Category: Blog

Health Delivery Systems

Less than a fortnight ago, the  World Health Organisation,  Director-General, Dr Tedros Adhanom Ghebreyesus warned that the impact of climate change may reverse the progress made in the fight against malaria. This according to him is due to “COVID-19-induced public health disruptions, humanitarian crises, drug and insecticide resistance, and global warming impacts”. As contained in the recently released World Malaria report, the changing climate poses a substantial risk to progress against malaria, particularly in vulnerable regions. This may just be another critical reason needed to lift the climate change/health nexus while ensuring effective mainstreaming of  health in the global climate change agenda.

There is no gainsaying that developing countries like Nigeria and others  must be on the alert to prepare for the potential impact of this new development necessitated by climate change. Despite the hysteria that greeted the reported number of Africa’s delegates (especially Nigeria) to the just concluded 28th United Nations Climate Change Conference otherwise referred to as  Conference of Parties (COP28), It is pertinent to reflect on the economic and human resources invested in the event to explore actual opportunities.

The conference was no doubt a huge platform  where thought leaders and experts across the  world come together to chart pathways  to address the climate crisis, and proffer succor on how  vulnerable communities can adapt to the effects of climate change. This is in a bid to achieve the  overall goal of  net-zero emissions by 2050. With over 70,000 delegates expected to attend this important event every year; from business leaders, young people, climate scientists, Indigenous Peoples, journalists, and various other experts and stakeholders; the opportunities are boundless.

With the 2023 Intergovernmental Panel on Climate Change report revealing that over 3.5billion people live in areas that are vulnerable to climate change, it’s just a matter of time before nations feel the impact if there are no effective measures for early preparedness and response against climate change.  This may have contributed to the call for urgent action on climate change and health by  the Global Health Community.  This is also not a coincidence as similar calls were made before the 2022 Conference as the World Health Organisation reiterated the fact that,  climate crisis continues to make people sick and jeopardizes lives. This yet again buttressed the call to make healthcare delivery amidst climate change  a critical area of discussion during the conference.  Thus it was not surprising when the COP28 Presidency joined with the World Health Organization to announce a new ‘COP28 UAE Declaration on Climate and Health’ (the Declaration) to accelerate actions to protect people’s health from growing climate impacts.

Thus developing countries like Nigeria have a huge opportunity to build on their participation in the conference to explore ways to alleviate the grueling impact of climate change on healthcare delivery and policies.  One of the first signatory to the Declaration on Climate and Health, Malawian President Lazarus Chakwera revealed that  extreme and unfavorable weather events have consistently displaced citizens, causing the spread of infectious diseases that has led to the death of thousands in countries like Malawi.

Nigeria specifically in recent times witnessed increased flood and rapid desertification. For instance, in the last 18 months, Nigeria experienced massive floods caused by global warming with huge economic and health implications like loss of lives, properties leading to chronic hunger and vulnerability to water-borne diseases.  Also, the potential threat to  livelihoods like agriculture and  fishing is no doubt cause for concern with potential challenges of food security which negatively impact health and nutrition.

While a handful of organizations are taking both intentional and unintentional steps to combat the impending impact of climate change, it is vital to galvanize important stakeholders  across all sectors to discuss their role in supporting the process.  A typical example of such steps is eHealth Africa’s deployment of a modular solution that involves the design and implementation of renewable energy solutions for healthcare facilities, especially in low-resource settings. The  Renewable Energy for Public HealthCare (RE4PHC) solar system is designed to be deployed to health facilities with minimal access to power but at the same time reducing the emission of greenhouse gas from generating sets due to lack of electricity.

However there is need for public and stakeholder sensitization and coordination on the potential impact of climate change in the African region especially in Nigeria. Organisations and government agencies like Nigerian Park service, Great Green Wall, ministries of Agriculture, Marine and Blue economy amongst other Non governmental organizations both within and outside the region must coordinate to ensure effective action against climate change.

This is in a bid to further explore the causes and impact of climate change within and around the African context while educating the people on activities that have consistently escalated the current risk. A basket fund can also be created to pull resources from the public and private sector, especially companies whose activities contribute to emission of greenhouse gasses and global warming with support from international thought leaders and experts in climate change interventions.

The idea of dissecting the nexus between climate change and health is to ensure that Low and Medium Income (LMIC) like Nigeria to advance its aspiration to meet up with acceptable global standards as regards critical actions that aides early preparedness and response.

Atef Fawaz is the Executive Director of eHealth Africa. He is a Complex operations Management and ICT expert with experience in Humanitarian Response and Digital Health

#Child Health, #SARMAAN, #Data Management

By Mohammed Bello

In a bold move to address infant mortality, the Nigerian government through the Federal Ministry of Health, in collaboration with implementation partners, initiated the Safety and Antimicrobial Resistance of Mass Administration of Azithromycin on Children 1-11 months in Nigeria (SARMAAN) research project. The project’s focal point is the mass administration of Azithromycin to children aged 1 – 11 months to understand its impact on safety, antimicrobial resistance, and overall reduction in infant mortality.

The SARMAAN project unfolds in two phases: firstly, to investigate the safety and pattern of antimicrobial resistance (AMR) resulting from Azithromycin administration, and secondly, to assess the cost, feasibility, and acceptability of the drug delivery through various platforms. With three (3) successful cycles completed across six states, the project is well on its way to achieving its milestones.

The study areas – Jigawa, Kebbi, Kano, Sokoto, Akwa Ibom, and Abia are a microcosm of the diverse challenges and opportunities in Nigeria. Their unique characteristics- geographical features to economic structures, provide a rich backdrop for a comprehensive understanding of the SARMAAN project’s impact on healthcare delivery. The research looks at the interplay of factors such as regional health disparities, cultural nuances, and existing healthcare infrastructures. This nuanced examination allows for a more profound appreciation of the project’s significance within the context of Nigeria’s varied landscapes and sociodemographic compositions.

eHealth Africa worked on data management in six implementing states, using digital tools to streamline processes. Key deliverables included the digitization of paper-based case reporting forms, the creation of a study database, and the training of data collectors. The meticulous approach ensured data accuracy and reliability.

The implementation approach, outlined in the document, emphasizes a systematic methodology. With a focus on data processing, storage, and dissemination, the project leveraged digital platforms like Kobotoolbox and Tableau to ensure a smoother information flow.

The raw data is collected, filtered, sorted, processed, analyzed, stored, and then presented in a readable format. The stages deployed to process the collected data.

For this study, data uploaded to the Kobo server is first processed in the Feature Manipulation Engine (FME) before being sent to the study’s Postgre SQL database. The next stage is GeoServer, where fields are exposed as needed and finally disseminated using Tableau.

The SARMAAN project has seen significant achievements in its implementation, with over 18,100 children reached out of the 17893 children targeted across 3 cycles. Training initiatives, data processing, and cleanup were conducted meticulously, contributing to the success of the project. The Tableau dashboard provided a comprehensive overview of the progress, ensuring transparency and accountability. The SARMAAN project dashboard can be accessed via the link.

Despite the successes, the project encountered challenges, including violations of daily community visitation targets, inadequate training facilities, and security concerns. In addition, some data collectors needed more essential tools. Stakeholder engagement gaps existing in certain states also hindered compliance.

The project offers valuable insights, highlighting the importance of daily visitation plans, group training approaches, and adapting to cultural norms. Recommendations include the need for targeted outreach strategies, increased female data collectors in specific regions, and an extended training period for enhanced proficiency.

The SARMAAN project stands as a testament to the power of research and collaboration in addressing critical health challenges. By navigating challenges and incorporating key lessons, the project is poised to continue making a positive impact on infant mortality rates in Nigeria. The journey so far reflects a commitment to innovation, data-driven decision-making, and the well-being of the nation’s children.

PARTNERS

By Favour Oriaku

eHealth Africa (eHA) has the strong belief that access to proper healthcare is a right, not just a privilege. Consequently, eHA continues to create innovative solutions that provide underserved communities in Nigeria with the tools to take charge of their health and well-being. Through their digital innovations, eHA is bridging the gap between technology and healthcare. Currently, the organization is improving their offering by merging their two main applications – LoMIS Deliver and  LoMIS Stock – into one, all-encompassing platform: LoMIS Suite. This platform will enhance the management and delivery of vaccines and other health supplies. By doing so, ensuring that essential healthcare services are consistently available. 

LoMIS Deliver alone has successfully delivered over 17 million vaccine doses and 16 million essential goods to their destinations, overcoming logistical challenges to keep healthcare running smoothly. At the same time, LoMIS Stock has provided healthcare workers with a more efficient way to report, offering real-time visibility of stock levels and streamlining the planning process through a mobile app.

The merging of these two applications by eHA, promises to be a powerful tool for improving existing health systems. It will help manage stock levels, track deliveries, and enhance decision-making processes with ease and precision. With these merged applications, every piece of data collected will contribute to better delivery schedules, improved stock availability, and, most importantly, ensuring that every member of the community has access to essential healthcare services. The integration of the LoMIS applications represents not just a technological advancement, but a ray of hope for a society in pursuit of a dependable and efficient healthcare system at the last mile.

Fatimah Howeidy, the project manager, shares her perspective, saying: “Every data point we collect represents real people, families, and their futures. By merging our LoMIS Deliver and LoMIS Stock applications, we’re not only improving our technology but also ensuring that vaccines and health supplies are always available when and where they’re needed most, and the process is managed using a more improved system.”

This initiative is supported  by the Digital Health Innovation Accelerator Program (DHIAP), which was launched in 2021, and is powered by the WFP Innovation Accelerator and BMZ digilab – the innovation lab for digital solutions, initiated by the Federal Ministry for Economic Cooperation and Development (BMZ) in collaboration with GIZ, the German Development Bank KfW, and the Bill and Melinda Gates Foundation. eHA project has been selected as one of 5 finalists for the WFP Sprint Programme, and is supporting the implementation by providing  financial support, as well as access to mentorship, guidance, and a strong network of peers and stakeholders to inspire and share knowledge and best practices. 

Through initiatives like these, eHA is empowered to offer not just technological solutions; they are weaving a future where healthcare is consistent and accessible to all. This future includes mothers who wish to see their children thrive without vaccine-preventable diseases, healthcare workers who rely on dependable data and supply chains, and communities that rightfully deserve equitable healthcare. In the synergy of technology and health facilitated by eHA, each vaccine delivered represents a stride towards improved health outcomes. Every report submitted through the app strengthens the battle against vaccine preventable diseases. And each decision made with precise, real-time data paves the way for equal healthcare accessible to all.

Fatimah encapsulates eHA’s spirit by saying, “Our solutions, especially when combined into the LoMIS Suite platform, are more than just applications. They are our commitment, represented in data, ensuring that every child and every family in our communities has reliable healthcare.”

In this intricately woven digital solution created by eHA, technology and health are seamlessly interconnected, ensuring that each individual and every community can consistently count on fair and reliable healthcare. It’s not just a project; it is a commitment to accessible healthcare through the power of technology and unwavering dedication of our healthcare professionals.

By Atef Fawaz

In the last two decades, more than 1.3 million people and nearly two trillion dollars have been lost to disasters caused by natural hazards, a United Nations Development Program (UNDP) data reveals. These disasters tend to come with varying degrees of devastation and impacts while in many other cases, affected locations tend to battle with especially public health emergencies during and after such disasters. 

While these disasters are largely natural, the escalation of wars in different parts of the world causes both humanitarian and environmental depredation with potential public health exigency. For instance, since its commencement in February 2022, the World Health Organisation revealed that about  7 million individuals have been displaced within Ukraine and another 7.5 million refugees have been displaced across Europe with over 6000 deaths. Meanwhile in the first 2 weeks, the Palestine-Israeli war has registered over 3000 deaths with many more wounded and displaced. 

Thus there are major concerns that the ongoing crisis in the region is not just an international relations crisis but also a public health crisis that can result in long-term consequences. With the few available hospitals overcrowded, overwhelmed and reaching breaking point while corpses litter the streets, medical experts are concerned about the potential outbreak of infectious diseases especially in Gaza.  Beyond little or no access to good food and water, victims of the ongoing crises risk mental health disorders like depression, anxiety amongst others. Even in the cause of seeking succor, displaced persons are largely exposed to health risks which could degenerate into pandemic both now and in the future. 

For instance, Dr. Jack Tsai, a professor and regional dean at UTHealth Houston School of Public Health in San Antonio is worried that people who are forcibly displaced are at greater risk of communicable diseases such as COVID-19 and measles, which could lead to an outbreak. Also, the impact of deadly weapons like rockets, gravity bombs, amongst others could escalate the potential of future disasters from floods, and earthquakes to public health crises like pandemics and other  outbreaks. 

At the moment, immediate medical attention for the victims of war remains a priority, these nations could be preparing for an impending public health emergency in the near future. With hospitals vulnerable to attacks and healthcare workers losing their lives in the process, the diminishing healthcare facilities and personnel will no doubt contribute to an impending health emergency both during and aftermath of the conflict.  It’s more worrisome that these crises have the potential to spillover to neighboring countries and allies to affected nations as a result of mass migration.

This no doubt underscores the importance of developing robust Digital health intervention strategies to complement existing structures for a more improved response to a potential public health emergency and response. One important global best practice is the operationalization  of Emergency Operation Centers (EOC) that provides a platform for response teams to collect, analyze, prioritize, monitor, and disseminate information about health crises or disasters. This goes  a long way in providing access to information to stakeholders to ensure timely and effective decisions to ensure effective response to health emergencies. Just last year, the WHO inaugurated its first EOC in Gaza as part of efforts to improve emergency response amidst incessant conflict and health emergencies like the COVID-19 pandemic. 

Thus this is an opportunity to identify digital innovations and creative strategies to respond to impending health emergencies in the region.  Experts have suggested that Digital Health solutions can facilitate the integration of health data to monitor impacts, and potentially predict impacts on health, and also serve as decision support tools to provide alerts for potential related disasters. For instance, the Center for Strategic and International studies in one of its briefs on Disaster Risk Reduction through Digital Transformation revealed that, using data from Twitter feeds or even from satellite imagery has helped map the spread of disasters, especially with pandemics. Similarly, it was said that social media platforms played an important role in identifying and discussing symptoms of COVID-19 even before it became a pandemic. The online conversations no doubt helped medical experts to determine the origin of the virus and its eventual spread.

Also, applications like Geographic Information System; an important analytical mapping technology, helps build early warning systems in a bid to understand where potential hazards are located, how many people are affected and what response is needed. With this deep modeling capabilities of GIS, public health leaders and governments in developing nations or vulnerable locations  have a huge opportunity to build a predictive and estimation data repertoire, which can lead to more efficiently targeted emergency preparedness and recovery strategies.

There is also a need to develop emergency communications applications in a bid to reach out to a large public about emergency response efforts. Through this kind of mobile applications, users can receive weather reports, locate emergency shelters and even register for disaster aid. The app offers tips for handling over 20 types of emergency situations and disasters.  An example is the First Aid Disaster Readiness App developed by the  American Red Cross which provides health instructions in situations where victims cannot access hospital immediately. The app has consistently helped in to control bleeding, treat a broken bone, perform Cardiopulmonary resuscitation amongst others. Aside from providing support on first aid for allergies, asthma attacks, burns, choking, distress, heat strokes, stings and bites, the multiple section application also provides detailed information on preparing for situations like  an earthquake, drought, flooding, landslides, tsunamis, volcanoes, and more.

Developing nations must also learn from the current situation by strongly investing in digital structures, building partnerships across all critical stakeholders and developing a legal framework that meets global standards in a bid to internalize effective digital health strategy.  

Atef Fawaz is the Executive Director of eHealth Africa. He is a Complex operations Management and ICT expert with experience in Humanitarian Response and Digital Health