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Much Ado about Monitoring & Evaluation?

By Emerald Awa- Agwu and Olayinka Orefunwa

Case Study

Thomas* has just received some feedback from donors to suggest that his organization may need to refund some of the funding it received. The donors feel that there is insufficient evidence to demonstrate that the project achieved its outcomes and overall objectives.

Thomas managed a three-year nutrition project, which aimed to combat malnutrition in children under the age of 5 by training local women and caregivers to produce nutritious meals for children from 6 months to 5 years using indigenous, locally available foods. He and his team conducted several activities including producing recipe manuals, organizing food demonstration classes, developing communication materials, and educating women on nutrition and hygiene issues.

Thomas believed that the project had achieved great results. Malnutrition rates had dropped and mothers in the community had a better knowledge of how to create nutritious, balanced meals with local foods in order to support the optimal growth and development of their children. He simply could not understand why the donors could not understand this. After a lot of back-and-forth conversations, the donors asked to see the Monitoring & Evaluation Framework for the project. Thomas and his team had never created one.

What is Monitoring & Evaluation?

Over the last decade, monitoring and evaluation (M&E) processes have become an important source of knowledge management and organizational learning in the development sector. Monitoring and Evaluation (M&E) are processes that help project managers like Thomas as well as donors and relevant partners to assess the performance of a project or organization. Monitoring is a systematic, continuous and long-term process of gathering information about a project’s progress towards its set objectives. Evaluation helps to determine if the project has, in fact, achieved its goals and delivered the expected outputs as planned.

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Why is Monitoring & Evaluation Important?

As we saw from the case study, neglecting M &E can have dire consequences. It is important to factor it in from the inception of the project. Best practices in programming and project management suggest that an equivalent of 5% - 15% of the overall project budget should be allocated to M &E.  Here are a few reasons why organizations and project managers should have a strong M & E framework in place.

1. M & E is relevant for donors to assess the quality of project implementation. In the development sector, an M &E framework is required by donors for them to gauge how reliable an organization is as a partner, before considering them for future collaborations and opportunities.

2. Together, M&E help to keep track of how efficiently projects are implemented (with regards to using resources and inputs) or how effective the programs are. This is extremely valuable for project managers like Thomas because it helps them ensure that donor funds are being used judiciously to get the best value for money.

3. M&E is also important for identifying challenges and gaps so that changes can be made as needed.

4. It allows teams to learn from each other’s experiences, and to build on expertise and knowledge.

At eHealth Africa, M & E is led by our Monitoring, Evaluation, and Research (MER) team and is built into projects from the inception to close out. The MER team supports project managers across the organization to develop solid M & E frameworks that guide project delivery according to laid down standard operating procedures. Apart from their internal quality assurance functions within projects, our MER team supports eHA’s efforts to contribute to public health research.

The team provides research services to organizations including universities and implementing partners to conduct qualitative and quantitative studies on a wide range of areas.  In addition, eHA’s MER team provides third-party monitoring services for humanitarian organizations so that they can have a true picture of the quality and impact of their interventions. Recently, our MER team provided technical leadership in a baseline data survey for the Clinton Health Access Initiative (CHAI). The survey aimed to gather data relating to perceptions and practices relating to sexual and reproductive health among males and females of reproductive age in Kaduna, Katsina and Kano states.  Over the course of three years, CHAI will support the state governments of Kaduna, Kano, and Katsina to increase contraceptive prevalence rates and utilization of reproductive health services, which should lead to reduced rates of unintended pregnancies and unsafe abortions. The increased use of family planning, in addition to sustained gains in the provision of quality emergency obstetric services, should lead to a further reduction in the number of maternal deaths in the same time period.

To effectively achieve this goal, a clear understanding of current levels of knowledge on reproductive health was required. First, as a baseline against which program outcomes can be measured at the end of the project, but more importantly, as a basis for which strategies for program intervention can be designed and delivered. eHealth Africa trained the data collectors to use Android-based digital applications such as ODK to collect data across 70 LGAs and supervised the data collection process.

eHealth Africa staff including MER lead, Yinka Orefunwa visit Soba LGA in Kaduna State to conduct data quality assessments for the CHAI survey

eHealth Africa staff including MER lead, Yinka Orefunwa visit Soba LGA in Kaduna State to conduct data quality assessments for the CHAI survey

Overall, to avoid scenarios like the one in our case study, organizations need to recognize Monitoring and Evaluation as a necessary component to ensure the quality of their project execution and the accuracy of their outcomes. M&E ensures visibility and accountability as donors, implementing partners and relevant stakeholders will have adequate information about successes, challenges and even changes made in the course of the project.

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.

Technical Career Development at eHealth Africa

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

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

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

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

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

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

Evance, Senior Software Developer in Software & Solutions Development

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

Sandra, Senior Business Analyst in Software & Solutions Development

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

Oluwafemi, Associate Manager, DevOps Engineering

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

Detan, Associate Manager in Geographic Information Systems

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

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

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