MyChild in Afghanistan — four key innovations to close immunisation gaps

Colleagues from Shifo, Afghanistan’s Ministry of Public Health and the Swedish Committee for Afghanistan meeting in Shifo’s Stockholm office, August 2017

During the first week of August Shifo hosted our partners from the Ministry of Public Health (MoPH) in Afghanistan and the Swedish Committee for Afghanistan (SCA) for a three-day Health Innovator Programme workshop. The purpose of the workshop was to inform about the results and innovations that have come out of our work so far in Mehterlam District in Afghanistan where, with financial support from IKEA Foundation, MyChild Solution has been implemented in 51 health service delivery points since October 2015.

To date, 12005 children have been registered, 2528 children are fully immunised and 1342 children are followed up with SMS reminders.

Speaking during the opening of the workshop, Deputy Minister of Public Health Dr Feda Mohammad Paikan referred to some of the challenges the Afghan health sector faces, such as the “high number of unregistered children, and shortage of skilled health workers, especially female. These health workers spend a big portion of their day on manually entering patient information, which can lead to errors, and partly due to this, we have not been able to produce complete data to assist us with our planning.”

He added that in response to these challenges, the Ministry is taking a systematic approach — which includes strong partnerships with non-state actors such as SCA and Shifo — to strengthening health service delivery with a focus on women and children.

Innovations

During the workshop, a number of innovations that were introduced for the first time in Afghanistan were presented. Dr Humayon Safi, SCA’s Health Programme Director in Afghanistan spoke about the collaborative process of working with health workers themselves that led to these innovations:

  • New capacity building approach — previously, as is common practice in many organisations, Shifo representatives conducted all capacity building. Instead, health workers now lead peer-to-peer training, where local health workers trained in MyChild Solution will be transferred to new health facilities to support their colleagues during service delivery. This is the first time peer-to-peer training among health workers has been used in this manner in this region, and is a step which further ensures the sustainability of the solution and enhances the local ownership of the new practices.
  • Electronic Vaccine Stock Management — implemented for the first time in Afghanistan, this solution enables the automatic calculation of vaccine needs, and generates reports on vaccine usage and wastage. Health workers are able to obtain the status of stock supplies automatically, and no longer need to manually calculate and try to predict needs when making orders. MyChild Solution automatically keeps track of wastage rates of each vaccine, and then predicts and generates information on vaccines and supplies needed for the upcoming month — reducing the workload for health workers.
  • Vaccination Follow up List — a list of defaulters is automatically generated and shared with vaccinators on a monthly basis, a task that previously was manually done. Cross-checking child registers to find children is a time consuming task, one that was often skipped due to lack of time and resources.
  • Monthly Immunisation Register — a monthly register was introduced which includes health records of children that received services during a specific month. This function is especially relevant for monitoring and evaluation processes, where data in the Monthly Report is validated by comparing it to the health records of the children that received services during that month.

Evidence presented

“…A cost-effective, high-impact, quick-win intervention…as a low-resource country we should look for such interventions and this is one of those” — Dr Zelaikha Anwari, Director of Reproductive Health, MoPH, Afghanistan

Questions relating to the sustainability of MyChild Solution beyond the proof-or-concept stage were a key aspect of discussions during the workshop. Timothy Anderson, a researcher based at Tallinn University in Estonia who is working with Shifo, presented evidence from evaluations done in conjunction with SCA in Mehterlam.

Mr Anderson investigated the time spent on vaccinations for new visitors and follow-ups, daily administration including tally sheets and stock taking, and monthly administration such as activity and supply reports; and did as well, a cost analysis comparison between the current HMIS system, MyChild Solution and an alternative point-of-care electronic system.

The cost analysis showed that while the operational costs of MyChild Solution could be higher in comparison to the cost of printing HMIS forms, it offers significant advantage in improved data collection and in time gains for staff.

It was found that health workers reduced the time previously spent on administrative tasks by 73% and that children could be potentially served 74% faster. For health workers, this has created time to deliver more personalised care, health education and serve more children, and has meant a substantial reduction in their administration workload.

Interviewed for the evaluation studies, health workers said that the unique ID number assigned to each child makes it easy to retrieve child health information, making them better equipped to serve children even if their child health card had been lost, as data for any child could be found electronically. An added benefit is that they find that the data generated from MyChild Solution helps them with planning and decision-making.

For Dr Shafiq Shahim, Director of the Health Ministry’s Aid Coordination & Health Systems Strengthening Unit, these results were compelling, given the difficulties Afghanistan faces with poor data quality. He said that after visiting Mehterlam where he saw MyChild Solution in use, and learning of the results of the evaluations, he was convinced: “I can say now I’m fully in the picture from the benefit and cost analysis of this project, and the scope of this initiative. I really found it useful and responsive for our health system. I’m sure definitely it will contribute to the improvement of the quality of the data of our health system”.

Moving forward

The biggest outcome of the discussions and results presented during the workshop, was that together with our partners at SCA and MoPH, we have agreed to continue working together to expand MyChild Solution in the provinces in which SCA supports delivery of health services, and to extend the capabilities of the system in other areas like maternal health, family planning services and nutrition.

We have also agreed that it will be important to continue research and innovation regarding monitoring and evaluation, to see how best we can work to strengthen this process. It is important to continue evaluating the type of data that is actually needed by health workers on a monthly basis, so we can adapt and ensure that we meet needs in the best way.