Strengthening Liberian Human Capacity for Health Services

By Elizabeth Shelley

Since the height of the West African Ebola virus outbreak, eHealth Africa (eHA) has been working with the Liberian Ministry of Health (MOH) to rigorously improve nationwide electronic disease reporting systems, laboratory and diagnostic systems, and emergency management operations.

Data Management and Integration Training - Gretchen (Consultant) instructing trainees. 

Data Management and Integration Training - Gretchen (Consultant) instructing trainees. 

eHA established Emergency Operations Centers (EOCs) in each of Liberia’s 15 counties and supported specimen sampling and storage at 5 priority laboratories. Today, eHA is poised to launch our new electronic Integrated Disease Surveillance and Response (eIDSR) app on a national level. With each of these advancements, eHA recognizes the need to ensure the development of a local workforce to maintain these systems beyond the end of eHA’s involvement. As our teams continue to create innovative technological solutions to some of Liberia’s most pressing public health challenges, we are simultaneously providing experts to deliver training workshops for the continued management of these systems, and on ways to modify them to respond to a changing environment.

Recently, in partnership with the US Centers for Disease Control and Prevention (CDC), eHA delivered a workshop to MOH staff members in all counties, Surveillance Officers, and other National Public Health Institute of Liberia (NPHIL) staff on Threats and Hazard Identification and Risks Assessment (THIRA). In this workshop, participants learned to more effectively detect, investigate, and respond to potential public health emergencies.

Data Management and Integration Training

Data Management and Integration Training

eHA and the CDC recently delivered training workshops to MOH employees on risk communication and additional workshops technical skills required to manage software solutions and ICT infrastructure. Last year, eHA and the CDC brought representatives from the Linux Association to Liberia to conduct Africa’s first ever Linux Association Administrator Certification program. The workshop, conducted at eHA’s central office in Monrovia, resulted in ten professionals becoming  fully qualified Linux System Administrators.

As the development of our eIDSR Offline Tracker application progresses, eHA is simultaneously planning workshops to train MOH employees, District Surveillance Officers (DSOs), and additional Healthcare Workers (HCWs) on using the software. eHA recognizes the importance of developing local capacity to maintain the software and associated databases, to make modifications as required, and resolve bugs as they occur. This capacity strengthening will prove crucial for sustaining these projects.

Reaching the Hard-to-Reach

Solutions to the Healthcare and Nutrition Crisis in the Lake Chad Region

By Natalya Nepomnyashcha

Years of violent conflict and forced displacement have affected around 17 million people in the Lake Chad Basin, including the regions of North-eastern Nigeria, Northern Cameroon, Western Chad and South-east Niger. Due to food insecurity and the lack of basic healthcare services, the region is experiencing a widespread health crisis and high levels of malnutrition. Accessing the most remote, insecure, and hard-to-reach areas for emergency service provision and humanitarian assistance remains a pressing challenge.

eHealth Africa (eHA) is a health social enterprise focused on improving health systems in West Africa. eHA designs and implements data-driven solutions that respond to local needs and provides underserved communities with tools to lead healthier lives. The German-African Business Association (Afrika-Verein der Deutschen Wirtschaft) is the foreign trade association representing German companies and institutions with an interest in Africa.

Panelists L-R: Anna Sophia Rainer, Prof. Dr. Titus Kühne, Natalya Nepomnyashcha, Dr. Gabriele Poggensee, and Anu Parvatiyar.

Panelists L-R: Anna Sophia Rainer, Prof. Dr. Titus Kühne, Natalya Nepomnyashcha, Dr. Gabriele Poggensee, and Anu Parvatiyar.

Together, the two institutions hosted an event that provided insights into what is happening in the Lake Chad Basin and identify solutions. The speakers included:

  • Dr. Gabriele Poggensee, Global Health and Biosecurity Unit, Robert Koch Institute
  • Prof. Dr. Titus Kühne, Director, Institute for Computer-assisted Medicine, Charité
  • Anu Parvatiyar, Associate Director, Programs, eHealth Africa

After an introduction by Anna Sophia Rainer, Project Manager, German–African Business Association, the panelists discussed the most pressing issues in the Lake Chad Basin. These included drought, terrorist insurgencies, insecurity, lack of equipment, poor infrastructure, dissatisfaction with the governments, and as a result, shaky political conditions.

Functioning disease surveillance systems are one necessary component to help detect and respond to other health problems. Dr. Poggensee believes that the Ebola outbreak of 2014 was a wake-up call for the whole world. Since then, developed countries have been more willing to invest not only in humanitarian aid but also into strengthening health systems and building capacities for potential outbreak responses in Africa. In this context, trained personnel are key to any successful response. Tools are great, but it’s more important that people know how to use them effectively.

eHA works on the outbreak response for polio and broader disease surveillance efforts in the Lake Chad Basin. Having supported polio eradication in Nigeria for several years, eHA helps track immunization campaigns across the region. With polio receiving substantial attention and funding, it also opens doors for related work, such as GIS mapping. For immunization and other aid purposes, it is important to know the location of settlements and points of interest, especially in regions where many roads or entire villages have been destroyed by active insurgents. eHA uses satellite imagery and field intelligence to provide invaluable data that enable aid to reach hard-to-reach populations.

Speaking on the use of digital tools, Prof. Dr. Kühne pointed out that we need a more coordinated approach so tools complement each other as opposed to several projects either targeting the same issue from different directions or missing the bigger picture completely. Rwanda, the Silicon Valley of Africa, is a positive example for a well-managed and interoperable system. To Prof. Dr. Kühne, ownership is the key factor in handling digital health tools.

Dr. Poggensee, Prof. Dr. Kühne, Natalya (Comms & Operations Coordinator, eHA) and Anu. 

Dr. Poggensee, Prof. Dr. Kühne, Natalya (Comms & Operations Coordinator, eHA) and Anu. 

According to Dr. Poggensee, another challenge is that many stakeholders develop new digital tools that are not compatible with the existing tools used by WHO. She stressed that this is vastly important since surveillance should not be done for the sake of collecting data, but for the sake of taking action. Anu Parvatiyar summarized it in a nutshell: Instead of collecting data to do reporting, it is essential to collect real-time data to be able to react promptly in case of an emergency. This is exactly where digital tools provide a huge advantage.

Integrating tech and health, eHA achieves its mission by establishing new standards in the delivery of healthcare to most vulnerable communities in West Africa. If you are interested in working with us, please have a look at our job board or contact our team at berlin@eHealthAfrica.org.

 

Women’s Empowerment At eHealth Africa

Women's empowerment remains a significant topic of discussion all over the world as women often face discrimination, especially when it comes to employment and work conditions.

According to UN Women, women are overall paid less than men. Women in most countries earn on average, only 60 to 75 per cent of men’s wages. In addition to this, a report by the World Bank implies that gender differences in official legislation impact women worldwide. In 90 percent of 143 economies that were studied, researchers found at least one law that restricts women’s economic opportunities. On the other hand, McKinsey & Company found that women’s economic equality is good for businesses. It increases organizational effectiveness and companies greatly benefit from increasing leadership opportunities for women. eHealth Africa (eHA) takes the topic of Women’s Empowerment very seriously and set it as a strategic goal for the year 2017. Amongst other HR initiatives, this led to the formation of eHA’s first Women’s Empowerment Group.

Peer coaching at the eHA Campus in Kano, Nigeria

Peer coaching at the eHA Campus in Kano, Nigeria

The group started in April 2017 and is based at the Nigeria office in Kano. The aim of the group is to give women a safe space to reflect on personal development and gain greater self-confidence.  So what makes this program so special and effective? The concept for the group was developed in collaboration with Tanja Schomann from Philia. Philia is an organization that teaches peer coaching as an alternative method to traditional mentoring schemes and counseling.

The basic idea is to use peer coaching as a tool to enhance communication skills that promote dialogue and mutual understanding. Participating women support each other in reaching their individual goals as well as enabling spillover effects on entire communities. The Philia Peer Coaching concept focusses not just on topics immediately related to work, but on all areas of life. The idea is that empowerment is a mindset that encompasses the entire personality. A woman that is unable to cope with problems at home will not be able to perform well at work. This is why eHA and Philia chose a more holistic approach to women’s empowerment.

Philia taught me to be a better listener. It also taught me that most women tend to have the same problems regardless of their culture and backgrounds
— Layal Srour (Participant)

The group meeting is conducted on a weekly basis. Each session consists of 30 minutes of peer coaching and 30 minutes of teachings on personal development and communication skills. With eleven women participating in the pilot phase, the group has reached a great level of openness, sharing, and mutual support - which is not always easy to reach in a professional context.

Strengthening Programmatic Excellence And Empowering Our Staff

By Natalya Nepomnyashcha

eHealth Africa (eHA) held its first ever Global Programs Conference in our Kano office. 50 participants from 6 offices and three continents represented 5 programmatic pillars as well as over 30 different projects in 10 countries.

The main conference goals were:

  • To promote knowledge sharing among various program teams and offices
  • To provide in-person training on people and process management
  • To promote a common understanding of eHA's mission, values, and resources
  • To spend time together growing, and collaborating better as a team

Together as a team, we looked back at our first project in Nigeria, a Maternal Health project in Kaduna, to our first entry into combating Polio, to our regional impact during the Ebola outbreak. We went further to discuss our current endeavors such as expanding the team in the Lake Chad region and the GIS GRID project that will map all states in Nigeria.

This conference was a great opportunity to highlight our integrated approach of connecting data, insight, and execution. As a team, we discussed the previously identified guiding principles in determining the eHA best project fit, which are:

  1. Can we do it better than anyone else in the space?
  2. Is it driven primarily by our beneficiaries?
  3. Is it transformational?

The conference was held from May 17-21, 2017. Day one of the conference was focused on knowledge sharing. The teams had the opportunity to share and present various  projects, results, and impact to one another, be it Health Camp, electronic Integrated Disease Surveillance, and Response (eIDSR), or Vaccine Direct Delivery.

“My personal highlight was seeing the Health Camps boxes, a project in Nigeria. I didn’t know that eHA was testing the items. We also collected data to determine what needs to be in the boxes. It’s such an integrated model” - Dayo Spencer-Walters, Deputy Country Director, Sierra Leone

Day two was focused on people development. We showcased our interest and love for investing in and developing our greatest asset, our people. The conference participants attended a professional management training, where they learned about the importance of delegation and effective communication amongst other topics discussed.

No eHA conference would be complete without learning about the proper use of data and maps. On the final day, participants received very insightful in-house session on how data and maps can be used practically to allow for an evidence-based and timely decision-making.

At eHA, we understand and emphasize the importance of balancing work and life, hence we allocated some of the conference time to attending fun dinners with the team and participating in a slew of games such as trivia night.

The evaluation showed that the conference helped eHA staff to grow professionally, personally, and as a team:

  • Almost 90% said the conference made them more excited to work for eHA
  • 94% thought the conference provided content for personal and professional growth

As a result, participants not only received input on how to grow as managers, and gained insight into various projects - the group grew much closer as a team and will be able to represent our core values at a new level.

Impact & Quality // Innovative Problem-Solving // Passion // Honesty // Growth & Learning // Ownership

Are you interested in joining eHA? Have a look at our current job openings. We look forward to your applications!

Spotlight: eHA Internships

Yaya Jaiteh was eHA’s dynamic Product Marketing Intern in the Spring of 2017.

First day at the Berlin office. L-R: Natalya Nepomnyashcha (Internship Supervisor, Berlin) and Yaya Jaiteh

First day at the Berlin office. L-R: Natalya Nepomnyashcha (Internship Supervisor, Berlin) and Yaya Jaiteh

When deciding to apply for this internship, Yaya hoped to learn more about public health. “I always saw strengthening of the health sector as one of the most effective approaches in development work, Yaya explains. “I was also starting to develop an interest in software development and health tech solutions during a project I was working on prior to the internship. At eHA, I had all that in one internship while working with a truly international team”.

Boat ride in Sierra Leone

Boat ride in Sierra Leone

Yaya had the pleasure of being based in eHA’s German office and traveling to eHA’s Sierra Leone office. He also played a significant role in marketing two major eHA projects - Electronic Integrated Disease Surveillance and Response (eIDSR) and Service Availability and Readiness Assessment (SARA) during the course of his internship. While in Sierra Leone, Yaya was supervised by Hawa Kombian, Executive Projects Manager. 

“I really learned a lot during this internship. This makes it hard to sum up the lessons I learned during a period as short as just two months. To mention some key aspects, I would say that working within a team that is international and diverse was an exciting experience”.

Yaya has been an amazing intern with eHA. We wish him the absolute best in his future endeavors! Check out our job board and join our team today. 

 

 

 

Sierra Leone’s 117 Call Center Transitions Into A Sustainable Public Health Mechanism

By Hawa Kombian

June 22nd, 2017 marked the official celebration of the 117 Call Center’s transition into a sustainable public health mechanism for Sierra Leone. This successful transfer of ownership has been highlighted as an instrumental step towards strengthening the ability of Sierra Leone’s Ministry of Health & Sanitation (MoHS) to efficiently identify and respond to public health emergencies and other challenges.

Officials from the MoHS, UK Aid, eHealth Africa (eHA), and the United State’s Center for Disease Control and Prevention (CDC) gathered to mark this momentous occasion. The event was held at the Public Health National Emergency Operations Centre (PHNEOC) in Freetown, Sierra Leone.

The 117 is a MoHS initiative set up in 2012 as part of a wider support system to improve maternal and child health. In 2014 it 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. Funded through the Government of the United Kingdom’s  £13.7 million aid package to the Ebola Response Consortium, eHA provided technical and operational support to expand the 117 to every district in Sierra Leone. eHA developed a custom software to enable near real-time documentation of call details and the dispatching of the 117 calls to District Emergency Response Centers. This system also provided call-back services to deliver updates on the dispatching of health workers to original callers. 

Speakers (left to right): A CDC Representative, the Deputy Minister from the MoHS, the British High Commissioner to Sierra Leone, the Deputy Chief Medical Officer from the MoHS, the Head of PHNEOC, and eHA’s Deputy Country Director of Sierra Leone.  Photo: Hawa Kombian, eHA

Speakers (left to right): A CDC Representative, the Deputy Minister from the MoHS, the British High Commissioner to Sierra Leone, the Deputy Chief Medical Officer from the MoHS, the Head of PHNEOC, and eHA’s Deputy Country Director of Sierra Leone. 

Photo: Hawa Kombian, eHA

Speakers at the event included eHA’s Deputy Country Director in Sierra Leone, the Deputy Minister of Health from the MoHS, the Deputy Chief Medical Officer from the MoHS, the British High Commissioner to Sierra Leone, and several CDC representatives. 

“117 has been a real effort and success in partnership between the Ministry of Health [and Sanitation], the UK Government, eHA, and other partners on the ground. eHA will continue to be a willing and able partner with the Ministry to improve health outcomes in Sierra Leone” - Dayo Spencer-Walters, eHA's Deputy Country Director, Sierra Leone.

The event concluded with a ceremonious ribbon cutting performed by the British High Commissioner and the MoHS’s Deputy Minister of Health, followed by a tour of the new call center space in the PHNEOC facility.

The British High Commissioner to Sierra Leone and the Deputy Minister of Health from the MoHS complete the official ribbon-cutting ceremony. Photo: Hawa Kombian, eHA

The British High Commissioner to Sierra Leone and the Deputy Minister of Health from the MoHS complete the official ribbon-cutting ceremony.

Photo: Hawa Kombian, eHA

At the height of the EVD crisis, the 117 received an average of 6,000 alerts of suspicious deaths and sickness per month. Over 300 dispatchers and operators were trained to utilize the eHA software solution and provide weekly updates to the MoHS and partners. This information was invaluable in the management of the outbreak, as it informed near real-time response efforts. With continued funding from UK Aid’s Resilient Zero program, the 117 call center currently receives around 2,000 alerts per month to its decentralized data managers who are deployed across all 13 districts in Sierra Leone. The 117 is a key element in strengthening the public health surveillance system, including tracking maternal deaths, child deaths, and suspicious infectious disease cases.

With a desire to maintain a strong disease surveillance system that can prevent and respond to public health threats, the MoHS will exercise renewed leadership over the technical and operational aspects of the 117. In light of this, the CDC Foundation has committed to short-term funding support for the project.

The public is encouraged to continue to place calls and send public health alerts to the 117 in order to report all deaths and suspicious illnesses in their respective communities. Social mobilization activities will continue in national efforts to enhance disease prevention, management, and the overall health sector development in Sierra Leone. eHA remains committed to achieving its mission by improving preparedness for potential public health emergencies across underserved communities in West Africa. To find out more about the work that eHA does, kindly subscribe to our monthly e-newsletter.

Electronic Immunization Registry and Tracking System in Sierra Leone

Written By Hawa Kombian

In November 2016 we announced the launch of a Child Immunization Initiative in Sierra Leone - an Electronic Vaccination Record and Tracking Project, also known as VaxTrac. The goal of this initiative was to implement an electronic registry for children’s immunizations in order to provide timely and quality data for decision making.

The Immunization Dashboard shows the client's immunization history and upcoming immunization dates. Photo credit: Bryan Gastonguay

The Immunization Dashboard shows the client's immunization history and upcoming immunization dates. Photo credit: Bryan Gastonguay

Funded by the Centers for Disease Control and Prevention (CDC), eHealth Africa (eHA) implemented the project in collaboration with VaxTrac, Africell, and the Child Health Division at the Sierra Leonean Ministry of Health and Sanitation (MoHS). The pilot phase ran from November 2016 to June 2017.

The VaxTrac project has been a thriving success in the Western Area Urban District of Freetown. eHA has led the training of over 110 MoHS health officials and workers from 50 health facilities to conduct electronic registration for children receiving vaccinations via the VaxTrac app. The patient profiles are generated and linked using biometric indicators (i.e. fingerprint scans) from their caregivers or via a QR code sticker on their traditional vaccination cards. Each child’s demographic and vaccination details (i.e. type of vaccine and date of administration) are collected via the VaxTrac mobile app and synced to the VaxTrac monitor analysis system, which the MoHS can access.

VaxTrac has helped us give accurate return dates [for immunization follow-up] to our patients.
— Trained, Freetown Health Care Worker (HCW)

In addition to storing immunization information in a secure and accessible platform, VaxTrac includes features which support the health system proactively addressing child immunizations. The system has a “call-back” feature which tracks follow-up vaccination timelines and calls caregivers with reminder messages encouraging them to bring children back in for their next round of immunization. This friendly and automated reminder helps ensure that vaccine coverage is as high as possible. It further provides a simple and reliable mechanism for healthcare workers to conduct routine follow-ups.

Ultimately, the MoHS will be able to utilize compiled VaxTrac data to make more strategic and informed vaccination decisions via the VaxTrac monitor dashboard which runs data analysis and produces reports.

Following the success of the pilot where over 20,000 patients were registered, the completed end-of-pilot evaluation will provide information on necessary software upgrades to ensure that the app remains user-friendly and is streamlined for data collection and analysis. The project partners plan to expand VaxTrac to the 20 remaining health facilities for 100% coverage within the Western Urban Area District. This activity will include greater engagement of MoHS staff in the process of training health care workers to use the VaxTrac app, monitoring its usage and effectiveness throughout health facilities, and analyzing the data collected for a clearer understanding of immunization trends across the district.

eHA establishes new standards in health delivery through the integration of information, technology, and operations. This supports our mission to improve the quality of healthcare for underserved populations across Africa. To join our team or find out more about the work we do, kindly visit our website.

eHealth Africa Releases 2016 Annual Impact Report

Written by Elizabeth Shelley

eHealth Africa’s (eHA) 2016 Impact Report illustrates the multifaceted ways in which eHA partners with Ministries of Health (MOH) to improve healthcare for underserved populations across West Africa. Through the integration of information, technology, and logistics, eHA has been working to build stronger health systems that respond to local needs throughout the region since 2009.

As a result of eHA’s work in 2016:

  • 958,030 women and children received free medicines in Northern Nigeria;
  • Over 30,000 people benefited from an Integrated Community Health pilot in Guinea; and
  • Over 13 million life-saving vaccines were delivered to remote health facilities;

Following our unprecedented expansion into West African countries in response to the 2014-2016 Ebola outbreak, eHA spent much of 2016 establishing an integrated approach to improving health services region-wide. eHA has consolidated its support across five focus areas: Health Delivery Systems; Public Health Emergency Management Systems, Disease Surveillance Systems, Laboratory and Diagnostic Systems, and Nutrition & Food Security.

Within each of these focus areas, eHA is working to provide innovative technological solutions using data-driven metrics for success, while simultaneously building local capacity to use and maintain these systems. For example, over the course of 2016, eHA leveraged having the largest geographic information system (GIS) team in West Africa to extend its support to the Nigerian government in identifying hard-to-reach communities which are chronically omitted from health service deliveries. eHA is also tracking deliveries of vaccines and other medical supplies to these regions using our own geospatial technology.

These GIS tools are also enhancing the effectiveness of vaccine delivery campaigns to ensure that no households, and thus no children, are missed. As a result:

  • Over 1,000 settlements in remote areas were identified and mapped;
  • 13.3 million antigens were delivered to health facilities in these regions; and
  • Northern Nigeria’s Borno state experienced a 17% increase in coverage by vaccination teams between October and December 2016.

eHA’s strategic model reflects a deep commitment to an integrated approach in global health and development work. Our experience working as an implementer and a leader in this regard allows us to provide value, responsiveness, and scale in our work. We look to continue providing technological solutions that respond to local needs and provide underserved communities with tools to lead healthier lives.

The 2016 Annual Impact Report is now available online. If you are interested in monthly updates on eHA’s work, please sign up for our newsletter.

Meningitis outbreak response: How a mobile laboratory helps save lives

This article originally appeared on Africa Health and was written by Natalya Nepomnyashcha, Communications and Operations Coordinator, eHealth Africa.

To tackle the recent outbreak of Meningitis in Nigeria, eHealth Africa (eHA), a Nigeria based social enterprise, constructed a mobile biosafety level 1 laboratory to be able to test samples in the immediate vicinity of the suspected cases. The lab was constructed in Sokoto State, which experienced a particularly high number of suspected cases. If needed, the lab can be easily transported to other States. Constructed within just 23 days, the lab is housed in a thermal insulated 40 foot shipping container.

The lab contains medical diagnostic equipment, an incubator, a centrifuge, a water distiller, an autoclave, and tools for electronic data capture. Power, water, and internet connectivity were installed to enable full lab functionality. All surfaces are chemical- and water-resistant.

To find out more, see July edition of Africa Health please.  

eHealth Africa expands Disease Surveillance across West and Central Africa

Written By Olajumoke Arinola & Nwanyibuife Obiako

eHealth Africa (eHA) is collaborating with the World Health Organization (WHO), Bill and Melinda Gates Foundation (BMGF), and Novel-T to scale up Acute Flaccid Paralysis (AFP) surveillance in Liberia, Sierra Leone, and Chad.

Each Android device has the AVADAR app that HCWs can use to report suspected AFP cases. Photo: Ojabo Daniel, Media Coordinator, eHealth Africa

Each Android device has the AVADAR app that HCWs can use to report suspected AFP cases. Photo: Ojabo Daniel, Media Coordinator, eHealth Africa

AFP surveillance remains a key indicator of the progress of polio eradication in Africa. Building on the success of the pilot of the mobile based Auto-Visual AFP Detection and Reporting (AVADAR) surveillance system in Nigeria, the project has been scaled up to strengthen surveillance by improving timely detection and reporting of suspected AFP cases in countries at risk of the re-emergence of the polio virus, and those most recently affected by the Ebola virus disease.

AVADAR has been operational since March of 2017 in the Liberian districts of Commonwealth, St. Paul, Careysburg, and Central Monrovia. It has also been used in the Sierra Leonean districts of Western Urban, Western Rural, Tonkolili, and Kono. More recently, Community Informants and Healthcare Workers (HCWs) were trained by eHA instructors on the use of the AVADAR app in Chad, making Chad the first francophone country utilizing AVADAR.

"In Chad, our team saw first hand the essence of integration of project planning with local context in terms of recruitment, training language, understanding health administrative levels, and the impact of country-specific regulations on logistics coordination and project success" - Olajumoke Arinola, Assistant Project Manager

Five weeks after its implementation in Sierra Leone, 4 AFP cases were detected out of the 41 suspected case alerts reported through the AVADAR. In Liberia, 6 AFP cases were detected out of the 89 suspected cases. After one week of implementation in Chad, 8 cases were reported and investigated with 1 confirmed to be an AFP case by Disease Surveillance and Notification Officers (DSNOs). Pre-implementation activities and partner coordination have commenced for other Lake Chad region countries, namely Cameroon and the Niger Republic.

In 2016, there were 3 new cases detected of wild poliovirus and circulating vaccine-derived poliovirus type 2 (cVDPV2) in Borno, a security-challenged state in northern Nigeria. This prompted the urgency to strengthen surveillance not only in Nigeria but across the entire Lake Chad region. In selecting specific local government areas and districts where AVADAR would be functional per country, WHO and the respective Ministries of Health (MoH) prioritized working in densely populated areas where AFP surveillance had been reportedly low.

The AVADAR app has a 30-second video of a child with AFP symptoms embedded in it which reminds Community Informants and Healthcare Workers to report suspected cases weekly. In addition to English, the video has already been produced in the three major Nigerian languages (Hausa, Igbo, and Yoruba), major languages in Sierra Leone (Krio, Themne, Mende, and Kono), and French. To avoid ambiguity and to generate maximum impact, the AVADAR video was also voiced in Chadian Arabic with text translations in French for its implementation in Chad. This has increased the surveillance network in these countries through sensitization of traditional birth attendants, traditional healers, barbers, and other community residents on how to accurately detect and report suspected AFP cases.

To date, eHA has distributed GPS-enabled mobile devices and solar chargers to over 2,000 Community Informants and Healthcare Workers in the four current AVADAR focus countries. eHA has also trained each mobile device recipient on the proper use of the phones and the AVADAR app. To ensure Community Informants were fully sensitized on how to detect and report suspected AFP cases through the app, participants were divided into small groups, with just 10-15 students per eHA instructor. Ample time was allocated to role plays and class demonstrations with the instructors communicating in the local language of the informants.

"Without eHA’s strategy of one facilitator to a group of 10 informants, these people (informants) wouldn’t have been able to use these phones and report AFP cases." - Dr. Faisal Shuaib, Executive Director, NPHCDA

eHA remains committed to working with Ministries of Health and other AVADAR implementing partners to strengthen AFP surveillance systems across Africa in order to end the spread of polio. Visit our website to find out more about our work strengthening West Africa’s disease surveillance systems.

eHealth Africa Providing Technical Support to Help Curb Nigeria’s Meningitis Outbreak

By Daniel Ojabo

Between December 13, 2016 and April 30, 2017, 11,594 suspected cases of Meningitis and 955 deaths have been reported across Nigeria. The current outbreak of Meningitis in the country is bigger in magnitude than previous outbreaks and has affected 184 Local Government Areas (LGAs) across 13 states and the Federal Capital Territory (FCT).

Meningitis is an inflammation of the membranes covering the brain and spinal cord. Meningococcal meningitis is a bacterial form of meningitis, a severe and deadly infection of the membranes that cover the brain and spinal cord (1). Six states, namely Zamfara, Sokoto, Katsina, Niger, and Kebbi have crossed the epidemic threshold. These states are affected by Meningitis serotype C strain (NmC) as the predominant serogroup and Yobe with Meningitis serotype A strain (NmA) as the predominant serogroup (2).  NmC has accounted for 83% of laboratory-confirmed cases and the population is severely under-vaccinated against Nmc in these affected areas (3).

Due to the lack of robust diagnostic laboratories in this region, suspected cases of meningitis were being tested using the Pastorex test kit; a rapid test kit used to determine whether a cerebrospinal fluid (CSF) sample is positive for Meningitis or not. Further tests to determine the type of causative organism (Microbial Culture) and its abundance in test samples usually require samples to be transported to the Federal Capital Territory, Abuja and Lagos.

eHealth Africa (eHA) is partnering with the World Health Organization (WHO), the Nigeria Centre for Disease Control (NCDC), the National Primary Health Care Development Authority (NPHCDA), the University of Nebraska Medical Center (UNMC), UNICEF, and others to continuously support the Ministry of Health in the fight to contain the current widespread outbreak of Meningitis. As part of efforts to control the spread of Meningitis in northwest Nigeria, eHA designed and built a well-equipped laboratory in Sokoto state. Tests conducted in the laboratory involve gram staining, cytology, Pastorex Agglutination Test, and Microbial Culture. Over 345 samples have been registered and analyzed at the Sokoto lab during this current outbreak.

Sokoto Laboratory

Sokoto Laboratory

Housed in a 40-foot shipping container, the laboratory has room for a modular setup that allows for mobility to locations with an active outbreak, and thus diagnostic needs. This equipment allows not only the Pastorex test to be carried out on CSF samples collected in Sokoto and neighboring states but also culture and gram staining. For the initial weeks of operation, staff from IFAIN laboratory, Abuja, served as laboratory systems managers to support the operation of the Sokoto lab and to guide the Sokoto Medical Laboratory Scientists (MLS) through operations of the laboratory.

To strengthen surveillance and effective response to active public health emergencies, eHA also set up a toll-free hotline (08003432584) to receive reports of suspected cases. The hotline collects basic information about the cases and shares the information on the number of reported cases and the respective location with stakeholders on a daily basis. The hotline also receives calls from hospitals designated as sample collection and treatment sites for Meningitis. Eventually, this information will be collected using electronic data collection tools located at each of the sample collection centers, but in the meantime, the information on cases and sample collection will be collected through calls to the hotline. The hotline experience will be aligned with the Nigeria Centre for Disease Control (NCDC) efforts towards preventing outbreaks of this scale in the future.

Visit our website here to find out more about our work improving preparedness for potential public health emergencies and responding effectively to active public health emergencies.

 

 

References

  1. World Health Organization (WHO). Media Center: Meningococcal Meningitis page. World Health Organization (WHO) website. http://www.who.int/mediacentre/factsheets/fs141/en/. Updated November 2016. Accessed April 26th, 2017.

  2. The Nigeria Centre for Disease Control (NCDC). An Update of Meningitis Outbreak in Nigeria for Week 18. Nigeria Centre for Disease Control (NCDC) website. http://ncdc.gov.ng/diseases/sitreps/?cat=6&name=An%20Update%20of%20Meningitis%20Outbreak%20in%20Nigeria. Updated April 2017. Accessed April 26, 2017.  

  3. Assessment Capabilities Project (ACAPS). Nigeria: Meningitis Briefing Note 11 April, 2017. Assessment Capabilities Project (ACAPS) website. https://www.acaps.org/sites/acaps/files/products/files/20170411_acaps_start_briefing_note_nigeria_meningitis.pdf. April 11, 2017. Accessed April 25, 2017.

 

eHA Announces Three New Board Members

eHealth Africa (eHA) is proud to announce the appointment of three new members to its Board of Directors. Joining the Board of Directors are Andrew Karlyn, My T. Le, and Jamie McPike. The development of a comprehensive Board of Directors will give support to eHA by providing:

  • Professional governance
  • Service as global representatives
  • Mentorship to senior leadership, and
  • Guidance on important organizational functions

Andrew, My, and Jamie each bring invaluable expertise to the eHA community and we look forward to working with them in the coming months and years. Their appointments are part of a multi-year expansion of the eHA Board of Directors. You can learn more about each of our Board of Directors by visiting the " Our People" section of the eHA website.

Andrew Karlyn

Andrew Karlyn is USAID’s Global Development Lab’s Africa Regional Advisor and is based in Nairobi, Kenya. In this role, he supports USAID’s digital finance initiatives in health, social protection, agriculture, and democracy and governance programs. Andrew was a principal contributor to The Population Council’s mHealth initiatives. This work spans over 30 projects in HIV prevention and treatment; maternal and newborn health; and poverty, gender, and youth interventions.

My T. Le

My is a lecturer in the Electrical Engineering Department at Stanford University. She also serves as the Founding Director of the Stanford Gap For Good Program, a program that enables students to work with leading NGOs and nonprofits on global health and sustainable development projects. In addition, My invests in and advises startup companies in the US, Canada, and India.

Jamie McPike

Jamie has played an integral role in several large-scale quantitative and qualitative research initiatives, working to investigate and understand complex social issues. The focus of her human rights research includes child health inequalities in rural and urban India, gender inequality, housing and social inclusion, and sustainable urban development. Her National Science Foundation funded dissertation project is an ethnographic examination of social processes that shape the implementation of urban housing policies in Bangalore, India. Jamie is currently a Ph.D. candidate in the Department of Sociology at Brown University.

Sierra Leone’s New Digital Health Reporting System: Greater Accuracy and Timeliness

This article originally appeared on K4Health and was written by Taylor M. Snyder MPH, Senior Technical Advisor, eHealth Africa. 

eHealth Africa (eHA) is collaborating with the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), and other partners to support Sierra Leone’s Ministry of Health and Sanitation (MoHS) to strengthen surveillance for all priority diseases and improve preparedness for potential public health emergencies.

As eIDSR’s intended users are mostly new to smartphone use, eHA simplified the user interface and designed it to closely resemble familiar paper reporting forms. Photo: Les de Wit, Software Project Manager, eHealth Africa

As eIDSR’s intended users are mostly new to smartphone use, eHA simplified the user interface and designed it to closely resemble familiar paper reporting forms. Photo: Les de Wit, Software Project Manager, eHealth Africa

eHA’s main role in the eIDSR Technical Working Group set up by the MoHS is developing and implementing a mobile electronic Integrated Disease Surveillance and Response (eIDSR) application for health care workers (HCWs). The eIDSR app improves the entire health system by allowing data to be more accurately captured at facilities, and then allowing this improved data to be shared with the district and national levels.

eIDSR was built on DHIS2, which supports the MoHS’ decision to utilize DHIS2 as the preferred health data collection tool. eHA used an open-source native app from DHIS2 and expanded its functionality to improve the submission capabilities and user interface. Each of these expanded functionalities was based on understanding the Sierra Leonean health and HCW context.

eIDSR app’s intended users are predominantly first-time smartphone technology users, so eHA simplified the user interface and designed it to closely resemble familiar paper reporting forms. Following initial trainings, members of eHA’s Global Health Informatics Team go into the field and mentor HCWs on the use of their Android phones and the eIDSR app.

Visit here to find out more, please. 

eHealth Africa Transforms Disease Surveillance and Response in Sierra Leone

Electronic Integrated Disease Surveillance and Response (eIDSR)

By Daniel Ojabo & Hawa Kombian

Sierra Leone’s Ministry of Health and Sanitation (MoHS) is collaborating with eHealth Africa (eHA), the Center for Disease Control and Prevention (CDC), World Health Organization (WHO), and additional partners to strengthen surveillance for all priority reportable diseases and improve preparedness for potential public health emergencies.

Screenshot of eIDSR App

To reduce the frequency of the errors, which are prevalent in paper-based reporting and during the process of transferring data from one platform to another, eHA developed a mobile electronic Integrated Disease Surveillance and Response (eIDSR) application. This eIDSR app enables the entire health system to accurately record and share community-level health information from the district level to the national level.

Sierra Leone’s disease surveillance and reporting has improved drastically as a result of this new process. According to a recent CDC article, weekly disease reporting improved from occurring in 35% of health facilities, to occurring in 96% of all Sierra Leonean health facilities. This new disease reporting system has also cut the number of data entry errors in half, and verifies data 60% faster than the previous paper-based reporting system.

At the recent eIDSR National Rollout Review event in the Port Loko district (a district in the Northern Province of Sierra Leone), health facility workers and representatives from eHA, CDC, and WHO convened to assess the extent to which the rollout objectives had been achieved thus far. While speaking at the event, eHA’s Executive Director Evelyn Castle expressed her delight and emphasized that the system would be closely linked to Sierra Leone’s Front Line Field Epidemiology Training Program (FETP).

We have been working with the Ministry of Health and WHO for the last few months on implementing a new electronic way to submit disease surveillance information. Instead of only submitting information from the district level, we are looking at collecting information from the health facility level
— Evelyn Castle, Executive Director and Co-Founder of eHealth Africa.

Collecting data at the health facility level would ensure that community-level health issues are captured. It also increases the accuracy of population wide health information. Thus, this approach better supports the district's’ ability to understand the needs of the multiple communities located within their district. When the information is ultimately provided to the national level, this allows for a more accurate, detailed, and timely assessment of disease prevalence nationwide. This information can then be used to make near real-time decisions about any potential disease outbreak.

Healthcare worker utilizing eIDSR app

Healthcare worker utilizing eIDSR app

Healthcare workers can now use the eIDSR app to submit weekly case reports of the standard 44 WHO priority diseases, conditions, and public health threats - including cases of diseases such as malaria and cholera. The eIDSR app is operational at all District Health Management Teams (DHMTs) across the country. It is currently being piloted in six (6) community health facilities within the Port Loko district to ensure that granular area level data is as accurate as possible before being consolidated at the DHMT level, through to the national level.

For the pilot, data was entered into mobile devices (i.e. tablets and smartphones) at the community health facility and sent to the DHMT before final transmission to the national level at the MoHS. This data is stored within DHIS2 (District Health Information System 2), a web-based open-source information system. DHIS2 is housed in the MoHS server and is managed by the MoHS Directorate of Policy, Planning Information. The DHIS2 is a tool for collection, validation, analysis, and presentation of aggregate statistical data, tailored to integrate health information management activities. The DHIS2 analytics and reporting functions utilize a dashboard interface to develop graphic and comprehensive insights into the state of public health across Sierra Leone.

eHA remains committed to achieving its mission by improving preparedness for potential public health emergencies across underserved communities in West Africa. To find out more about the work that eHA does, kindly subscribe to our monthly e-newsletter here.

 

GIS Open Source versioning tool for a multi-user Distributed Environment (part 2)

This article is the 2nd part of GIS Open Source versioning tool for a multi-user Distributed Environment and originally appeared on GOGEOMATICS Canada. 

An Interview with Dami Sonoiki, GIS Department Manager and Samuel Aiyeoribe, Lead GIS Architect at eHealth Africa in Kano Nigeria.

1- What projects and workflow in eHealth Africa is this FOSS4G tool being used for within your GIS Team?

One of our largest data management platforms is the Geospatial Database dedicated for our National Polio program support. The data is used to support Polio Vaccination Campaigns in Northern Nigeria to ensure maximum vaccination coverage during every round of campaign.

Thus, the database must be kept up to date with the latest available geospatial data. This always requires having multiple staff processing geospatial data from multiple locations. Hence this is a good use case for the plugin. The plugin is also currently being used to manage geospatial data among multiple countries where eHA operates. This has helped simplify workflow, improved efficiency and increased data integrity.

Furthermore, we use the QGIS Versioning plugin to manage our Health Facility Database.

2- What did you see as the next development of such QGIS versioning plugin?

It will be great to develop and enable spatial filtering when using the PostGIS checkout. This is currently possible with SpatiaLite checkout, but it will be great if this can be the next phase for PostGIS checkout.

In addition to the above, the possibility to implement a PostGIS checkout (offline form the source DB) to another PostgreSQL/PostGIS instance will be a good plugin upgrade.

To learn more, click here for full article.

Coding for Good: Finding Tech Jobs in the Social Sector

eHealth Africa (eHA) hosted 'Coding for Good – Finding Tech Jobs in the Social Sector' to bring together the non-profit, development aid, and social enterprise sectors with tech professionals searching for jobs. The event was held at the Co.up, a co-working space in Kreuzberg, Berlin.

Although finding employees with technical expertise is often a priority for social organizations, and finding a socially responsible career is important to many tech professionals, these groups often struggle to reach one another. Amongst the panelists were:

Key learning points for attendees covered the topics of: finding job positions, compensation for work in the social sector and the intersection of tech and health NGOs. Panelists highlighted how channels that social organizations, especially non-profits, typically use to recruit differ from the ways tech professionals normally navigate the job market. Many nonprofit organizations lack the resources to hire recruiting agencies or head-hunters, so they rely on community job boards (job websites that do not charge a fee for posts) and the personal networks of their employees.

Remuneration in the social sector was also discussed by the panelists. A common misconception among attendees was that working in the social sector could mean a pay-cut. However, the expert panel shared information on the many nonprofits and for-profit social businesses which do pay the industry standard in the tech field.

IMG_1883.jpg

Additionally, not every nonprofit is behind on technology and trends - there are many that are run like successful for-profit businesses by thought leaders who are paving the way for a massive new generation of tech professionals. At eHA, we are committed to using tech to improve and expand availability of health care for underserved populations in Africa.

eHA was pleased to host an event that provided tech professionals with valuable insights into the environment and daily work occurring in the social sector. Additionally, social businesses and NGOs gained first-hand perspective from tech professionals regarding what they are looking for in their careers and how they maneuver through their job search processes. Having provided thought leadership and a great exchange platform to attendees, eHA is looking forward to hosting similar events in the future.

Integrating tech and health, eHA achieves its mission by establishing new standards in the delivery of healthcare to most vulnerable communities in West Africa. Our outstanding technical personnel is an essential part of our success. If you are interested in joining us, please have a look at our job board here. You can also check out our Elastic Stack Volunteer program here or contact our team at berlin@eHealthAfrica.org.

GIS Open Source versioning tool for a multi-user Distributed Environment

This article originally appeared on GOGEOMATICS Canada and was jointly written by Nicolas Gignac, Dami Sonoiki (eHealth Africa) and Samuel Aiyeoribe (eHealth Africa). 

In today’s digital world, organizations are effectively working to publish clean and up-to-date dynamic geospatial data. This data needs to be time-based in order to track changes in multiple versions within short periods. Finding the best tool that adapt seamlessly to one’s own organization’s workflow and capability has been a challenge faced by many organizations.

Managing geospatial data processing within a large team of editors in a distributed work environment can be complex especially with regard to conflicting modifications related to geometries or attributes. When managing a centralized database or an open crowd-sourcing environments, editors may like to track changes and edit data while disconnected from the centralized master database, using source code versioning like tools.

A number of tools already exist in the market to tackle versioning, for instance ArcGIS versioning database in the ESRI world. Unfortunately, this option requires buying multiple Desktop and Server licenses.

In the OpenStreetMap platform, Overpass queries can reveal modification history. However the tool cannot be used for an in-house database. There is also GeoGig and PGversion as Free and Open Source Software for Geospatial (FOSS4G) tools, but both lack functionality to fulfill the above described purposes. The setup involves using PostGIS as the main repository by having the ability to edit specific geographic sections of a data layer and to work offline without having to write any lines of code from the editor.

GIS Team Members

GIS Team Members

To learn more, click here for full article.

'Africa Health' features eHA's Integrated Community Health Pilot (ICHP) in Guinea

A holistic approach to improving community health in Guinea

This article originally appeared on Africa Health and was written by Taylor M. Snyder, MPH, Senior Technical Advisor, eHealth Africa

eHealth Africa (eHA) is driven by the philosophy that focusing on improving the overall basic standard of healthcare, rather than using a disease-based model of healthcare, can lead to population-wide health improvements that achieve value for money.

eHA Guinea’s Integrated Community Health Pilot (ICHP) implemented connected reforms in order to improve community health at scale through sustainable platforms. ICHP was funded by The Paul G. Allen Family Foundation, and its project realisation phase was less than one year. The Guinean Ministry of Health (MOH) was critical to the project’s success, as they were engaged from ICHP’s onset and selected the subprefecture of Timbi Touni as the pilot’s site. Continuously engaging the Timbi Touni community to collaboratively implement evidence-based and locally-adapted solutions was key to achieving health infrastructure and medical supply improvements, connectivity and the digitisation of health data, and healthcare worker (HCW) capacity building.

To learn more, click here for full report.

Health Camps: Enhancing Access To Healthcare in Kano State

By Daniel Ojabo

Some areas of northern Nigeria still do not have consistent access to healthcare. This is mainly due to the lack of health facilities in remote areas, and the inability of local populations to access transportation to functioning primary healthcare centers.

eHA Health Camps 1

Health Camps (HC), a demand-creation intervention, was birthed to fill this gap by working with government partners to supplement monthly polio vaccination campaigns (Immunization Plus Days) with essential medicines. It also serves as a means to address persistent cases of refusal of polio vaccines by heads of households.

Funded by the Bill & Melinda Gates Foundation, eHealth Africa (eHA) has supported the Kano State Ministry of Health as an implementing partner. We procure, package and distribute medications across the 44 Local Government Areas (LGA) in the State.

By the end of 2016, eHA had distributed 82,452 HC boxes across over 27,000 settlements in Kano; up from 34,188 HC boxes delivered in 2014. In September 2016, to ensure that the National Guidelines of Malaria testing before treatment were met, Rapid Diagnostics Test (RDT) Kits were introduced to the HC boxes. RDTs permit a rapid, accurate, and accessible detection of malaria parasites, particularly in remote areas with limited access to health facilities. This exercise has promoted a more rational use of increasingly costly drugs, through enabling health workers to distinguish between fevers caused by malaria parasites from those caused by other illnesses.

Last year, we recorded increased cases of malaria in the state. So, the Kano State government provided some rapid diagnostic test kits for malaria.
— Dr. Kabir Ibrahim Getso, Commissioner For Health, Kano State.
eHA Health Camps

Each HC box contains supplies for 100 people. These supplies include RDTs, and medicines to treat malaria, tapeworms, ulcers, diarrhea, scabies, and other diseases. Trained community health workers administer RDTs for malaria and prescribe corresponding medications. In cases where the diagnosis are advanced, the beneficiaries are referred to the nearest health center.

eHA procures and packages over 2,000 HC boxes for every Immunization Plus Day (IPD) campaign. Since 2014, over 5 million people have benefited from HCs; including 2.2 million children under the age of 5. This initiative has also seen 3.6 million cases of malaria diagnosed and treated, which is around 70 percent of total patients serviced since inception.  

We found out that a lot of people were voluntarily bringing out their children to accept the vaccination, getting an opportunity to also treat minor ailments which the Health Camps were designed to basically address.
— Dr. Ahmed Suleiman Haladu, State Lead Polio CDC-NSTOP

After more than two years without wild poliovirus in Nigeria, the Government reported in August 2016 that 2 children had been paralyzed by the disease in the northern Borno state. The cases highlighted the need to prioritize immunization of children particularly, in hard-to-reach areas in northern Nigeria. In the last quarter (Oct. Dec.) of 2016 alone, over 480 thousand children were Immunized with Oral Polio Vaccines (OPV) at HCs. The significant progress and achievements in the past couple of years, have been due to the high level of political commitment and leadership. Traditional community leaders have also provided credibility to the project by openly promoting and encouraging community members to attend HCs.

We are making all efforts to ensure that the government reaches everywhere for people to understand the mission behind this program.
— Alhaji Ja’afaru Ahmed Gwarzo, Sarkin Tsafta, Kano Emirate Council.

eHealth Africa Pilots AVADAR Surveillance System to Track Progress Toward Polio Eradication

By Daniel Ojabo

In response to the recently reported cases of wild poliovirus in Nigeria, eHealth Africa (eHA) partnered with Bill and Melinda Gates Foundation, WHO, and Novel-T to pilot a mobile-based surveillance application  for Acute Flaccid Paralysis (AFP) in children.

Defined by WHO as “a rapid onset of weakness of an individual's extremities”, AFP often causes weakness of the muscles of respiration and swallowing, progressing to maximum severity within 1-10 days. AFP surveillance, being one of the four cornerstone strategies of polio eradication, seeks to identify all cases of polio through a system that targets any case of AFP as a potential case of polio. The surveillance tool is an Auto-Visual AFP Detection and Reporting (AVADAR) mobile application installed on android-enabled mobile devices, provided to Health Workers and Community Informants, to aid in the detection and reporting of AFP cases within health facilities and local communities.

Screenshots of AVADAR Application

Screenshots of AVADAR Application

According to the project manager, Umar K. Idris, “AVADAR was designed to improve the sensitivity and quality of AFP surveillance, particularly in places with low performance indicators”.

The AVADAR project was piloted on 5 August, 2016 in the Local Government Areas (LGAs) of Oyun (Kwara state) and Kuje (FCT, Abuja) for an 8 week period. In Kuje, community informants reported 26 AFP cases within the 8 week period. This was a considerable increase compared to only 23 cases reported in the 33 week period (from January to July 2016) before implementation of the AVADAR pilot. Similarly, in Oyun there were 8 reported AFP cases within the 8 week period (August to October 2016), compared to only 4 reported cases in the 33 week period prior to AVADAR.

Building on the successes achieved, the project was scaled up to include 8 LGAs in Borno state in November 2016, with plans to further expand into other states.

“We are on the verge of expanding into Adamawa, Sokoto and Yobe. We also aim to implement it in the Lake Chad Region (Chad, Cameroon & Niger Republic), post-Ebola countries (Guinea, Liberia, Sierra Leone), as well as the Democratic Republic of Congo and South Sudan in 2017”, Idris said.

According to the Global Polio Eradication Initiative (GPEI), the absence of AFP surveillance provides a gateway for wild poliovirus to continue circulating around the world. Innovations like AVADAR have already  improved the surveillance network by providing health workers and community informants with an active surveillance tool to effectively report suspected AFP cases. The surveillance data will serve as a measure of progress towards polio eradication and allow polio program stakeholders to effectively plan and implement strategies for supplementary immunization activities (e.g. national immunization campaigns).

To strengthen communication amongst the local health workers and community informants, eHA trained over 800 health workers and provided them with over 800 GPS-enabled smartphones and solar chargers. AVADAR has expanded the surveillance network by bringing in more community informants, health workers and designated health facilities to improve the sensitivity of AFP surveillance amongst surveillance personnel (in terms of timely detection and reporting). The AVADAR software includes an embedded 30-second video of a live child with AFP symptoms having difficulty crawling/walking, as well as an electronic data collection form for submission of detailed information on suspected AFP case patients. This video is sent as a weekly reminder to Health Workers and Community Informants (on their GPS-enabled mobile phones) responsible for reporting all suspected AFP cases in their health facilities and communities.