CJID: Improved PHC service delivery in local communities

In the current ward system delivery of health care services in Sub-Saharan Africa, the PHC facilities act as the beehive of service delivery within the community. There are several reasons why this is so, ranging from the prevention of common disease states to the complex system of referral, all the way to influencing community-based health care policies to bringing the health workers in the community in more direct contact with members of the community. 

Globally, community-based healthcare systems are known to be more resilient, serve the needs of the people better and lower the cost of healthcare delivery in the long run. There has been an increased focus on strengthening and repositioning PHC systems to play a more significant role in developing communities since the realisation of the critical role that well-built PHC systems play in the capacity building of communities. Indeed this was re-echoed by the WHO Commission on Social Determinants of Health when it stated clearly: 'Healthcare systems have better health outcomes when built on primary health care (PHC) – that is, both the PHC-model that emphasises locally appropriate action across the range of social determinants, where prevention and promotion are in balance with investment in curative interventions, and an emphasis on the primary level of care with adequate referral to higher levels of care'.

With renewed efforts internationally in repositioning PHCs, it is vital to know how far the Nigerian system has been fairing to meet the needs of a growing population, changing social dynamics, and an evolving political system. Notably, the Nigerian state had even established a framework that mirrored the PHC model even before the Alma Ata declaration in the 1987 PHC plan.

But through an ever-changing political landscape, varying social factors, and geopolitical policies, the PHC system has had several adverse factors to contend with. We aimed to look at the state of the PHC facilities in Sub Saharan as an indicator of the performance of the PHC system while comparing this with stated recommendations and international standards. 

It is also pertinent to note that in April 2001, heads of state of African Union countries met and pledged to allocate at least 15% of their annual budget to improve the health sector. The Federal Government of Nigeria, through its renewed commitment to more funding in this area, came up with the 1% consolidated revenue fund idea, to be focused mainly in this area, in the Basic Health Care Provision Fund after the implementation of the National Health Act 2014. The fund is to be used primarily to improve and provide basic services at the PHCs. 

Evidence from the WHO states that of the total global mortality rates, a significant 15 million deaths yearly are said to be 'premature'. More importantly, 85% of these 'premature' deaths occur in low and middle-income countries. With Nigeria belonging to this category as a lower-middle-income country, it raises several concerns. However, a crucial asset to address the rising increase has not only been utilised but left out of the conversation altogether. 

PHC services being the first point of contact, have particular importance if used appropriately. PHCs are to be, at the bare minimum, equipped to monitor not only communicable or non-communicable parameters; moreover, it is to this level of care that community members diagnosed with one form of disease or the other would return to for continual care. 

From poor infrastructure to no medical equipment, the PHC has ceased to meet its obligation in the quality of healthcare provided.

Our solution seeks to improve the standard of PHC service delivery in local communities; across the six geopolitical zones in Nigeria by scaling up our existing  Primary Health Care (PHC) tracker. The Tracker is a civic platform designed to spotlight the challenges, neglect and needs in PHCs whilst holding state and non-state actors in primary health administration accountable. CJID developed the Tracker to measure and track the quality of service delivery provided by the PHCs. CJID also built the Tracker for data-driven and evidence-based advocacy, by the media and civil society, for improved healthcare delivery at PHC levels. CJID created the Tracker to collate user-generated reports and map the collated reports.

We built the Health Care Tracker on the Ushahidi platform (an ecosystem of software and tools created to facilitate the work done by human rights advocates, journalists, election monitors and those responding to disasters and crises). According to Ushahidi, its tools are built from and use a mix of Python, PHP, Javascript, Ionic, Ansible, Terraform, AWS Services, Codeship, Travis CI, Github repositories and ultimately, any technologies that allows Ushahidi to improve its software. 

The Tracker collects crowdsourced data about primary healthcare centres to tell evidence-based stories that bring attention to the various issues that plague Nigerian primary healthcare centres. Users can aggregate the data for further analyses. Users can organise data into categories, perform filter and search functions, and visualise data. The tracker displays reports using a map, data mode and activity views so users can view what's happening at different locations and identify trends or problems. Since creating Primary Health Tracker, we have championed transformational change by ensuring the completion of developmental projects in rural communities. We have tracked over 400 PHCs, and published over 50 investigative reports on Nigeria's leading investigative journalism platform - Premium Times.

Our approach is better in this region because it provides a clear picture of the state of health and quality of care citizens receive. It also offers diverse health care stakeholders, including patients, frontline health workers, policymakers, and everyone in between, the means to understand what's working well and where further improvements are needed. 

It provides a comprehensive vision and purpose for data collection, improves data quality, and manages empirical data. It provides a measurement that primarily informs all primary health care providers for practical performance improvements and generates real-time digital data. 

It enhances communication among information or data systems, eradicates the burden of data collection being borne by frontline health workers, and provides instant feedback mechanisms for data collectors.

The solution includes an upgrade of the already existing health tracker (https://healthcaretrackerng.crowdmap.com/) application to capture: 

1. Number of immunised children
2. Location of PHC
3. Functionality of the PHC
4. Number of Health workers at the PHC
5. Number of attacks on the PHC by the community
6. Budgetary allocation

We designed this solution for people living in low and middle-income countries, which includes Nigeria. We will scale the solution to other West African countries to affect lives in low and middle-income countries.

The Tracker provides improved measurement methods that are low cost, fit-for-purpose, shareable across information systems, and streamlined for data collectors.

The target population are the citizens that need primary care from the health care provider; these include women, children, pregnant women, men and others. Through this solution, the quality of health care delivery will be improved, thus causing a reduction in mortality ratio, strengthening immunisation coverage and improving the quality of life. 

The solution will also enable the PHC providers to quickly make interventions when necessary to address the immediate need of their users by using real-time data reports from the platform, timely information on the state of service delivery and monthly town hall meetings. 

In the last five years, CJID has visited the six geopolitical zones in Nigeria, interrogating processes around: human resources for health, health financing, PHC logistics and budgetary allocation. One significant outcome of this is the 2019 health dialogue, where, with critical stakeholders, we discussed issues extensively around Universal Health Coverage, focusing on the Primary Health Centres. 

The CJID team has the residence knowledge of health development driven by technological insights and innovations, which makes the team the best fit to deliver this solution. Also, we have the largest network of student journalists drawn from STEM and Non-STEM courses trained on developmental issues, including PHC tracking and reporting. 

The Tracker has been tested, tracking over 200 PHCs.The organisation has engaged several stakeholders across the country, identifying the gaps in the level of care delivered to rural and urban patients. The team at CJID includes data scientists, health workers, and development professionals, aside from our over 200 volunteering networks spread across tertiary institutions country-wide - thereby positively impacting the communities they serve.

CJID is limited by funds to track the over 20,000 PHCs in Nigeria. 

If selected, the fund will help overcome the technological challenges the Tracker faces and existing market barriers; whilst we build a system that fits into the cultural space in Nigeria (language translation).

With the current health landscape in Nigeria, to effectively measure the improvement of  Primary health care centres, there is a need to track more than 70% of the PHCs in Nigeria. To do this, the organisation does not have enough resources (financially and human resources) to effectively track the quality of services provided by the Primary health centres. To advance this - the organisation believes that the funding from this challenge will help expand the current funding purse to drive this intervention.

The multi-functionality approach in tracking and record keeping, and also the following:

1. The solution is user friendly
2. Network friendly
3. Number of immunized children
4. Location of PHC
5. Functionality of the PHC
6. Number of Health workers at the PHC
7. Number of attacks on the PHC by the community
8. Budgetary allocation

One of the impacts envisioned for this project is to enable positive impacts from civil society organizations, community-based organizations, Policy makers, and government institutions through regular town hall meetings. 

Our impact goals are:

• Improved quality of health care provided at the grassroots
• Improved universal health coverage.
• Achieving sustainable development goals like
  • SDG 1:No poverty
  • SDG 3:Good Health and Well-being
  • SDG 5:Gender Equality
  • SDG 6: Clean Water and Sanitation. 

We will measure these goals through monthly comparative analysis and quarterly evaluation using the collected data. 

CJID will measure the progress by monthly monitoring and possibly re-engineering its theory of change. The use quarter baseline assessment from the community people to evaluate the result. The centre will also monitor the percentage change in diseases and death at the community level, per capital investment in health, and the state of Water, sanitation, and Hygiene (WASH).

Inputs

Activities

Outputs

Outcomes

Impact

-Consultants

-PHC tracker software

-Survey guides

-Stakeholder dialogues

-Training

-Surveys/Data collection

-Real-time primary health care tracking

-Data assessment and management

-Storytelling

-Participants are briefed about Primary health care tracking in their various environment

-Participants are trained on the use of the Tracker

-Quantitative (use of questionnaire), qualitative (FGD, IDI) and observatory means are used to get information on the use of the Tracker

-Information from the PHC tracker is analysed and published on different media platforms

-Data from Primary health centres are cleaned, analysed and turned into infographics and chart presentations. Pictures and videos are also cleaned for proper visibility

-Different data stories on Primary health care captured that written and published on different platforms

-Improved quality of care

-Improved purpose for data collection for advocacy and performance evaluation

-Increased real-time digital data 

-Improved communication among information or data systems

-Improved service delivery at the primary health centres in local communities in Nigeria.

Indicators

Means of Verifications

Person responsible

Number of dialogue meetings

Reports

Project Officer

Number of people trained 

Attendance, Pictures

Project officer/ M&E officer

Type of survey

Number of respondents/Sample size

Questionnaire, FGDs

M&E officer

Number of PHCs tracked monthly

Reports, data from PHC tracker

Project officer/ M&E officer

Quality of data gathered, managed and analysed

Data software (Excel, PowerBI, etc.)

Data analyst

Number of stories published on PHC tracking

Reports

Project officer

The Health Care Tracker is hosted on the Ushahidi platform (an ecosystem of software and tools created to facilitate the work done by human rights advocates, journalists, election monitors and those responding to disasters and crises). According to Ushahidi, its tools are built from and use a mix of Python, PHP, Javascript, Ionic, Ansible, Terraform, AWS Services, Codeship, Travis CI, Github repositories and ultimately, any technologies that allows Ushahidi to improve its software. 

The Tracker collects crowdsourced data about primary healthcare centres to tell evidence-based stories that bring attention to the various issues that plague Nigerian primary healthcare centres. Users can aggregate the data for further analyses. Users can organise data into categories, perform filter and search functions, and visualise data. The tracker displays reports using a map, data mode and activity views so users can view what’s happening at different locations and identify trends or problems.

Ushahidi collects the PHC data for our solution and complies with the EU's General Data Protection Regulation (GDPR) to protect whatever personal data the platform collects. All Ushahidi vendors also comply with the EU's GDPR.

Healthcare workers, University students, and data entry clerks will be trained to use the solution. We will incentivise them with a modest amount to support mobile data and other requirements needed for optimal performance.

As an organization, CJID has diverse voices at all levels. The organization is welcoming and safe for all employees. The Centre has policies that promote equity, inclusiveness and fairness among staff. 

CJID's hiring, leadership and board show a remarkable balance with respect to gender, religion, and ethnicity/tribe.

The Centre for Journalism Innovation and Development (CJID), formerly the Premium Times Centre for Investigative Journalism (PTCIJ), is a West African media innovation and development think (and do) tank. Founded in 2014 as a non-governmental organisation in Nigeria, the Centre has been a leader in investigative journalism, civic technology, open data, verification, promoting journalist welfare and safety, elections and the freedom of information and expression. Our theory of change is that free and empowered media is a catalyst for ensuring democratic accountability in inclusive and sustainable development. Over the last couple of years, the Centre has expanded its footprints beyond Nigeria into specific niches in Ghana, Sierra Leone, Liberia and The Gambia.

In the last six years of operations, CJID has worked with its sister organisation, Premium Times, to unravel corruption and demand accountability in various sectors in Nigeria. Both organisations are well regarded for their daring, professional and ground-breaking work, having reported extensively on governance, corruption, human rights violations, and regulatory failures. We have exposed massive corruption by governments and corporations and highlighted the plight of the oppressed in society.

Some reports have won support and laurels like Nigeria's most prestigious media award Wole Soyinka Investigative Journalist of the Year Award, the Diamond Awards for Media Excellence [DAME] and the West Africa Media Excellence Conference and Awards [WAMECA]. Premium Times reporters have also won CNN African Journalist Awards and African Investigative Journalism Awards. Premium Times is the only Nigerian publication with a Pulitzer Award, the Global Investigative Journalist Network [GIJN] Shining Light Award, the One World Award, and numerous regional and national laurels to lead this new charge to renew journalism in Nigeria.

CJID operates a multi-sided model where we provide various value propositions (products, services, solutions) to different target markets. Sometimes, we offer a service to two targets (customers and beneficiaries). The 'customer' pays, and the beneficiary receives it for free. Sometimes CJID acts as a funding mechanism for its parent company - Premium Times. Funding generated by the Centre is sometimes used to support the parent organization to serve beneficiaries and fulfil its social impact mission.

CJID is always exploring the nexus of storytelling and distribution innovation to define a new fundraising strategy. To this end, we put a premium on our content to help raise the revenue to implement our work. It is safe to say we currently adopt a cocktail of fundraising strategies, including events, book publishing, training, and grants.

CJID has received grants from organisations like the MacArthur Foundation, Luminate, Bill & Melinda Gates Foundation, and National Endowment for Democracy to support the many programmes and projects that we implement.

This funding has enabled us to build a social accountability platform - Udeme.NG, a whistleblowing platform - Leaks.NG, a storytelling platform for campus/student journalists - Campus Reporter, and a fact-checking and verification platform - Dubawa.