The Changer Tech Open Air Hangout

As part of the Berlin Tech Open Air 2016 Festival THE CHANGER (www.thechanger.org), Ashoka's PEP, Green Alley and Impact Hub Berlin organized a social tech startup hangout for people interested in social entrepreneurship, social change and using tech for good.

eHealth Africa’s CTO Didi Hoffmann presented to an interested audience of approximately 200 people how eHA is using tech for good in Africa.  Other special guests included the Jourvie team, who created an app to fight eating disorders. An organization called Changers offered solutions for carbon print reduction to companies. The EIDU app was demonstrated, a self-teaching app for pre-school children in developing countries. The HiMate app was present as well, an app that offers vouchers to refugees.

These tech demonstrations were followed by two hours of networking and responding to questions at dedicated stands. At the eHA stand, Didi Hoffmann, Francesco Occhipinti and Natalya Nepomnyashcha talked with attendees about eHA's work and provided live demos of the mobile data collection application HAT. Members of the eHA team interacted and demonstrated this app with multiple investors, social entrepreneurs and public health professionals.

Our thanks goes out to The Changer and the other organizers and sponsors! We look forward to seeing how the new partnerships and relationships benefit health tech and the health of communities worldwide.

Update: Immunization Plus Days

During the March round of National Immunization Plus Days (NIPD), eHealth Africa (eHA) provided vaccinator tracking support to ten southern states in Nigeria: Cross River, Bayelsa, Edo, Ondo, Oyo, Osun, Ogun, Lagos, Ekiti, and Delta. In May, eHA took part in the state-level IPD in 24 Local Government Areas (LGAs) in three of Nigeria’s northern states (Bauchi, Katsina, Kano).

The May IPD campaign took place from May 14-17. Our field officers were on the ground in 24 LGAs providing technical support for the vaccinator tracking activity. Every IPD campaign is different and, as usual, the May campaign presented a variety of new experiences and challenges for our vaccinator tracking teams.

One of the issues faced was the distance from the campaign takeoff point office to the ward settlements where the vaccination teams traveled for daily house-to-house visits. Many wards were 4-5 hours away from the base office in the respective LGAs. As a result, some teams could not return their phone trackers on a daily basis as intended. This caused a delay in the uploading of geographic “tracks” from the the team’s phones onto our server. Consequently, daily field results (via dashboard visualization) were only able to be reviewed at the end of the campaign by stakeholders, as opposed to on a daily basis at campaign evening review meetings. This was especially the case for several LGAs in Bauchi and Yobe state.

Poor network issues also made it difficult for our staff to upload data in a timely manner to the Emergency Operations Center (EOC) dashboard in the states they were based. This issue was mainly experienced in Yobe state areas including Fika, Jakusko, and Machina LGAs. Another key issue was security problems in several locations due to insurgency threats and political unrest, notably in Yobe state.

After encountering and overcoming the above-mentioned challenges, we are glad to report that our eHA field officers successfully conducted vaccinator tracking activities for the May IPD campaign. We were able to get valid recordings of the geographic coverage achieved by the vaccination teams for each LGA supported. We look forward to the upcoming campaign in October, and remain committed to aiding the nation in achieving its goal of receiving the certification of eradication of polio from WHO in 2017.

eHA Nigeria Hosts Representatives From HarvestPlus

A recent report from UNICEF shows that Nigeria as a country loses 145 women and 2,300 children between the ages of 0-5 years every day. While there are a variety of causes such as disease, one of the largest culprits in this tragedy is malnutrition. In Nigeria, malnutrition accounts for over 50% of morbidity and mortality in a large proportion of children between the ages of 0-5.

In view of this, eHealth Africa (eHA) is developing a new partnership with HarvestPlus to address malnutrition in Northern Nigeria through production and consumption of biofortified foods. eHealth Africa’s Nutrition and Food Security Program Manager Dr. Sarma Mallubhotla hosted representatives of HarvestPlus:Country Director Paul Ilona and Communications Manager Ifeoma Okonkwo. The representatives met with eHA Executive Director Adam Thompson, Deputy Country Director Atef Fawaz, and various program managers. They also met with Monitoring, Evaluation and Research Coordinators, as well as the Global Health Informatics team leads.

To start the brainstorming session, representatives from both eHA and HarvestPlus provided overviews of their organizations. After these introductions, discussions were held on how the proposed partnership could help introduce more nutritious Provitamin A rich Maize and Cassava, Iron rich Sorghum, and Zinc Rice to farmers in Northern Nigeria. The discussion also explored possible ways to create awareness of the nutritious value of the crops and encourage their uptake across the value chain. All of these discussions are focused on one goal: improving the diet of the most vulnerable population in Nigeria.

HarvestPlus leads a global effort to improve nutrition and public health by developing and disseminating staple food crops that are rich in vitamins and minerals. HarvestPlus works with public and private sector partners in more than 40 countries and is part of the Consultative Group on International Agricultural Research (CGIAR), and the Research Program on Agriculture for Nutrition and Health (A4NH), which helps realize the potential of agricultural development to deliver gender equitable health and nutritional benefits to the poor. 

As a result of this joint brainstorming session, eHA and HarvestPlus are looking forward to developing a collaborative agreement and detailed work plan to build a productive partnership that will contribute to the fight against malnutrition in Nigeria.

eHA Hosts the Bill & Melinda Gates Foundation

eHealth Africa (eHA) was happy to host the Bill & Melinda Gates Foundation (BMGF) at our Kano Headquarters from May 18-20 for our first Proactive Assurance Review.

The Assurance Review consisted of an assessment of eHA's financial, programmatic, and organizational management practices. The purpose of the assessment was to allow BMGF to better understand eHA programmatic and operational capabilities. The process provides assurance to BMGF leadership that eHA is utilizing the foundation funds appropriately. 

In addition to the Assurance Review, eHA Executive Directors Evelyn Castle and Adam Thompson had the opportunity to discuss eHA's upcoming Capacity Development Grant with BMGF. The Capacity Development Grant will provide eHA with the opportunity to develop a strategic and operational plan as well as develop some additional core organizational capacities. 

We are very grateful for the opportunity BMGF is providing to eHA through the Capacity Development Grant, as well as the time they have taken to conduct the Proactive Assurance Review. We know both are going to provide eHA with the ability to grow and be successful.

US National War College Delegates Visit eHealth Africa Liberia

A team of delegates from the National War College led by Col. Mitchell recently visited the eHealth Africa (eHA) Liberia Office, and were welcomed by eHA Country Director Aurelio Gomes. Other eHA team members present to welcome the delegates were Program Manager Olivia Elee, Project Manager Aji J. Kalau, Operations Manager Sulaiman Sesay, and Health Informatics Manager Nathan Humphreys. The purpose of the visit was for the War College delegates to learn about eHA activities and operations in Liberia at the peak of the 2014 Ebola Virus Disease (EVD) outbreak.

Aji Kalau presented an overview of eHA operations during the fight against the EVD outbreak. Mr Kalau explained that eHA operations began in September 2014 where support teams were set up, and National and County Emergency Operations Centers were established. eHA teams renovated specimen collection and blood testing labs, as well as community care centers.

Mr Kalau went on to describe how eHA developed IT related software to support contact tracing activities, as well as tools for monitoring each patient's status at the Ebola Treatment Units. eHA’s Country Director Aurelio Gomes spoke about the valuable support, partnerships, and funding that allowed eHA to provide the response needed to successfully combat the EVD outbreak in Liberia.

Col. Mitchell and his team responded to the presentation with questions about challenges encountered by eHA during the Ebola response, how these challenges were handled, and how set goals were achieved in spite of the challenges. The delegates also inquired about eHA’s experience working in a multicultural scene with diversity and partnership in the fight against EVD. All their inquiries were answered by the Country Director and eHA team members.

The delegates also talked about their experience in the field using cutting edge ehealth technology, especially in places where there is little to no internet connectivity available.

At the end of the meeting, the National War College team presented Liberia’s Country Director with a commemorative coin and a mug. Col. Mitchell expressed appreciation to eHA for agreeing to meet with his team, and also commended eHA for a job well-done in supporting Liberia’s Ministry of Health during the fight against the 2014 Ebola outbreak.

eHealth Africa At Liberia’s NGO Fair 2016

In late March, the Liberia International Non-Governmental Organization (LINGO) Forum collaborated with the National Civil Society Council to organize a non-governmental organization (NGO) fair in Monrovia, Liberia. This is the second annual event, and both African and International NGOs attended. This year’s theme was “Strengthening Partnerships.”

The LINGO Forum is composed of an international network of NGOs, and was established in Liberia in 1997. LINGO’s mission is to support and improve coordination between members through communication, information sharing, advocacy, liaison activities and capacity building.

Participants of the NGO Fair were welcomed to the event by Andrew Hoskins, the Country Director of Medical Team International. He spoke about the importance of the theme, and encourage continued attendance of future events. Frances Reeves, Chair for Liberia’s National Civil Society Council, encouraged NGOs to remain strong partners to the Government of Liberia.   

eHealth Africa demonstrates eHealth Tech

eHealth Africa (eHA) was represented by Country Director Aurelio Gomes at the organizations booth, where he was accompanied by other team members from the office.

Nathan Humphreys, Information Systems (IS) Manager, welcomed partners who visited eHA’s booth and discussed eHA’s work. “Technology used by eHA  is very good,” said one of the participants. “If we need data from the field, it takes months to reach the health facilities. But it now take less time, since the application used by eHA can register and send data within minutes,” he said. “I am very impressed, and will have to speak with my office about it.” 

The eHA team presented a video which showed how eHA’s data collection systems work, and followed this up with a real time data collection exercise. The team went from booth to booth using a smartphone to register information from other organizations. eHA data collectors Mark Miller and Israel Kollie sampled 118 individuals from 50 organizations. Data was then aggregated and displayed through graphics via a screen at the eHA booth. Age, gender, and the number of participants entered per organization data was collected.

This exercise showed the incredible value and effectiveness of eHA data collection and analysis capabilities.  Seventeen international NGOs took part in the exercise and were highly impressed with eHA’s health technology tools and opportunities for more prompt digital delivery of health information. Multiple organizations committed to follow up meetings and potential partnerships, in order to build their electronic capabilities in health delivery.

A Successful Event And An Interview On National TV

The fair was a great success. eHA built many great relationships, and looks forward to potential partnerships. eHA’s Country Director Aurelio Gomes was interviewed by reporter James Kaypo on Liberian television, and said “eHA is committed to being a strong local supporter for the Liberian Government’s health initiatives."

Watch the interview video below or on our YouTube channel. 

[youtube=://www.youtube.com/watch?v=wJibV1D3nLc&w=854&h=480]

SweetPotatoes: A Realistic Answer for Nigeria's Nutrition Crisis

Net houses with sweetpotatoes pre-basic seed.

Nigeria is among the top producers worldwide of staple crops lncluding cassava, yam, and sweetpotato (SP). Unfortunately, it has done little to curb malnutrition and poverty rates in the country. Regardless of its production of the aforementioned crops, Nigeria continues to rank high in the list of countries suffering from food shortages, food insecurity, and poverty.

Nigeria has one of the highest rates of malnutrition in the world with over 300,000 children dying every year from acute malnutrition and over 10 million stunted children. The percent of children in Nigeria who are too thin for their height, or wasted, increased from 11% in 2003 - 18% in 2013. This is significantly higher than the critical threshold for declaring emergencies (15%).

The prevalence of vitamin A deficiency effects 29.5% of the population, with the World Health Organization listing Nigeria as a “category one” country, the worst rating. Conditions are even worse in Northern Nigerian states. In Kano the prevalence of stunted growth for children under five years of age is as high as 48%. High levels of malnutrition lead to increased child mortality, and significantly reduce learning and economic capacity, effectively stagnating economic development.

Orange-fleshed sweet potato (OFSP)

Enter, the sweetpotato. The sweetpotato is an important root crop in Nigeria. Nigeria is the second largest producer of the crop in Sub Saharan Africa. It has the ability to thrive in marginal soil, while its broad agro-ecological adaptability makes it a food security crop because it can be grown in all of Nigeria’s 36 states. It has a relatively short production cycle (3-4 months) and its roots and vines can be utilized for both human and animal consumption. The orange-fleshed sweetpotato (OFSP) is developed and bio-fortified with vitamin A by the International Potato Center (CIP) and the National Root Crops Research Institute (NRCRI). The best thing about OFSP? It only takes 125 grams of OFSP to supply the recommended daily allowance of vitamin A for children and non-lactating women.

The NRCRI is helping smallholder farmers and targeted beneficiaries, specifically women and children, to fight vitamin A deficiency in Nigeria and Sub Saharan Africa. The CIP is also working in collaboration with eHealth Africa (eHA) to jointly set up the OFSP quality declared planting materials at centrally located multiplication plots/net houses in Bayero University Kano.

Through technology and research, eHA and our partners look forward to seeing how the OFSP combats malnutrition and improves the overall well-being of the Nigerian people.

March 2016 IPD Campaign

Since 2012, eHA has worked with the Nigerian Government, the Global Polio Eradication Initiative, and other partners to stop the transmission of the poliovirus and completely eradicate the disease from Nigeria. So far this year, Nigeria has seen zero new cases of paralytic polio,  with the last case declared in Nigeria on 24 July 2014. This is significant for Nigeria, which was one of only three countries in 2015 still considered endemic. In Africa as a whole, the entire continent is now non-endemic for poliovirus.

eHA continues to implement polio projects in Nigeria through Polio Immunization Plus Days (IPDs) that focus on Vaccinator Tracking and an eTallySheet pilot. These ensure all children in Nigeria are polio free.

Vaccinator Tracking and the eTallySheet Project

In the Vaccinator Tracking program, eHA equips field vaccinator teams with GPS-enabled phones which are carried throughout the course of IPDs. The phones pick up and track the geographic coordinates of the settlement locations visited. Tracked coordinates are then uploaded by eHA staff into a custom Vaccination Tracking System (VTS) dashboard that state health administrators and partners can access during daily campaign review meetings. These meetings happen at local government and state levels with the purpose of monitoring field vaccinator team movements, discussing the  percentage of geo-coverage achieved that day, and ensuring settlements missed by vaccinator teams are targeted during the fifth and final day of the campaign (known as a “mop up” day).

The eTallySheet (eTS) project is funded by the World Health Organization and the Gates Foundation and provides a digital method of gathering immunization information during polio vaccination campaigns. Benefits include the timely digital submission of data and validation of population estimates (specifically for children under five) in areas known for poor enumeration data, high growth populations, and migratory populations. eHA also provides GPS-enabled phones with Open Data Kit collection forms to locally recruited eTS supervisors. These supervisors follow house-to-house vaccinator teams during IPD campaigns, and record important vaccination data per household visited.

March 2016 Immunization Plus Days

The March IPD campaign took place from March 19-22. While eHA staff usually support vaccinator tracking in the Northern Nigeria region, this campaign involved project field officers being deployed to 10 southern states(Cross River, Bayelsa, Edo, Ondo, Oyo, Osun, Ogun, Lagos, Ekiti and Delta). They carried out vaccinator tracking activities and eTS implementation across 60 wards in 26 Local Government Areas (LGAs). A total of 63 eHA field officers were deployed to train, supervise and monitor 279 locally-recruited eTS team supervisors.

The field teams encountered unique experiences and challenges during this IPD round due to their deployment to new states with unfamiliar terrains and infrastructure. Many ward destinations were a long distance from the campaign take-off points (up to five hours travel time), so some teams were unable to get back in time for day-of uploading of collected data. In some LGAs, teams were delayed while resolving issues with local governments, resulting in long days. Awareness of security challenges required practical strategies to keep the campaign moving forward efficiently.

The eHA team saw great enthusiasm and excitement from local health workers regarding vaccinator tracking. Locally-recruited eTS supervisors were fully engaged in the eTS application training and mastered it quickly. In Northern Nigeria, house-to-house vaccinations were the main focus, however in Southern Nigeria, vaccinations were administered at churches, markets, and mosques.

A Successful Campaign

In the end eHA field officers successfully conducted the vaccinator tracking and eTS implementation exercises for the March IPD campaign. We look forward to the next IPD campaign May and remain committed to supporting the Nigerian government to achieve it’s goal of receiving the World Health Organization’s polio-free certification by 2017.

Enhanced Health Camp Training

Since answering the call in 2014 from the Kano State Polio Emergency Operations Center (EOC), eHealth Africa (eHA) is a regular partner for driving Health Camp support for Immunization Plus Days (IPDs, which take place in Kano State’s 44 Local Government Areas (LGAs). As part of the National Polio Eradication Program in Nigeria, eHA is supported by the Bill and Melinda Gates Foundation.

What are Health Camps?

Health Camps were created and incorporated into IPDs with the goal of incentivizing community members to receive polio vaccinations for their children, aged 0-5 years. The incentive was created by providing free medicines through health camp boxes, as well as free consultations with a community health worker. If the consultation results in a health need that goes beyond the scope of the health box, the patient is referred to a hospital for needed treatment.

Health Camp workers are a valuable and sustainable resource for Nigeria’s health infrastructure. Having properly trained clinicians and assistant clinicians working in close partnership with local health workers contributes substantially to obtaining more practical, effective, and culturally relevant health care delivery systems at a community level.

Enhanced Health Camp Training

Because of the importance of the health care worker in the efficiency of Health Camps for their local communities, eHA is designing the Enhanced Health Camp Training as an intensive and engaging learning environment to increase the skills and teamwork of health workers.  The target audience of the training program will include Local Government Immunization Officers, Essential Drug Officers, and community health workers (clinicians and assistant clinicians).

eHA's community health trainers will facilitate the training, alongside Kano state’s EOC partners. This new enhanced training will be implemented in a series of graduated steps that, when completed will instill confidence and ensure a smooth performance of the health camp workers.

The Training Curriculum

To create the Enhanced Health Camp Training, eHA staff will begin by identifying the health needs, priorities, and resources from the Kano State Primary Health Care Management Board, other partner organizations, and communities themselves. These requirements will then be translated into a curriculum which will be used by trainers, and will create an evaluation process measuring the outcome of the training.

The training program is anticipated to be conducted once, before the March IPD round, to last four days: one day for hand-off training of curriculum for trainers themselves, one day for training at the state level, and a two-day LGA level training during the 2016 IPD months.

An important goal in creating this training is ensuring it covers the comprehensive needs of the EOC. That is why EOC leadership will play a crucial role in spearheading the training and direct it toward solving local needs at the EOCs.  

The expectation on data following the training is that the quality of Health Camp data will increase. This increase in quality should go hand in hand with a reduction in human factor data errors, reducing the rate of data cleaning required per round.

Enhanced Training for Better Results

Expanding the knowledge and skills of Health Camp workers to assume more responsible roles in primary health care programs is a productive and rewarding experience for the trainees, for other health professionals, and for community members. Most Health Camp workers have many years of experience tending to family members health problems. They are dedicated to serving their patients and are eager to expand their skills in providing better healthcare to communities. The Enhanced Health Camp Training will build upon the wealth of knowledge and experience staff already possess.

The training will also help facilitate the expanded scope of eHA, and initiate direct contact with Health Camp workers in all LGAs, providing a tool to give regular field feedback. Enhancing the role of these practitioners and promoting closer collaboration between them and medical community offers new hope for improving the overall health of individuals and families through sustainable primary health care programs in Africa.

Africa Healthcare Summit

In London, Adam Thompson showcased eHA’s innovative approach of engaging with the private sector to improve healthcare outcomes in West Africa.

The Executive Director and Co-Founder of eHealth Africa Adam Thompson was recently in London, where he spoke at the Africa Healthcare Summit (17-18 February). He spoke as part of a panel looking at the roles that NGO partnerships play in improving healthcare for people across the African Continent.

Mr Thompson focused on the innovative approach that eHA played in responding to the Ebola response that affected West Africa. He talked about how the eHA team set up the Emergency Operations Center (EOC) in Lagos, Nigeria at the very beginning of the Ebola outbreak, directly procuring services from private sector organisations. These included telecoms companies for services to allow health care workers to track Ebola cases in the field, gas stations for emergency response vehicles, and internet service providers for connectivity to run the EOC.

By adopting a more creative approach and working with the private sector as a partner rather than vendor (which is normally a lengthy formal tendering process), the EOC was set up in one week. This resulted in Ebola being contained within months in Nigeria, and only 20 cases across the country. Guinea, Liberia and Sierra Leone also adopted this approach, and eHA played a crucial role in the setting and scaling up of both EOCs and call centers within months. This was an extraordinary achievement given the logistical challenges and scale of the problem.

There were a large number of high profile delegates present, including eight Ministers of Health, representatives from the African Development Bank, and numerous Senior Managers from leading private sector health companies across Africa, including Siemens Healthcare.  Notable speakers from Nigeria included the Honorable Minister of Health Professor I.F Adewole, who focused on how the President of Nigeria is placing a high priority on health system strengthening given current challenges. The health policy is being reviewed, which includes developing a health ICT framework. We hope that this framework will ensure that millions more from remote areas of the country will now have access to health care.

The second day of the summit focused on discussions around public-private partnerships, improving primary healthcare in Sub-Saharan Africa, and the importance of Non-Governmental Organization (NGO) partnerships. The conference overall was a great opportunity to witness how private sector partnerships play a vital role in tackling priority global health challenges.

A Strong Partnership: Kano State and eHealth Africa

The Kano State Primary Health Care Management Board renovation project provides the right facilities for staff to deliver crucial primary health care interventions across Kano State.

eHealth Africa (eHA) is finalizing a project with the Executive Secretary (ES) of the Kano State Primary Health Care Management Board (KSPHCMB), Dr. Muhammed Nasir Mahmoud, to renovate and upgrade the KSPHCMB’s Offices in Kano, Nigeria.

eHA worked for one month with the KSPHCMB to renovate the building and outside areas. Internet, solar panels, electricity and other facilities were added to provide a better work environment for the Executive Secretary and over 50 staff working for the KSPHCMB. “I believe if one has a conducive environment to work in with the right equipment, tools, and facilities, there should be no reason for people not to work effectively,” said Dr. Mahmoud.

Dr. Mahmoud, has been in the role for over six months, and has seen a real difference in how stakeholders and visitors now see the board’s work through the building’s renovations. He manages the day to day activities of the KSPHCMB, and also oversees the activities of 1,143 Healthcare Facilities in 44 Local Government Areas of Kano State.

“When I came, the place had a lot of issues and was dilapidated,” said Dr. Mahmoud. “The renovations have built up KSPHCMB’s portfolio and general standing in the community. People come here everyday now, and are always impressed with the changes they see, which makes me proud to head this organisation.”

"Today’s world is a technological world, and without technology people will continue to be disadvantaged. I believe the innovations of eHA will continue to benefit us and other sectors in Kano." - Dr. Muhammed Nasir Mahmoud

The renovation project is one component of the joint work and long term partnership between  eHA and the KSPHCMB to improve primary health care in Kano State. Kano State has many challenges in health care delivery because of security issues and physical challenges in reaching remote locations. This results in the most vulnerable segments of society falling severely ill with preventable and treatable diseases including malaria, tapeworms, ulcers and diarrhea.

Collaboration projects between eHA and KSPHCMB include the management and coordination of immunizations across the state, a health communication system (Kano Connect), management of Emergency Operation Centers, Geographic Information Systems (GIS) tracking, and the implementation of Health Camps linked to monthly Immunization Plus Day (IPD) campaigns. Another collaboration is Vaccine Direct Delivery, which takes vaccines from KSPHCMB cold stores and directly delivers them to rural health facilities.

“I have been partnering with eHealth Africa for many years,” said Dr. Mahmoud,”and we are currently working on signing a MoU to strengthen communication within the primary health care system. I know there are many areas where we will continue to partner with eHA, and I hope we will continue to explore these other areas. Today’s world is a technological world, and without technology people will continue to be disadvantaged. I believe the innovations of eHA will continue to benefit us and other sectors in Kano.”

pGNOSIS train eHA GIS staff on cutting edge Geospatial Open Source Software

In early February, twenty members from eHA’s Geographical Information Systems (GIS) team based in Kano, Nigeria completed training in a suite of leading Geospatial Open Source Software called QGIS.

QGIS is a desktop application that will allow GIS to view, edit and analyze geospatial data from a variety of formats. It will play a large role in supporting the transitioning of polio assets from eHA to the Nigerian Government, which is a crucial part of building local capacity for the polio legacy. Training was delivered by pGNOSIS UK, a UK training company which has a partnership with Boundless, the world’s leading geospatial IT solution company. Training specifically focused on QGIS, PostGIS and Boundless standard for Geoserver training.

“Technical training and re-training is crucial to the continuous growth of our GIS work,” said Dami Sonoki, eHA’s Geographic Information Systems Team Manager. “Continuous training will improve the competence of the workforce, and keep up with the fast paced growth in software and technology. This will ensure our work solves priority healthcare challenges like finally eradicating polio in Nigeria, and ensures local communities get the health care services they deserve.”  

Guinea’s Community Health Empowerment Through Technology

eHealth Africa (eHA) continues its close collaboration with Guinea’s Ministry of Health by contributing to their efforts to reform the country’s healthcare system, with supporting funds from The Paul G. Allen Ebola Program.

In January 2015, eHA launched Guinea Connect in the prefecture of Pita, by helping health facilities produce their very first digital monthly reports. Guinea Connect was designed by eHealth Africa's Berlin based Global Informatics Department and is being locally managed by eHA Guinea’s Information and Communication Technology team. Guinea Connect’s objectives are to incorporate data-sharing mechanisms and centralize health facility data from primary health care providers. The program will enhance the overall health systems communication and allow for rapid and effective decision making.

Guinea Connect is a not a stand alone system, it is one aspect of eHealth Africa's Integrated Community Health Post Pilot program, which was launched in September 2015 in the sub-prefecture of Timbi Tounni. The program covers eight districts in the sub-prefecture. Overall, the program is piloting the use of an eHealth data collection application, automating health facility monthly reports, creating a ministerial closed user group, and introducing an e-learning platform to community health workers. The platform will support Guinea’s Ministry of Health’s capacity building program for its agents.

The pilot program also entails refurbishing six Health Posts, building one Health Post, transforming the former health center building into a residential facility for center workers, and building a new suitable Health Center. eHA will temporarily support operations in all facilities and gradually hand over to a newly created Community Association, which will ensure sustainability. The association will be composed of members from existing community groups and the diaspora.

Local authorities, Ministry of Health officials, as well as the community members welcomed the program and the opportunity to work together with eHA in improving the area’s health system. In December  2015, community members had the opportunity to express their gratitude directly to the Paul G. Allen Ebola Program's Deputy Director Brennan Banks, who visited the project area.   

eHealth Africa Hosts Jigawa State Delegates

In January, Executive Director and Co-Founder of eHealth Africa (eHA) Adam Thompson hosted a team of nine delegates from the Jigawa State Government. The Jigawa State team included Deputy Governor Ibrahim Hadejia and Commissioner for Health Dr. Abba Umar, Commissioner of Education Rabia Eshak, Commissioner of Lands and Regional Planning Honorable Adamu Sarki Miga, and the Commissioner of Water Resources Ibrahim Mohammed Garba Hannun Giwa.

The meetings started with an introduction by Adam Thompson, followed by a presentation by eHA Geographic Information Systems (GIS) Department Manager Dami Sonoiki. Dami provided insights on geospatial data, which is currently being hosted by eHA to benefit the Nigerian Government.

The session included a breakdown of eHA’s GIS technologies, distribution of data management  and open source data versions and systems. Dami recommended that a distributed data management and versioning system using an open source data platform could be used by  Jigawa State to effectively manage and share data. After a brief breakout session, eHA’s Deputy Country Director Atef Fawaz led further discussions on eHA’s other projects and programs.

The last activity of the visit was a comprehensive tour of eHA’s Kano campus. The delegates were impressed with the many facilities on the campus, and thoroughly enjoyed the tour.

Ebola Rapid Diagnostic Test Pilot Training

eHealth Africa provided operational and logistical support to the Ministry of Health and Sanitation (MoHS), and the U.S. Centers for Disease Control and Prevention (CDC) for a pilot two day training session for MoHS swabbers and surveillance officers in Western Area and Kenema, Sierra Leone. The training focused on the implementation of Orasure’s OraQuick Ebola Rapid Screening Test (RST) in routine dead body swabbing. This pilot is being implemented to inform an upcoming national rollout of the OraQuick RST, scheduled for February or March this year.

A common cultural practice in Sierra Leone is for a group of family members to wash and prepare the deceased relative before burial. This practice was discontinued by the Government of Sierra Leone (GoSL) during the Ebola outbreak in an effort to curb transmission. Safe and Dignified Burials (SDBs) were introduced by the GoSL as an alternative burial method for family members by qualified and properly attired health care workers.  The Ebola outbreak has significantly decreased, so the GoSL has began to allow family members to bury loved ones as long as the individual has not met the Ebola case definition before expiring. A swab of the body is taken before the body is approved for burial and delivered to a regional laboratory for testing. Due to a lack of resources, swab laboratory confirmations can take 2 - 5 days on average before the family is informed of the result, and sometimes longer. The benefit of point-of-care tests like OraQuick,  is that family members can be notified of presumptive results almost immediately, which enables the deceased to be released with confidence to family members within the same day.

OraQuick is easy to perform and requires only a drop of blood from a finger prick or swab from the oral cavity of a live patient. A swab from the oral cavity of the deceased may also be used for testing. The tests can be performed onsite, require minimal specialized training to perform, and produce a presumptive result in only 30 minutes. The RST has received U.S. FDA’s Emergency Use Authorization approval. When testing deceased bodies, only OraQuick has been cleared for use.

The goals for the training and implementation of RST testing was as follows:

• Provide a reliable, simple, and rapid Ebola testing technology option.

• Improve compliance with dead body swabbing which enhances surveillance.

• Provide alternate technology for presumptive POC diagnosis of suspect EVD cases, and manage more effectively the number of samples submitted for Ebola RT-PCR analysis.

The training was highly effective, and produced the following results:

• 38 DSOs, swabbers, and surveillance officers were trained on the OraQuick Ebola RST Protocol.

• Participants were refreshed and re-trained on proper PPE protocol and procedures

• The training confirmed the existing surveillance system supports the developed RST protocol.

• Surveillance teams in the Western Area and Kenema will collect OraQuick Ebola RSTs over the next three weeks.

The swab teams will receive certificates of completion at the end of the three week pilot from eHA and the CDC. They directly engage with local communities during the testing process and  have received positive feedback and willingness from households and family members to have their loved ones tested for Ebola using the RST device.

Lessons From The Field For eHA Program Designers

In 2016, eHA seeks to continue discovering and designing strategies and solutions to deliver healthcare to some of the hardest to reach areas in Africa. To design and create the right technology and information tools for health workers, the software and hardware must be developed and chosen to address the obstacles and needs of healthcare workers where they work and in the conditions they face.

Lucy Chambers is the eHA team member working on Kano Connect, based in Kano State, Nigeria. Kano Connect increases health worker communications, provides an mHealth platform for key reporting activities in supervision for routine immunizations, a vaccine supply management application, and a closed user group for health professionals to send and receive alerts and enable discussions. Lucy’s work also takes her to Nigeria’s capital, Abuja, as she works with team members on the a dashboard for program analysis in the Polio Emergency Operations Center (Polio EOC) and the Vaccine Stock Performance Management Dashboard with the team at the Department of Logistics and Health Commodities.

Lucy has experienced the benefits of being in the field, and seeing firsthand what healthcare workers face with regards to the technology they use.

Here are a few tips she has to keep in mind when creating programs for healthcare workers in the field.

1. Hard to reach means 'really, really hard to reach' by European standards. In many projects around Nigeria, you will see the category 'Hard to Reach' (HTR). Even if you have to go on a motorbike to get to a settlement nearby, it’s still not hard to reach by African standards. If you hear HTR in Africa, think boats or helicopters. Think riding as far as you can in a car before you run out of roads, followed by a motorbike trip, followed by a boat trip across a large river, and then a long walk to finally reach the settlement. At that point, you can say you’ve reached a truly Hard To Reach settlement. You can never make assumptions about any infrastructure that these settlements have which makes having people on the ground to test on site essential to any requirements gathering.

2. One of the most common things you have to design and plan for is competing priorities. Health workers are working hard in the field and are pulled in many different directions, and are required to multi-task and prioritize while working with a great deal of autonomy. With these amounts of competing priorities, it’s crucial that the tech tools we create truly save time and that health workers can see the benefits of their work in real-time. With programs like the Vaccine Stock Performance Dashboard coming online, the health worker can refer to it for logistics, prioritization, and to ultimately save time.

"...it’s crucial that the tech tools we create truly save time and that health workers can see the benefits of their work in real-time."

3. If you are making a dashboard, make it highly screenshotable. Data and information from health applications must have more than just the health worker as a potential audience. Screenshots are often used to add to presentations and trainings at the local EOC (Emergency Operations Center). It is important that all the info needed can be displayed on the screen as is not cut off, and that it appears clear to the eye from far away. That means color combinations must make information legible for not only mobile phones and tablet screens, but also for large conference room screens and slide decks.

The MAPS Toolkit: An Assessment & Planning Tool for Scaling and Sustaining Mobile Health Interventions

By Nikhil D. Patil, Monitoring, Evaluation, & Research (MER) Department Manager at eHealth Africa

The Global mHealth Forum is a two-day event convening during the mHealth Summit, one of the biggest annual gatherings of mobile health professionals and entrepreneurs, globally. Presented in partnership with USAID and the mHealth Working Group, this year’s Global mHealth Forum took place in Washington, DC from November 9 - 11, 2015 and was attended by more than 4,000 delegates from around the world. The 2015 focus was on mobile and connected health in low and middle income countries.

One of the sessions that Taylor & I were most excited about was an interactive presentation on the newly released MAPS Toolkit: mHealth Assessment and Planning for Scale. The MAPS Toolkit was officially launched in September 2015, and the Global mHealth Forum was one of the first public meetings for stakeholders, partners, and beneficiaries to engage with the toolkit.

The MAPS Toolkit is a “comprehensive self-assessment and planning guide designed to improve the capacity of projects to pursue strategies that increase their potential for scaling-up and achieving long-term sustainability.” This tool is designed for use by project managers, specifically teams with an mHealth product that has already been deployed, and who are aiming to scale the product and increase impact. While global health experience formed the tool, its use can be expanded far beyond the health context and into related fields like economic equality and agricultural production. The toolkit was developed by a consortium of partners including the WHO Department of Reproductive Health and Research, the UN Foundation, and the Johns Hopkins University Global mHealth initiative.

Harnessing feedback from mHealth implementers and technical experts on their experiences with scaling mobile health interventions in the field, the MAPS Toolkit provides a framework for scale and sustainability using six major “axes”: groundwork, partnerships, financial health, technology & architecture, operations, and monitoring & evaluation. These six axes contain a set of structured questionnaires for both team members and teams as a whole with a resulting scorecard that will help projects gain a better understanding of where that project needs to go on its “journey” towards scale and sustainability. The toolkit also serves as a decision tool, helping implementers devise strategies to overcome barriers to scale. The activities contained within the toolkit are meant to be iterative and completed multiple times throughout the life-course of the project post-pilot.

According to the MAPS Toolkit, these are the six axes of scale, key determinants of successful scale-up and sustainability relevant to all mobile health projects:

1. Groundwork: The initial steps of specifying the key components of the project’s approach to scaling-up, assessing relevant contextual influences, and taking stock of the scientific basis for the product

2. Partnerships: Collaborations with external groups to support the process of scaling up, including strategies for identifying, developing and sustaining fruitful partnerships

3. Financial Health: The projection of scale-up costs, and the development of a financial plan for securing and managing funds over the long term

4. Technology & Architecture: Steps taken to optimize the mHealth product for scaling up based on its anticipated user base, purpose, integration with information systems and compatibility with other components of the information systems architecture

5. Operations: Organizational and programmatic measures for supporting the implementation, use and maintenance of the product throughout the scaling-up process

6. Monitoring & Evaluation: Decisions and activities that enable effective process monitoring and in-depth outcome evaluation, based on project and stakeholder needs

The presentation was extremely insightful for both Taylor & I, and the six interactive sessions following the introduction prompted us to discuss areas where we felt “weak” and “strong” with regards to projects within eHealth Africa’s product portfolio. Based on our experience with designing, implementing, and scaling mHealth products in low-resource settings, we felt the toolkit had a two main limitations.

First, the toolkit specifically states that it was designed for products that have already been deployed in the field, presumably an mHealth intervention that experienced proven “impact” in the pilot phase and is now looking to deliver value at scale. However, we feel that scale really should be considered prior to product development as there are key design factors related to the way that mHealth products are built that determine how and where the product can scale and be sustained. Building a product for 1,000 users is different from building a product for 10,000 users, which is different from building a product for 100,000 users. Invoking the recently developed Principles for Digital Development, a complementary tool that could be used prior to deployment would also be beneficial to mHealth organizations to ensure we’re ideating new products with scale in mind from inception. Fortunately, the toolkit’s axes are broad enough categories that they can provide a loose framework useful for program planners for this purpose. We were excited to chat with Dimagi at the mHealth Summit about their newly released Maturity Model which somewhat addresses this issue.

Second, assessment tools such as the MAPS Toolkit can require considerable resources and time on behalf of the implementing organization - including conducting the assessments and developing action plans to implement changes based on those results. In order to integrate the results of the MAPS Toolkit into scale and sustainability planning for mHealth products, donors and other stakeholders will need to see the value in such a tool and contribute funding for routine assessment & mid-course corrections throughout the journey to scale. Advocates for the toolkit should work with donors and encourage them to invest in the tool (financially) when working with implementers that are ready to scale their mHealth products.

Given the scope of the MAPS toolkit, there is definitely great potential to use it internally at eHA to better understand where our various mHealth products are and how we can help them scale across West Africa. We are excited to test out this tool and identify areas where eHA can improve our internal sustainability models to ensure impact at scale for our portfolio of mHealth products.

Nikhil D. Patil is the Monitoring, Evaluation, & Research (MER) Department Manager for eHealth Africa and is based in Kano, Nigeria. You can follow him on Twitter & Instagram (@npatil55). Taylor M. Snyder is a MER Consultant with eHA based in Salt Lake City, Utah. You can follow her on Twitter (@TaylorMarie_MPH).

The International Training of Trainers on Sweetpotato

Stephanie Okpere in Sweetpotato field during the ToT Training, ARMTI, Ilorin.

The International Training of Trainers (ToT) on "Everything You Ever Wanted to Know about Sweetpotato" was held in Ilorin, Kwara State, from October 5 -16. It was a 10-day intensive program, organized by the Agricultural and Rural Management Training Institute (ARMTI), the Federal Ministry of Agriculture and Rural Development, and the Government of Nigeria. eHealth Africa (eHA) was represented by Stephanie Okpere, Project Coordinator from the Nigeria office. Stephanie’s training was sponsored by the International Potato Center (CIP). 

ToT was organized as part of ARMTI's goal to train "extension personnel" on the latest developments in Sweetpotato production and utilization across Africa. ARMTI in the last three years has jointly organized this course with the CIP, and Helen Keller International’s and Reaching Agents of Change project. The ToT course aims at increasing investments in the Orange-Fleshed Sweetpotato (OFSP) to combat vitamin A deficiency among children and women of reproductive age.

"The Sweetpotato ToT Course was a great learning experience both in theory and practice. I did a presentation of the training to over 200 staff members of eHA, and also did a step down training on sweetpotato for 35 field personnel in Kano." Stephanie Okpere, Project Coordinator

Stephanie Okpere conducting step-down training in Kano.

ARMTI also seeks to build the capacity of public sector extension and NGO personnel to effectively implement initiatives aimed at promoting the dissemination and appropriate use of Vitamin A-rich OFSP in the value chain.

“The training on Sweetpotato to eHA staff was a great opportunity to build our programming capacity in OFSP-based Nutrition & Food Security interventions, and Agricultural Commodity Value Chain Drive in Kano and other States in Northern Nigeria.” - Dr. Sarma Mallubhotla, Program Manager, Health, Nutrition and Agriculture

Dr. Sarma Mallubhotla addressing the trainees in eHA.

Click here to read about the use of the Orange-Fleshed Sweetpotato to fight malnutrition in Africa.  

Information, Inspiration, & Equality: Reflections from the American Public Health Association 2015 Conference

by Nikhil D. Patil, MPH

In early November, I joined 12,000 of my fellow public health colleagues in Chicago, Illinois for the 2015 Annual Meeting of the American Public Health Association (APHA). APHA is a venue for public health professionals and leaders from around the world to discuss and share evidence and strategies for improving the health of populations, domestically and abroad. The theme for the 143rd meeting was “Health in all Policies,” highlighting the impact of where someone lives, works, learns, and plays on their ability to live a healthy life. The event focused on how we can create policies at community, state, and federal levels to ensure the scale and sustainability of public health interventions. 

Dr. Vivek Murthy, MD, MPA, the US Surgeon General reflected on this theme in his opening plenary saying “health has to be woven into every strand of public policy,” reminding all attendees that we must all step up and be the leaders that our world needs. He spoke of three elements at the heart of public health leadership: information, inspiration, and equality. First, public health needs to adapt to changing information platforms and identify the best avenues for communicating health messages. The information we communicate matters, but how we communicate that information is just as important and will require that public health modernizes its approach to reaching people through relevant channels. Second, information is not always sufficient to change behavior. Inspired messages through innovative platforms are necessary to increase people’s agency and empower them to live healthier lives. Finally, equity is central to public health practice and in order to remove inequality, every life has to been seen as valuable. 

He is hopeful about public health and the progress we’ve made in the field, saying “this is how we will change the world together: by modernizing how we share information; by finding ways to inspire and support people in their pursuit of health; and by ensuring we are creating a world that is grounded in equality, a world where opportunity is available to all.” I can’t think of a statement that is more reflective of the values eHealth Africa holds as an organization.

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Responding to this year’s theme, I was in attendance to present a poster on behalf of my Geographic Information Systems (GIS) and Monitoring, Evaluation, and Research (MER) colleagues. Titled “Mapping telecommunications coverage at public health facilities in Northern Nigeria,” the presentation focused on equitable mobile coverage being necessary to support mobile and electronic-health interventions, particularly in low-resource settings. The poster discussed a GIS-enabled methodology for modeling estimates of telecommunications coverage at public health facilities across Kano State, mapping two out of the four mobile network operators in Kano. The modeling methodology used a radio frequency approach and required location coordinates for cell towers and public health facilities; results estimated an overall low telecommunications coverage at health facilities across Kano. A methodology useful for program planners of mobile health programs, we advocated for the role that governments can play in developing policies to encourage improved mobile network infrastructure to support mHealth programs across the state, in partnership with the private sector telecommunications industry. 

eHA’s poster fit under APHA’s “Health Informatics & Information Technology” (HIIT) poster and presentation section. The accompanying poster presentation I gave was well-received. Several of the HIIT attendees requested additional information and connections with eHA and our services, which I look forward to following-up. Overall, the conference was well organized, although a bit hectic due to multiple, simultaneous meetings and presentations making it difficult to see and meet everyone. However, I left the conference excited about the advancements that my fellow public health colleagues were making to improve the health of populations around the world, and inspired to share some of what I learned with my colleagues back in Nigeria.

Nikhil D. Patil is the Monitoring, Evaluation, & Research Department Manager for eHealth Africa and is based in Kano, Nigeria. You can follow him on Twitter & Instagram (@npatil55).

eHA at the Global Health Supply Chain Summit 2015

The Global Health Supply Chain Summit was held 11-13 November, 2015 in Dakar, Senegal. The summit focused on the coordination of people, products, and processes to maximize the impact of global health supply chains.

Summit attendees heard case studies, strategies, and frameworks to better coordinate global health supply chains logistics and implementation. Country planners, pharmaceutical industry reps, and NGOs including eHA joined an array of renowned industry professionals and representatives from multiple countries. The summit was presented in both English and French.

Presentations & Strategies

eHA’s Director Adam Thompson was a presenter, along with eHA’s Adia Oroghene. They presented two studies, focused on:

1. Passive Voltage Monitoring and Implications for Cold Chain System Capacity

2. Vaccine Last-Mile Supply Chain in Kano, Nigeria

Key Take-Aways

The key points below summarize the case studies, reviews, and strategies discussed at the summit:

1. There is a need for public/private sector partnership in the supply chain model, where the private sector takes up the burden in the last mile of delivery

2. Donor funding should focus on low income countries

3. Insurance schemes should fund a large portion of the supply chain model

4. As the private sector takes up responsibilities in the supply chain partnership, human resources are vital for taking competency into consideration

5. Drug regulation will ensure quality in the supply chain

6. Drones are the future of last mile delivery solutions. Drones are already being used for shipping humanitarian commodities where needed, for example, in Nepal

7. Drone projects will be launched in 2016 in East Ghana by the US Centre for Global Supply Chain Management

8. The use of mathematical models in simulating supply chains is still important, and remains the best way to provide visibility for supply chain optimization

9. The GAVI Vaccine Alliance (GAVI) has approved a new supply chain strategy focused on ensuring vaccine availability, vaccines are highly efficient resources for the supply chain

10. GAVI have expanded to include non-vaccine demands

11. GAVI’s goal is to ensure vaccine coverage and equity, making sure they are accessible in both urban and rural areas for anyone who needs them

12. Voltage fluctuation is a challenge which affects the lifespan of cold chain equipment

13. Availability of voltage fluctuation data would help manufacturers design future cold chain equipment for Africa.

Connections Made

While at the summit, eHA made connections with other organizations to talk about the future of supply chain partnerships. These organizations included PATH (Seattle), Axios (Nigeria), the Federal Ministry of Health (Nigeria), GAVI (Geneva), and USAID (Nigeria). The summit was a great opportunity to streamline supply chains, thereby increasing the speed and delivery of global healthcare.

Want to explore more about the Global Health Supply Chain Summit? Visit their website at http://ghscs.com/.