Bed Space Tracker (BST)

Nigeria has the highest number of maternal and newborn mortalities in Africa accounting for 23% of the global maternal deaths in 2017. One of the factors that leads to these mortalities are sub-optimal referral systems. Patients with complications are often referred from one hospital to another without prior confirmation of bed availability.

The solution aims to reduce the frequency of patients being referred to multiple hospitals before ultimately accessing care. The solution will address this problem by providing real-time information to healthcare providers and end-users on which hospitals have available bed spaces.  

Maternal and neonatal death continue to be a global burden. If this solution is scaled up it will address the type 2 delay: the delay in accessing care. Patients will be able to access care faster without going through the vicious cycle of looking for a hospital with bed space.

In a December 2019 investigation conducted in the two largest referral facilities in Lagos State, Nigeria, it was revealed that the lack of bed space left patients stranded for days at the Accident and Emergency unit, with some of them eventually receiving the required care or meeting an untimely death.

Maternal and newborn health emergencies are critical in any health system as survival for a mother or a newborn is dependent on access to timely care. When a patient is referred from a primary or secondary care facility, she has to navigate numerous barriers, including significant traffic in Lagos to reach a facility. If on arrival there is no bed space at this facility, she has to be referred again to another health facility without the assurance of a bed space. For many mothers this means multiple trips to a number of health facilities. In this time, in addition to mounting frustration, many viable fetuses become stillborn, some newborns develop lifelong morbidities, some mothers die or develop lifelong morbidities as well. These all contribute to the current 556 maternal deaths per 100,000 live births in Nigeria and the 39 neonatal deaths per 1,000 live births in Lagos state.

The bed space tracker is a real-time dashboard that provides updates on bed space availability in Lagos State. Healthcare providers can access the dashboard to find the hospitals with available bed space when referring patients. The BST will be an expansion of the services provided by Navihealth.ai™ which currently serves as an online directory of health providers and health facilities in Nigeria and some other African countries. 

Most facilities in Lagos have a mechanism to monitor their bed occupancy rate. In some facilities this activity is done daily, while others do this at the end of each shift. This solution will leverage the existing systems to populate the dashboard. Each health facility will also provide a list of services provided and their emergency contact numbers. With this, each facility from where a referral is originating can verify the availability of services and bed spaces to accommodate the patient being referred. The solutions could also improve emergency preparedness for health facilities for incoming referrals as they are primed by the referring care provider. 

We believe that if care providers in Lagos State have access to real-time data on bed space availability to surrounding hospitals it may improve the outcomes of women.

We will leverage the Human Centered Design approach to engage the end users (healthcare  providers and health care users) in designing various aspects of the solution. 

For the health providers, this solution enables the referring health provider to attain a level of certainty that the health facility a mother and/or her newborn is being referred to is ready to provide the required care. In the health facility where mothers are referred to, the notification they receive when the referring care provider or a self-referring patient calls with enquiries, helps them to better prepare to receive and manage emergencies for mothers and their newborns. 

For the care users who sometimes have to initiate self-referrals to these facilities, they are able to access information about health facilities which render the desired services they seek and also the availability of bed spaces for cases which may require admission.

The survival of mothers and their newborn in cases of emergency is contingent on the timeliness of interventions. There is evidence that the time lost traveling to different health facilities in Lagos in search of bed space worsens health outcomes. 

Lagos state has the highest teledensity and internet access in the country. The use of the bed space tracker which will be freely available through mobile and web interfaces and will help care providers and users maximize the chances of survival for each referred patient and also reduce delay in receiving care in health facilities.

In most hospitals in Lagos State, bed space occupancy is tracked manually and the information rarely gets to the people who receive referral calls on behalf of the hospital. BST is unique because it gives the referring facility access to real-time information to select the hospital to refer their patient to. On the other end the receiving hospital is notified by the referring hospital and they are able to prepare for the arrival of the patient. For the patient that is self referring they are able to access the platform and find  the closest hospitals  which provide the services they require. 

When a patient is referred from a health facility to a referral centre, ideally these patients should be conveyed in health facility ambulances to the referral facilities in the company of trained health workers. However, due to infrastructural challenges, some women have to utilize private or public transportation and endure gruelling traffic to get to the referral facility only to be referred out again in cases where there are no bed spaces. 

This solution strategically harnesses information which ordinarily resides in each health facility with a dedicated facility team uploading information daily into the provider interface of the platform to feed a real-time dashboard that informs decisions for health providers as well as healthcare consumers saving time and potentially improving outcomes.

NaviHealth™ is a web-based software online directory of health services, facilities and providers powered by mDoc. NaviHealth™ was created to help address the information asymmetry across citizens, patients, providers, and other groups in the healthcare area. The power of NaviHealth™ lies in the comprehensiveness and the reliability of the information provided and maintained by accredited healthcare providers and facilities. 

With the NaviHealth™ directory, patients can access an accurate and comprehensive resource of licensed healthcare professionals, their facilities and services offered helping them make more informed decisions on where they can get quality care. Healthcare professionals are also able to find and connect with other healthcare professionals. Healthcare providers are also able to make more timely and appropriate referrals for their patients making healthcare better for everyone.

NaviHealth™ is currently being used by over 6614 facilities and 2156 healthcare providers across Nigeria since inception. At the early phase of the unprecedented COVID-19 pandemic, NaviHealth™ launched a COVID-19 page dedicated to providing healthcare users with information on COVID-19 testing facilities, isolation and treatment centers across Africa with the aim of ensuring users have verified information on where they could get testing and treatment. Currently, the page has information on 604 COVID-19 sites with 364 testing facilities and 240 Isolation/Testing Centres.

Most health facilities in Lagos run a shift system and to ensure continuity across shifts, health workers have handover meetings for the outgoing and incoming health workers. Bed occupancy is one of the parameters ascertained and transmitted across shifts and is documented in a shift summary report. The first challenge is that due to the manual methods of collection, responsible staff (in most cases Director of Nursing Services) in large referral centres, do not know the facility bed occupancy in real time. Secondly, with the limited communication across health facilities, many care providers refer clients out in hope that they meet an available bed space in the facility. These patients who may be facing a life-threatening condition may then be faced with the option of visiting several facilities before they receive care.

What we propose is an automation of the aggregation process of bed occupancy rate in wards within and across health facilities starting with Lagos state and spreading nationally using a simple UI on the Navihealth.ai platform. In year one, we will leverage our current engagement with the 26 general hospitals to ensure each facility profile (including services rendered, emergency contacts) is updated on BST. We will sensitize and train frontline workers on the use and modalities of data entry on the BST platform. We will also train their medical doctors to seamlessly access the available BST data on the platform at point of referral.  Lagos state Ministry of health will provide oversight for BST implementation and we will work with them to integrate the data quality assurance mechanisms for other health data for the BST data. Once the BST works seamlessly across referral facilities, we will expand the scope of its use to health workers in other health facilities and also the general public who may choose to access services at these centres.

A similar intervention which utilized short message service (SMS) based data-exchange software to improve maternal and newborn health outcomes in selected Woredas in rural Ethiopia, had in addition to improved maternal health outcomes also demonstrated an increase and effectiveness of  referrals between facilities (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5682387/)

While the Navihealth.ai platform has been in use since 2018 and has served over 8,700 persons, the BST UI on Navihealth.ai is still under development. We envisage that over 50,000 persons will benefit from its use in the first year as we utilize BST in public referral centres. With a spread to all health facilities in the state and a scale to other states in Nigeria, we envisage that BST will serve over one million users in 5 years.

The BST aims to increase access to timely emergency Maternal and Newborn health (MNH) care in the event of care referrals within Lagos State by 2025.

The implementation of the BST will prioritize four strategic pillars to maximize the impact.

Health worker engagement: We will utilize a phased approach in onboarding health workers onto the platform. Within the first year, we will leverage our relationship with all the 26 General Hospitals in the State, to sensitize and onboard health workers on the BST app. Thereafter public primary facilities which feed referrals into these centres and care users will be onboarded. By the fifth year we aim to have sensitized and onboarded health workers from a minimum of 90% of all accredited facilities in Lagos.

Citizen engagement: We will deploy grass root and social media marketing strategies to create BST awareness with the hope of achieving over 50,000 utilization of the app in the first year and at least 1 million in the fifth year

Stakeholder engagement: We will expand our strategic support for MNH to LSMoH to include equipping focal persons with the requisite skills to oversee and problem solve in the course of BST implementation as well as manage the emerging data for evidence based decisions.

Feedback systems: Health users will be able to provide feedback for services received in each facility on the platform. This will also help intending care users make informed decisions and also serve as motivation for quality service delivery for care providers

Year One Risks

Culture

• Lack of buy-in from the healthcare providers

  • Reluctance of health facilities to share data with external bodies 

  • Resistance from health workers when new systems are introduced (health workers may not want to use the platform)

• Quality of data uploaded (healthcare providers may upload data that is not reliable or timely)

Technical 

• Health workers may face challenges uploading their facility data on the Navihealth.ai provider interface

Financial

• Lack of funds to develop and launch the Tracker to potential clients

Year Five Risks

Market Barrier

• Competition from other app developers addressing the same issue

Year One Risks

Culture

• To address the lack of buy-in risk, the team will design a robust engagement and sensitization plan that will highlight the value proposition of using the app to the healthcare providers.

• To address the data quality risk,  the team will leverage the HCD approach to co-design guidelines and standard operating procedures for uploading data to the platform. A data verification process will be in place to ensure data uploaded is reliable. The process will include a feedback system that routinely informs facilities on their data quality. 

Technical 

• To address the technical risk, the team will train healthcare providers that sign up to use the service. To ensure the costs of the training are economical, the team will leverage technology to hold web based training sessions. 

Financial 

• To address the financial risk, the team will source for funding by sourcing for investors, and applying to Tech Accelerators/Incubators for support

Year Five Risks

 Market Barrier

• We envisage that the market will have many players and many tech solutions addressing this challenge in a couple of years as the world becomes more digital. To ensure the BST remains relevant, we will always invest in and leverage innovation and adaptability. Our organisation will ensure the app evolves with the times and remains relevant to its users

N/A

Currently 7 full time staff

HSDF has worked with over 150 public and private sector facilities providing primary and secondary care in Lagos since 2014 to reimagine and redesign care using quality improvement methods to improve health outcomes. The need to solve for a bed space tracker was borne out of our experience in trying to curb maternal and newborn deaths resulting from late facility presentations. On the other hand, the Navihealth™ app powered by mDoc was conceived in response to the Ebola crisis in 2014 as many clients who desired to get tested experienced difficulties finding centres which offered the tests. In 2018 the Navihealth™ was successfully launched providing thousands of Nigerians a user-friendly online directory of licensed healthcare providers and facilities around them who offer the desired care they need to access.

The solution team proposes leveraging HSDF's insights, experiences and relationships with relevant stakeholders for maternal and newborn health in Lagos state to ensure a seamless integration of the bed tracker technology in referral management in Lagos state unto the NaviHealth app. We would also be leveraging the technology expertise of mDoc that has driven disruptions in the healthcare sector with products such as CompleteHealth and Navihealth™ which improve care access and experiences for healthcare consumers and providers. This expansion of Navihealth™ to track bed spaces will innovatively solve a complex health system challenge with the potential of saving many more lives.  

To implement the BTS, HSDF will partner with mDoC. HSDF will oversee the engagement of the different stakeholders (including Lagos State Ministry of Health, care providers, care users), while mDoc will provide the technical expertise required for powering and ensuring good user experience with the BST interface on NaviHealth.a.

Value proposition: using real time data to identify bed space availability in referral facilities and facilities providing secondary care to enhance timely access to care by pregnant women and sick neonates

1. Key Resources

The NaviHealth Platform that provides information on facility location and services provided therein

The Solution team

2. Key Activities include

• Conduct routine sensitization of end-users on the function and usage of the platform (this is to ensure that end-user understand the importance of uploading reliable data)

• Healthcare providers upload data daily onto the platform 

• Data uploaded is verified for reliability and published 

3. Type of Intervention   

• Mobile App 

4. Customer Segments include:

• Healthcare providers

• Community health workers

• Traditional birth attendants

• Pregnant women 

• Neonates

• Healthcare leadership (Governing Agencies)

5. Impact Measures include

• Number of pregnant women who received timely access to care based on BST

• Number of neonates who received timely access to care based on BST

• Number of healthcare providers who made appropriate and timely referrals based on BST information 

6. Key Stakeholders include:  Governing agencies of the public and private facilities, Public and Private health providers, pregnant women, neonates and their families

7. Major Costs include :

• Personnel

• Fixed costs (rent, utility bills etc.)

• Web App customization

• Back-end data quality check and customization

8. Surplus would be used to add new functionalities on both the back-end and the front-end of the solution, 

9. Revenue

• Investors, Grants: 80% at startup phase

• The State Ministries of Health, Governing Agencies buy in: 20%, evolving to a licensing model

We will engender sustainability of the BST from the outset by engaging three critical levers: a stakeholder-led approach which embeds emerging data with existing processes, effective user engagement and strategies to offset cost of maintaining the platform

Stakeholder-led approach: The Lagos State Ministry of health oversees all health affairs in the state and their leadership in the BST will be critical for sustainability. The bed space availability is a complex problem which we have discussed extensively over the last 5 years on HSDF’s MNH project with the relevant stakeholders. We will also work to ensure an integration of the data emerging from the BTS into the planning and research unit of the state ministry to foster evidence-based planning for MNH in the state.

Effective user engagement: The BTS will have a responsive feedback system which enables the users (care providers and users) to share experiences of health facility use. This data can help intending care users make an informed decision and can also be a driver for improved care quality for care providers.

We are applying to Solve because we are looking forward to the resources and support that Solvers are exposed to, to facilitate the crystallization of the proposed solution.

We would like to partner for support to  optimize our search functionality on NaviHealth.ai to serve the results as quickly as possible to the user.

We would like to work with the MIT Faculty amongst others. We believe they can help us refine our thinking and launch the Tracker right