized) EMID application
Image: eHA

Both process flows allow users to register via the PubReg portal and receive registration ID before visiting the vaccination center to receive the vaccine. At the vaccination site, both processes allow for manual registration of clients into the EMID physical register, and receive a vaccination card with QR code.

eHA’s EMID Project Manager, Stephanie Okpere (right), during a Strategy Group meeting at NPHCDA Headquarters, Abuja.
Photo Credit: eHA

Tope Falodun,  eHA’s Associate Project Manager on the EMID project, affirmed that “the new process departs from the old as it allows for instant validation of clients once registered. Upon successful validation, the optimized EMID system generates a vaccination ID for clients that register at the physical site. For those who register via PubReg, their registration ID is replaced with the vaccination ID, eliminating duplicates, unlike the old system. The new vaccination ID is generated from the QR code for both online and offline clients to avoid duplicate registration. If the registration on the optimized (native) app is unsuccessful, the error message redirects the user to the specific item that needs to be updated or corrected. After correcting the error message the recorder saves the information to complete the registration and validation process.”

EMID Recorder for Isale-Agbara PHC, Egunsola Ayobami (middle), at the pre-deployment training of the native (optimized) EMID application in Osogbo, Osun State
Photo Credit: eHA

End users have found the new process flow more responsive than the old one, and better fit for purpose. As the EMID Recorder at Isale-Agbara Primary Healthcare Centre in Osogbo, Osun State, Egunsola Ayobami, confirmed, “one of the important variations from the old system is the ability to validate a client instantly, making the work easier and faster. It is also easier to use. When in doubt, I now know how to contact helpdesk, and their responses are instant,” he concluded.

Deployment of the native EMID application across Nigeria, with its optimized process flow, guarantees seamless data capture, storage and real-time retrieval. 

eHA’s areas of  expertise are data management, project logistics, infrastructure and ICT services, working in the following focus areas: health delivery, public health emergency management, disease surveillance, laboratory and diagnostics, and nutrition and food security.

Equipping Laboratories for Stronger health systems

By Emmanuel Uko

The journey of supporting and augmenting laboratories in Africa has only started, and evidently, the gap is huge. At the WHO Polio lab in Maiduguri, Borno State, eHA identified cases of damaged, obsolete and inadequate equipment and swung in to supply the needs with support from the World Health Organization (WHO).

As we walked into the office of Professor Marycelin Baba, the Director of the Laboratory, Professor of Medical Virology and lecturer with the University of Maiduguri, we could tell how busy the facility had become on a daily basis. Samples from patients were brought in  on a queue for processing. “Our work here is becoming satisfying”, Prof told us expressively, “especially with partnership from the World Health Organization (WHO) and eHealth Africa (eHA). They have provided various major equipment that enable the center to remain functional”, she said, her passion unwavering for 32 years in the profession.

The lab in Maiduguri, was set up by  Global Polio Laboratory Network (GPLN), to distinguish poliovirus as a cause of acute flaccid paralysis (AFP) from AFP caused by other diseases. It serves the northern part of Nigeria while the one earlier established in Ibadan, Oyo State, serves the southern part of the country. 

Prof. Marycelin Mandu Baba, Director, WHO Polio Laboratory in Maiduguri, is happy to have participated in the polio eradication process in Nigeria.

Photo Credit: eHA

The WHO Polio Laboratory in Maiduguri, like many other labs in developing countries, often  grapples with acute shortage of equipment, reagents, machines, power supply and human resource, which affect its productivity. Research has shown that the number of optimally functional laboratories accredited to international standards were 380, as of 2014; 91% of these were in South Africa. This means that 12 out of 49 countries in the region had one or more laboratories accredited to international quality standards; 37 had none. However, the Global Polio Laboratory Network consists of 146 WHO-accredited polio laboratories, in 92 countries, across the six WHO regions of the world.

Nigeria has 2 of those 146 WHO-accredited polio laboratories. eHA currently provides support to 7 laboratories: 2 in Nigeria, one each in Uganda, Kenya, Ethiopia, Egypt and the Democratic Republic of Congo. The organization is strategizing to commence support to laboratories in Cameroon, Côte d'Ivoire, Ghana, South Africa, Senegal and Central African Republic. This support will improve laboratory and diagnostic services for Africa’s teeming population. “We continue to carry out needs audits and take steps to offer solutions where we identify gaps,”  said eHealth Africa’s Project Manager, Tolulope Oginni. eHA has supported the lab with digitized biosafety cabinets for tissue culture, a Polymerase Chain Reaction (PCR) Workstation, a PCR thermomixer, multi-channel and single-channel pipettes of varied volumes for serology.

Dr Muhammad Talle of the WHO Polio Laboratory in Maiduguri showcases how the new PCR thermomixer donated by eHA works.

Photo Credit: eHA

Dr. Muhammad Talle remains hopeful that the lab will continue to deliver appropriate services according to approved standards.

Photo Credit: eHA

“eHA has brought us relief”, said the Assistant Director for Lab Technical Operations, Dr Bamidele Oderinde, who came in later to the conversation. “The new machines help to reduce technical problems and the functionality complaints we have. We have upgraded our operations, research capabilities and training standards for our students”.

Professor Baba remains keen on contributing her quota towards the eradication of viral diseases, through differential diagnosis of acute flaccid paralysis. According to her, the newly equipped lab benefits people beyond Borno State and extends to other parts of Nigeria. Supporting this lab and other laboratories is part of eHA’s service areas, to build and operate effective laboratories in-country across the globe, and develop the tools and technology needed for effective dissemination and use of public health-related information.

The Director, Prof. Marycelin Baba (3rd right), with eHA delegates and other staff of the laboratory, during eHA’s visit to the lab.

Photo Credit: eHA

Renewable Energy for Improved Healthcare Delivery in Nigeria

By Juliana Okoro

Access to energy is a prerequisite for quality health care and it is fundamental to the achievement of universal health care coverage and the Sustainable Development Goals. Yet, about one in four health facilities in Sub-Saharan Africa lack access to electricity, and three in four facilities lack reliable power. The lack of sufficient and reliable power is jeopardizing the well-being of hundreds of millions of people, especially women and children, who often bear the brunt of inadequate primary healthcare services. According to Dr Julie Yemi-Jonathan. O, Country Manager, We Care Solar, “without a reliable source of electricity, nighttime deliveries are most of the time, attended in near darkness, cancelled or conducted by flashlight, and the outcomes are often tragic.”

Off-grid renewable energy solutions present a key opportunity to provide clean, reliable and cost-effective electricity to rural health centers, which can dramatically transform the quality of healthcare services provided to rural communities.

Harnessing the enormous potential of renewable energy to improve energy access for primary healthcare facilities requires combined action from the health and energy sectors. To this end, the Nigeria Energy Conference, which took place between 20 - 22 September 2022, brought together key energy and health sector stakeholders, including policy-makers, practitioners, financial institutions, development partners, and NGOs that can play a role in enhancing electricity access for primary healthcare facilities.

During a panel session at the conference, eHealth Africa facilitated a discussion about sustainable energy for improved healthcare delivery in Nigeria. The panelists discussed what needs to be done to ensure that Primary Health Centers (PHCs) have access to energy for better health outcomes. Acknowledging the challenges most PHCs face, the panelists elaborated more on how the lack of electricity in primary health centres has led to more medical emergencies and increased mortality rates.

The panel discussion sparked the much-needed, cross-sector thinking around how to deliver energy to health facilities, especially in resource-constrained environments. A resounding takeaway was that distributed solar power and energy-efficient devices hold great potential for creating stronger and more resilient health systems in Africa and beyond.

We Care Solar's deployment of solar suitcases to Primary healthcare centers has had a tremendous impact on reducing child mortality and maternal mortality rates. According to the company’s representative on the panel, “a lot of our health facilities do not have access to a reliable power supply. We have seen cases where surgeries are turned down because of a lack of power. Sometimes surgical operations are suddenly interrupted, leading to the death of the patient, due to power failure”. This she said, “prompted We Care Solar to develop the Solar Suitcase”. 

Another speaker, Mohammed Bello, a project manager at eHealth Africa, identified solar energy as the reliable solution to these challenges. He highlighted some projects implemented by eHealth Africa with support from partners and stakeholders to ensure health facilities across the country have access to a reliable power supply. According to him, eHealth Africa is working with the Nigerian Energy sector and Integration Consulting firm, which are critical players on issues concerning energy.

The panel speakers and moderator after the session hosted by eHealth Africa at the Nigeria Energy Conference 2022

Key lessons from the panel session hosted by eHealth Africa at the Nigeria Energy Conference 2022:

• There is a dire need to increase renewable energy access in primary health centres, especially those in remote areas.

• The use of solar panels as an alternative source of electricity in primary health centers will help mitigate the energy challenges faced by primary health centers.

• Health facilities should be a top priority in electrification plans for both national governments and development partners. Off-grid renewables offer rapidly deployable, reliable, cost-effective solutions.

• In order to address the energy access needs of healthcare facilities, the energy and health sectors must work together. This should happen at all levels, from strategy and planning to policies, budgeting, procurement and implementation.

• Innovation has to be encouraged and promoted, as in the case of the solar-powered suitcases by We Care Solar. Also, in the design of robust, low maintenance, efficient, user-friendly medical devices suited for remote off-grid areas.

• Energy-efficient medical devices, combined with off-grid renewable energy and telecommunications, can expand the services offered by primary health centres in under-served communities. This also reduces the need for patients to travel to larger, more distant facilities.

• There are funding opportunities from donors as long as the organization involved can provide evidence of work done in this field.

How eHealth Africa is implementing the Geolocation Health Facilities Database Initiative (GHFDi) Project in the Republic of Togo

By Friday Daniel, Chinedu Anarado and Munachi Okoro

The public health space has relied on platforms from multilateral agencies and nonprofits to plan interventions. Platforms such as the Humanitarian OpenStreetMap, the WHO Integrated Supportive Supervision (ISS), and electronic surveillance (e-SURV) database, GRID3, and the Global Health mapping platforms were some of the only sources of information on health facility data. But these data sources can be inadequate, rarely reflect the realities on the ground and do not have the imprimatur of relevant government authorities. Equally, Ministries of Health in most WHO countries lack the capacity to curate and manage their health facility data, leaving a critical information gap in the health planning process. 

The WHO conceived the Geolocated Health Facility Data initiative (GHFDi) project as a public good to enhance access to information on the status, location and functionality of health facilities across participating WHO member countries. The overall idea is to deepen capacities in each country to manage this data, ensure its openness and availability in planning public health interventions. 

The GHFD project requires participating countries to grow their capacity to curate and manage their health facility data. But first, an assessment of the existing health facility list or registry is essential. This is expected to provide insight into the efforts required to achieve an ideal scenario which is a database of health facility information, with name, location, unique identifier, geographic coordinates and hosted in an open source platform. Countries may then choose to share this information with a global database managed by the WHO, and then invest in an ongoing process to grow their capacity to ensure the information is updated periodically. 

eHealth Africa is one of the implementing partners of the AFRO region responsible for implementing this project in the Republic of Togo. On the 9th of August 2022, an introductory meeting was held at the headquarters of the Ministry of Health in Togo. This meeting was organized by eHealth Africa in partnership with the Ministry of Health and the WHO country office. 

It brought together various stakeholders responsible for establishing and updating the health facilities database in Togo, including the Ministry of Health (MSPAUS), the National Institute of Statistics and Studies and Demographics (INSEED), as well as the delegate ministry in charge of Territorial Development.

Landscape assessment and data collection session during the workshop in Togo

With an introduction by Dr. Ouedraogo Romain Hilaire, health systems coordinator at the WHO country office, Mr. Compaore Fabris, eHealth Africa representative in Togo and Chinedu Anarado, program manager, eHealth Africa, discussed with the participants on how GHFD seeks to strengthen the capacities of the Ministry of Health to guarantee the availability, quality, accessibility and use of a health facilities master list (HFML) in countries. 

This capacity building should enable the Republic of Togo to have a standardized database open to the public. Participants discussed the seven strategic pathways through which the GHFD initiative will strengthen the Ministry of Health, including governance and policies, partnerships and collaboration, technical capacities, innovation, financial sustainability, communication and advocacy, interoperability, and data management.This introductory meeting led to the conclusion and agreement to hold a participatory landscape analysis workshop on August 30th and September 2nd.

At the end of this workshop, it was discovered that Togo has a unit in charge of the health services mapping, who oversees the health facilities master list (HFML). The Ministry of Health in Togo appreciates the initiative and sees it as an opportunity to strengthen the government's efforts to ensure universal access to care.

Group photograph of the workshop participants

eHealth Africa has since implemented a landscape assessment and is currently developing a report and cost work plan that will itemize the efforts required to bring Togo to the ideal scenario. 

To learn more about the GHFD initiative: https://www.who.int/data/GIS/GHFD 

How a Global Health Facility Database can improve the timely delivery of health services

By Chinedu Anarado

The COVID-19 pandemic amplified gaps in global capacity to respond to public health events of such dimension and scale. The world was slow to respond, and when it did, wealth inequalities ensured that some countries had access to life-saving support before others. Poorer countries largely bore the burden of COVID-19 as they grappled with huge infrastructure gaps while trying to ensure their people were safe from COVID-19. At the same time, global health strategists did not have access to the information they needed to deploy appropriate interventions to support developing countries. 

Bamali Nuhu Hospital, Kano Municipal, Kano, Nigeria

The impact of this scenario was predictable. Vulnerable populations were more affected, while those living far from health facilities required more effort to get vaccinated. In Africa, the average readiness rate for vaccine rollout was 40 percent. These issues highlighted the pressing need for improved data that can provide relevant insights into the location of health infrastructures and the distribution of healthcare services. The world needed definitive answers to a straightforward question: where are the health facilities?

Quality data about the location and status of health infrastructures at the local, national and international levels could have improved global efforts to contain COVID-19. With reliable information on health facilities, Governments can improve their vaccine logistics, distribute personal protective equipment (PPE), and expedite vaccine and therapeutics rollout. It became evident that if we want to rapidly reach the needed populations with the necessary support, we must understand their accessibility to health facilities. 

In December of 2021, the World Health Organization (WHO) launched a global campaign to improve access and visibility of health facilities among member states. This global initiative is being implemented across WHO regional offices in Africa (AFRO), South East Asia (SEARO), Eastern Mediterranean (EMRO), and the Western Pacific (WPRO) regions. The goal is to help countries collate and validate their health facility master list and contribute this information to a global database of health facilities. 

“In this age of information, member states need updated database tools to reach the World Health Organization’s triple billion targets for healthier populations, universal health coverage (UHC), and health emergencies protection.”

— Steve Macfeely, Director, Data and Analytics ,World Health Organization

Republic of Tanzania’s Health Facility Registry

We can achieve these challenging targets with robust and authoritative data collection, integrated into a collaborative system that allows citizens and municipalities to identify the locations and services provided by health facilities in their vicinity.

This Global Health Facilities Database (GHFD) will serve as a central repository, providing information such as the health facility’s name, location, and type while assigning a unique identifier to each. In addition to improving aspects of primary care, this data can improve response time, identify gaps in quality, and support advanced health emergency efforts, such as the COVID-19 response.

The public health space has relied on platforms from multilateral agencies and nonprofits to plan interventions. Platforms such as the Humanitarian OpenStreetMap, the WHO ISS, and e-SURV database, GRID3, and the Global Health sites mapping project were some of the only sources of information on health facility data. But these data sources can be inadequate and often do not reflect the realities on the ground. Hence, the WHO has conceived the Global Health Facility Database (GHFD) project as a public good to enhance information access on the location and status of health facilities across all WHO member countries. 

The GHFD project will require participating countries to update their health facility data, participate in an assessment of the existing health facility list or registry, sign an MoU with WHO to share that information with a global database managed by the WHO GIS office, and receive capacity support to ensure the information is updated periodically. A standard health facility list should bear information on the status, location, and capacity. 

Each facility in each country will come with a unique identifier on the GFHD database. Thirty-two countries in Africa are participating in the project’s first phase, which will run for five years. eHealth Africa is implementing this project in five countries: Cameroon, Chad, the Gambia, Seychelles, and Togo. For eHA, this is one of the ways we support the strengthening of health systems and ensure that we can improve access to care for vulnerable populations.

“Supporting WHO member states with establishing and maintaining a master list of health facilities and combining them into a standardized health facility registry will not only strengthen national healthcare delivery systems but also provide a critical resource needed to respond to any public health emergency of international concern (PHEIC).”

— Vince Seaman, Senior Program Manager, Polio, The Bill and Melinda Gates Foundation

We believe that the time has come to support establishing and maintaining a master list of health facilities in each WHO member state and the creation of a global health facility database (GHFD). The availability, quality, and accessibility of the master list of health facilities and the Global health facilities database will transform our capacity to deliver interventions and ensure that wastage of health consumables such as vaccines reduces and health support is prompt and timely. 

Five crucial points for a successful data collection exercise

Insights from the Kano State Primary Health Care Monitoring and Evaluation systems assessment

By Chinedu Anarado

Are you planning a data collection exercise? If yes, you will be best served with some of our field experience implementing various data collection activities. eHealth Africa has more than a decade of experience collecting large-scale data, including qualitative and quantitative data. These span geographic information system data, vaccination and vaccinator tracking data, implementation of health systems improvement, and reproductive health services surveys. At every point in a calendar year, eHealth Africa team members are in a remote community interacting with locals and trying to understand the reason for some challenges preventing effective public healthcare service delivery.  

We recently concluded data collection efforts in Kano state to assess the challenges to data use in decision making within the monitoring and evaluation (M&E) framework of the Kano State Primary Healthcare Management Board (KSPHCMB). Leveraging support from Technical Advice Connect (TAConnect), eHA designed a mixed study to help us identify the quality of data, their collection process, and how best to encourage empirical decision making and improve the quality of healthcare services delivery. From a sampling population of over 1000 persons within the state primary healthcare (PHC) M&E system, including data generators and data users, we sampled 596 respondents for our quantitative questionnaire and 21 respondents for our qualitative tool. Their responses are now guiding our analysis and findings. Here are five big lessons we learned while delivering this effort. 

1. Stakeholder engagement is the key to success , and no stakeholder is more important than the other. Any person’s response could be the insight that unlocks the issues you are trying to solve. But they can make or break your ability to reach all your respondents and access all the communities from where you require information. Our approach was first to map out all the stakeholders and their interests in the project. Next, we agreed on a means of communication and what information was important to them before we reached out. Adequate and open communication is the key to successful stakeholder engagement. We ensure we address all their concerns, make them a part of the project, and, where permissible, include them in helping you to get access to the communities you need to study. Ensure to share your collection tools with stakeholders for their input where necessary. Overall, mainstream stakeholder engagement throughout your collection phases if you want to be successful in data collection.

2. Failing to plan is planning to fail. A field plan helps you understand how much time you need to start and end every data collection effort. Because we have a lot of experience implementing data collection, we can estimate the time required to conclude an exercise accurately. To do this, we establish certain parameters such as the number of data collectors available, how many questionnaires are to be administered, the coverage area, and how long it will take to administer a questionnaire to one respondent. With these figures, draw up a field collection plan to estimate the quantity of data one enumerator can collect in a day. This information is vital if you plan to pay data collectors based on performance or measure their effectiveness. Ensure to include a couple more days for mop-up and recollection. This will help address unforeseen delays and disruptions. eHA has designed a tool, Planfeld, that automates planning for field logistics in public health. Planfeld improves efficiency, reduces your turnaround time, and saves valuable resources. It ensures you do not miss any planned collection location since it allows you to input your planned coverage areas. Planfeld uses the data portal, published by eHA, with over 350,000 points of interest and more than 451,000 settlements across Nigeria and it is interoperable with any geodatabase

3. Test your tools. Our best practice at eHA is finding an equivalent to the sample population outside the study area and administering the proposed instrument. In this study, we leveraged the Jigawa State primary healthcare management officials to pilot our tools. The essence of this exercise is to give us real-time information on the issues we could encounter in the field and plan for them. Field testing will also highlight any problem with your survey tools and allow you to correct such problems before you begin data collection. For example, in the Kano State M&E assessment, we discovered challenges regarding the page-to-page transition. We spent the next couple of days reviewing the open data kit forms. We resolved this issue before commencing data collection in the field. Pilot testing is also the platform to test to see if your collection estimates and timelines are realistic. It is best practice to use pilot testing to simulate if your collection plan is workable.

4. Establish and implement quality checks. For example, collection teams must record the geo-coordinates of the collection locations. It is essential to check the time to complete a single form. These are some ideas that could signal the quality of data collection—for instance, spending five minutes on a form that should take 20 minutes to complete signals that an enumerator is doing something wrong. In a GIS collection project, an enumerator collected several points from one location. Our quality checking standards flagged this, and we immediately rectified it. Quality checks ensure you do not return to the field to implement recollection when you have finished data collection because of quality issues.

5. Engage and train experienced data collectors. Over the years, eHA has built up a cadre of enumerators who understand the job and our quality standards. This lessens the time we spend training them. It has also helped us to reduce field errors and ensure the correct information is collected. Pre-collection training is still important, though, and it is an opportunity to introduce new tools, collection modalities, and quality standards to your enumerators. Training also allows you to address respondents' psychography, social and cultural norms. For instance, do not send male enumerators to interview female respondents in a conservative society. If this must happen, it must be in public and under the supervision of another adult.

An assessment is only as good as the data supporting it. If you collect poor-quality information, the analysis will be flawed. Thus, it is vital to align some of your collection approaches, like the outline above.

Taking A Bite Out of Malnutrition

By Hafsat Jaafar

In less than a decade, the number of acutely malnourished children receiving treatment globally has quintupled: increasing from just over one million in 2011 to over 14 million in 2020. Nigeria has the second-highest number of under-five child undernutrition in the world, with about 2 million children suffering from severe acute malnutrition. A major challenge directly impeding child nutrition is the reduced access and utilization of maternal and youth-friendly sexual and reproductive health services. 

In 2016, the United Nations (UN) declared the Decade of Action on Nutrition and stakeholders have made more efforts to contribute to Nutrition improvement globally.  The World Bank is taking a double-pronged approach to address malnutrition through the Accelerating Nutrition Results in Nigeria (ANRiN) project. ANRiN focuses on reaching pregnant women, adolescent girls, and children under the age of 5 years. The project aims to abate the surging rate of malnutrition through appropriate maternal care, counseling,  infant and young child feeding, healthy sanitation behaviors, prevention and, when necessary, appropriate treatment of diarrhea, and ensuring adequate intake of essential vitamins and minerals through food fortification and supplementation.

eHealth Africa as a lead consortium member has begun the implementation of the ANRiN project in 12 LGAs of Kaduna State; Kaduna South, Chikun, Kajuru, Kagarko, Jaba, Zangon Kataf, Jema’a, Sanga, Kaduna North, and Ikara. The eHA- ANRiN team delivers the Basic Package of Nutrition Services (BPNS) and Adolescent Health Services (AHS) to beneficiaries of the project. This includes; behavior change communication to improve infant and young child feeding behaviors, namely early and exclusive breastfeeding (0-6 months) and appropriate complementary feeding (6-23 months); micronutrient powders to children 6-23 months to improve the quality of food provided for complementary feeding; iron/folic acid supplementation for pregnant women with counseling to improve compliance; intermittent preventive treatment for malaria to pregnant women; zinc and ORS for treatment of diarrhea in children 6-59 months; vitamin A supplementation twice a year for children 6-59 months; deworming twice a year for children 12-59 months; and counseling and provision of commodities to married adolescents in Kaduna for increasing birth spacing.

eHealth Africa among winners in 2021 edition of the Wiki Loves Africa Photo Contest

By Oladipo Olurishe

2nd Place Winner Wiki Loves Africa Photo Contest 2021

Our submission to the Wiki Loves Africa 2021 Photographic Competition came 2nd place out of over 8000 entries.

Wiki In Africa, the international organizers of the Wiki Loves Africa challenges the global photographic community each year to respond to a call for photographs of life in Africa along a specific theme. This year, the competition called for photographers to contribute images that visually interrogated the theme of Health + Wellness within the African context but looking at the positive aspects within that sector of African life.

The image which emerged as a global winner was shot at the Kano head office of eHealth Africa during a Malaria Microscopy Training conducted by our Laboratory team. The image was uploaded by Dr. Nirmal Ravi who leads the team and was present during the session.

Need for Stable and Sustainable Energy for better Healthcare Delivery in Nigeria: A case study of Kano and Osun State Health facilities

By Mohammed Bello

A recent publication by International Renewable Energy Agency (IRENA) stated that around a billion people today rely on health facilities without electricity supply. While most large hospitals may have round-the-clock access to power, electrification rates drop significantly for rural clinics. In the absence of reliable power, many of the basic life-saving interventions cannot be undertaken safely or at all.

Also, a recent study analyzing over 121,000 health facilities, in 46 low and middle-income countries, found that almost 60% of them lacked access to reliable electricity. Even facilities with electricity access can often suffer from an unreliable supply – negatively affecting the ability of medical professionals in rural communities to deliver modern health services.

Renewable energy is at the forefront of solving this issue. Off-grid (stand-alone and mini-grid) renewable energy solutions represent a cost-effective, rapidly deployable, and reliable option to electrify healthcare centers, transforming lives whilst bolstering global efforts to achieve Sustainable Development Goal 3 – good health and wellbeing.

Lack of sufficient and reliable power is jeopardizing the well-being of millions of people, especially women and children, who often bear the brunt of inadequate primary healthcare services. In fact, worldwide, more than 289,000 women die every year from pregnancy- and childbirth-related complications, many of which could be averted with the provision of better lighting and other electricity-dependent medical services (Sustainable Energy For All, 2019).

Like the pilot Energy survey from 10 selected health facilities across seven (7) Local Government Areas (LGAs) of Kano state in August 2020, the expanded phase was also carried out by the Nigerian Energy Support Programme (NESP), a technical assistance programme co-funded by the European Union and the German Government and implemented by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH in collaboration with the Federal Ministry of Power (FMP), in partnership with eHealth Africa. It was conducted in close cooperation with geospatial data experts from INTEGRATION Environment & Energy GmbH (INTee) and Reiner Lemoine Institut (RLI) in Germany. This is part of the effort of the NigeriaSE4ALL Initiative to offer the most up-to-date, ground-truth, electrification data available in Nigeria.

The expanded survey was also carried out using a remote interview method for conducting interviews with the health facility in-charges in selected health facilities across 43 out of 44 LGAs of Kano, and 27 out of 30 LGAs of Osun state.

The findings from the result of the earlier concluded pilot survey necessitated the expansion in the scope of the survey, to gather sufficient information that would help provide a bigger picture of the energy needs, current situation, and guidance for the planning of possible implementation of suitable energy solutions for communities. The expanded scope covered a total of 291 health facilities - 173 health facilities in Kano state and 118 health facilities in Osun state.

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Helpdesk Agents administering questionnaires remotely to Health Facility In-charges in Kano and Osun State

The methodology used in collecting the data is through remote administration of survey questionnaires via phone calls, to ensure adherence to and support the COVID-19 response efforts in Nigeria and minimize the risk of infection through physical contact.

The primary aim is to assess energy gaps and identify the potentials for connection to an off-grid power source (renewable energy) and at the same time, determine the readiness for Covid-19 response at the Primary Health facility level.

The diagram below presents a summary of the implementation approach adopted for the survey.

Figure: Summary of the implementation approach adopted for the survey.

• The following four major data sources were utilized; 

  • list of health facilities extracted from the eHA data portal, 

  • Grid Clusters (potential location for off-grid infrastructure),

  • Senatorial administrative boundary

  • Contact list for Health Facility representatives

Health facility data and senatorial administrative boundaries were downloaded from the eHA Data portal/ GRID3 as shapefile format, power grid location was downloaded from Nigeria SE4ALL Webmap; in Geojson format, containing the KEDCO - Grid Data MV Lines (2016) and Osun state MV power lines. 

Finally, a structured survey was designed to capture the energy required capabilities and capacity of the health facilities.

Fig 2. Map showing the distribution of Primary health facilities in Osun state(Left) and Kano state(Right)

Activities

Remote administration of questionnaires to the health facilities in-charges via phone calls to identify the following:

• the health centers’ current electricity supply status

• general services provided by the health centers, 

• their current ability to cope with the COVID-19 response

• available infrastructure at the health center that would impact considerations around power requirements

Key Findings

• The survey findings indicate that all infrastructures do not meet up the minimal requirement stated by NPHCDA and some health services needed to be upgraded

• Power shortages affect the functionality of many types of equipment at the health centers across all assessed facilities thereby, affecting the output and overall performance of the facilities in terms of service delivery.

Benefits of the survey

The outcome of the survey provides visibility on areas and health facilities that require urgent intervention, such as the provision of PPEs to the health facilities and other equipment/infrastructures. Also, the data collected were subsequently published with updated health facilities infrastructure and services information on the eHA data portal for public access and to all for non-commercial use.

Finally, the survey makes readily available information relating to health facilities and the preventive measures taken during the COVID-19 crisis.

Future Survey Use Case Potential:

The remote survey showcased the capacity to effectively gather information on energy sources and requirements whilst supporting efforts in preventing the spread of the COVID-19 virus, without requiring a face-to-face engagement. 

Considering the necessity for energy supply, especially at health facilities, these surveys present a clear understanding of current energy systems that may not be sustainable and the need to consider alternative sustainable energy systems that would have minimal impact on climate change and make lives better.

Ultimately, surveys can be conducted nationwide to establish a baseline for the energy requirements of Primary Healthcare facilities.

It is evident that the functionality and efficiency of the Nigerian health systems especially in rural settings, can not be optimized with the use of on-grid electricity, some components of which are affected by unstable weather due to climate change. As such, harnessing renewable energy will be an alternative way of addressing the persistent power challenges in the health sector.

The Program Partners

Remote Data Collection as a First Step for Developing a Digital Information System to Guarantee the Supply of Quality-Assured Blood to the South African Population

By Dr. Alexander Pinz

The project    

The provision of safe and high-quality blood and blood products is a significant challenge for blood establishments in times of crisis. Depending on the crisis at stake, blood demand may suddenly explode, e.g. with mass casualty events; or there will be shortages in blood supply because of infectious diseases (epidemics, pandemics), and environmental catastrophes (e.g. floods, droughts). In these situations, it is important that blood establishments can rely on adequate information and emergency plans, enabling them to ensure the continuous supply of blood and blood products to both the entire population, and the persons severely hit by the crisis. However, currently, blood establishments are rarely included in national or regional emergency management plans. They often lack adequate information technology, enabling them to foresee slowly emerging crises or to react appropriately to catastrophic events that suddenly happen. According to the participants in the CoordinatedBlood-Workshop, which took place in Berlin in September 2018, these challenges apply to the South African blood supply system, too.

To better prepare blood establishments for crises, the BISKIT-consortium—comprising eHealth & Information Systems Africa, the Paul-Ehrlich-Institut (German Federal Institute for Vaccines and Biomedicines), and the Working Group Inter-disciplinary Security Research (Free University Berlin), the European Research Center for Information Systems (University of Münster), and the Chair for Software & Digital Business (Technical University of Darmstadt)—has started the project Blood Information System for Crisis Intervention and Management, funded by the German Federal Ministry of Education and Research. The aim of this research project is to improve the supply of safe and quality-assured blood and blood products before, during, and after a crisis to the South African population. To achieve this objective, the consortium is going to 

• develop an information-system including a user-interface (demonstrator) for data-based decision-making, 

• develop crisis management plans and recommendations for crisis communication, and

• organize and implement capacity building training on the use of the demonstrator.

The challenge

To accomplish these objectives, we need an enormous amount of data. First, we have to map the South African blood transfusion as well as crisis management systems, including their major stakeholders. Second, we have to visualize the entire blood supply chain from vein to vein. Thus, we have to assess every single process step such as donor recruitment, donation, processing, and testing, transportation, and storage, as well as issuing of blood products. Also, we need GIS data on the locations of the relevant facilities like blood establishments, mobile clinics, hospitals, etc. Finally, we need quantitative data on the duration of each process step, the number of donors/donations, number of products, etc. However, due to the COVID-19 pandemic, we are not allowed to fly to South Africa to start our data collection process. So what can we do?

The solution

We exploited the digital tools available to us to start a virtual data collection process. Thus, we use video conference systems to implement key-informant interviews with relevant stakeholders of the South African blood transfusion and crisis management system. We store the data in a CKAN-portal that only members of the BISKIT consortium can access. To make the information obtained via these interviews available to the entire consortium, we transcribe the interviews with artificial intelligence software. We then analyze the anonymized transcripts with cloud-based as well as standard qualitative analysis software.

Having, so far, conducted 20 key informant interviews with persons responsible for different parts in the blood supply chain, and the crisis management system, we have t great insights into how the South African blood transfusion and crisis management systems work. We can use these insights to map the relevant actors and processes of the respective systems. In addition, we now have a notion of the different data available for upload. With this information, we start modeling the blood supply chain from a logistical perspective, and, thus, get the project started.

The world saw more video calls this year due to the COVID-19 pandemic.

Sure, virtual data collection differs from data collection on-site. The social aspects of collaboration are missing. Nevertheless, in the interviews, we created a good atmosphere with the project partners in South Africa. Using video calls enabled us to at least see each other and get the relationship-building process started. This adaptation to the travel restrictions resulting from the COVID-19 pandemic has shown us we can collect data with digital technology. This approach enables us to better focus on the travels that are relevant for project success. It helps us to reduce our carbon footprint of development cooperation work. However, we are also looking forward to getting to know our project partners in person. Because in the end, this will further improve the quality of the data we can collect, and, thus, contribute to the aim of increasing the resilience of the South African blood supply system by using digital technology.

Dr. Alexander Pinz is the Project Manager for the Blood Information System for Crisis Intervention and Management (BISKIT) project at Paul-Ehrlich-Institut (PEI). PEI is the leading organization within the BISKIT consortium and responsible for coordinating the project implementation.