ABUJA, Nigeria — It takes nearly an hour to drive from Akure, the Nigerian capital of Ondo state, to the remote, palm-flecked village of Aseigbo. That’s on a clear day. During the wet season, the narrow dirt road leading to the village turns to churning mud, virtually cutting off the small community from the outside world for months at a time, until the season changes and the ground dries. Phones don’t work here; it’s outside the range of any cell tower. Nor do most homes have electricity or indoor plumbing. In case of emergency, or an outbreak of disease, it might take the central authorities weeks — or even months — to mobilize a proper response.
At least, that’s how things worked before the satellite receptors came. Today, thanks to a new partnership, not only is Aseigbo on grid — allowing local health care workers to contact central authorities at the touch of a button — but they are able to record patients’ health data via tablet, which can immediately be uploaded to a cloud. In a country where the vast majority of health data are still recorded by hand on registries, if taken to scale the project has the potential to revolutionize health coverage in Nigeria.
More on the partnership
The International Partnership Program project between U.K.-based commercial satellite operator Inmarsat, social enterprise InStrat Global Health Solutions, and public authorities in Ondo state, is funded by the UK Space Agency, with the aim of tackling health care challenges with satellite communications technology.
For more information about the IPP, visit the official website.
When people think about the many applications of satellite technology, improving health care delivery in the developing world is probably not the first thing that comes to mind. But the new International Partnership Program aims to do just that. By combining satellite networks with tablet technology, the project partners hope to launch Nigeria’s health system into the modern digital world.
Harness the power of big data
Despite boasting the biggest economy in Africa, Nigeria faces formidable health challenges: A 2017 UNICEF report found the country to have the third-highest infant mortality rate in the world. One major contributing factor is a human resource gap. The World Health Organization identified Nigeria as one of 57 countries with a critical shortage of health care workers, far fewer than the threshold of 2.3 doctors, nurses or midwives per 1,000 people to ensure minimal access to health care for all.
Nigeria’s health information system is also primarily paper-based — which means that before a patient can be treated, their data need to be recorded on paper rosters then transferred by hand from one health care provider to another. It’s a system that can lead to significant delays and data loss — particularly when patients are referred to secondary or tertiary health care facilities.
Looking at these challenges gave Nigerian diaspora professional Okey Okuzu an idea. Formerly the director of strategy and innovation at pharmaceutical giant Novartis, Okuzu had managed projects that used big data to improve health care delivery.
“I started to think, what if we could take this system-design thinking and bring it into Africa, in Nigeria, and begin to design things that could make systemic impact in health care delivery?”
Inspired by this thought, he founded InStrat Healthcare Solutions in 2010. Initial pilots relied on mobile phones and SMS technology, however he felt that SMS technology would soon become obsolete and subsequently worked with a VecnaCares Charitable Trust to customize its newly developed health management application, CliniPAK, for the Nigerian context. This interaction led to the mobile version of CliniPAK, which can be run on tablet computers.
The idea behind CliniPAK is a simple one: Health workers record individual patient information directly on the app, which is delivered in real time via the cloud to remote servers, where the information is aggregated and delivered to state health authorities. This solves two problems at once. Government officials have access to extremely accurate data at the local, regional, and national levels on which to base policy decisions. Patient care also improves, by ensuring that workers mostly at primary health facilities have immediate access to patient data, rather than having to wait for paper records to be transferred by hand.
While a great idea in theory, they almost immediately ran into challenges, for example a lack of 3G connectivity. “Before we started working, the first thing we would do is take a smart device, turn it on, and see if there was network or not,” Okuzu said. “If there was no cellphone network, we’d put an ‘X’ over that facility, and we couldn’t work there.” In practice, that meant that roughly one-third of Nigeria’s 30,000 facilities were off limits.
That’s where the satellites came in: By installing satellite receptors powered via solar panels in remote villages in rural Nigeria, they were able to provide network coverage to villages without electricity or running water.
“Working with the UK Space Agency and Inmarsat, we’ve been able to go into those places which arguably is where the need is most dire, because they are the most remote places,” he said. “And we’ve been able to allow them to reap the benefits that we bring with modern mobile technology.”
Video trainings to address the human-resource gap, and save lives
CliniPAK was an immediate hit with health care workers who no longer had to spend hours each day transferring patient health data from one roster to another, or days every month carrying copies of the rosters to public health authorities for verification.
But it soon became apparent that health care workers had other unaddressed needs. Along the way, they found out that the health workers that were responsible for managing the health data weren’t being trained, said Okuzu.
“They were in such rural places that there wasn’t a critical mass of them in any one health care facility [and] that it made sense for the government to send trainers,” he added. “We recognized that on this same device that we were using to capture patient data, we could put in an application and deliver training on that same application.”
InStrat partnered with Medical Aid Films, a company that produces medical training videos for health care workers in developing country environments, to deliver films on a mobile health worker training application — called VTR Mobile. The videos are scripted, walking the health care workers through unfamiliar procedures — including how neonatal resuscitation with an ambu-bag works, or how to turn a breach baby — and dubbed into local dialects.
“Video is much more accessible, particularly for people who don’t have a high level of literacy,” explained Sophie Scott, a production manager with Medical Aid Films. “While doctors do have high literacy levels, the local attendant probably doesn’t. She might know how to deliver a baby, but not what to do if the woman hemorrhages.”
Health care workers immediately saw the videos’ benefits. Yemisi Olorunemojutimi, a health extension worker in Aseigbo, said that before the village had InStrat tablets or satellite coverage, she’d routinely run into cases she didn’t know how to treat.
“For pregnancies or deliveries that were complicated, we had to refer them to the general hospital. If I had patients that had high blood pressure, I’d have to refer them,” she said. “When I first saw the VTR Mobile, I knew this was the solution [for] the problem of our people.”
Today, not only does she feel better equipped to treat patients, she also uses the videos to raise health literacy among villagers. A recent Wednesday saw the health worker conducting a breast-feeding clinic at the health center, surrounded by dozens of village women with their infants on their laps. Rather than merely telling the women they should breastfeed exclusively, she showed them a video that explained why it was vital for their babies’ health. “When they see the video, they know this is true. They change what they do,” she said.
Using tablets and satellites for disease surveillance
By the time Dr. Francis Akanbiemu, the executive secretary of the Ondo State Primary Healthcare Board, heard about an outbreak in the village of Irele, three people were already dead. They had no idea what was killing people. “At first, we thought it was some sort of disease, like Ebola,” he said.
Tracking down the cause of an outbreak is painstaking: First, health professionals need to travel to the site. Once they arrive, they interview sick patients or next of kin to try to find patterns that might indicate a point of infection, and then develop theories of what might have caused people to become ill.
All of this is recorded on paper. At the end of the day, each worker manually inputs all collected data into a computer. Next they have to take samples of potentially contaminated substances (for example, potentially contaminated food or drink, soil samples that might be contaminated with toxic mold, or blood samples for bacterial or viral infections) to send to a lab for further testing. “The process, it can take days and weeks,” Akanbiemu said.
This time, however, they were able to use tablets installed with CliniPAK, which were modified to input the data they needed to track down the cause of the disease. “By the end of the day, we had already detected a pattern,” said Akanbiemu.
Within days, they established that methanol poisoning from contaminated alcohol had caused the outbreak. Immediately, they contacted the head of the village, who banned the contaminated alcohol. “Lives were saved,” said Akanbiemu.
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Now, InStrat is piloting a new early detection disease surveillance system in the local government area of Ifedore. This is in line with the IPP project’s next goal: To use satellites, tablet technology, and big data to improve disease surveillance and rapid response throughout the country. By tracking and triangulating routine disease surveillance data, school absences, pharmaceutical sales and visits to the local health facilities, Okuzu hopes to be able to create an algorithm that will alert health authorities of potential outbreaks long before they become fatal.
“Had we had the proper alert system, the outbreak of methanol poisoning could have been avoided,” he said. “There were data crumbs that we could have picked up, to identify what was really going on before people started dying.”
The path forward
Despite gains, the IPP project still has obstacles to overcome, such as the sustainability of the project.
“The issue of sustainability is the biggest concern — how long are we going to get the support?,” said Emmanuel Abatta, head of the National Health Management Information System at the Nigerian Ministry of Health. “Let’s say 20 facilities in Ondo state are being supported by Instrat, and we begin to rely on them to get data to the central health authorities, then tomorrow that support isn’t there — that would be a big challenge. So there needs to be a sustainability plan in place to make sure that doesn’t happen.”
Okuzu is unfazed: While today the UK Space Agency and Inmarsat donate much of the technology — including the satellites — he believes that one day, the IPP project can be self-sufficient: “There are always private companies who will want to buy the sort of data that we are collecting,” he said. “Once we reach a critical mass, it can fund itself.”