COVIDaction RHS awardees fighting to save time and vulnerable lives in Uganda
In the early 2000s Rustam Nabi, Director of the Shifo Foundation, was working on digital healthcare systems in Sweden when he was invited by a delegation from Uganda to share how he was using IT systems. It was this trip that planted the seed for a future relationship between Shifo Foundation and Medical Teams International to work together and find a tech solution that not only saves time but can also save lives.
18 forms
Fast forward to 2013 and a few people at Shifo had been working to replace a health information management system for people who have to fill in a lot of forms in places like Afghanistan. Shifo is a non-profit, based in Sweden that works to strengthen data systems so that reliable information can be used to help eliminate children suffering from preventable diseases.
Last year, working with Medical Teams International, a global humanitarian organisation that provides life-saving medical care to refugees, Shifo has been finding a way to get rid of the paperwork and let medical practitioners spend more time with the people who need them most.
Medical Teams has operated in Uganda since 2004 and supports refugee healthcare in settlements around the country. With a catchment population of over one million people, their team sees the need for quality data in order to provide quality health care.
A few forms for a medical service doesn’t sound unusual until you look at the scale of the problem. In the situation Shifo was working on, each child generated 18 forms for their healthcare.
Multiply this by 150 kids attending one medical centre to get a vaccination, and that’s already 2,700 forms. Managing all this data takes valuable time away from medical practitioners who could be administering healthcare but end up filling in paperwork. In the end, balancing this against time costs, which do you choose? Do the medical work or do the paperwork?
Beyond this, the insufficient data must be checked and analyzed manually. This is not always done correctly and takes a long time. It’s expensive to send people out to follow up with all of those children and the bottom line is that the kids may not be getting the medical care they need.
16 minutes
Shifo calculated the amount of time spent on one child to become fully immunized — including all of that paperwork. “It takes 16 minutes,” says Rustam Nabi, Director of the Shifo Foundation. “We wanted to bring that time right down, maybe replace some forms and simplify the whole process.”
In Mukono District near Uganda’s capital, Kampala, only 20% of clinics have reliable electricity. Most of Uganda’s 130 districts don’t have a connection to reliable grid electricity.
Parachuting a tech solution into this environment doesn’t solve the problem and according to Nabi, it can make things worse in terms of the time required to set things up and have everyone trained to use things effectively.
“We understood that the best solution is the one that is closest to the existing system and utilises the strengths of that existing system.”
Nabi and his team quickly learned that their initial proposed solution would not work and so they set about addressing the challenge with smart paper solutions. “We understood that the best solution is the one that is closest to the existing system and utilises the strengths of that existing system,” he says.
$43 USD
Scaling technologies to provide a new system not only has technical challenges but it also has a cost. According to World Bank data, in 2018, health expenditure per capita in Uganda stood at just over $43 USD. In comparison, the UK stood at $4315 USD and $5981 USD in Sweden. This means there’s not a lot of room for new tech solutions in Uganda. “When you bring a solution you have to make it cost-effective,” says Nabi. “It has to be super affordable so that the government can sustain it by itself. So many health systems are donor-funded, but what happens when that donation stops? These systems need to stand up by themselves.”
The Ministry of Health in Uganda accepted Smart Paper after it was presented with successful results from testing and showed the technical feasibility of the solution.
The beneficial aspects of Smart Paper included improved electronic health records, 100% follow up with clients that had a valid phone so that they could receive timely essential services, improved data capture, more relevant data for stakeholders, better health services for women and children, and a more sustainable operating cost in comparison with the existing system or other alternatives. It was clearly a hard case to turn down on those terms.
100 years
Digital healthcare solutions may be taken for granted in clinics around Europe but over years of working in LMICs Nabi’s view of the meaning of healthcare has changed. “In my mind before I was working to help 100-year-old guys in Sweden become 120. In Uganda you can really save the lives of women and children if you can collect some basic information,” he says.
When news of the COVID-19 pandemic started to spread, Shifo and Medical Teams saw the potential of the pandemic to harm existing health systems as it applied more pressure to already underserved facilities.
“In my mind before I was working to help 100-year-old guys in Sweden become 120. In Uganda, you can really save the lives of women and children if you can collect some basic information,”
Medical Teams International understood the danger posed by COVID-19 when cases started spreading in China. The organisation started developing contingency plans and as one of the main healthcare providers for refugees in Uganda, they knew they would have to pivot to address the pandemic while also making sure that routine services could still be offered.
Nabi hopes that working toward gathering better data in smart ways will help to make health systems more resilient, “You have to protect it,” he says. “There has to be preparedness and a response but you need a strong system to understand what is going on at all levels.”
Speed is something that these new systems can work on to improve health systems. While demographic health surveys may take place every three to five years and include intensive manual data work, improving that system can capture a better picture more frequently, “It’s our intention to do this every month as part of a routine health system,” Nabi says.
“This vision that we’re working towards is a day when no mother or child dies or suffers from preventable diseases.”
4 minutes
COVIDaction is helping Medical Teams and Shifo to further improve the systems they are running in Uganda and beyond. “We’re working to minimise the time it takes for health workers to collect their data,” Nabi says. “We learned that it would take 16 minutes to fill in those forms and we have already brought this down to four minutes. Now four minutes is not even enough of a reduction. Our target is of course zero when you can completely eliminate that administration for health workers. But four minutes is a good start.”
“This vision that we’re working towards is a day when no mother or child dies or suffers from preventable diseases,” says Nabi. “So that’s why we’re building one of the missing pieces. There are many missing pieces, right? But we’re just working with a few missing pieces and trying to make them happen. So that one day we can reach that vision.”
