Smart Primary Health Care Informations (Smart-PHCI)

In regions where roads are not passable or non-existent, going to a health facility for patients, care staff and health data collectors alike is an obstacle course! Often, health facilities are hours away on foot, so communities are deprived of access to primary health care. This is all the more relevant because of the lack of healthcare personnel in rural areas and even more so in areas of conflict or insecurity (where healthcare personnel are afraid of being kidnapped by armed rebels), such as in the Health Districts of the West region of Cameroon bordering the North West region in socio-security crisis for 6 years, where nearly 60% of health care establishments are no longer continuously functional and hundreds of thousands of populations are left to their fate. One of the consequences of this problem is the quality or absence of real health information on primary health care provided by these health establishments which are still functional during the periodic activities of collecting and monitoring health information (as part of the government health programs/projects) during which they sometimes travel for hours on the road before realizing the absence of personnel in charge of data or simply the absence/availability of data carriers (registers , medical records, etc.).

This catastrophic situation therefore has consequences on the routine health information that is supposed to be shared with higher-level regulators who use it for the strategic orientations of the health system through rapid decision-making.

As a team passionate about using innovative technology for social good, this challenge will enable SOLDIS to improve the quality of life of a large population in these hard-to-reach regions through available and reliable information. and the provision of health care by mobile teams.

Our magic solution:

The innovative Smart-PHCI approach is based on a set of health care settings selected in hard-to-reach areas whose mapping via KOBOTOOLBOX makes it possible to confirm their functionality in real time and to share information with decision-makers at higher levels data collected by recruited and trained health personnel using smartphone technology at both household and health facility levels, resulting in the delivery of medical products by drones or the deployment of mobile clinic for emergency or time-scheduled actions.

This solution is complementary to the existing one. Currently, nursing staff have to travel for hours to file the monthly activity report at the higher level (District Health Service). With this digitized system the physical report can be filed a long time later just for archiving.

In addition, this solution which will aim to send mobile clinics immediately if necessary does not currently exist. This is also the same for these medical products that can be sent to inaccessible areas using drones.

Setting up such a project allows government programs PBF, Global Fund, INGO:

1. For routine health data (monthly daily activity report):

o rapidly deploy a mobile clinic, particularly in emergency situations (security crisis, epidemic, natural disaster, etc.) for affected populations.

o to provide regulators of the local health system with reliable data for careful planning of the resources to be provided to field teams taking into account the information in their possession (stocks of equipment, essential drugs, vaccines, contraceptive products, etc.) at through the logistics within their reach (motorcycles, cars, canoes, drones, etc.) in rural populations that are difficult to access.

2.For longitudinal health surveys (on the same target populations):

o to assess the changes made in the health of the population with regard to indicators concerning morbidity, lethality and mortality in rural populations that are difficult to access, in particular children, women, disaster victims and people living with disabilities.

o give an overview of certain primary health care indicators not currently taken into account by the national health system (monthly report of routine activities) particularly with regard to malnutrition, abortions, gender-based violence, Menstrual Hygiene Management (MHM) and Water, Hygiene & Sanitation (WASH).  

Personally, I worked as a Medical & Community Verificator in the Performance Based Financing (PBF) Program. This World Bank government program which aims to strengthen the national health systems of low-income countries allowed us to collect routine data each month on primary health care (medical consultations, vaccinations, deliveries, surgeries, etc.) provided in hundreds of public or private health care settings in Cameroon.

As a result, the major problems for our medical checks were the notorious absence of certain personnel on our arrival in these health care settings, or rather the absence of data documents (registers, medical records, etc.) and the impossibility for us to collect the data after traveling very long distances.

These problems were further aggravated by the poor/absence of telephone /internet network coverage in these landlocked areas. And even in the case of telephone network / internet coverage, the lack of electrification in these rural areas did not always allow health care personnel located in these rural areas to print the physical monthly activity report forms to be completed.

In addition, most of the care staff (due to their overload with care activities, etc.) did not always manage to produce and send their monthly activity report on time to the higher levels (Health Districts or even to fill in the DHIS-2) with in return negative repercussions in terms of the promptness and completeness of the health information system.

The problems we intend to solve through this challenge are respectively:

o Financially: reducing travel costs for health data collectors in very remote areas.

o Technically/Culturally: public or private health care settings will make a qualitative leap towards the digitization of health data produced by providing primary health care.

o Legally: this project comes to restore equity in the health interventions of the populations of urban areas and rural areas as well as the consequent distribution of the resources necessary for the provision of primary health care.

The Smart Primary Health Care Information (Smart-PHCI) project is fueling a data revolution to guide priority public health programs. This premium data:

o will be collected frequently, quickly and managed locally.

o help decision makers understand what works and what doesn't, allowing decisions to be made that are more sensitive and responsive to changing needs.

Smart-PHCI surveys collect actionable data on a variety of primary health care topics that inform policy at national levels. The project implements longitudinal surveys and a new cross-sectional panel design to fill a data gap:

o collecting information from the same target populations and households over time for regular monitoring of progress and to understand the drivers of dynamics in the use of health services and products.

o an approach not currently used by other large-scale surveys. Its design of data collection introduced an innovative approach by recruiting Community Health Workers (CHWs) or caregivers who are trained in data collection using smartphone technology.

Finally, this project innovates in these health care settings in remote areas by making it possible to:

o confirm the effective functionality of the health facilities without traveling to the selected sites;

o automatically collect health information from said health facilities without going there;  deploy more responsively mobile clinic to provide health care, particularly in case of an emergency (outbreak investigation) or scheduled activities (health campaigns). 

The expected impact of this project in the coming years will be to have data reporting indicators (completeness and timeliness rates) improved to at least 50% in health facilities located in rural areas of Cameroon and in comparable countries with regard to decision-making, particularly in epidemics and other emergencies.

The use of this tool increases, both at community and health setings levels, the rates of malaria diagnosis, HIV/TB screening, initiation of antimalarial treatment, HIV/TB, retention in HIV/TB treatment. Tuberculosis, lower HIV viral load and case fatality and mortality rates. It will also have an impact on other areas of public health (diseases with epidemic potential under surveillance of expanded vaccinations (poliomyelitis, measles, yellow fever, cholera, COVID-19…), family planning methods, post-abortion care, violence gender-based, menstrual hygiene management, Water, Hygiene & Sanitation /Schistosomiasis ...) This project will enable the monitoring and evaluation of health programs (performance), as a register of facilities and mapping of the availability of services, for the management of logistics in rural communities.

1. Health Facility Reporting Practices

oProportion of health facilities that submit reports on time in the national health information system;

oProportion of health facilities that submit complete reports to the health district;

oProportion of health facilities that report zero cases for epidemic-prone diseases in the national health information system;

oNumber of epidemics missed by health facilities (detected by the national level).

 2. Laboratory practices

oProportion of health facilities in rural areas that directly report laboratory data to the national health information system;

oProportion of district laboratories visited or not that transmit data in the national health information system;

oProportion of the mortality rate of epidemic-prone diseases reported directly in the national health information system.

3. Functionality indicator of health establishments in landlocked areas

oPeriodic report on the functionality of these health establishments;

oRate of accessibility of populations to health care personnel delivering primary health care in rural areas.

4.Indicator of health coverage by mobile health teams in landlocked areas

oPeriodic ratio between the number of people identified for a specific health intervention by the mobile teams/number of people actually reached.

oThe number of out-of-stock health products (contraceptives, drugs, vaccines, etc.) over a given period.

oProportion of emergency resources (contraceptives, drugs, vaccines, etc.) provided to health facilities or mobile teams on time by means of motorcycles, drones, etc. in very difficult to access areas.

oVaccination coverage rate, contraceptive prevalence rate, proportions of medical referrals, rate of morbidity.

We will use the theories of adoption and appropriation of technological innovations for an African artificial intelligence. As a result, these approaches follow one another with Weiss and Heide (1993), Vowles et al. (2011) who for their part link this type of process to the degree of sophistication and complexity of technological innovation. They teach that the more sophisticated and complex the innovation, the more complicated the adoption process becomes. As for Ransbotham and Mitra (2010), they explain that innovation adoption processes are not set in advance and that they remain dependent on the perception of consumers, organizations, etc. Faced with so much literature, the project takes into account three recurring theories, constantly invoked when it comes to technology and development. This approach should be included in the chapter of constructive efforts for the advent of AI in Africa. Moreover, the choice of the scientific popularization of these theories finds referential support in Lacroix (1949) when he affirms:

“No theory without practice, no practice without theory. Man needs a theory to observe facts; he needs facts to build a theory. He will not be able to escape this dilemma and will never know anything until he decides to cut the Gordian knot of knowledge and to imagine a theory that will allow him to grasp the facts” (Lacroix, 1949, p. 53 ).

On the other hand, it will be necessary to align with the new technologies possible if all the providers are well trained and equip them with smartphones (Smart-PHCI) in all the health systems which will appropriate this tool.

Source: https://journals.openedition.o... of 07/24/2022

The technological solution proposed in this case is mainly the Kobotoolbox

mobile application in which a Smart-PHCI form will be configured (according to the health indicators targeted in these geolocated regions). The programming language used here will be either HTML5 or PhoneGap.

Given the logistical difficulties of transporting tons of drugs over long distances, drones can also be used.

Primary data in this project will be collected by frontline trained healthcare providers. That is, those who produce them in health facilities.

The demonstrated strength of SOLDIS lies on its ability to effectively convey messages and advocacy on various health issues and capacity to designing and analysing data with the apps technology. Despite its limited field staff and funding resources, SOLDIS has successfully executed for free small projects that addresses issues on WaSH gap, empowerment of girls and women and gender-based violence.

SOLDIS is also noted with its efforts in partnership building with various stakeholders from the community and local level government as Universities in Cameroon. Further efforts will be made to engage community stakeholders in the process through organized forums so that the community will be aware of the project and can be encouraged to participate in its planning and delivery.

SOLDIS’s approach in development is inclusive and anchored in the following and will be evident in the implementation of the proposed project:

o bottom-up approach to engage the grassroots in many aspects of decision-making processes.

o working with the government agencies and partner stakeholders and sharing the responsibilities to meet development needs and challenges.

o clients knowledge on health services served by the Health system and customary ways of decision-making to promote social inclusion and gender equality.

o community based communication technique to address communities where popular media fails to attain because of illiteracy and low accessibility.

SOLDIS has wide experience in project management acquired from the several projects that have so far been implemented by us. For the last one year, SOLDIS has been on the ground implementing projects on capacity building for community based organizations (CBOs). The management structure of the organization is relatively flat, thus enhancing easy management communication and feedback relays. The organization structure recognizes the importance of involving the community in the implementation of the projects in the specific areas. Thus, the inclusion of the CBOs in the management structure of SOLDIS was to enhance community involvement. The CBOs are given the grassroots’ roles so as to create an easy communication channel between the community and SOLDIS. In addition, all the management staff has experience and “drive” to run community based projects that are aimed at alleviating Primary Health Care and poverty problems. In our team we have many expertises with the members of staff respectively in charge of human resources, finances resources, field coordination, field epidemiology, Education/Gender, WASH, nutrition, midwifery, computer sciences, data analysis,  etc.  All have project management skills acquired at the University level plus a minimum four years in Project Management and proven experience with Kobo toolbox. The Field coordinators are appointed for each project in one or a group Health Care Facilities, schools and households. The appointments take into consideration the specific requirements of the particular Health Care Facilities and surrounding community. The Field coordinators MUST be conversant with the Health settings, area/location and the community in which the project is taking place. Thorough scrutiny of the applicants is done taking into consideration that the Field Coordinators are the eyes of SOLDIS in the field. In addition, a Project Accountant will be recruited, stationed on site and will report to Finance and Administration Manager. He/She will be in charge of project accounting and report preparations including posting of the receipts and documents, keep record of the project accounts and carry out bank reconciliation to ensure proper usage of the funds.

Mixed : Free-for-service (Provision social services directly to a third-party payer (National Health System and its international partners)) and Low-income client (Internal Displaced Populations, rural populations, etc.)

This project can permit to evaluate the outcomes of the ongoing health program in Health Care Facilities and then, will sustainably create demand of health services and products like drugs, vaccine or the specific care. Thus, regarding the available indicators and further interest from financial partners in the long term (eg: selling of birth control products), our revenue streams should cover our expected expenses.

More over the results of this survey, along with interpretations and recommendations, will be published in both local and international publications with higher impact factor. This will provide new empirical evidence on the impact of SOLDIS project activates in Cameroon and the larger Sub-Saharan Africa region.

SOLDIS has existed since 2019 and has not yet received financial support from the Government for the projects carried out so far. Although we carried out actions on behalf of COVID-19, with the NGO OXFAM international and the NGO AMCOW, these were unfunded activities and we were there only for the purpose of gaining notoriety.