eHealth Africa (eHA)'s Polio Programme

eHA uses information and communication technology (ICT) to provide support for the global effort to eradicate polio. Polio response in northern Nigeria is led by the Nigerian government in partnership with the United Nations Children's Fund (UNICEF), Rotary International, the World Health Organization, the United States (US) Centers for Disease Control & Prevention (CDC), the US Agency for International Development (USAID), and the Bill and Melinda Gates Foundation. Without an understanding of population, terrain, and transportation, large numbers of settlements (especially in Northern Nigeria) are missed by polio vaccinators. Here are some examples of the eHA's approaches to support the work of these partners:

• In 2012, there were 122 confirmed cases of polio in Nigeria. In response, The Gates Foundation funded eHA to build and manage the Emergency Operations Centers (EOCs) in northern states with the highest infection rates, and also a National Polio EOC in Abuja to coordinate activities between state governments and national agencies. eHA provides management, a fully-equipped working space, and fast internet speed in Nigeria for the EOC - a challenge for agencies working in insecure or remote regions.
• eHA's Geographic Information Systems (GIS) team captures data, which assists locally-based data collectors to map previously missed settlements, often in insecure regions. The software is loaded onto GIS-enabled tablets that allow data collectors to gather crucial demographic information. This is used in microplanning activities by local governments and partners to ensure more children are reached in large-scale immunisation campaigns in Kano and Bauchi states. eHA's innovations mean that, during immunisation campaigns, the Global Positioning System (GPS)-enabled mobile phones carried by vaccinators track team movement and promptly identify missed settlements. These are revisited and ensure more children are covered.
  • For example, in response to the 2 wild poliovirus cases detected in Borno State in August 2016, an outbreak response campaign ran from August 27-30 in 5 Northern states. eHA provided support for the campaign by supplying over 8,000 GPS-enabled mobile devices to field vaccination teams to enable the collection of geo-coordinate information on settlements reached during their house-to-house visits. To provide technical field support, eHA deployed over 70 field staff to 37 Local Government Areas (LGAs) across the 5 Northern states. Data collected by the vaccination teams was then uploaded onto a local server to enable key health administrators and partners, at the LGA and state level, to visualise the data collected from the daily field activities on the Vaccination Tracking System (VTS) dashboard. (eHA partners with Novel-T to operate a custom VTS and dashboard that monitors the vaccinator's movement, area percentage covered, and missed settlements. Each vaccinator has an Android-based mobile phone equipped with a custom tracking application, which identifies missing areas and new locations for campaign "mop-up" days.) From the results, polio programme stakeholders were able to see the percentage of geo-coverage achieved and, most importantly, the number of missed settlements that will require follow-up visits.
• eHA provides GPS-enabled smartphones and maps of hard-to-reach settlements to WHO and UNICEF mobile health teams, who travel to remote communities and supply families with routine vaccines and basic care services year round. Mobile health teams capture the GPS coordinates for each settlement they vaccinate and upload health register summary data daily to WHO-UNICEF accessible databases.
• eHA works with the End Game Strategy team in Kano to analyse data from immunization campaigns of all noncompliant settlements and households in the state, so EOC staff then effectively address noncompliant hotspots.
• In response to the 2016 cases of wild poliovirus in Nigeria, eHA partnered with The Gates Foundation, WHO, and Novel-T to pilot a mobile-based surveillance application for Acute Flaccid Paralysis (AFP) in children. The tool is an Auto-Visual AFP Detection and Reporting (AVADAR) mobile application installed on android-enabled mobile devices, provided to health workers and community informants to aid in the detection and reporting of AFP cases within health facilities and local communities. (eHA trained over 800 health workers and provided them with over 800 GPS-enabled smartphones and solar chargers.) The AVADAR software includes an embedded 30-second video of a live child with AFP symptoms having difficulty crawling/walking, as well as an electronic data collection form for submission of detailed information on suspected AFP case patients. This video (see below) is sent as a weekly reminder to health workers and community informants (on their GPS-enabled mobile phones) responsible for reporting all suspected AFP cases in their health facilities and communities.
  • The AVADAR project was piloted on August 5 2016 in the LGAs of Oyun (Kwara state) and Kuje (Federal Capital Territory (FCT), Abuja) for an 8-week period (August to October 2016). In Kuje, community informants reported 26 AFP cases within the 8-week period. This was a considerable increase compared to only 23 cases reported in the 33-week period (from January to July 2016) before implementation of the AVADAR pilot. Similarly, in Oyun there were 8 reported AFP cases within the 8-week period, compared to only 4 reported cases in the 33-week period prior to AVADAR. Building on the successes achieved, the project was scaled up to include 8 LGAs in Borno state in November 2016, with plans to further expand into other states. AVADAR has expanded the surveillance network by bringing in more community informants, health workers and designated health facilities to improve the sensitivity of AFP surveillance amongst surveillance personnel (in terms of timely detection and reporting).

Immunisation and Vaccines, New Technologies