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Community-based ICT for Maternal Healthcare in Africa

Periodic Reporting for period 2 - mHealth4Afrika (Community-based ICT for Maternal Healthcare in Africa)

Reporting period: 2017-05-01 to 2019-04-30

A key challenge in many resource constrained environments is lack of access to sufficiently qualified and experienced healthcare professionals. In Africa, there are no doctors in primary healthcare facilities – making the knowledge of nurses critically important. The World Health Organisation highlighted in 2016 that Electronic Health Records (EHR) enhance patient diagnosis and treatment through access to accurate, timely patient data.

The social need mHealth4Afrika focused on was to replace traditional paper-based registries with a comprehensive, scalable, adaptable and multi-lingual patient-centric technology platform that integrates Electronic Medical Record and Electronic Health Record functionality with the use of medical sensors at the point of care, strengthening the quality and accuracy of aggregate reporting to inform resource allocation and policy formulation, and strengthening healthcare delivery, staff capacity and greater intensity of community engagement.

It was clear from the needs assessment and baseline study carried out in Q1 and Q2 2016, that none of the intervention primary healthcare facilities in deprived semi-urban, rural and deep rural environments in Ethiopia, Kenya, Malawi and South Africa, previously had access to use of medical sensors or a complete electronic patient record system at the point of care.

The agreed starting point for the co-design of this platform with all key stakeholder groups (Ministries of Health, District Health Offices, Clinic Managers and primary healthcare professionals) was to start with maternal and newborn healthcare, which have unacceptably high morbidity and mortality rates.

The level of detail captured in paper-based registries is constrained by their physical nature and they often reflect older medical knowledge. It can be challenging to create a comprehensive medical history for patients who have engaged with multiple services or attended different health facilities, and data duplication across different program registries. This can impact on quality and continuity of care.

mHealth4Afrika is a HL7 FHIR-compliant patient-centric health platform built on DHIS2, focused on supporting UN SDG 3. Co-funded by the European Commission under Horizon 2020 (ICT-39-2015) and co-designed and validated with Ministries of Health, District Health Officers, Clinic Managers and Health Workers in Ethiopia, Kenya, Malawi and South Africa, it strengthens healthcare delivery in resource constrained environments by integrating electronic medical record (EMR) and electronic health record (EHR) functionality with the use of medical sensors, and analytical, visualisation and decision support tools to facilitate monitoring and interpretation of patient results. It saves time through automatic generation of aggregate data, lab integration and presenting easy-to-digest client histories and supports greater client retention through SMS appointment reminders.

mHealth4Afrika is designed to support the efficiency and effectiveness of both management and healthcare staff, particularly in primary healthcare facilities. It does this by increasing:
• Quality and impact of care through timely capturing of patient information, systematic storage of important data points in patient records and improved frequency of follow up
• Frequency of contact with a focus on healthcare prevention through use of state-of-the-art technologies at the point of care and SMS reminders
• Accuracy and quality of monthly aggregate program indicators used for decision making
• Access to educational materials for clinic staff and patients to improve skills
As part of the co-design methodology, extensive consultation was undertaken with key national stakeholders in Ethiopia, Malawi, Kenya and South Africa between October 2015 and January 2016 to inform the needs requirements and carry out a base line study. The needs assessment analysed end user profiles, usability and user experience requirements, health data elements to be captured, the overall clinical workflow and reporting requirements. The baseline study documented: previous exposure to the use of digital technology, previous technology use in healthcare delivery contexts and existing working practices in semi-urban, rural and deep rural clinics. The specification for the mHealth4Afrika alpha prototype was prepared and implemented on the basis of a common cross-border platform to be used in the four participating countries.

The alpha prototype was validated in a mix of urban, rural and deep rural intervention clinics across the four participating countries during November and December 2016. Feedback received from healthcare workers using the alpha prototype was positive, validating data sets included and identifying additional functionality and data sets for the beta system. This is a very important part of the co-design process adopted to ensure mHealth4Afrika addresses real-life requirements

Following validation of the alpha prototype (which focused on maternal and newborn healthcare), the specification for the beta platform and subsequent pilot platform was updated to have a much broader medical program focus as well as incorporating a significant level of new functionality. A series of CE approved medical sensors to measure blood pressure, heart rate and blood oxygen saturation, temperature, haemoglobin, glucose and weight were short listed for use in the clinics.

Healthcare professionals were trained on general digital literacy, typing as well as touch screen laptops, computers and sensors and other necessary equipment.
mHealth4Afrika has gone beyond the current state-of-the-art in the use of mHealth in Ethiopia, Kenya, Malawi and South Africa based on feedback provided by key stakeholders. Any solutions previously used or evaluated were siloed-solutions – i.e. program specific, limited to one or two medical programs funded by a specific donor organisation.

mHealth4Afrika adopted a holistic approach to strengthening primary healthcare delivery. The introduction of basic ICT infrastructure, digital literacy and preventative maintenance training and support will make a significant difference to operational capacity and further strengthen the quality and consistency of primary healthcare delivery. With the introduction of medical sensors, mHealth4Afrika will support a reduction in cases referred for tests in secondary and tertiary health facilities and help earlier identification of cases requiring referrals. We can minimize the risk of errors by using digital measurements. The level of enthusiasm with which our work has been received is reflected in the requests to extend medical programs and functionality to address the needs of specialist clinics and hospitals, including referral hospitals.

The expected results from mHealth4Afrika will make a significant contribution to informing and supporting the evolution of current and future eHealth implementation strategies in African Member States and support generational leapfrogging in terms of technology adoption and provision of quality primary healthcare in resource constrained locations.
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