On the way to reducing the workload for Ugandan health workers
Published 26 October, 2016
Shifo Foundation, working with Dokolo Local Government in Uganda in a programme endorsed and supported by IKARE has successfully introduced a new resource, MyChild Card, for health workers that takes us one step closer to ensuring that every child in low-resource settings is registered to receive life-saving vaccines and preventive health services.
Some 340km from the capital of Kampala lies Dokolo, a rural district in the Northern Region of Uganda, whose population in 2014 was estimated to be 184,000 people of which, approximately 37,000 are children under the age of 5. Within the district, income poverty is high, literacy rates are low, and there is poor access to basic services. Out of 17 health centres only one — Dokolo HC4 has a reliable source of electricity; sadly efficiency is hampered by frequent black outs. Nevertheless, every health centre is staffed, with each of them having a Nursing Officer, Enrolled Midwife and an Enrolled Nurse at least. The challenge is that the staffing norms have not been revised for a long time, and the ever increasing population places a demanding workload on the health staff. In spite of this, the district health leadership and health workers share a deep commitment to providing preventive health care for the children.
Following the decision to implement MyChild Card throughout the district, Master Trainers from the District Health Office were trained on MyChildCard and new, family-centred work processes. They subsequently formed part of a team led by Shifo Foundation in July 2016, when health workers from all 17 health centres across the district, including nurses, health information assistants and health centre managers gathered for training sessions. During the two days, health workers participated in interactive sessions that were intended to build their capacity to deliver child health services in a more efficient way that reduces their daily workload.
Immediately following the capacity building sessions, MyChild Card was implemented across all Dokolo health centres. These services include immunisation; monitoring nutritional status, growth and development; HIV prevention and counselling; and provision of mosquito nets and supplements such as Vitamin A and deworming.
Speaking about the changed work processes, the health management information system (HMIS) Focal Person in Dokolo District, Susan Aboce said, “the transition to MyChild Card is going very smoothly. It will take some time before every stakeholder gets used to the new way of providing child health services and managing data, but we are already seeing a big reduction in the amount of writing the health workers have to do — and this was one of the biggest time consumers for them.”
Health workers have been vocal in expressing their approval for the way MyChild Card is already having an impact on their work. Nursing Officer at Dokolo Health Centre 4 Esther Kadito Oloi said, “I’m just too happy for Shifo to train me to use MyChild Card because the workload which was in the EPI [immunisation department] was about to demoralise me because there are too many books to write.”
“Sub-Saharan Africa has only 4% of the health workers but 25% of the global burden of disease. These workers perform wonders with limited resources on a daily basis. With the introduction of MyChildCard we not only help increase their time spent with children and families, but also ensure that data critical for individual and aggregated follow-up like immunisations is collected. As the system also automatically generates reports necessary for informed decision making we believe that we are helping to create the foundations necessary to deal with some of the root causes for child mortality and poverty” says Anne Holm Rannaleet, IKARE’s Executive Director.
The process of providing care in low-resource settings is a challenging and obstacle-filled one, but we believe that providing health workers with the right tools empowers them, and leads to improved child- and family centred care.
Voices from the field — health workers and decision makers in Dokolo District
Notes to Editor
MyChild Card is an innovative child health card that is a hybrid of conventional paper and digital technology. It merges the usability of paper at the point of care delivery with the accuracy of technology when it comes to data access and processing. Health workers capture information relating to each child on paper-based MyChild Cards. Specifically designed Vouchers which are part of MyChild Cards are subsequently scanned and data uploaded onto a secure server where an electronic medical record is created for each child, detailing all of the vaccines and preventive health services they received. Moreover, parents receive SMS messages to remind them about the next due date and aggregated reports are automatically generated and shared with key stakeholders.
MyChild Card has the potential to improve work processes, by reducing administration and reporting for health workers from 50–60% to less than 10% of time spent per day, and by eliminating the need for ledgers for Child Registers and other paper-based reports. A key benefit of this is that families and children spend less time waiting to receive health services and scarce health personnel can focus on delivering proper care rather than focusing on data gathering.
Further, MyChild Card is based on Smart Paper Technology, which delivers all the benefits of electronic health record systems. This means that it can be used without relying on electricity, security or internet connectivity.
IKARE Ltd (pronounced “I care”) is a UK registered charity operating according to the venture philanthropy principles. It thus works closely with its investees, providing not only tailored financial but also non-financial support and access to networks. Taking a multi-year view IKARE aims to strengthen the capacity of its investees so they in turn can deliver more social impact. Having since 2006 been actively involved in the Stamp Out Sleeping sickness initiative in Uganda (www.stampoutsleepingsickness.com) providing start-up financing to a number of young veterinarians IKARE has first- hand experienced both the need to take a One Health view as well as the necessity for accurate data for informed decision making.
IKARE’s main donor is IK Investment Partners (www.ikinvest.com/IKARE), a European private equity group.
Shifo Foundation is a non-profit organisation based in Sweden. Our vision is a day when no child dies or suffers from preventable diseases. Shifo works to strengthen health systems and child health service delivery. We focus on child registration and follow up on children to ensure they receive all essential health services including vaccinations, nutrition, growth monitoring, and tracking the prevention of mother to child transmission of HIV.
We want to ensure that every child is registered and followed-up to receive life saving health services during their most vulnerable time — birth, infancy and childhood, and ensure that every child grows up strong and healthy. Shifo has developed MyChild System, which addresses some of the toughest challenges in reaching every child with preventive health services by enabling child registration, empowering parents with knowledge, enabling effective work processes for health workers, and providing reliable and relevant information for improved decision-making.