By Sharon Atieno
With Africa gearing up towards achieving universal health coverage by 2030, countries are making effort to ensure that primary health care (PHC) is strengthened. PHC forms the backbone of a country’s health system and thus key to ensuring healthy lives among citizens. It is against this background, that various African countries have turned to innovations to answer some of the needs of PHC thus revolutionizing access to and provision of health services.
Through a mobile phone system referred to as Babyl, around 2.2 million patients in underserved populations of Rwanda mainly in rural areas have been connected to care providers. After registering with the system, patients call to request an appointment with an expert. At the appointed time, a Kigali-based nurse at the call centre calls the patient and conducts an initial screening. This gives the nurse a clear understanding of the patient’s history and symptoms and enables them to identify the next line of action which may include giving medical advice or referring the patient to a Babyl doctor.
If the patient requires a prescription, Babyl will send a unique ID code via text message that the patient can bring to the nearest pharmacy, where a pharmacist will confirm the code and prescription on a Babyl web portal. If the condition is beyond the scope of services Babyl offers or is not conducive to treatment via a virtual consultation, the patient is referred to the nearest health facility (based on the patient’s insurance cover), with a referral note from the consulting nurse or doctor.
In a bid to reduce maternal mortality rate, the Rwandan government working with UNICEF and other partners developed a basic mobile phone tool for tracking maternal and child health, referred to as RapidSMS-MCH system, which enables rapid communication and alerts between community health workers (CHWs) and health facilities and helps improve community reporting on key maternal and child health indicators, including nutritional status and treatment for malaria, pneumonia, and diarrhea.
The data that CHWs collect through the system ranges from prenatal care, delivery, postnatal care, growth monitoring, and maternal, newborn, and child mortality. They submit data on these key indicators for all children under age 5 to a central RapidSMS-MCH database, which can be accessed by facilities and is stored on a central server.
When danger signs are present and emergency obstetric care is needed, the CHW can send an emergency RED code to the system, which alerts the nearest ambulance driver and the manager of a nearby health facility.
The same approach is also used in Kenya whereby a mobile phone application named mPAMANECH is used in informal settlements within Nairobi, to enable community health volunteers (CHVs) collect data. The app analyzes the data according to a standard protocol on management of pregnant mothers, newborns and childhood illnesses. On danger being detected, a mother is automatically flagged for referral from among a list of referral facilities in the app. It also alerts the CHV within 24 hours if a client they referred has not yet visited the health facility and also allows clinicians to alert CHV if there is a need to follow-up on a particular client for support.
mPAMANECH helps in documentation and the tracking of feedback within the referral process. All the information is accessible to the Ministry of Health at the sub-county level.
Nearly 50 North Star clinics referred to as blue box clinics, across 13 countries offer a basic package of PHC services, including reproductive health services and screening for non-communicable diseases. The innovative electronic health care data system that captures and stores information on patient demographics and service utilization, allows patients to receive treatment at any Blue Box clinic, thereby ensuring continuity of care and making care delivery more efficient.
The electronic medical records, called health passports, which patients can access at the Blue box clinics allows its health workers to provide coordinated and continuous care. It also allows North Star providers and government partners to analyze epidemiological data to identify health trends throughout eastern and southern Africa. Aggregated and anonymized data are shared with ministries of health and are a valuable resource for understanding disease trends and profiles of mobile populations along major transit corridors such as truck drivers.
The push-based supply chain model –YeksiNaa- a supply distribution scheme that uses real-time data to manage supplies and direct health commodities through routine stock management, has changed the delivery of essential health products in Senegal thus reducing corruption and ensuring that essential medical supplies do not run out.
Third-party distributors make monthly deliveries of health products directly to facilities, where they evaluate current stock and enter data into CommCare, an online platform, allowing their logistics managers to track consumption trends and predict future needs.
Facilities are charged only for the commodities consumed during the preceding month. This strategy lifts the burden of logistics and operational tasks from health facility staff and shifts the financial risk away from facilities to ensure that monetary constraints do not hinder a clinic’s ability to provide essential commodities. Yeksi Naa uses a tablet-based logistics management information system that transfers data in real time to the district, regional, and national levels.
The new report by Primary Health Care Initiative (PHCPI) features different case studies on data innovations for strengthening PHC thus showing the importance of quality data in improving health care. If Africa is to achieve Sustainable Development Goal three –ensure healthy life and promote wellbeing for all at all ages- then drastic changes need to occur in its health system including its approaches to addressing health issues.