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PATH’s 40th and the future of digital health

By Celina Kareiva, Communications Associate, BID Initiative

May 18, 2017

Posted in , , ,

Photo: Bill & Melinda Gates Foundation/Ricarrdo Gangale. Nurses scan infant health cards to verify which vaccinations are required as part of the BID Initiative in Ngarenaro Health Center in Arusha, Tanzania. The facility has adopted tools that ease data collection and make intelligent use of this new information.

Imagine walking for several kilometers to vaccinate your baby, leaving at dawn and following the dusty road between your village and the nearest health facility 40 kilometers away. When you arrive, there is no one staffing the welcome desk. The clinic is short-staffed and the queue in the waiting room requires at least an hour wait. When it is finally your turn, the vaccine your baby needs is out of stock. You’ll have to come back another day, but by that point you’re outside the recommended window for vaccination, and your baby is at higher risk for infection.

Now imagine the power of a simple suite of tools that allows health workers to avoid these multiple system failures. Electronic immunization registries enable health workers to capture patient information from birth, streamlining their vaccine records and noting when they have missed a recent dose. Barcodes, placed on child health cards, allow nurses to effortlessly scan and reference patient records. Digital health can seem like a futuristic, catch-all term that encompasses everything from smartphone apps to electronic medical records, but in Tanzania and Zambia, it’s making real, marked impact through such initiatives as BID and Tanzania’s Data Use Partnership.

Last Friday, PATH celebrated 40 years of changing lives with a reception and gala in Seattle, Washington, where PATH offices are headquartered. We reflected on the role of digital health and immunization then and now. From BID’s electronic immunization registries to the Visualize No Malaria campaign, PATHs work in digital health is helping to pave our way forward to another 40 years of impact. Health vignettes, like the one pictured below, helped tell this story.

Photo: PATH. At PATH’s 40th anniversary celebration, a digital health vignette portrays a typical facility before and after shifting from a paper-based system to an electronic immunization registry. Instead of stacks of immunization registries, health workers encounter clean visuals and easy to decipher data that help them understand how to better deliver care.

Even after four decades, immunization remains one of the most cost-effective and successful interventions in global health. Digital health is primed to push this success even further. With the ability to identify what patients are missing vaccines, and access to more reliable stock tallies, health workers are able to care for their hardest to reach patients.

Collecting data has long been part of the daily routine of health workers, but in many health settings, its data for data’s sake. With limited time and huge volumes of information, health workers have no way to make sense of these numbers. Salome Mbegela, a Reproductive and Child Health Nurse in Charge at Meru Hospital in Arusha, Tanzania, remembers when data collection used to dictate her work day.

Before the BID Initiative, data collection was governed by deadlines and was an exercise in futility. With limited ownership and understanding of the information they were collecting, health workers felt no obligation to improve the system or to put the data to use.

But the BID Initiative strives to evolve the data collection process using tools to help make health information understandable and easy to use for people of all health literacy levels.

“If I see red or yellow on the stock graphs, it means [I need to] re-order and am almost out,” explains Salome of Tanzania’s EIR dashboard. “If I see red or yellow on the on-time vaccination, then my children are not fully protected. Also if I see red or yellow on my target, it means I was not able to meet my expectations and I need to know why and to work on the issue in order to improve. The EIR generates reports that show us what we have been doing each day in colors, percentages, and graphs. We now feel something when we see the other colors on our reports. We are working for green.”

Rather than passively collecting data, Salome can make sense of the numbers on her screen. She knows when she is missing her targets and feels empowered to act.

Muruta Kiboko, Assistant District Immunization and Vaccine Officer in Arusha DC, Tanzania explains that low immunization coverage rates are often a result of poor management of data collection and use.

In some areas [of Tanzania] mothers would walk up to 40 kilometers just to get their children immunized, but would get to the clinic and be told to come back some other time because there is no vaccine,” says Muruta. “BID’s [data-use tools] have improved this by having the nurse view the stock dashboard the first time she logs into the system, which gives her a quick picture of what is in her fridge. She can then send a request for supply earlier and ensure she has all she needs to cover every child coming to the clinic in that particular session.”

Later this month, Zambia will join Tanzania with the introduction of its own EIR. There is tremendous potential for digital health technologies to improve access to, quality of care, and patient engagement. Remarkable successes have been achieved in the past decade illustrating how technology can improve health service delivery in the developing world. As PATH turns 40, digital health is likely to only become more important to its mission and reach.

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