Sustaining impact: Lessons from Kano Connect’s handover

By Fatima Adamu and Abdullahi Halilu Katuka

Kano Connect is a communication and information sharing platform developed by eHealth Africa, with funding from Bill and Melinda Gates Foundation in 2014. It features electronic management tools such as comprehensive directories of all the health facilities and health workers across all levels in Kano State. Using the platform, health workers can submit and review reports on routine immunization from their mobile phones or through a dashboard.  Health workers on the Kano Connect platform can access the contact details of any staff and communicate for free within a closed user group resulting in prompt and quality reporting, improved visibility and effective accountability.

In 2016, eHA officially handed over the Kano connect project to the Kano State Primary Health Care Management Board. However, we continue to provide support and guidance in line with our vision. Prior to the handover, reporting rates through the platform were at an average of 25%. After the handover, reporting rates increased to an average of 95%.
This demonstrates the importance of working hand in hand with the states which we work in to ensure  the sustainability of our projects and our impact.
In this blog post, we share 2 key lessons from eHA’s approach to building state ownership of the Kano Connect platform

Lesson 1: Build capacity
In the course of the Kano Connect project, eHA conducted a total of 21 trainings and workshops for over 1400 health workers across all administrative levels of the Kano state health system. The health workers worked on diverse thematic areas such as Maternal and Child Health, Nutrition, Pharmaceutical Services, Epidemiology and Disease Control and Routine Immunization.
They were trained on how to use an android phone, send Routine Immunization supportive supervision reports using the Open Data Kit (ODK) e-forms, how to use the dashboard for decision making, reporting through the LoMIS Stock applications, using the LoMIS Stock dashboard for decision making ensuring that all the stakeholders understood the platform.

Lesson 2: Train your Replacement
eHealth Africa trained 5 health workers as the pioneer members of the Kano Connect Operations Unit to manage the day to day running of the Kano Connect project. The unit members were trained on the standard operating procedures of the eHA Kano Connect team and how to execute daily tasks including:  

• Administrative management of the Kano Connect project

• Capacity building of Kano Connect users, including onboarding of new users

• Dashboard management (updating, adding, and deleting user information)

• Collation of summary reports from dashboards

• Information and data management through form hub

• Conducting surveys (paper-based and electronic)

“Presently, I’m a data management officer for Kano Connect. eHealth Africa trained me and other Kano Connect operation unit staff to manage Kano Connect dashboard issues like updating, adding, and deleting user information and exporting Information and data management through form hub to populate a report”

— Shamsuddeen Muhammad, Kano Connect Data management officer

Presently, Kano Connect is piloting its e- learning mobile application and dashboard  in three local government areas: Fagge, Nassarawa and Gabasawa local government areas in Kano State. Kano Connect eLearning provides access to learning materials and resources that health workers can access on their mobile devices.

Once again, eHealth Africa is partnering with Kano State to ensure that that knowledge gaps are identified and that health workers can gain skills and knowledge for improved health delivery.

Aether - An interview with the team

eHealth Africa developers are active in a number of open source communities. Indeed, many of eHA’s solutions have incorporated open source software such as Open Data Kit (ODK), CKAN, OpenHIE, DHIS2, and Humanitarian OpenStreetMap (HOT).  We are just weeks away from giving back to the community in the form of two new projects - Aether and Gather. We’re excited to support others who are developing solutions for the global good.

We interviewed the team behind eHA’s Aether to discuss the reasons why they created an open source development platform for data curation, exchange, and publication.

Aether is being developed by a multi-country team working in three different continents, so it was a challenge to sit down with them all in one place. Still, we talked with four people key to its development and asked them what exactly Aether is and why eHA decided to create it. Our conversation included the Director of eHA’s Global Health Informatics Dave Henry, Aether Product Manager Doug Moran, Systems Architect Shawn Sarwar, and Technical Team Lead Adam Butler.

Why is eHA developing Aether?

During our discussion, Shawn Sarwar explained that throughout eHA’s years of experience developing ehealth solutions we faced recurring challenges when scaling the impact of our products within the communities we serve.

Although eHA develops great tailored solutions for specific problems and customers, we were not always leveraging possible synergies between different projects. Shawn gave three reasons why solutions are typically been developed as stand alone projects:

1. Customization can create maintenance challenges. When multiple customers use a particular solution, a certain level of customization is required. The various codebases can drift apart, making it difficult to apply bug and security fixes across all of them.

2. There isn’t always a standard set of components across projects. One team may know one technical stack, while another could have a different preference. This leads to the siloing of potentially useful components according to people’s comfort and familiarity.

3. Almost every project needs to integrate with one or more external systems. Because of this requirement, teams normally plan to write their own integration to exchange data between different applications.

As a consequence, we became very good at creating variations of common solutions. But instead of reinventing the wheel each time, what if we could capitalize on a framework for the development of ehealth solutions? This, Dave Henry explained, is what drove eHA to develop Aether.

He explained that these challenges are not unique to eHA; they point to a broader issue that slows development and deployment of many healthcare systems. Information and Communication Technology (ICT) solutions for global public health use cases rely heavily on open source software, but while individual open source applications have been put to good use, the ability to integrate them into sophisticated solutions has been limited to countries with sufficient funding and visionary, determined leadership. Dave explained that even the most successful solutions leave behind a legacy of isolated data silos. Last September, eHA decided to wrangle these problems by setting twin goals:

1. Simplify the integration of popular ehealth applications.

2. Provide a consistent way for data to flow from these applications directly to where it needs to go.

Today the Aether team is pleased to announce the results of this effort: the Aether platform and it’s first companion solution Gather.

What is Aether ?

“Aether is a platform for data curation, exchange and publication.”

— Dave Henry, Director of Global Health Informatics, eHealth Africa

More precisely, it is an integrated set of tools and services that allows developers to connect to data sources, interpret data structures, and map attributes into a normalized set of entities defined by a formal schema. Aether flows the resulting data in real-time to one or more downstream destinations. The publication process is open and modular – the destinations receive data based on the schema (a de facto contract) and are completely insulated from the source systems. Data can be delivered concurrently to multiple destinations.

In this way, Aether facilitates the flow of data between data-producing and data-consuming applications, enhances data security and privacy, and accelerates the transmission of data between organizations. Basically, Aether allows for faster and more accurate data-driven decision making that helps save lives.

Aether helps organizations exchange health data faster and easier, but most of all it improves the productivity of developers that create ehealth solutions. According to  Doug Moran, Aether is a product built by developers for developers to facilitate their work and free them to focus on the actual solution rather than infrastructure. Solutions become easier to deploy, maintain, and upgrade than traditional one-off projects built from scratch.  By building on a common foundation, the software development process becomes well defined, predictable, and repeatable.

Basically, Aether is a framework of best practices for ehealth systems design. The Aether developers have done much of the dirty grunt work so that the project teams can do the exciting and heroic stuff that solves real problems for real people.

And what about Gather ?

Dave also talked to us about Gather, the first solution and use case built on the Aether platform. Gather leverages Aether and 3rd-party open source software to collect and distribute data collected during large scale field surveys, receives survey data from forms submitted via Open Data Kit (ODK), and ingests it into an Aether pipeline for processing and distribution. The Gather solution includes the ability to flow data into ElasticSearch / Kibana as well as the CKAN Open Data Portal.  The Aether platform services are used to package and operate the ODK components, the Gather user interface, the Aether core modules and the Aether publishers.  Gather is just the first – but arguably the most universal – use case that eHA will address with Aether.

Technical Team Lead Adam Butler elaborated on the implementation of Gather across the countries where eHA’s operates. He explained that in Sierra Leone, the CHAMPS (Child Health and Mortality Prevention Surveillance) network uses Gather to collect data as part of an initiative to identify and prevent child death. In Nigeria, the GRID (Geospatial Reference Information Data) project uses Gather to collect spatial reference data and other points of interest such as health facilities, schools, markets, and post offices to create a geo-database that the government uses for data-driven decision making. In the Democratic Republic of the Congo, the DRC Microcensus project used Gather to conduct a microcensus in the region of Kinshasa and Bandundu in order to predict how many people live in each settlement and estimate the total population for DRC, information that is playing a vital role in the current Ebola outbreak.

What is eHA’s vision for Aether ?

According to the Aether team, eHealth Africa’s goal is to establish and support a vibrant global community around Aether and Aether-enabled solutions. Aether serves three distinct purposes:

1. A platform for integrating, distributing, and operating sophisticated solutions for specific ehealth industry use cases.

2. A facility for organizations that are taking their first steps into data governance and (internal) application interoperability.

3. A controlled “on ramp” for organizations that engage in formal data sharing using international standards.

Aether will be launched as open source software this summer. Stay tuned for the release announcement!

“Solutions based on Aether enable faster and more accurate data-driven decision making that helps save lives.”

Improving Coverage Rates, One Track at a Time

By Emerald Awa- Agwu and Friday Daniel

The real story of Nigeria’s immunization coverage rates is told at the ward level. For over five years, eHealth Africa through the Vaccination Tracking System program has been supporting the increase in immunization and geographical coverage rates of 4017 wards across 19 states.

eHA, through the Vaccination Tracking System program (VTS), acts as the eyes of the immunization coordination teams at national, state and local government levels. They are able to gain a deeper understanding and insight into what exactly takes place at the wards, communities and settlements during the house to house immunization campaigns.

Debriefing at a state- level review meeting in Sokoto State

The VTS program uses software- encoded phones that track, record and store the coordinates of their locations- and all the vaccinators have to do is take the phone with them on their vaccination exercises. eHA also deploys project field officers to each local government area, to handle any technical difficulties and to ensure that the data from the phones are uploaded to a dashboard.  At the review meetings that take place daily, eHA paints a picture of how much progress has been made- breaking it down to local government, ward and if necessary settlement levels.

Why is this Important?

Nigeria has always struggled to improve Routine Immunization (RI) coverage rates. The major challenge was the discrepancy between the high number of missed children discovered during monitoring visits and the high numbers of vaccinated children reported by field vaccination teams. Stories and reports of vaccinators pouring away vacci nesor refusing to visit settlements were common but holding them accountable was difficult.

In line with eHA’s virtuous cycle strategic model, the Vaccination Tracking System program arms the federal and state governments, ministries of health and partner organizations with reliable data and insight, that they can quickly use to make informed, evidence-based decisions. VTS  is a game changer because it helps the immunization coordination teams- World Health Organisation (WHO), United Nations International Children’s Emergency Fund (UNICEF), National Primary Healthcare Development Agency (NPHCDA), Nigeria’s Federal Ministry of Health and partner organizations- discover exactly what settlements the  vaccinators have visited or not; as well as what locations they had visited within each settlement. VTS also gives the relevant partners a visual representation of which wards or settlements were underserved thereby, enhancing the ability of the national and state RI task teams to target such communities.

VTS motivates the ward focal persons (WFP) and LGA teams and removes the risk of complacency especially in wards with high coverage rates. Results of each campaign day’s activities are delivered by proportion of settlement type covered and overall percentage coverage for each ward. In other words, WFPs are told the percentage coverage of their wards that have been covered and locations where they need to pay more attention to. This inspires them to work harder and more efficiently.

VTS project coordinator, Friday Daniel at a ward- level review meeting in Sokoto state

VTS has improved the capacity of WFPs to investigate low coverage rates, get answers and where necessary, conduct trainings for the vaccinators. Through VTS, a WFP in Barawaga Ward of Bodinga LGA of Sokoto State discovered that his ward was recording low coverage rates, not because his vaccinators weren’t going to the communities but because they weren’t spending the required minimum time at each house. Empowered with this knowledge, he was able to train his vaccinators to observe best practices during the campaign. Where vaccinators consistently under- vaccinate, even after being trained, adequate actions can be taken.

The Vaccinator Tracking System is helping Nigeria, starting with the northern states to improve our coverage rates, one track at a time.

Increasing Sierra Leone's efficiency in disease detection with eIDSR

By Sahr Ngaujah

In a continued effort to increase the capacity of  Sierra Leone’s health systems, eHealth Africa (eHA) has partnered with the U.S. Centers for Disease Control and Prevention (CDC)  to support the government of Sierra Leone by increasing the early detection and reporting of government-identified priority diseases using the Electronic Integrated Disease Surveillance Response (eIDSR) framework.

eHA developed a mobile electronic Integrated Disease Surveillance and Response (eIDSR) application in response to requirements stipulated by the Sierra Leone Ministry of Health and Sanitation (MoHS).  This eIDSR app enables the MoHS Surveillance system to accurately record and share health facility-level information from the district to the national level. From health workers in hard-to-reach rural areas up to health officials in the major urban centers, eIDSR connects the health system to generate a clear and accurate picture of the health landscape.

In the first quarter of 2018, eHA introduced two new features to the eIDSR app; data approval and sms compression. These new features align with  Joint External Evaluation (JEE) as stipulated by the International Health Regulations (2005).) Since June 2007, countries—including Sierra Leone, have been making efforts to strengthen their core capacities.

Prior to  the introduction of the electronic data processing system, Sierra Leone’s Integrated Disease Surveillance and Response (IDSR) system relied on a paper based process  where the disease surveillance data summary was compiled in a spreadsheet and then mailed to appropriate authority every Monday. This manual system helped to monitor diseases in Sierra Leone. However the time constraints reduced efficiency. The paper-based method was also prone to human error, resulting in questionable credibility and completeness of information.

“Before the introduction of eIDSR, most National health information from the Primary Health Care Unit were written hard copy. It took a lot of time for data staff to capture written hard copy data into the soft health management system. Data processing with the paper based system was time consuming and error prone. Transitioning to eIDSR would improve the quality and timeliness of health information.”

— Dr. Tom Sesay, District Medical Officer (DMO), Port Loko - Northern Sierra Leone

One new feature  implemented in the eIDSR app is data approval. In the past, health care workers who were responsible for submitting necessary reports and data would enter the data  and there was no opportunity for superiors 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.

The new data approval feature now prompts the district staff to review and validate all data received from the health facilities before it is seen by other users. eHA also provides daily monitoring of the approval process and quickly resolves any challenges that may arise.

With this new feature in place and the support provided,  the quality of data used for disease surveillance is improved significantly and human errors are minimized.

Training health care workers on the new features in the eIDSR app in Freetown, Sierra Leone

One of the biggest challenges experienced during the roll out of eIDSR was internet connectivity. There are many  facilities that do not have internet access to upload their data on site. The initial solution to that challenge was to provide an alternative for the facilities to upload their data into the national server; that alternative was using Short Message Service (sms)  to submit their data.

In the first version of the eIDSR application, seven (7) SMSs were required to upload the eIDSR weekly reporting form by SMS. With this sms compression upgrade the number is now reduced to one.  The introduction of SMS compression has resulted in facility staff saving time needed to find locations in the community where they can have internet access or strong network connection for 7 SMS submissions. It also cuts down on costs as less SMSs are needed to complete the upload into the national server. Through the sms compression, health facility staff are not  likely to leave their facilities to upload their data. The few that might have to leave will not likely have to walk long distances to have their data uploaded.

“eIDSR has built the capacities of our health workers most of whom had little experience in the use of smartphones. eIDSR has contributed to improving our interaction with our facility staff.”

— Albert Kamara, District Surveillance Officer, Port Loko

eHA has now trained 142 health care workers at the Western Area Urban  District Health Management Team (DHMT) in Freetown, Sierra Leone. This training of trainers session was aimed at cascading the new upgrade to other health workers. These two new features in the eIDSR application are adding immediate value to Sierra Leone’s health systems, by simply automating work.These are best practices for future generations to uphold and retain.

Getting Vaccinations on Time

By Hawa Kombian

One of the primary challenges facing routine immunization (RI) in northern Nigeria is a poor vaccine supply chain system which causes consistently high stock out levels. High stock out levels occur when vaccines are not delivered on time and are exacerbated by limited cold chain equipment (CCE) to keep the vaccinations viable. High stock out levels cause low RI coverage because there are fewer vaccines available when needed.

eHealth Africa (eHA) was engaged as a third-party logistics (3PL) supplier to provide a solution for this problem and the Vaccine Direct Delivery (VDD) program was the clear answer to streamline vaccine and dry goods delivery supply chain to CCE equipped health facilities. VDD works by:

One of the terrain challenges encountered by eHA's officers

• Leveraging eHA’s geographic and information systems (GIS) capabilities to optimize delivery routes (including rugged terrain as pictured), reduce cost and maximize efficiency.

• Collecting, analyzing and reporting data to provide custom delivery workflow support through a near real-time electronic data collection application - Logistics Management Information Systems (LoMIS) for stock level summaries via an integrated reporting dashboard.

VDD is a proven and effective model which enhances the efficiency and quality of Nigeria’s vaccine supply chain network. In collaboration with partners, VDD is implemented by eHA across some of Nigeria’s northern states specifically, Kano, Bauchi, and Sokoto. The program has had a proven and large-scale effect across northern Nigeria. The project has succeeded in improving both access and availability of healthcare for underserved populations, by enhancing the local vaccine supply chain network. It ensures that key and priority antigens are available, as evidenced by the low stock out rates, and are a major contributor to improved RI, especially for children's health. 

World Immunization Week: VaxTrac - helping health workers provide vaccines in Sierra Leone

By Musa Bernard Komeh and Uche Ajene

Through routine immunization programs, health workers bring life-saving vaccines to people around the world. At eHealth Africa, we work  with our partners to increase vaccination rates in the countries we work in. In Sierra Leone, one of the ways we do this is via VaxTrac.

VaxTrac at work in the Macauley Street Government Hospital, Freetown

VaxTrac, is a clinic-based vaccination registry system which health workers can use in the field to enroll children and track their immunization records. It eliminates the need for paper-based cohort books, tally sheets, and monthly reporting forms and improves health workers accuracy and efficiency.

With the introduction of VaxTrac technology into the routine immunizations activity of  Sierra Leone’s Western Area Urban, significant contribution has been made with a view to improving on quality, timely, and useful  immunization data. eHA VaxTrac currently covers 50 health facilities including the biggest and only children’s referral hospital in Sierra Leone.

One of the key features of  VaxTrac is that health workers can easily access information on defaulters which can be used for defaulter tracing activity during their outreach programs within  the communities they serve. Priority areas within the Western Urban Area have been identified which will further strengthen processes and contribute to the success of the project. This was based on lessons learned and data collected from 2016-2017.

eHA further commits to:

• Working closely with the District Health Management Team of Western Area Urban to ensure regular and more structured outreach programs that will target defaulters

• Sharing of facility performance to in-charges so they know where improvement should be made to achieve higher coverage

• Training of more health workers on the use of VaxTrac

• Modifying of the VaxTrac software to increase user friendliness and usefulness.

“In 2017, a total of  39,101 children were registered on VaxTrac. We have plans for more efficient and impactful work in 2018.”

— Musa Bernard Komeh, Project Supervisor, VaxTrac

At eHA, we know #VaccinesWork and we look forward to successful outcomes with increased immunization coverage and a reduction in defaulter numbers.

Did You Know?

Our GIS & Data Analytics team has mapped over 20,000 points of interest across 19 districts within the Lake Chad region (in Chad, Cameroun and Niger)?

This GIS data is crucial in ensuring that polio vaccination campaigns reach the total populations of at-risk individuals. In the past, vaccination campaigns relied on old maps and data, which left thousands of people unaccounted for, and left them out of the campaign plans. However with more robust maps like these,  planning and executing vaccination campaigns has become easier. Now teams can identify missed settlements, map accurate routes for vaccine and other vital health commodities delivery.

Our executive Director, Evelyn Castle, spoke recently at the Global Digital Health Network forum, sharing how using mapping data can help us end infectious disease outbreaks, and shared how eHealth Africa has used GIS mapping to fight polio and ebola. Click here to watch her presentation.

To learn more about our GIS & Data Analytics services, please click here

Extending the Digital Agenda in Underserved Communities

By Elizabeth Okunlola

The ongoing digital revolution has given birth to innumerable changes in communication, collaboration, knowledge sharing, and innovation. Technology is now a way of life,  and certainly the United Nations’ Sustainable Development Goals cannot be achieved without technology.

Technology has become a major driver for growth and development. It allows one individual to execute a task meant for 10 in an efficient and cost-effective manner. However, it comes with its own challenges, especially in the areas of access, adoption, and application. eHealth Africa (eHA) is committed to bridging the digital divide by promoting digital inclusion through her health intervention programs for vulnerable communities across Africa.

eHA implements interventions that not only improve the work performance of health workers but also their digital skills with new trends and technology that prepare them for today and the future. While creating solutions, workers are educated on new and emerging technologies that create opportunities and make them more efficient in their jobs. Several technology-driven projects like AVADAR, eIDSR, Kano Connect, et al., provide digital opportunities for health workers even at the last-mile to be relevant in this digital age. These projects address issues surrounding free access to technologies as eHA, through donors and support from implementing partners, provides hardware, software, high-speed internet connectivity, and access to a range of relevant work content.

Our programs and projects provide digital literacy services that assist health workers to navigate, understand, and evaluate their work through consistent training. They also promote collaboration and communication by leveraging new media tools and encouraging self-exploration; making it possible for workers to explore digital resources on their own.

The Kano Connect project, for instance, has promoted digital inclusion by creating access to, adoption, and application of technology for work. To engender access, the Kano Connect project provided 1,416 phones and 100 free SMS within a Closed User Group (CUG). It also provided a zero-rated data access (250mb) for job related data-driven applications on the Kano Connect infrastructure. In the area of adoption, the project provided digital literacy services for health workers - 1,416 health workers were trained across all levels (State, Zone, and LGA) in the Kano State Primary Health Care Management Board (KSPHCMB).

At eHA, we work on solving big problems. We believe in the power of technology to make a transformational difference in health systems, and we know that when we do high-quality work, we have the opportunity to change lives in the communities we impact. Sign-up for our newsletter today and get all the latest information on what's happening at eHA.