Revolutionizing Malaria Interventions in Nigeria: 5 Digital Tools Leading the Fight

By Judith Owoicho

Several factors may account for why malaria is so common in Nigeria which bears up to 25% of the malaria burden in sub-Saharan Africa. It remains a significant health concern. In 2021,  the country accounted for 31% of global deaths from the disease. Control of malaria is often hinged on global strategies,  including prompt and effective case management, intermittent preventive treatment (IPT) of malaria in pregnancy, and integrated vector management (IVM): use of insecticide-treated nets (ITN), indoor residual spraying (IRS), and environmental management (EM), all of which have been employed at varying degrees to combat the disease.

Efforts made over the years were further stalled in the first year of the pandemic which saw a rise in malaria cases and deaths. With at least half of the world's population at risk of contracting malaria, it is critical to continually explore new interventions to prevent and treat the disease.

 So far, insecticidal-treated nets have proven to be the most effective way of preventing malaria and reducing death rates in Nigeria. However, their distribution to the last mile is often a challenge. To overcome this challenge, several organizations have turned to technology and digital tools to enhance the efficiency of malaria intervention programs. Here are five innovative tools that have been predominantly used:

LoMIS

Lomis is an offline logistic management tool custom-built by eHealth Africa for the Seasonal Malaria Campaign (SMC)  in Borno, Nigeria. The platform was used to support the distribution of malaria commodities, including insecticidal treated nets (ITNs), malaria diagnostic kits, and antimalarial drugs. Through the  platform,  government and development partners were able to track the distribution of malaria commodities from the national level down to the health facility level. The tracking system ensures that malaria commodities are delivered to the right places at the right time, and that stock-outs are minimized. It also ensures  that malaria commodities are not lost or stolen during transportation and that they are stored properly at health facilities. It has improved data management and reporting in the malaria sector in Nigeria.

Planfeld

Plainfield is eHealth Africa's digital solution- a mobile and web-based application that helps you plan field logistics for public health interventions. It is deployed for malaria campaigns to ensure better planning, tracking of teams, data collection, and coverage with geospatial tools. Micro planning is done based on the geospatial listing of settlements from the Nigeria data portal: mapping information and can be auto-generated to estimate the appropriate number and distribution of teams to effectively implement activities within specified days across selected settlements or locations. The planning is carried out at the local government administrative level for each ward/district to be covered. GIS-enabled mobile devices are deployed to every ward/district where malaria activities are to be implemented. GPS tracks and location data are collected, via passive and active monitoring respectively. These geospatial datasets are analyzed via automated systems to determine which settlements are reached and the proportion of settlement areas that have been covered. With the use of the Planfeld during the seasonal malaria chemoprevention campaign in  2020, coverage of all 27 LGAs in Born was achieved, reaching over 2 million children.

CommCare

CommCare is a digital platform that has been used to support the distribution of insecticidal-treated nets (ITNs) to hard-to-reach areas. Through the platform, community health workers (CHWs) can register households and distribute ITNs, recording data on the location, number of nets distributed, and the size of the household. This information is then sent to a centralized server, where it can be monitored and evaluated for effectiveness. CommCare has also been utilized to support the treatment of malaria. CHWs can use the platform to diagnose and treat malaria in the community, recording data on the diagnosis, treatment, and follow-up visits. In addition to ITN distribution, CommCare has also been used to support behavior change communication (BCC) campaigns to educate communities on the prevention of malaria, delivering educational messages to individuals and communities, providing them with the information they need to protect themselves from the disease. Commcare has been used in 130 countries for several interventions including malaria.

Reveal

Reveal is a global good and an open-source platform that uses spatial intelligence to drive the delivery of life-saving interventions. Reveal has played a critical role in improving the efficiency and effectiveness of malaria interventions, particularly in the areas of data collection, analysis, and reporting. It has been used to collect data on the distribution of insecticidal treated nets (ITNs), malaria diagnosis and treatment, and other malaria interventions. Community health workers (CHWs)  use the platform to record data on the number of ITNs distributed, the number of people tested and treated for malaria, and other key indicators. It also generates automated reports on the status of malaria interventions, including ITN distribution, malaria diagnosis and treatment, and other key indicators. The platform can also generate alerts and notifications, highlighting areas where interventions may be falling short. It has also been integrated with national health information systems, allowing for data to be shared across different levels of the health system. This integration enables program managers and policymakers to monitor the effectiveness of malaria interventions at a national level.

RedRose

RedRose is a mobile-based platform that provides real-time monitoring and evaluation of malaria programs, allowing for tracking progress and identifying areas for improvement. It enables health workers to collect data in real-time using mobile devices including information on the number of ITNs distributed, the number of malaria cases diagnosed and treated, and the number of pregnant women who received intermittent preventive treatment for malaria. This real-time data collection helps to quickly identify challenges and respond to them before they escalate. Its digital mapping capabilities allow for the identification of areas with high malaria burden and prioritizes interventions accordingly. The platform can also be used to map the distribution of ITNs, ensuring that they reach the last mile. It includes an SMS reminder feature, which sends reminders to health workers and patients on important tasks and appointments. This feature helps to ensure that patients receive timely care and that health workers stay on top of their tasks. 

The use of digital tools for malaria control in Nigeria may face several challenges, including technical and implementation challenges, as well as limitations in reach. Addressing these challenges will be essential for the successful integration of digital tools into malaria control efforts. However, the use of digital tools for malaria control in Nigeria has great potential to improve the diagnosis, treatment, and prevention of malaria. Other areas needing a closer look may be to identify and address the challenges and limitations of digital tools and to maximize their potential for malaria control in Nigeria.

How Digital Tools Connect Rural Populations with Modern Diagnostics and Treatment for Tuberculosis (TB)

By Judith Owoicho

Tuberculosis is a big burden in Africa. The region accounts for more than half of the 30 high-burden TB countries worldwide. In 2020, at least half a million lives were sadly lost to this curable and preventable disease in Africa.  

Efforts have been made in funding and creating more testing and diagnostic options, however, in many rural villages in Africa,  access to modern diagnostics facilities is a significant challenge that results in delayed diagnosis, inadequate treatment, and poor health outcomes for tuberculosis. Lack of the necessary infrastructure and resources, such as electricity, water, and transportation, to set up and operate modern diagnostic facilities continue to impede the elimination of tuberculosis in the region. More effort is required to connect rural populations with central modern diagnostics facilities for TB/HIV diagnostics and care.

Digital technology has shown significant potential in advancing disease surveillance, monitoring, management, and care. It is being applied in innovative ways to help overcome barriers to prevention, detection, treatment, and management of infectious diseases including tuberculosis, to promote treatment adherence, support learning and knowledge dissemination progress in low and middle-income countries. One of such technologies is the Health Telematics Infrastructure (HTI).

Bridging the gap between rural population and urban diagnostic facilities

eHealth Africa worked with the Charité University of Medicine to design HTI, a digital solution to improve, analyze, and evaluate the diagnosis and treatment of TB and HIV. It was implemented in St. Francis Referral Hospital (SFRH), Ifakara Health Institute (IHI) in Ifakara, and Kilombero District, Central Tanzania. The system is a low-cost open-source software solution that captures data, tracks samples, and provides healthcare workers and patients with real-time feedback via SMS. With this digital platform, nurses can access a TB Diagnostics Dashboard on an android phone to view patients' information and make decisions based on their test results. Patients or disease suspects are registered using an OpenDataKit form template, while sputum/blood samples are labeled with pre-printed QR codes to track shipment status from collection to the central diagnostic facility. Laboratory staff enter the test results into the HTI database, and rural healthcare staff/patients are informed about the availability of test results via SMS messages.  So, Instead of patients traveling to facilities, samples and information are transported and managed by the HTI system, which works under low-bandwidth and unstable internet conditions, anywhere with at least 2G coverage. 

Overall, the system significantly shortened the previously long turnaround time from first symptom until treatment initiation, it eliminated the paper based workflow and delayed information transmission replacing it with a digital workflow. It shortened the long distance to the molecular test facility by providing mechanisms for village level tests and it eliminated the high financial burden by moving samples and data  instead of patients.

Community engagement and involvement

Digital tools such as the HTI offer viable solutions to the challenges faced by rural communities, enabling them to access high-quality healthcare regardless of their location. To ensure the success of digital solutions especially in rural communities, it is important to involve local communities in the planning and implementation process. Community engagement can help to identify the specific needs and challenges faced by rural populations, as well as the most effective ways to address them. In rural Tanzania, there was awareness creation for the communities and in addition, capacity building for community health workers. This ensured that more cases of TB were identified and the rapid spread of the disease curtailed. By involving local communities and organizations in the process, we can ensure the success of these initiatives and work towards a future where all populations have access to modern diagnostics facilities for effective management and control of infectious diseases.

Partnerships and Networks: Essential for achieving food security

By Chinedu Anarado

By 2030, the United Nations (UN), and its agency, the Food and Agriculture Organization (FAO) hope to have achieved Sustainable Development Goal 2—end extreme hunger in the world. As of 2017, an estimated 821 million people globally are facing extreme hunger. The bulk of this group lives in Sub-Saharan Africa, where 237 million people were undernourished. In Northeast Nigeria alone, 2019 saw an estimated 2.6 million people left severely food insecure due to the insurgency and conflict1.

Climate change, poor farming practices and the nonexistence of sustainable partnerships and support systems all contribute to the growing cases of low crop yield. Most farmers do not have access to the right kind of information, and where they have information, they lack sustainable support to implement them.

During the planting stage

Recognizing this, the UN identifies the need for governments and private actors around the world to ramp up investment through enhanced international partnerships, research and extension services, and technology. This will increase agricultural productivity in developing countries, thus strengthening nutrition and food security systems. 

Here is how eHealth Africa leveraged partnerships and existing structures to drive the introduction and adoption of the Farm Management Tool (FMT) among 25 farmers in Kano State.

• FMT started as Cornbot, a mobile application built in partnership with Dr. Cornelius Adewale, the Bullitt Environmental Dellow at Washington State University. The application was built to aid farmers to identify, detect, manage and control Fall Armyworm (FAW), a major pest of maize and 85 other plant species. It was an entry for the 2018 FAW Tech Prize jointly sponsored by Feed the Future, the United States Agency for International Development (USAID) and the Centre for Agriculture and Biosciences International (CABI). These platforms continue to provide financial support, expert knowledge, and interventions to local farmers around the world.

• Upon winning the Frontier Innovation Award, eHA and WSU utilized the prize money to build FMT. The project was implemented in a three-pathway approach consisting of a mobile application and a web-based dashboard to aggregate data, face to face training sessions and practical hand-holding sessions. To recruit the farmers, eHA and WSU partnered with the Kano State chapter of the National Agriculture Extension and Research Services (NAERLS) to hold a pre-implementation workshop for 40 smallholder farmers. The workshop gleaned useful information that helped the project team to understand the farmers’ current agricultural practices, challenges, and level of knowledge.

A local farmer watches a video about bio-pesticide production using Neem leaves

• After the workshop, 25 farmers were selected to participate in the study. They each earmarked 25 square meters of test farmland to test the efficacy of incorporating four Good Agricultural Practices (GAPs) put forward by FAO, on crop yield. eHA partnered with Gwarmai Consulting, a local consultancy company to provide handholding support to the farmers, from pre-planting to harvest. The farmers learned soil testing, pest scouting, weeding, plant spacing, fertilizer application, and ash application for soils with high alkaline content.

Farmers at the Pre-Implementation Workshop

The results were impressive. In comparison to the Kano State average Maize yield of 2,750 kg/hectare, test farms recorded a 116% increase. Test farms also had a 195% increase compared with the national average of 2,020 kg/hectare.

In addition, the farmers acknowledged the value of the new information and committed to imbibe them and share with other farmers within their networks. It is often said that information is power. However, the information will never produce the desired effect without platforms and networks to get it across to those who need it. The success of the Farm Management Tool is an example of how Nigeria can reverse food insecurity if the right partnerships and platforms are leveraged to get much-needed information and skills across to local farmers.

Strengthening the Malaria Continuum of Care through Data Collection and Research

By Les de Wit and Emerald Awa-Agwu

In 2018, there were approximately 258 million cases of Malaria worldwide and 93% of these cases occurred in Africa. Pregnant women and children have been the focus of most Malaria eradication projects and this has led to a remarkable decrease in the prevalence and incidence of the disease in this population1. However, among young people and non-pregnant adults, the number of new cases is on the rise.1 and very little is known about the attitudes and health-seeking behavior of this group around Malaria.2

Patients at Nuhu Bamalli Maternity Hospital

To answer the questions about the knowledge, attitude and behavior patterns of young people and to inform Malaria strategy and program development to eliminate the disease, data was needed. 

With our expertise in data collection, eHealth Africa teamed up with Restless Development, a youth-led development organization, whose mission is to place young people at the forefront of change and development and CUAMM, an Italian non-governmental organization. This key goal of the project was to support the implementation of the Fighting Malaria Improving Health Project, funded by Comic Relief and GSK.

How did we do this?

eHA developed the digital survey tool, set up mobile devices for data collection and provided data visualization and analysis, as well as related training. The survey was created using an open-source tool often utilized in low resource settings, Open Data Kit (ODK). 

Following the creation of the electronic survey, tablets were installed with an ODK app and configured to download the survey form. Data was collected from 5,000 individuals between the ages of 15 - 24 in three chiefdoms within the Port Loko district of Sierra Leone. Chiefdoms are the third and lowest administrative levels of governance in Sierra Leone. eHA trained a team of young people to conduct the survey and send reports electronically. Data collection could take place in the absence of an internet connection because of ODK’s ability to store data offline and then, synchronize to the server periodically when an internet connection became available.

eHA has developed an ODK companion tool, Gather, which allows for secure turnkey integration with various data sharing solutions. Using Gather, the collected data was able to be viewed online in an open-source visualization service, Kibana. The Gather and Kibana connection allowed representation of data in near real-time - as soon as the survey responses were synced from the mobile tablets the survey results would appear live in Kibana which had been configured with a number of data monitoring dashboards to provide aggregated views of response data.

At the conclusion of the two data collection periods, the results were automatically compared within Kibana and workshops were held in Lunsar in conjunction with all stakeholders to review and discuss survey findings.

A refresher training on ODK for researchers in Lunsar, Sierra Leone

Overall, the insights gained from these projects supported learning around how action research can help young people to take a leadership role in identifying the underlying causes of public health issues in communities.

eHealth Africa in the Fight against Malaria

Malaria is a public health issue that eHealth Africa is extremely passionate about. We have collaborated with several partners to identify challenges within the continuum of care and to provide the decision-makers and program planners with solutions that are appropriate for their contexts and with data that paints a true picture of the situation so that they can make informed decisions. 

A data collector in Kaduna State, Nigeria

Recently, we supported Malaria Consortium to map nine hard-to-reach local government areas of Kaduna State and eleven hard-to-reach local government areas of Kano State. We leveraged our expertise in Geographic Information Systems to collect geospatial data relating to settlement names and locations, and the nearest functional primary and secondary health facilities to the settlements over a period of two weeks.

Also, last year, eHealth Africa partnered with Case Western Reserve University, Hemex Health and the University of Nebraska Medical Center (UNMC) to design the Sickle and Malaria Accurate Remote Testing (SMART), an integrated point of care platform that diagnoses, tracks and monitors sickle cell disease and malaria in low-resource settings. The solution won the Vodafone Wireless Initiative Project Prize. 

eHA also worked with THINKMD and the Kano State Primary Health Care Management Board (KSPHCMB) to implement a 2-month study among community health workers (CHWs) in five LGAs to determine if the MEDSINC, a digital clinical assessment platform could improve adherence to the Integrated Management of Childhood Illnesses (IMCI) clinical guidelines. 

As always, our goal is to support our partners with technological solutions that can improve health delivery and increase access to quality health services for underserved populations.

LOMIS Stock Goes National!

By Joshua Ozugbakun and Emerald Awa-Agwu

How can accurate, real-time health inventory data will improve access to essential medicines and save lives?

With over 23,640 health facilities alone in Nigeria (as at 2005), collecting, managing and keeping track of health commodity stock data can be cumbersome. For the Nigeria Centre for Disease Control and Prevention (NCDC), the agency that is tasked with ensuring that pharmaceutical and health commodities are available in all the 36 states of Nigeria and the Federal Capital Territory, Abuja, this is a major challenge. To effectively prevent, treat and control diseases, medical supplies, and essential medicines must be available at all health facilities, treatment centers, and laboratories at all times. If the NCDC is unable to keep track of its own stock inventory data, its ability to deliver on its mandate will be hindered.

Prior to now, NCDC used to stock, track delivery, and management of pharmaceutical products using paper-based documentation. This method was not only error-prone but made it difficult to access and analyze information about pharmaceutical commodities stock and allocation across the 36 states in Nigeria and Abuja (FCT). This led to delays in the decision-making process to replenish commodities and in turn, stockouts at health facilities and treatment centers. 

The resultant effects of these delays and stockouts are poor health outcomes like high mortality and morbidity rates, low life expectancies, and distrust in the health system. There are already several unpleasant stories of people who had diseases that were not detected or treated adequately because the medical supplies and essential medicines were unavailable, and the statistics only worsen as one goes from urban to rural areas.

Health workers in Chiranchi Primary Health Center using LoMIS Stock to take health stock inventory

The LoMIS Stock mobile application

To address this challenge, NCDC partnered with eHealth Africa to automate its supply chain processes for the distribution of pharmaceutical and laboratory commodities. eHA introduced and scaled up LoMIS Stock, a solution that has been used by the Kano State Primary Health Care Management Board (KSPHCMB) to manage the supply and availability of vaccines and health commodities at last-mile health facilities, since 2014 with great success.

The tool allows health workers to submit reports relating to vaccine stock availability and utilization, alongside other details as required by various users, thus ensuring that near-real-time data relating to vaccine and pharmaceutical stock inventory can be accessed by decision-makers and health program planners for evidence-based planning and action. For example, NCDC’s ability to monitor the real-time stock levels of antiviral medications like Rivabirin at health facilities will ensure that response campaigns are executed in a seamless manner and that Nigeria is better able to respond to outbreaks of viral hemorrhagic diseases.

Since October 2019, eHealth Africa’s Technical team has been working with NCDC’s Supply Chain Unit to configure/customize the tool whilst entering data on its National Stockpile onto the system. Currently, over 300 commodities have been entered onto the system and we expect more commodities to be added in the course of this year. This will ensure that the distribution of these commodities is faster and more efficient and that the agency’s operational processes are targeted and data-driven. 

eHA and NCDC are employing a staggered approach to ensure that the tool is rolled out and adopted by the State Ministries of Health, treatment centers and NCDC-affiliated laboratories across 36 states and FCT of Nigeria by June 2020.  The potential for transforming health service delivery and health information management in Nigeria through technology is limitless.

Going digital improves Disease Surveillance in Sierra Leone

By Sahr Ngaujah and Nelson Clemens

According to WHO, Sierra Leone is the first country in the Africa region to fully transform its national disease surveillance system from a paper-based system to a  web-based electronic platform. This is due to the introduction of the electronic Integrated Disease Surveillance and Response solution.

Sierra Leone was one of the hardest-hit countries during the 2014 EVD outbreak in West Africa. The country’s poor disease surveillance infrastructure highlighted the need for a robust disease surveillance mechanism. Introducing an electronic method for disease surveillance reporting became one identified remedy for improving disease surveillance in a country that was still trying to catch up with the rest of the world in terms of digital technology. 

Paper-based health data recording and reporting from across Sierra Leone’s 1300 health facilities became increasingly inadequate and inaccurate and was also characterized by late reporting, incomplete district-level reports, multiple data entry errors, and difficulty storing and retrieving data.

With an expertise in health informatics, eHealth Africa (eHA) designed the electronic Integrated Disease Surveillance and Response (eIDSR) solution and has been implementing the solution in collaboration with Sierra Leone’s Ministry of Health and Sanitation (MoHS), the U.S. Centers for Disease Control and Prevention (CDC), the World Health Organization, Focus 1000, and GIZ since 2016, with  the objective to enhance disease prevention and control through the digital capture and submission of data on epidemiologically-important diseases. The eIDSR project was funded by the CDC. 

eHA customized an open source health information tool from DHIS2 for the purpose-built digital data collection and reporting. The eIDSR tool is integrated into the national health system through its compatibility with the health information systemDHIS2, which is used in over 45 countries, especially those with vulnerable health systems like Sierra Leone. eHA developed the web form and custom mobile application, piloted both, and created a Short Message Service (SMS) submission solution for health workers to submit their weekly surveillance reports in locations where internet access is weak.

Nwanyibuife Obiako, Senior Programs Manager, eHA Sierra Leone, making a statement during the eIDSR rollout closing ceremony

As of June 2019, 2758 health care workers at the health facility and district level were trained by eHA on the use of eIDSR across Sierra Leone. These health care workers now monitor 26 disease categories digitally. Digitizing health-related data has yielded positive outcomes in Sierra Leone. eHA has supported the rollout of eIDSR to all 14 administrative districts in Sierra Leone and a ceremony was held on June 6th in Tonkolili district, with participants from the MoHS and other implementing partners, to celebrate the milestone achieved.

“Thanks to eIDSR, we have seen an improvement of multiple surveillance indicators, such as reporting completeness and timeliness. It’s evident that a critical part of this success is partnership and collaboration.”

— Nwanyibuife Obiako, Senior Programs Manager, eHA Sierra Leone

Nelson Clemens, eHA’s eIDSR Project Coordinator presenting during the eIDSR rollout closing event

The eIDSR system has also enhanced:

•  Reduced data entry errors

•  Reporting completeness, timeliness, and efficiency

Reducing data entry error

Optimal data management and quality are crucial to the delivery of high-quality healthcare services. Accurate data is essential to informed decision making and appropriate public health action. In the past, when health care workers submitted their reports, there was no opportunity for their superiors to perform data quality assurance. This sometimes resulted in erroneous data being sent to the national level, reducing the quality of data used for disease surveillance in Sierra Leone. With eIDSR, digital data is now managed in an efficient manner at District and National levels and made available to all relevant parties in the quickest way possible.

“The electronic system has reduced the number of data entry errors in half, and is capturing and verifying data 60% faster than the paper-based IDSR system.”

— CDC

Reporting completeness, timeliness, and efficiency 

The eIDSR tool was created to improve the speed of the flow of information within health systems. Through the electronic Integrated Disease Surveillance Response (eIDSR) solution, disease prevention, and control is enhanced through timely electronic capture and submission of data on epidemiologically-important diseases as data can now be submitted, reviewed and acted upon near real-time.

“...My colleague Surveillance Officers would agree with me that eIDSR has relieved our stress. eIDSR roll-out commenced in the Kambia district in November 2018. A week following the roll-out, we achieved 98% of timeliness of reporting and has not gone below 90% since.”

— Usman Barrie, District Surveillance Officer, MoHS, Kambia district.

Disease surveillance plays an important role in disease prevention, control and elimination. 

eHA continues to work with its partners to ensure eIDSR is sustainable in Sierra Leone.

Strengthening Routine Immunization using Lessons learned from Polio Emergency Support

By Joshua Ozugbakun & Emerald Awa-Agwu

In July 2016, after over two years of being polio-free, two wild poliovirus cases were discovered in Borno State, Nigeria. This launched fresh efforts to strengthen the four pillars of polio eradication including Routine Immunization (RI), Supplementary immunization activities (SIAs) (including national Immunization Plus Days (IPDs)), Surveillance and targeted mop-up campaigns.

A health worker vaccinates a child with the Oral Polio Vaccine

Partners, both local and international, collaborated with the Nigerian government at state and national level, through various interventions and projects to increase the coverage and effectiveness of IPDs and mop-up campaigns in order to increase herd immunity and stop polio transmission, especially in high-risk states like Adamawa, Borno and Yobe states. These interventions were coordinated by the State Emergency Routine Immunization Coordination Centers (SERICCs). Each SERICC is led by individual state governments and help to improve information sharing, joint programming of public health emergency management activities (planning, implementation, monitoring, and evaluation) with partners. The National Emergency Routine Immunization Coordination Center (NERICC) is responsible for strategy development and oversees the activities of all the SERICCs. With this coordination mechanism in place, the menace of polio is being tackled collaboratively and Nigeria is well underway to being declared ‘Polio Free’, a major milestone in its vaccine-preventable disease management efforts.
A major takeaway for Nigerian polio eradication stakeholders after years of battling polio is the need for data collection, management and storage systems to be upgraded. As the need to halt poliovirus transmission increased, it became increasingly obvious that paper-based data management systems were incapable of providing decision makers with the reliable, actionable data which they needed for effective programming. eHealth Africa responded to this challenge by supporting states across Nigeria to develop comprehensive, digital maps using our expertise in Geographic Information Systems (GIS). The accuracy of these maps improves the microplanning process and guarantees a greater coverage of settlements during campaigns.

Our GIS technology has improved the quality of maps used for polio campaign planning

In addition, through our Vaccinator Tracking Systems (VTS) project, GIS-encoded Android phones are used to record and store passive tracks of vaccinators as they conduct their house-to-house visits; allowing decision-makers to have an accurate picture of the settlements that have been covered during IPDS and mop-up campaigns. This data can easily be accessed through dashboards for a more detailed analysis and breakdown of coverage information.

Supporting polio emergency response activities also highlighted the need for the Nigerian health system to move from an emphasis on SIAs and campaigns to strengthening the RI and disease surveillance systems. Sound routine immunization and disease surveillance systems are necessary to sustain the herd immunity built through polio campaigns.

In Kano state, the LoMIS Stock solution helps the State Primary Health Care Management Board to ensure that the vaccine supply chain is maintained. Health workers at the facility level use the LoMIS Stock application to send reports on a variety of vaccine stock indicators including vaccine utilization, vaccine potency, stock levels, wastage rates, and cold chain equipment status. Supervisors access the reports through the LoMIS Stock dashboard and are able to respond appropriately. This ensures that the RI system is maintained and that health facilities are never out of stock.

In the past, Acute Flaccid Paralysis (AFP) surveillance in health systems across Africa was passive. This meant that disease surveillance and notification officers (DSNOs) only reported or investigated suspected AFP cases that were presented at the health facility. According to the U.S Centers for Disease Control and Prevention (CDC)1, over 72% of polio cases are asymptomatic and as such, will not present at the health facility. In addition, DSNOs are unable to visit every single community to actively search for AFP cases due to logistics and security challenges. Relying on data from passive AFP surveillance causes programs to be designed based on data that excludes the asymptomatic polio cases. Auto-Visual AFP Detection and Reporting (AVADAR) reduces the burden on the DSNOs by enlisting members of the community to actively find AFP cases and report using a mobile application on a weekly basis; thus, providing accurate real-time surveillance data that can be used for program planning and implementation.

An often overlooked factor that promoted the transmission of the poliovirus was the rejection of the polio vaccine by mothers and households due to various myths and socio-cultural barriers. By engaging traditional and religious leaders as ambassadors of vaccination, more mothers and households are accepting the polio virus.

The central lesson in Nigeria’s journey so far towards polio eradication is the importance of collaboration and engagement at all levels including communities. eHealth Africa is proud to be supporting governments and health systems across Africa to respond to the polio emergency.

Fighting Cholera with the Power of Geospatial Mapping

By Ayodele Adeyemo & Hawa Kombian

The Cholera Threat

According to the World Health Organization (WHO), cholera (an infectious disease which causes acute watery diarrhea) remains a global threat to public health with an annual average of 82,000 deaths. In Nigeria, the cholera burden has been an average of 10,000 cases annually with over 70% of the cases coming from Bauchi, Yobe, and Zamfara states.

Following the review and recent publication of WHO guidelines on cholera control, the Nigeria Centre for Disease Control (NCDC) has begun the implementation of innovative approaches to tackle cholera via:

• Strengthening disease surveillance for early detection and quick response through innovative use of technology and data.

• Improving coordination for technical support, resource mobilization, and partnership.

• Adopting a multi-sectoral approach to meet the 2030 cholera elimination by working with the environment and Water and Sanitary Hygiene sectors to ensure that communities have good water and sanitary facilities which will prevent further outbreaks

The Digital Health Advantage

What does an innovative model for cholera prevention and control look like?

In 1854, John Snow mapped out the cholera deaths during an outbreak and observed that they all occurred within short distances and were clustered around the Broad Street pump. He went ahead to carry out statistical tests to illustrate the connection between the source of water and the cholera cases.

View fullsize

Source: Netcentric Advocacy

In synergistic partnership, NCDC and eHealth Africa (eHA) used advanced geographic information systems (GIS) technologies to build on John Snow’s ideas of mapping. eHA uses data-driven solutions and tools to improve community health, with specific expertise in the design, development, validation, and deployment of predictive models for diseases like cholera.

GIS allow experts to explore different aspects of a geographical point. The identification of patterns can drive insights and enable health stakeholders to make informed decisions about how to best plan public health interventions. Due to computational and technological advancement, GIS has been used in public health for epidemiology, resource planning, and surveillance among others.  

NCDC and eHA were able to utilize GIS capabilities to enhance the data management within the NCDC National Incident Coordination Centre (ICC). The ICC serves as a the emergency operations center for coordinating disease outbreaks at the national level.

eHA’s GIS and Data Analytics team works with the NCDC to map cholera hotspots (areas where cholera persists) across Nigeria’s Local Government Areas (LGAs). At the start of the outbreak, hotspot analysis helps determine where to vaccinate and what quantity of vaccines are required per LGA. This exercise ensures the effectiveness of the oral cholera vaccine immunization campaigns which are rolled out to stop the spread of disease.

In planning, data from 2012-17 displays the spread of cholera outbreaks and also shows the relative risks of the various LGAs which have reported an outbreak during the five year period.

The Big Picture Data Source: Nigeria Centre for Disease Control

Data Source: Nigeria Centre for Disease Control

We layered the 2018 outbreak data with the historical hotspot analysis to identify specific trends and possible overlaps. The result of the hotspot analysis identified 83 LGAs as hotspots, with 87% reporting at least one case with over 70% of the burden from Bauchi, Kano, and Zamfara states. The LGAs identified as hotspots have enabled the government to make informed decisions about where to request vaccines to ensure that the most vulnerable areas are supported.

Data Source: Nigeria Centre for Disease Control

We continue to collaborate with the NCDC to strengthen cholera surveillance in Nigeria. The partnership ensures that data management and analysis expertise contribute to faster response and informed decision making before, during and after outbreaks.

This work was done in collaboration with the following partners:

• Yennan Sebastian- NCDC

• Adesola Ogunleye - NCDC

• Heloise Lucaccioni - UNICEF

• Helen Adamu - UMB

• Kobi Ampah- WHO Geneva              
  

How eHealth Africa supports Universal Health Coverage across Africa

By Emerald Awa- Agwu

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

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

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

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.

eHealth Africa and partners boost Sierra Leone’s surveillance capacity through 117 Call Center

By Uche Ajene

Photo caption: Alexander Taylor, 117 Call Center Manager conducted a tour of the upgraded facility

Between 2018 and 2019, eHealth Africa (eHA) and the Ministry of Health and Sanitation (MoHS) worked together to ensure that Sierra Leone’s surveillance efforts were strengthened through the use of 117 Call Center.

The 117 Call Center is a Sierra Leone Ministry of Health and Sanitation initiative that was set up in 2012 as part of a wider support system to improve maternal and child health. In 2014, eHA partnered with the Ministries of Health (MOH) in Guinea, Liberia, and Sierra Leone to scale up existing universal toll-free numbers to become Ebola focused call centers. The 117 Call Center was scaled-up in response to the Ebola Virus Disease (EVD) outbreak - to serve as a tool to document, track and provide follow-up on suspected EVD cases and deaths. The 117 Call Center provides an early warning mortality and syndromic surveillance system tool that can detect, prevent and respond to disease outbreaks. Communities are sensitized to call the 117  line and report all deaths, suspicious illnesses, and events. In Sierra Leone, the 117 Call Center has helped to solve many issues like improving community death reporting through mortality surveillance; real-time alert reporting for infectious death, increasing alert and data support to the maternal & perinatal disease surveillance.

Recently, the 117 Call Center has seen major transformation-from extending the facility and giving it a facelift, to upgrading software for a more efficient system that the peoples of Sierra Leone can trust and utilize.

“We have upgraded the call center software for a more accurate and precise data collection. Our community health workers play a very vital role in reporting cases to 117. We have added a new caller category of Community Health Workers. We also provided internet services for all the districts for real-time reporting and data collection for 117. We have also improved on our SMS software service that now provides a single text code to a caller to receive the burial code which confirms that they have indeed called 117.”

— Sally Williams, 117 Project Manager, eHA.

In an effort to get the districts more engaged, 117 is not just centralized in Freetown. Alert desks have been set up in all 14 districts with District and Data coordinators there to manage the calls in real time.

“The 117 Call Center is making positive strides in the country and the upgrade has taken it to international standard. 117 is easier to rebrand, given its popularity across the country.”

— Dr. A.J. Moosa, Deputy Director - Health Security and Emergency.

Strengthening the surveillance system in Sierra Leone through the 117 Call Center is an unending quest.

“We are planning on re-branding 117 and utilizing the social mobilization officers especially in the districts so that we can reach a greater number of our communities and encourage people to call 117 for any and all emergencies!”

— Sally Williams

The 117 Call Center actively participates in the Surveillance Technical working group of the government of Sierra Leone’s One Health Approach Initiative, where the most updated information is shared as received via our call centers to guide interventions. Every day, the 117 Call Center is striving to produce better quality data to drive the evidence-based approach when handling public health issues in the country.

The Importance of High-Quality AFP Surveillance Data in the Fight to Eradicate Polio

Polio is targeted for eradication because the presence of the virus anywhere means that children everywhere are at risk. The Global Polio Eradication Initiative (GPEI) focuses on strengthening Acute Flaccid Paralysis (AFP) surveillance worldwide to detect and respond to the poliovirus, to build herd immunity to protect the population and to halt the transmission of the virus. The data on the spread of AFP is invaluable especially for polio-endemic countries like Afghanistan, Pakistan, and Nigeria because it helps in determining whether they can finally be certified polio-free.

There are four steps involved in AFP surveillance and the Auto- Visual AFP Detection and Reporting (AVADAR) project responds to the first step—finding and reporting children with AFP—in eight priority countries in Africa. In many of these countries, disease surveillance and notification officers (DSNOs) at the health facilities are unable to actively find AFP cases for reasons ranging from difficulty in accessing settlements to security challenges. AVADAR trains community informants to search for and report the presence and/or absence of children with AFP in their community, using a mobile application. The application also has an embedded video that shows a child with AFP so that community informants can better recognize an AFP case. This reduces the burden on the DSNOs and allows them to focus on confirming if the case is truly AFP or not.

How AVADAR works

To ensure that AFP surveillance is conducted impactfully and that the AFP surveillance data collected is accurate, timely and of high quality, the GPEI defined five global indicators: Completeness of reporting, Completeness of case investigation, Completeness of follow-up, Sensitivity of surveillance and Laboratory performance.

Global Polio Eradication Initiative: AFP Surveillance indicators

AVADAR was designed by eHealth Africa, Novel-T, the World Health Organization (WHO) and other partners, to contribute to the achievement of the above targets. Below are the measures that have been put in place to ensure the collection and use of high-quality data to track and reports suspected AFP cases, and to inform decision making for polio eradication.

• Coverage: To decide where to site an AVADAR system, WHO carries out an assessment of the target country/districts to identify rural, hard-to-reach and underserved communities which are typically more predisposed to poliomyelitis. The AVADAR system, equipped with geospatial tracking capabilities is then deployed to community informants/ AFP reporters. This unique feature of the application helps to validate the location of the suspected AFP case, independent of the reporter.  

• Reporting: The AVADAR application allows informants to deliver reports anywhere and anytime in order to prevent data loss and to ensure near real-time, accurate reporting.  The app is designed to be used by people with basic literacy levels and is available in eighteen local African languages for ease of understanding. A report is better able to provide insight and enhance planning or decision making when it is timely. One of the key weekly metrics captured on the AVADAR dashboard is the number of complete results that were submitted as at when due, thus ensuring that all informants are actively engaged. Informants are expected to look out for and report cases of children aged 15 years and below, who have any form of physical deformity on the limbs or arms. In the event that no AFP case has been sighted within a week, the informant must send a ‘no report’, to validate his presence on the system.  

  AVADAR has improved the rate of AFP reporting compared to the traditional system of AFP reporting. For example, between June 2017 and June 2018 in the Lake Chad Basin countries(Chad, Niger, Nigeria, and Cameroon), the AVADAR system recorded 589 supsected cases against the 213 cases recorded by the traditional AFP Surveillance system.

• Verification: Paralysis in children can be caused by several agents including the Poliovirus. After the community informants submit their reports of suspected AFP cases, trained health workers carry out further investigations to confirm if they are true AFP cases. The WHO has designated laboratories all over target countries that are certified to test fecal samples and isolate the poliovirus. AVADAR weekly reports show how many suspected AFP cases were reported, how many were tested and the number of cases confirmed to be true AFP cases. This sort of data measures the cost of a single confirmed AFP case, the prevalence and incidence of AFP in target areas, thus enhancing the quality of AFP surveillance data for decision making.

AVADAR dashboard

Having data on the spread of AFP in a geographic location helps with planning towards its containment. Since Poliomyelitis is mainly oral-fecally transmitted, sanitization and sensitization of the environment and inhabitants respectively can help reduce the spread of polio.  AFP data gathered across different locations has been used in making an informed decision on determining the number of health workers that can effectively manage its spread to neighboring communities. On the contrary, no data or false data could lead to health workers focusing their energy in wrong locations thereby risking the spread of polio and the extension of its existence.

Without reliable and accurate AFP surveillance data, true progress towards polio eradication cannot be measured. AVADAR’s impact in high-risk countries across Africa demonstrates how context-appropriate interventions and solutions can transform disease surveillance and emergency management systems.

“One of the most important features of the AVADAR system is the engagement of over a hundred community informants per county. They are trained and equipped for the first time to provide timely reports that can be accessed at all levels from the county to the national level and beyond, thereby allowing suspected cases to be investigated in an accurate and efficient way.”

— Dr Sylvester Maleghemi, WHO Polio Eradication Initiative Team Lead, South Sudan

Benefits of a Direct Delivery Model

By Adamu Lawan and Emerald Awa- Agwu

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

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

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

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

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

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

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

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

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

Practical Solutions to Challenges in Reporting: LoMIS Stock and eIDSR

By Abdullahi Halilu Katuka and Emerald Awa- Agwu

LoMIS Stock is an electronic stock management tool, developed by eHealth Africa as a part of a suite of mobile and web applications that address supply chain and logistics challenges in health systems, especially in Northern Nigeria. LoMIS Stock helps health workers report and keep track of vaccine stock usage and availability at the health facility level. Using these reports, their supervisors can prevent stock-outs at their health facilities by ensuring that vaccines and other commodities are always available. The information from LoMIS Stock also gives governments the real-time data that is needed to plan programs and interventions and to resolve issues.

The LoMIS Stock solution was introduced to Kano State in 2014 and is currently the official logistics management tool for Kano State Primary Health Care Management Board (KSPHCMB). Currently, the State cold store, all 44 Local Government cold stores, and 484 apex health facilities in Kano send weekly reports using the LoMIS Stock application.

Although health facilities reporting times have dropped by over 50% and reporting rates have tripled since the introduction of LoMIS Stock, certain facilities in hard to reach areas were consistently unable to send reports due to mobile data network challenges. Gleaning from lessons learned from a similar challenge encountered with our electronic Integrated Disease Surveillance and Response System (eIDSR) solution in Sierra Leone, eHealth Africa added an SMS compression feature to the LoMIS Stock application.

In Sierra Leone, we have recorded a significant improvement in the number of facilities that send timely reports using the eIDSR application. Health facility workers in Sierra Leone use eIDSR to collect data offline on epidemiologically important diseases and send surveillance reports. Initially, in areas with poor connectivity, the application would store the reports and submit automatically as soon as an internet or mobile connection became available. However, this meant that such facilities didn’t always meet the targets for timely reporting.

Introducing the SMS compression feature enabled health workers in the defaulting facilities to send their weekly reports using a USSD short code if an internet connection or mobile data was unavailable. Thanks to this feature,  all the districts in Sierra Leone consistently exceed the World Health Organization (WHO) African region and national report completeness and timeliness targets.

The USSD feature for LoMIS Stock has been piloted with the pharmaceutical department of KSPHCMB to monitor incoming and outgoing stocks and the results have promising. In the first month, the stock count report at the pilot health facilities shows 100% stock sufficiency reporting and 0% wastage. After the pilot period, the feature will be rolled out to all departments of KSPHCMB to allow better reporting and increased efficiency across health facilities in Kano state.

Innovative problem solving is one of our values at eHealth Africa and this is an example of how eHA develops context-specific solutions to problems in healthcare delivery.

eHealth Africa’s CornBOT wins Fall Armyworm Tech Prize for Frontier Innovation

Fall Armyworm (FAW) is a major farm pest capable of destroying 85 plant species including maize, sorghum, and tomato. Projections show that if FAW is not checked, sub- Saharan Africa could lose up to $13bn worth of food, keeping 300 million people in hunger.

In response to this, Feed the Future partnered with Land O’Lakes International Development and the Foundation for Food and Agriculture to launch the Fall Armyworm Tech Prize in March 2018. The prize sought for timely, context-specific entries that would enable smallholder farmers to identify, treat and track the incidence of Fall Armyworm in Africa.

CornBot mobile app

eHealth Africa partnered with Dr. Cornelius Adewale, the Bullitt Environmental Fellow at Washington State University (WSU), to develop CornBot, a mobile application equipped with audio-visual algorithms to enable farmers to identify, detect, prevent, manage and control FAW on their farms. The app is very user friendly as it is also available in the farmers’  local languages.

The application also provides handy information that allows the farmer to make requests for specialist’s help where needed. CornBot also has a dashboard that provides real-time information and a heat map for CornBot-reported FAW diagnosis and detection to researchers, decision makers and other stakeholders for surveillance purposes and informed decision making.

Fall Armyworm Tech Prize - Frontier Innovation award

Out of 225 applications from countries all over the world, CornBot scaled through four stages, including a user testing stage among smallholder farmers to ensure viability and effectiveness, and emerged as one of the 6 winners of the Fall Armyworm Tech Prize. At the AfricaCom Awards, eHealth Africa was presented with the Frontier Innovation award and was also awarded prize money of US $50,000.

About CornBot, the FAW Tech Prize panel had this to say, “CornBot had the highest testing score of all the solutions because the app’s interface was extremely easy to use and included a step by step FAW identification system for farmers. The solution is extremely comprehensive and accessible due to its use of human-centered design”

Through CornBot and our nutrition and food security systems focus area, eHealth Africa aims to develop data-driven, technological approaches to improving the quality and availability of nutritious food products throughout West Africa.

Aether 1.0 and Gather 3.0 software releases are out!

Today eHA and the Aether team reached an important development milestone in their contribution to the ehealth open source community -- the release Aether 1.0 and Gather 3.0.

The belief that timely access to accurate data can save lives drives our commitment to create open source software for the development and sustainability of ehealth solutions. We believe that by facilitating the collection, curation, and exchange of relevant health data, we empower decision makers and improve the effectiveness of public health interventions.

With this in mind, last year we started working on Aether, an ambitious project to create a framework for the development of ehealth solutions. We wanted to build a platform that could facilitate developers' work and ensure that ehealth products were built with the highest standards for interoperability, security, and privacy.

OPEN SOURCE RELEASE

We started transforming that vision into a concrete product in September 2017, and in July the following year, we celebrated the open source release of both Aether and Gather.

Aether is a reliable and secure development platform that enables organizations to build solutions that curate and exchange live information. Aether utilizes “data contracts” between systems, simplifies the movement of data between applications, and helps developers adhere to best practices for ehealth system design.

Gather is the first solution built on top of the Aether platform. Gather is a data collection and curation tool that securely collects data in the field and shares it everywhere it is needed. Thanks to Aether, Gather can perform data curation activities like data masking for privacy requirements and can easily be integrated with other systems and workflows for management, transformation, and analysis purposes.

We were committed to making these projects open source both as a way to give back to the public health community we have been active in for years and so that feedback could be used to quickly improve the solutions. Since their development and release, Aether and Gather have been used by eHA and our partners in a variety of projects.

DEPLOYMENTS

Understanding malaria awareness and practices among young people in Sierra Leone

In July 2018, we partnered with Restless Development and CUAMM Africa in Sierra Leone to provide data collection infrastructure for a malaria prevention campaign called "Youth-Led Malaria Prevention Messaging Survey".
The campaign aims to help public health authorities understand young people’s knowledge, attitude, and behavior towards malaria prevention and treatment. We use Gather for data collection and Aether to connect to a Kibana Dashboard for data analysis visualization. So far, 2,417 survey responses have been submitted.

Building a global high-quality humanitarian health facility database

In July 2018, we were awarded funding for a collaborative global health site mapping project with Healthsites.io. The objective of the initiative is to create a high-quality database that includes information on facility locations, medical staff, and services, which can be used to improve humanitarian crisis response. Data collectors will use Gather in the field to capture health facility data, which will then be connected and shared via Aether to Healthsite.io, Open Street Map, and Humanitarian Data Exchange.

Collecting geodata to gain insight into Nigeria and DRC Health and Demographics

In August 2018 we started implementing Aether and Gather in Kaduna State as part of the the GRID3 project, a multi-country initiative to support underserved communities by collecting and analyzing on points of interest such as settlements, roads, and hospitals. The geodata collected through Gather is automatically published via Aether to a publicly available, customized CKAN instance. As of October 12, 2018, 513,084 points of interest have been submitted through Gather.
Since August, eHA’s involvement in the GRID3 project has expanded into multiple states in Nigeria and to the Democratic Republic of the Congo (DRC). For its use in the DRC, we customized Gather in partnership with UCLA, CIESIN, Oak Ridge and Flowminder. The GatherDRC mobile app was built specifically for microcensus and other mapping tasks.

THE RELEASE AND NEXT STEPS

You can now download Aether 1.0 and Gather 3.0 and start using the software yourself.

Though this is an important milestone in our development process, it is only the beginning of a much longer journey. Currently, we are working toward the development of new features that will allow multi-tenancy, data validation rules, and workflows. In addition, connectors for other ehealth applications will be added, including:

BPMN: Integrate with Workflow processes and tools like Camunda

Zapier: Participate in data exchange with 100’s of existing Apps

DHIS2: Bi-Directional data exchange with DHIS2 API

FHIR: Bi-Directional data exchange via FHIR standard

We look forward to hearing your feedback on our products and hearing from interested organizations and potential partner that are interested in using Aether and Gather for the global good.

Get in touch with us at solutions@ehealthafrica.org

"Connecting the Dots - Geodata in Healthcare"- The eHA Meetup in Berlin

By Benedetta Ludovisi

Geographic data and accurate maps are essential for improving public health outcomes. Up-to-date information on where people live, the best way to reach them, and the location of nearby medical facilities is fundamental to enhancing healthcare systems. When settlements and points of interest are surveyed and mapped, frontline healthcare workers and medical supplies can reach even the most remote communities. The proliferation of geographic information systems (GIS) technology and spatially enabled data collection tools have helped governments and NGOs connect the dots in public health and improve effectiveness of health interventions.

Connecting the dots - Geodata in Healthcare” audience ready for the Q&A session

Johanna Roegele, the Managing Director of eHA German office, welcomes attendees and introduces the speakers for the evening

In order to take a closer look at this topic, our Germany-based office partnered with Viderum to host "Connecting the dots - Geodata in Healthcare" on September 19 at the co.up coworking space in Berlin, the second in a series of technology and global health meetups in Germany.

Johanna Roegele (Managing Director, Germany Office, eHealth Africa) welcomed attendees and introduced eHA’s and Viderum's speakers for the evening. She also shared her vision for these meetups—a forum to share the work eHA does with Berlin’s tech and global health communities, and to create opportunities for innovative organizations to partner and learn from each other.

Sebastian Moleski, Viderum's CEO, introduces their mission to the audience

The second speaker was Sebastian Moleski (CEO, Viderum) who introduced Viderum as an expert in Open Data working with high-profile partners in the field of data and health. He explained that their mission is to make the world's public data discoverable and accessible to everyone by providing data management solutions and tools that not only allow the strategic use of data, but also play a crucial role in analyzing, tracking and predicting public health trends.

Dave Henry, eHA’s Director of Global Health Informatics, gave a presentation on eHA's use of GIS technology for the VTS project, aimed at polio eradication, a disease for which immunization requires at least three vaccine doses within a child’s first year of life. GIS technology has enabled vaccination campaigns to locate, reach, and vaccinate children in hard-to-find settlements.

Adam Butler, eHA Technical team lead in Berlin, gives a demonstration of eHA's data collection tool Gather

After Dave’s overview of the effort to eradicate polio, its challenges, and the role of GIS technology in the initiative, Adam Butler (Technical Team Manager, Germany office, eHealth Africa) and Marko Bocevski (CTO, Viderum) got ready to demonstrate how geodata can be collected, shared and visualized using eHA’s and Viderum's tools.

Adam demonstrated eHA’s latest data collection tool Gather, built for secure, real-time, spatially-enabled data collection and map-plotting, to show how GPS-enabled devices can easily capture coordinates of health facilities, settlements, and roads.

Marko Bocevski, Viderum's CTO, shows the functionalities of Viderum's visualization tool for CKAN

Following Adam’s demo, Marko demonstrated the technology Viderum developed to enable the visualization and analysis of collected data. The tool, which can be connected to Gather, facilitates data-driven decision making, project planning, and implementation.  

Following the demos, we had time to engage with the audience and answer few of their questions that animated discussions around topics related to data privacy and local community engagement.

We would like to extend a special thanks to the speakers and audience members whose participation and collaboration were essential for the success of the event.

International Translation Day Spotlight: AVADAR

By Adaeze Obiako

“If you talk to a man in a language he understands, that goes to his head. If you talk to him in his language, that goes to his heart.”

— Nelson Mandela

This year, the United Nations is celebrating “International Translation Day” for the first time. The celebration is an opportunity to pay tribute to language professionals, whose work plays an important role in bringing nations together, facilitating dialogue, fostering understanding and cooperation, and contributing to the development and strengthening of world peace and security.

For eHealth Africa (eHA), translation has been instrumental to the success of several projects, particularly the Auto-Visual AFP Detection and Reporting (AVADAR) project.

When AVADAR commenced in 2016, we knew it was a worthwhile intervention towards the eradication of polio in Nigeria; however, we could not have anticipated just how much of a positive impact it would end up having on the Acute Flaccid Paralysis (AFP) surveillance system across Africa. Between 2016 and 2018, AVADAR grew from a small pilot in two states in Nigeria to a full-fledged project across 8 West and Central African nations. Several factors contributed to the success and scale of the project, one of which was the educational AFP video embedded in the AVADAR mobile app used to train community informants on proper detection (and subsequent reporting to health authorities) of AFP cases within their communities.

This is where language came in.

The project management team, made up of the World Health Organization (WHO), country Ministries of Health, the Bill and Melinda Gates Foundation, Novel-T, and eHA, knew early on that the key to ensuring accurate AFP detection and proper use of the AVADAR app for case reporting lay with developing a sense of connectedness and trust between all stakeholders (from project implementers to health workers to community informants) through the breakdown of language barriers.

Part of the pre-implementation phase in each country included research into what languages were spoken by indigenes using the AVADAR app and the AFP video, and the entire app was translated into each applicable language. Below is an example of the AFP video translated into Hausa, a local language commonly spoken in northern Nigeria, Niger, Chad, Cameroon and the Central African Republic.

In addition to the AFP video and app being translated into multiple languages, the training facilitators (who train informants on how to use the app) and field officers (who provide weekly phone troubleshooting support to informants) were all indigenes of the implementing regions and fluent in the local languages to ensure ease of communication and understanding for the AVADAR informants.

As AVADAR continues operation across Africa, it is clear that we have the power of translation to thank for bridging the gap and allowing thousands of community members and health workers across different African nations to support the fight against polio. At this rate, it won't be too long before polio, like smallpox, is considered a public health issue of the "past".

Preventing childhood diseases through Vaccine Direct Delivery

By Adamu Lawan

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

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

The Impact

Field Tracking System - transparency and efficiency redefined

By Uche Ajene and Detan Oyedele

In 2016, the Field Tracking System (FTS) was borne out of a need to provide a means for tracking vaccinators in Cameroon for the World Health Organization (WHO). The first system was developed as a collaborative effort between eHA and WHO to address the needs for polio vaccination tracking in Cameroon.
The question WHO Cameroon wanted to answer was "How do we know where the vaccinators have visited on a daily basis and how do we make adjustments to their plans while they are still in the field?"
The challenge was that vaccination teams were in extremely remote and unreachable villages for several days and they only had one chance to vaccinate children during campaigns. Any locations missed had to be addressed during the campaign.
The solution eHA and WHO Cameroon came up with was to use low-end smartphones to capture geo-coordinate information called "tracks" every 90 seconds to infer that locations where vaccinators stayed in for about 2 minutes, a vaccination occurred. We deployed the offline system in Cameroon, powered by our robust database that contains attributes and constraints that could easily be modified and adjusted based on factors that affect where vaccinators have reached and the time spent there. Such factors include the size of the house, village or community, security situation, road network, etc.
The output was an offline dashboard showing communities and households that were visited, partially visited, not visited, that the field teams used on a daily basis to assess their performance and readjust the next day’s plan during the campaign. This was great! And then users wanted more.

“I am frankly delighted that we have introduced etracking. etracking has enabled us to know the serious and hardworking vaccinators and the unserious ones”

— Head of Supervisors - Pagui, Cameroon January 2017

FTS is currently adopted in 3 African countries (Nigeria, Cameroon & Chad) for more generic tracking purposes of vaccinator and supervisory teams, sales teams, service administrators, data collectors. Some use cases worthy of note are:

• User’s ability to define and modify campaigns by defining dates, with phones automatically sending tracks to a remote server and coverage automatically calculated. With the online and offline dashboard access, users can download reports and generate insights across multiple campaigns.

• We work with our users to plan field activities on a daily basis based on predefined communities and attributes across static and dynamic administrative levels in any area.

• Additionally, when our users need to collect sources of data while they are in the field, we can help them integrate the data with the FTS to provide more insights into the field work beyond coverage information. Case in point - WHO Cameroon & WHO Chad were able to corroborate coverage information from vaccinators with additional supervisory data that validated vaccination efforts by capturing actual number of children vaccinated using Open Data Kit (ODK) forms as an input. This means that coverage expectations of "visited" was complemented by the actual number of children vaccinated captured by ODK forms. This then helped them to further to investigate anomalies.

“With the FTS, now we are 100% certain that we have reached everywhere in the islands”

— Sam Okiror (Head, Lake Chad Task Team), June 2018

We are now working with our users to build a generic tracking and monitoring system that can be triggered by other inputs besides  geo-coordinates. Consider a system that reports coverage based on predefined user criteria and triggered by user-defined events or change in status. Ultimately, FTS will receive input from various sources both offline and online. We are excited about the possibilities with FTS and building collaboratively with our users to meet their specific demands.

Aether and Gather - Open Source Release

By Dave Henry & Benedetta Ludovisi

Today is a very special day for eHA and the Aether and Gather development teams. Today these two projects are finally being released as open source software!

Aether, the software development platform for data exchange, curation and publication, is available to anyone to be evaluated and used to jump-start the creation of data-driven ehealth solutions.

Gather, the Aether-based solution for large scale data collection is also available, providing an end-to-end pipeline for streaming Open Data Kit survey responses to the CKAN Open Data Portal and other applications.

Read more about the reasons we created these two projects in our interview with the Aether team, and get more information on the Aether and Gather microsites.

If you are eager to get your hands on the software, you can try it yourself by following the step-by-step Gather “getting started” guide.

We look forward to hearing your feedback on our forums, and to seeing the amazing things that you do!!