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Fully equipped technology-based health screening kit

Blood pressure, pulse oximeter, Hemoglobin, fetal doppler, ultrasound and more

Robust backend system aligned to the FMOH obstetric protocol
Dashboards allowed visibility to multiple users
Two different types of ID for login were created by HOPS one for operational (access aggregate data) and one for technical team (all history of the client).
Connected multiple levels of health care service provision

Pilot Telemedicine Solution in Ethiopia

In 2019, World Vision deployed an innovative, fully equipped technology-based health screening kit that includes integrated medical devices such as blood pressure and ultrasound to improve access to prenatal screening for pregnant women.

A significant amount of time was spent building out the back end system to align with the FMOH obstetric standards and included things like a pregnancy wheel for LMP and dashboards to track high risk pregnancies.

Different users had different levels of access to the data, controlled by unique IDs and passwords

The mobile kits allow for timely identification, referral and management of pregnancies at risk of preterm birth, collaboration between multiple levels of health care service provision, and support essential data collection for pregnancy and preterm risk factors.

Two different type of ID for login were created by HOPS one for operational (access only data) and one for technical team (all history of the client).

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Implementation

Capacity Building

Implemented within a program focused on HCP skills training
Initial sensitization workshop and join implementation planning with all partners
Training of health staff on operation of the digital kit and ultrasound imaging
Training of referral hospital staff for supervision

Community Mobilization

Born on Time project had several demand creation activities:

Women’s groups
Male engagement
Religious leaders
Pregnant mother conference

Skilled frontline health workers

Demand creation

Remote monitoring and regular mentoring

Mentoring and Referral

Shift from emergency surgeon mentoring to University of Bahir Dar
Unique user IDs allowed remote monitoring and mentoring based on performance
Routine Joint Supportive Supervision

In consultation with RHB,ZHD and WrHO two PHCUs were selected
Sensitization workshop were undertaken in the presence of RHB,ZHD ,WrHO, Adite Primary hospital emragncy sturgeons, both PHCU heads and Maternity case team members .

5 days onsite training for midwifes, health officers, pharmacist, laboratory technicians and head of health center

Our original plan was that emergency surgeons’ at the referral hospital could replace the gynecologist position and have good understanding of US imaging and interpretation. However, as per our monitoring observation and input from health workers from both health, center emergency surgeries were either have no time or not competent enough to mentor midwifes on the US utilization.

Unfortunately after three months of evaluation midwifes were yet not comfortable in the way that the emergency obstetrics surgeon were supporting the HC staffs on US utilization.

Thus, we re-plan the training to be provided by gynecologist and radiologist from University of Bahirdar Hospital. After the specialists provided the training, midwifes start identifying some parameters.

In depth follow up training of midwives by obstetricians

For mentorship and quality imaging purpose the HOPs company created Different ID and password for all midwifes so that specialists will meteor them individually . In addition to telemedicine online the midwifes will go to specialist and they will be evaluated on the way they took the image, and the consultation part and advise the midwifes well. Because of this mentorship midwifes did well and they were happy as they stated on the meeting.

One on one consultation and mentorship of midwives by obstetricians via tele medicine

In person evaluation and mentoring by obstetricians on imaging techniques and patient consultation skills

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Benefits and Impact

Enabled the health workers to diagnosis and manage a range of pregnancy risk factors onsite hence greater satisfaction by the health care workers and the clients
Reduction in unnecessary referrals (referrals for ultrasound scanning services, and referral of cases that could managed locally by midwives)

Saved pregnant women the stresses of long-distance referrals
Helped families and the health system avoid unnecessary cost of referrals, allowing limited resources at referral centers to be used for life saving interventions

The compact mobile kit allowed health workers to do different types of examinations and tests in one space without having to send clients to different rooms and hence greater efficiency and convenience.
The electronic medical record made it easy to recover patient details (name of the patient, phone number, etc) and history during subsequent visits using medical record number.
Proved to have an important role for essential service provision during the pandemic

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Benefits and Impact

More than 1700 pregnant women received ultrasounds (1100 during the pilot, plus 600 with in last year by government)
Increased ANC seeking behaviors by pregnant mothers (Increased ANC coverage 48% to 73%)
Reduced problems related to the three delays and supports referral
For referrals, case history was available at the hospital so the gynecologist can see symptoms and treatment history, reducing time and unnecessary delay in supporting the mother
Most rural mothers did not know their Last Menstrual Period/Expected Due Date, ultrasound helped to estimate the gestational age, weight, sex, presentations, congenital malformations and amount of amniotic fluid

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Challenges

Low computer literacy among midwifes resulted in longer ANC consultations when using digital platforms and to take ultrasound image
The software (e-clinic) needs strong internet connection to upload pictures and videos and when it is opened for evaluation
Data server (data privacy and confidentiality)
Poor infrastructure (electricity, network connectivity, etc)
Portable ultrasound is not easily available on the market or too costly for deployment at scale
Lack of training curriculum and guidelines for portable ultrasound for midlevel or low-level health workers
Portable ultrasound can be life saving for mothers/newborns, but most government officials and partners consider it a luxury

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Recommendation �

Ensuring mid-level health workers have basic computer literacy will facilitate deployment of digital health solutions
Design of digital health solutions for LMICs should take into considerations the nature of infrastructure available, especially power supply and connectivity
National digital health strategies and infrastructure should create space for new solutions to be tested, including facilitation of data hosting
Deployment of portable ultrasound at Health center level is vital for early detection of pregnancy related compilations and reduced maternal, neonatal and still birth mortality and morbidity
WHO ANC guidelines recommends first trimester ultrasound for all pregnant women. National strategies that aim to improve quality and coverage of ANC should deploy portable ultrasound at Primary HC level and include mentorship by senior professionals.
Deployment of telemedicine solutions require trained gynecologists and radiologists and should be integrated within MOH Joint Supportive Supervision process

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Electronic Community Health

Information System

eCHIS

Anteneh Kinfe

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The Digital Health Blueprint

A mother document that Is meant to guide and support DH investments.

Priority Initiatives

Digital Performance Management (M&E of the performance of health care workers and managers)
Remote Health Care Delivery (CL-2-PR and PR-2-PR Telemedicine)
Digital Decision-Making Support and Learning (Training & continuous professional development alternatives)
Digital Health Payment (Digitizing the likes of Community-based Health Insurance schemes)
Data Exchange across Systems (Enforcement of standards & seamless data exchange among systems)

Point of Care Disruptive and Diagnostic Technologies (Point-of-Care tests that would replace the current MRI, CT Scan, and Ultrasound)
Unique Digital ID (Citizens’ ID – Collaborate; Patient ID – Work on it)
Digital Literacy (Narrow the Digital Divide among Citizens + HWs)
Digital Health Entrepreneurship (Unlocking the enormous economic potential of the health sector)
Digital Health Research and Development Centers (Emerging Techs, Digital Divide/Equity, Contextualizing, etc.)

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The Ethiopian �eHealth Architecture

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What is the eCHIS?�Electronic community health information system

A suite of Mobile applications with a web based monitoring portal
Captures electronic data on the Health Extension Program (HEP) and other community-level services, as well as utilize this data to improve HEP performance, community health outcomes, and also serve as a job aid to Health Extension Workers (HEW).

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Goals of the eCHIS

Reporting and Analytics
Service Delivery
Job Aides
Identification
Communication

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eCHIS Releases

Release 2

Child health
Nutrition/ GMP

Release 1

Family folder
Maternal health
Family planning
Immunizations

Release 3:

Communicable diseases

TB
Malaria

Release 4:

NTD
Non communicable Diseases
HIV

Release 5:

Logistic supply & management

eCHIS Pastoral edition

Pastoral family folder

Under Pilot

Implemented

Developed

Under pilot

To be started

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Focal Person

The eCHIS mobile application suite with three mobile applications

Health Center Worker

Client

Health Center

Health Post

Community

HEW

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High level architecture

Tablet

FMOH Server

Health center

with

Connection

All individual data is synced

to FMOH Server

Dashboard and reports

New system updates
New system setting data

CHIS data (HH list, service provided..)

WoHOs

ZHDs

RHBs

Referrals

Locally hosted

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Homescreen

Change the Language

Sync with Server regularly to ensure that:

Forms are sent to the server
Client data is updated from Health Center

Enter the application to begin reviewing information or to fill out forms

Exit the application securely to protect client information

Displays the last time a sync was completed and any pending forms

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All Client List Management

Icon Guide

Visit Priority

Visit Type (examples)

Visit Location

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RMNCH Service Delivery areas

Pregnant & Post-Partum

Nutrition

Family Planning

TT Vaccinations

Child Vaccinations

Sick Children

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eCHIS Implementation Status

Implemented across eight regions
Over 15 million household members and 3.5 million Households are registered.

44% (6,602) Health posts out of the 15,139 have implemented eCHIS.

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Implementation Challenges

Programmatic:

HEP program is over-engaged with so many responsibilities and packages hence so many modules.

Training + Logistic:

The trainings need longer days, and many HEWs are expected to be trained.
Problems in number and quality of tablets (Performance, malfunction, low battery capacity).
Only one of the two HEWs in a health post has tablet

Hosting Infrastructure:

Struggles in local hosting (connectivity, power fluctuation).

Financial:

Very resource-intensive program – yet, we don’t have clearly mapped out resources.

Maintenance and Support:

Lack of Helpdesk at lower levels

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