Interoperability is key for digital health solutions in Africa

At re:publica the Innovation Factory presented digital solutions for pregnancy and delivery care

Innovation Factory members from Cameroon, Germany, Kenya and Tanzania

At the re:publica convention on 9 May 2017 in Berlin, Steven Macharia, a digital health expert from Kenya, stated one of the Innovation Factory’s goals: ‘We promote interoperability between data management systems to help create a situation in which high quality health data is available and can be accessed by all who need it, when they need it’.

A multidisciplinary team of health and IT professionals from four countries - Tanzania, Cameroon, Kenya, and Germany – showcased their digital solutions in the panel session ‘Connecting health – systemic mHealth solutions for better pregnancy and birth giving care’, during the re:publica media convention this May in Berlin. re:publica is one of the largest and most exciting conferences about digital culture in the world. Every year representatives of digital culture come to this forum to share their knowledge and decision-making tools.

The Innovation Factory is a global initiative which the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH implements on behalf of Germany’s Federal Ministry for Economic Development and Cooperation (BMZ). It provides a collaborative and creative space for health and IT professionals to develop and support digital health solutions that are in line with the four partner countries’ national priorities. The approaches on which the team works build on existing experiences and lessons learned, they are people-centred, and they are owned and truly shared by the Innovation Factory partnership as a whole.

The Innovation Factory’s approach: communication, collaboration, coordination and continuity of care

The Innovation Factory’s crucial asset is its cross-country ideation process: The four country units do not work as individual organizations but as a multi-country team in which the different members inspire each other. Steven Macharia, a digital health specialist from Kenya, accurately summarized the advantages of such a collaboration:

‘I see this process in four words: communication, collaboration, coordination and continuity of care. If you look at the fundamental challenges we are all facing across the four countries, you will see that we all need systems that promote continuity of care and that agreed standards must ensure these systems’ interoperability. In our teamwork we are continuously learning from each other and this helps us to use our resources wisely. This is in line with a global trend towards the creation of common goods: instead of re-inventing and re-creating we aim to re-use and improve.’

‘The four countries’ problems are not exactly the same but they are similar enough to allow them to speak with one voice when it comes to the future of digital health. And they need a strong voice to bring their policy makers on board. Today large amounts of existing medical data remain unused because there are too many island solutions and we lack interoperability between different data systems’ - adds Titus Kühne, Director of the Institute of Computer-assisted Medicine at the Charité - Universitätsmedizin Berlin.

Interoperability between systems would permit sharing of health data across and within countries. Solutions reaching rural as well as urban areas could enhance health data density, quality and accessibility. One way forward is aggregating ‘conventional’ health information system data with those derived from mHealth applications through the creation of flexible data management systems. With its work, the Innovation Factory aims to provide such solutions, starting with Kenya, Tanzania and Cameroon. Three of them were presented at re:publica:

Tanzania’s mHealth Platform (NICmHP) for successful mHealth applications

Mwawi Leah Mlekano, Executive Director of ITIDO LTD and Secretary of Tanzania’s mHealth community of practice

Mwawi Leah Mlekano, Executive Director of ITIDO LTD, a catalyst for Innovation, presented the Tanzanian National Integrated Community mHealth Platform (NICmHP). The platform brings together successful digital community mHealth information systems that are currently in operation in Tanzania in order to enhance seamless and efficient service delivery. In the longer run the aim is to integrate the platform’s mHealth data with Tanzania’s digital health information system, which is based on DHIS2.

According to Ms Mlekano ‘Tanzania has seen a lot of mHealth projects already, but we struggle with repetition and redundancies: Projects tend to reach the same areas and communities instead of trying to cover those which others have not yet reached. One of our objectives is to make sure that this changes. We advise mHealth projects on what to do and where to do it.’

When asked about the platform’s sustainability Ms Mlekano replied: ‘Yes, sustainability is an issue for many of our mHealth projects. Today there is one organisation funding an mHealth project, tomorrow another organization arrives in the same area and starts a similar project, without connection to the first. In the end the government is not adopting either of the two and all funds and efforts go to waste. If we work like this there will be no sustainability and no scalability! With our project we want to change this. We are pushing the government to set a common standard for all mHealth projects in Tanzania. With such a common standard, it will become much easier for the government or for other organisations and funding agencies to build on what’s already there: If a project does A-B-C the next project can do D-E-F-G, and then someone else will continue’.

Improving the referral system between communities and health facilities in Cameroon

In Cameroon the eHealth project Happy Mothers provides mobile phones and tablets to will community health workers (CHW) to improve communication and timely referrals of pregnant mothers or mothers and young children in need of health services to the appropriate health facilities. The digital linking of health facilities and community health workers will allow for closer cooperation between health facilities and their clients in the surrounding communities and it will ensure that the health data about them are quickly available both for the health workers and for the national health information system, providing policy makers with a better information base for their for decision making.

During the Q&A session it was elaborated that the whole team behind Happy Mothers, coordinated by Prof. Dr. Samuel Kingue, professor of cardiology at the Medical Faculty and Biomedical Sciences at the University of Yaoundé, is convinced that the community health workers should be formally integrated in the national healthcare system: ‘It’s not too long ago that midwifery schools have opened in Cameroon and it will take many years until we have sufficient trained midwives in all communities. Until then we still need to work with community health workers and equipped with mobile phones and tablets they will be better able to play their part. Their role in the health system should be recognized and formalized by the ministry of health!’

Reciprocal eHealth solutions across the healthcare system in Kenya

Steven Macharia presented an approach entitled ‘Reciprocal eHealth solutions for Care Compliance, Competent Capacity and Continuous Communication’. It is based on the innovative DHIS2 tracker functionality. This functionality supports health workers by tracking women through antenatal care, delivery, and postnatal care and by sending out automated SMS reminders to women that miss their scheduled appointments. In addition it can generate daily or weekly visit schedules (work plans) for health facility staff and community health workers and it can help health facilities monitor the impact of educational events held at the community level by correlating them with subsequent client demand for the services promoted at the given event.

Further information

Anne Talk
July 2017

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