IntraHealth

Community Health Workers Making a Difference for Pediatric HIV Clients in South Sudan

rgoodwin — Wed, 27 Mar 2024 17:44:30 +0000

Community Health Workers Making a Difference for Pediatric HIV Clients in South Sudan

, Communications Officer

rgoodwin March 27, 2024

April 01, 2024 12:00 PM

In South Sudan, community outreach volunteers (COVs) like Lawrence Monday play a key role in the HIV response—linking health facilities and communities to extend services and acting as peers to people living with HIV. Under the supervision of an adherence nurse, Lawrence supports 160 clients on HIV treatment, including 15 children.

One of the children Lawrence helps is Timo*, who had a rough start in life. He was born in 2017 into a low-income family in Juba. His biological father was never around to help him as a baby, and his 25-year-old single mother had no job to support him or his two older siblings. She often went to the market to dance with Timo wrapped on her back, and well-wishers would give her some money or food items, which would help feed them for a few days.

Diagnosis and struggle

Timo’s mother knew she was HIV-positive. Although she had been receiving antiretroviral therapy (ART) from Nyakuron Primary Health Care Center (PHCC), when she became pregnant with Timo in 2016, she refused to take treatment and didn’t attend antenatal appointments. She feared she would be stigmatized at the health facility because she knew people who worked there.

When it was time for Timo to be born, his mother had a home delivery without a skilled health care provider. When Timo was three months old, both he and his mother became very ill. He couldn’t breastfeed well, became restless, and started bleeding from the navel. His 60-year-old grandmother rushed him to Nyakuron PHCC where he was assessed and diagnosed with HIV, and immediately enrolled on ART.

With the help of his grandmother, Timo successfully attended treatment for the following year. However, his ailing mother was often intoxicated. She would leave the children with her mother and dash down to a local spree to drink.

Timo’s mother continued to refuse treatment, and in 2022 succumbed to complications of HIV. At the time, Timo and his siblings were already fully under his grandmother’s care and they largely depended on the support of well-wishers.

Home visits from a community outreach volunteer

Nyakuron PHCC is now one of 14 health facilities supported by the Advancing HIV/AIDS Epidemic Control Activity (AHEC). AHEC is a four-year USAID-funded contract led by IntraHealth International building local capacity to provide comprehensive HIV services and free ART to people living with HIV in South Sudan. By partnering with the health facilities and local organizations, the South Sudanese government, and communities, AHEC helps train health workers to deliver high-quality HIV services and adapts evidence-based HIV prevention, care, and treatment interventions for people living with HIV.

In 2021, early on in the project, AHEC trained 160 COVs, including Lawrence Monday. The project provides a stipend and mobile phone airtime for communication to the COVs. In 2013, AHEC attached Lawrence to Timo to monitor his treatment progress through home visits and offer emotional and psychological support.

“It’s a challenge to keep children on treatment but the regular home visits are paying off,” Lawrence says. “I visit all my clients twice every six months, and I visit children at least once a week, because they easily forget to take their medication, to ensure that they adhere to medication. Within the last month, I’ve registered only 5 out of 160 clients with high viral loads, whom I’m closely following up for adherence counseling.”

“It’s a challenge to keep children on treatment but the regular home visits are paying off,” Lawrence says.

Timo was one of those who needed extra follow-up. In February 2023, when Timo was five, he lost weight and became very weak. When health providers at Nyakuron PHCC assessed him, his viral load was too high and unsuppressed. He seemed traumatized by the absence of his mother, lacked enough food, and sometimes refused the bitter taste of the medicine. The health providers developed a monitoring action plan, and after four months of Enhanced Adherence Counseling, his viral load was suppressed. The health provider transitioned Timo from Lopinavir to Dolutegravir and guided his grandmother on how to prepare and give him the medication. Lawrence helped link Timo to a nutrition center within the health facility where he received food portions monthly until his health improved by June 2023.

However, in October 2023, Timo developed swollen lymph nodes and a cough and was losing weight. During a home visit, Lawrence noticed Timo’s symptoms and immediately rushed him to Nyakuron PHCC, where he was referred to Al-Sabah Childrens’ hospital. Health workers at the hospital diagnosed Timo with opportunistic infections, including tuberculosis (TB). Timo was put on anti-TB treatment for six months, which he successfully completed with the help of Lawrence.

HIV & AIDS Infectious Diseases Maternal, Newborn, & Child Health Community Health Community Health Workers

Venez à la rencontre de Marguerite Diarra. Son but est de former davantage de sage-femmes et d'améliorer l'accès aux soins maternels au Mali.

cbales — Fri, 08 Mar 2024 13:00:21 +0000

Venez à la rencontre de Marguerite Diarra. Son but est de former davantage de sage-femmes et d'améliorer l'accès aux soins maternels au Mali.

, Technical advisor for communications

, Strategic communications manager

cbales March 08, 2024

March 08, 2024 12:00 PM

Par une matinée ensoleillée à l'école Vicenta Maria de Ségou au Mali, Marguerite Diarra démontre la gestion active de la troisième phase de l’accouchement en utilisant un Mama-U, un simulateur obstétrique/gynécologique représentant l'utérus d'une femme.

Marguerite forme des sage-femmes qualifiées prêtes à s'occuper des femmes au Mali, en particulier dans les communautés rurales. Elle a grandi à Beleko, dans la région de Dioila, et est devenue sage-femme en 2016. Aujourd'hui, elle est enseignante permanente et se spécialise dans les soins obstétriques.

Le Mali n'a pas assez de sages-femmes.

Le Mali, comme d'autres pays d'Afrique de l'Ouest francophone, ne dispose pas d'un nombre suffisant de sage-femmes qualifiées ou d'autres agents de santé. Il n'y a que 6,1 sage-femmes, infirmières et médecins pour 10 000 personnes, ce qui est bien inférieur au nombre recommandé, et la pénurie est encore plus grave dans les zones rurales. Cette situation entrave l'accès équitable des femmes aux services de santé, notamment aux soins maternels et à la planification familiale, et contribue aux taux élevés de mortalité maternelle.

Au Mali, plus de 500 femmes sur 100 000 meurent lors de l’accouchement. De plus, la formation initiale traditionnelle n’outille pas assez les agents de santé pour faire face aux conditions de travail réelles.

Le projet Classroom to Care (C2C) d'IntraHealth, financé par la firme pharmaceutique Takeda, aide 12 écoles privées de santé comme Vicenta Maria à adopter une approche de l'éducation basée sur les compétences.

L'approche par compétence est basée sur les besoins de la population.

Alors que la formation initiale classique consiste à élaborer des programmes par matière ou par objectif, les programmes de l’approche par compétence (APC) sont élaborés en fonction des besoins de la population et des compétences requises. Dans la formation classique, l'enseignant transmet les connaissances, tandis que l’APC est orienté sur la facilitation de l'apprentissage de l'élève.

C2C a formé 250 enseignants comme Marguerite au Mali, au Niger et au Sénégal sur cette approche.

Maternal, Newborn, & Child Health Health workforce development International Women's Day Gender Equality Midwives Nurses

Meet Marguerite Diarra. She’s On a Mission to Train More Midwives and Increase Access to Maternal Care in Mali

cbales — Fri, 08 Mar 2024 11:47:15 +0000

Meet Marguerite Diarra. She’s On a Mission to Train More Midwives and Increase Access to Maternal Care in Mali

, Technical advisor for communications

, Strategic communications manager

cbales March 08, 2024

March 08, 2024 12:00 PM

On a sunny morning at the Vicenta Maria School of Ségou in Mali, Marguerite Diarra demonstrates active management of the third stage of labor using a Mama-U, a training model representing a woman’s uterus after childbirth.

Marguerite is on a mission to produce more skilled midwives who are ready to care for women in Mali, particularly in rural communities. She grew up in Beleko, in the region of Dioila, and became a midwife in 2016. Now she’s a permanent teacher at the school, specializing in obstetrical care.

Mali doesn’t have nearly enough midwives.

Mali, like other countries in Francophone West Africa, doesn’t have nearly enough skilled midwives or other health workers. There are just 6.1 midwives, nurses, and doctors to serve 10,000 people, far below the recommended amount, and the shortage is even worse in rural areas. This hinders women’s equitable access to health services, including for maternal care and family planning, and contributes to high rates of maternal mortality.

More than 500 women die for every 100,000 live births in Mali. And, traditional preservice education has not prepared health workers for real-life work conditions.

IntraHealth’s Classroom to Care (C2C) project, funded by Takeda Pharmaceutical Company Limited, aids 12 private health schools like Vicenta Maria in adopting a Competency-Based Approach (CBA) to education.

The Competency-Based Approach to education is based on population needs.

Whereas classic preservice training involves developing programs by subject or objective, CBA programs are developed based on population needs and the needed competencies for job requirements. In classic training the teacher provides the knowledge, while CBA teaching is based on facilitating student learning.

C2C has trained 250 teachers like Marguerite across Mali, Niger, and Senegal on the CBA approach.

Maternal, Newborn, & Child Health Health workforce development Private-Sector Approaches International Women's Day Gender Equality Midwives Nurses

Uganda Sees Health Workforce Gains; Increases in Family Planning and Safe Deliveries at End of USAID Project

cbales — Mon, 19 Feb 2024 15:40:18 +0000

Uganda Sees Health Workforce Gains; Increases in Family Planning and Safe Deliveries at End of USAID Project cbales February 19, 2024

February 19, 2024

Between 2017 and 2023, Uganda strengthened its health workforce and systems, improved health services, and championed locally led development in collaboration with IntraHealth’s Regional Health Integration to Enhance Services in Eastern Uganda (RHITES-E) Activity.

Led by IntraHealth in partnership with The AIDS Support Organization (TASO), Communication for Development Foundation Uganda (CDFU), Malaria Consortium, and Medic, the USAID-funded project worked closely with the government at the national and local levels to expand access to high-quality health services. RHITES-E also supported Uganda’s response to the COVID-19 pandemic and an outbreak of Ebola Virus Disease and helped the Eastern region to be better prepared to respond to future threats through the establishment of public health emergency operations centers at the Mbale and Moroto Regional Referral Hospitals.

Focus on health systems strengthening

IntraHealth used health systems strengthening as its overarching approach for RHITES-E, building on strong collaborative relationships with districts, regional hospitals, health facilities, and communities, and fostering data-driven decision-making to strengthen local leadership in oversight of implementation. Key systems improvements include:

Through training and mentorships, built district capacity to use IntraHealth’s iHRIS human resources information system to guide health workforce planning, recruitment, deployment, and monitoring of attendance to duty. As a result, project districts used iHRIS data to fill 10,288 health worker positions, 76% of the approved positions in the region, while also reducing absenteeism.
Improved timely district reporting into the national health management information system from 67% to 91%, increased coverage of electronic medical records in antiretroviral therapy (ART) sites from 12% to 60%, and strengthened data quality and monitoring through digital health tools.
Strengthened laboratory services, including regular external quality assessments and faster turnaround times, leading to the first four labs in the region achieving international accreditation status.
Through mentorships, strengthened district capacity to coordinate supply chain management interventions to ensure availability, accessibility, and rational use of quality, affordable medicines and health supplies. Achievements included increasing the real-time ARV stock status weekly reporting rate from 13% to 61% from 2022-23 and maintaining multi-month dispensing of ARVs at 90% to reduce HIV clients’ need for clinic visits.

Integrated services for expanded access

Through a “whole of district” mindset, RHITES-E worked with district leaders, local partners, health workers, and community groups to expand access to health care in 30 districts in Eastern Uganda and Karamoja, home to over 7 million Ugandans. High-quality integrated services improved through the project encompass family planning; maternal, newborn, and child health; HIV/AIDS and tuberculosis; malaria; nutrition; and water, sanitation and hygiene. Highlights of results include:

Increased new users of family planning by 79%, from 249,351 to 447,169
Expanded users of long-acting and reversible contraception by 575%, from 47,059 to 317,726
Improved the percentage of women delivering their babies in a health facility from 57% to 81%
Achieved the 90% national target for childhood immunization through the essential program on immunization
Provided over 70,000 clients with ART for HIV
Achieved viral load coverage and suppression rates among ART clients of 98% and 93%, respectively
Increased the percentage of households with improved latrines (69% to 89%), safe drinking water (58% to 83%), and proper handwashing facilities (57% to 91%)
Through the Mbale Emergency Operations Center, implemented an intensive COVID-19 testing approach that improved result turnaround time from 14 days to 2 and achieved vaccination of 60% of the regional population by May 2023.

Engaging men in family planning

As part of RHITES-E, IntraHealth collaborated with ideas42 with funding from the William and Flora Hewlett Foundation on an initiative in six districts to improve the health and well-being of women of reproductive age, in particular by engaging the male partners of postpartum women in the benefits of child spacing. The “SupCap” project used a four-stage behavioral science methodology to co-design solutions with community members, including 1) an interactive game played by male partners of postpartum women, facilitated by village health teams; 2) a child spacing/referral card received by game participants to fill out with their partners and take to a health facility; and 3) text messages sent to game players, village health teams, and health workers. This project:

Reached over 20,500 male partners of postpartum women
Contributed to 61.5% of total postpartum family planning uptake in the six project districts
Tracked individuals who brought a child spacing planning card to the health facility: 100% received family planning counseling and 95% chose a method.

Transition to local partners

During its last two years, RHITES-E provided technical assistance in transitioning HIV service delivery to local implementing partners and family health services to the districts in alignment with IntraHealth’s and USAID’s focus on local capacity strengthening and locally led development. These local partners include Baylor Uganda, ANECCA, the Uganda Protestant Medical Bureau, and the Mbale and Moroto Regional Referral Hospitals, all of which received capacity development support from IntraHealth.

Resources

Uganda Country Brief

Tina Flores Tapped to Lead Frontline Health Workers Coalition

cbales — Mon, 29 Jan 2024 16:32:03 +0000

Tina Flores Tapped to Lead Frontline Health Workers Coalition cbales January 29, 2024

January 29, 2024

The Frontline Health Workers Coalition welcomes Tina Flores as its new director. Flores will shepherd in a new phase for the global coalition, one that is more focused on multilateral, regional, and country advocacy and engagement, as well as strategic growth.

The Frontline Health Workers Coalition is an alliance of 42 international organizations urging greater support and strategic investment for all health workers–including nurses, midwives, and community health workers–around the globe. Flores leads the coalition’s secretariat, which is hosted by IntraHealth International.

"Tina is the right person at the right time to steer the coalition."

“Tina is the right person at the right time to steer the coalition,” says Maqsoda Maqsodi, president and CEO of IntraHealth. “The COVID-19 pandemic brought overdue attention to the critical role of frontline health workers, but there remains a great need for increased and more targeted advocacy to ensure sufficient levels of supported and protected health workers to provide access to primary health care and to prevent the spread of emerging health threats.”

Flores is a veteran of the global health and advocacy fields, with years of experience building and driving coalitions to advance critical issues, including noncommunicable diseases, global health security, universal health coverage, and social determinants of health. Most notably, she established and led the secretariat for the Private Sector Roundtable for Global Health Security, a cross-industry coalition that mobilizes companies to collaborate with multinational organizations and governments around disease preparedness and response. An expert in policy, strategy development, and external engagement, she has been a trusted advisor to senior executives in multinational companies, NGOs, multilateral institutions, government, and academia.

"Tina brings in such great experience leading coalitions."

Most recently, Flores worked as an independent consultant with schools of public health and health companies to design strategies and craft multi-million-dollar initiatives to accelerate progress in health. Previously, Flores was vice president, external engagement at Rabin Martin, where she worked with C-suite, chief medical officers, and other executives from leading multinational health care companies, foundations, and academia on transformative strategies, access initiatives, and external engagement activities to influence global health policy and programs for underserved populations. In this role, she also leveraged her extensive networks to establish strategic alliances and partnerships with key stakeholders in the US and other governments, multilateral institutions, the private sector, coalitions, academia, and NGOs. Flores began her career as an intern at the Global Health Council, working her way to director, strategic communications, and the editor-in-chief for GLOBAL HEALTH Magazine.

“Tina brings in such great experience leading coalitions and maximizing the talents of both the private sector and the nonprofits,” says Crystal Lander, chief strategic engagement officer at Pathfinder International and chair of the Coalition’s Steering Committee. “I’m so excited to work with her in this new role.”

A new direction for the Frontline Health Workers Coalition

Flores joins the coalition as it coalesces around a renewed focus on primary health care and expands its work with multilateral, regional, and country stakeholders. To achieve its expanded portfolio, the coalition looks to grow its membership to include more advocates from across the global health community, as well as to reflect the broad spectrum of the health workforce.

Flores works with a dedicated steering committee, and members to define priorities and collaborate with partners to advance progress for health workers globally. The coalition, its members, and partners are already developing plans for World Health Worker Week in April, supporting the implementation of the Africa Health Workforce Investment Charter, and a half-day event during the World Health Assembly in May.

Join us!

Organizations interested in health workforce advocacy can apply to be a member of the Frontline Health Workers Coalition. Donors can provide funding to grow the coalition’s activities or sponsor specific events. Please contact us to discuss how we can collaborate.

About the Frontline Health Workers Coalition

Launched in 2012, the Frontline Health Workers Coalition is an influential voice for change and a trusted partner for health workforce policy guidance. Hosted by IntraHealth International, the coalition advocates for key actions to address the most pressing challenges facing health workers, including staffing, inadequate pay, migration, gender inequities, inadequate supplies and water, sanitation and hygiene, and mental health issues.

The coalition has primarily focused its advocacy on the US government and the World Health Organization. Key achievements and policy wins include:

Established World Health Worker Week, now a global advocacy movement every April that reaches millions of people
Increased frontline health worker voices in US and global health policy discourse, including during President Biden’s Global COVID-19 Summits
Released advocacy reports and fact sheets, including The Case for Investing in Primary Health Care Workers
New US government commitments across global health programs
New US government agency reporting requirements on health workforce efforts
The first ever WHO global strategy on health workforce (Workforce 2030)
New health workforce strategies at the The Global Financing Facility for Women, Children and Adolescents and Global Fund
Important health workforce provisions in the draft Pandemic Treaty as well as new UN political declarations on pandemic prevention, preparedness, and response and universal health coverage.

Picture It: New Surgical Equipment Will Improve Maternal Health in Senegal

cbales — Tue, 19 Dec 2023 14:41:52 +0000

Picture It: New Surgical Equipment Will Improve Maternal Health in Senegal

, MNCH/FP Technical Advisor, USAID MOMENTUM Safe Surgery in Family Planning and Obstetrics Project in Senegal

, MEL Technical Advisor, USAID MOMENTUM Safe Surgery in Family Planning and Obstetrics Project in Senegal

cbales December 19, 2023

December 19, 2023 12:00 PM

On December 6, the USAID MOMENTUM Safe Surgery in Family Planning and Obstetrics project (MOMENTUM Safe Surgery) donated five Universal Anesthesia Machines to hospitals in Thiès, Senegal, valued at approximately $117,000. The machines, which can run without electricity or medical oxygen, will improve equitable access to high-quality obstetric and family planning surgeries–including routine and emergency cesarean deliveries and peripartum hysterectomy–for nearly 600,000 women of reproductive age in the region.

Maternal and Newborn Health

How Is Our USAID Project in Central America Partnering with Communities and Community Health Workers to End AIDS?

cbales — Fri, 01 Dec 2023 14:08:44 +0000

How Is Our USAID Project in Central America Partnering with Communities and Community Health Workers to End AIDS?

, Strategic communications manager

, Communications Specialist

, Chief of party, Central America HIV Care and Treatment Project and regional director, Central America

cbales December 01, 2023

December 01, 2023 12:00 PM

The UNAIDS theme for World AIDS Day this year is Let Communities Lead. A new report highlights that communities living with, at risk of, or affected by HIV are at the forefront of progress in the HIV response, including connecting people to HIV services, and calls for more action to enable and support communities in their leadership roles.

We sat down with Yadira Villaseñor, IntraHealth’s Central America regional director and the head of one of our largest HIV programs, to find out how her team is collaborating with communities, community organizations, and community health workers (CHWs) to reach more clients with HIV services.

Villaseñor is the chief of party for the five-year USAID HIV Care and Treatment Project in El Salvador, Guatemala, Honduras, and Panama. According to 2022 data via UNAIDS, 103,000 people in these four countries are living with HIV and 31% are not on antiretroviral therapy (ART). The project focuses on training and equipping health workers to deliver high-quality HIV care and treatment, reducing stigma toward key populations (KPs) and people living with or at risk for HIV, and improving adherence to ART.

Q: How is the USAID-funded HIV Care & Treatment Project partnering with communities in Central America to increase access to stigma-free HIV services and help more people living with HIV receive treatment?

In Central America, the HIV epidemic is concentrated among KPs—men who have sex with men, transgender women, and sex workers. Stigma and discrimination, limited access to health care (including HIV prevention initiatives), and migration make the region vulnerable to a growing HIV epidemic. Our project provides technical and financial support to local community organizations that work with these KPs. This year we have sub agreements with five local NGOs, and we meet with them weekly.

Through the community organizations, we identify KP peers in these communities to be trained as CHWs and link them to facilities and implement community outreach activities.

For example, our previous USAID project in the region introduced health workers called adherence promoters to provide HIV counseling and testing and treatment support in health facilities. Adherence promoters immediately link people who are HIV positive to treatment, encourage HIV clients to attend routine medical appointments, identify clients at risk of dropping out of ART, link clients to other health or social services, including for treatment of opportunistic infections and co-infections, and follow up with people who don’t show up for their appointments. They work closely with community liaisons, who conduct home visits to clients who drop out of treatment.

Community liaisons coordinate with other community testing partners to improve linkage rates for referrals, so recently diagnosed users can be greeted and accompanied by them to clinical services. Community liaisons also provide direct service delivery such as counseling in the home, bringing ART medications when they can´t be picked up, providing emotional support when needed, helping patients recover when they have interrupted their treatment, and service reminders via WhatsApp. They deliver services in a culturally respectful manner that’s language appropriate and tailored to the users’ needs.

HIV & AIDS Community Health Health workforce development World AIDS Day Community Health Workers

Are We at the “End of the Beginning” for Global Digital Health? And What’s Next?

cbales — Wed, 29 Nov 2023 18:53:44 +0000

Are We at the “End of the Beginning” for Global Digital Health? And What’s Next?

, Deputy director of data science

, Former chief digital health officer

cbales November 29, 2023

November 29, 2023 12:00 PM

After decades of sustained focus by the digital health community, global bodies like the WHO, UNICEF, and the World Bank, and many country governments have embraced digital transformation as a key driver for achieving universal health coverage. But that may just be the end of the beginning for global digital health—to enable digital transformation that impacts health outcomes, we still have major challenges to address:

The proliferation of innovative, but not interoperable, digital tools has arguably left eHealth in eChaos.
The global health workforce is facing a shortage of 10 million workers by 2030 and many in post are leaving due to systemic burnout.
The open source data systems we rely on to make data available for high value Artificial Intelligence (AI) use cases suffer from under-investment and weak business models.

What opportunities exist to better leverage data and what long-term investments should be made to enable high value data use cases? Read on to learn how we’re taking on these challenges and opportunities at IntraHealth.

Connect with us at the Global Digital Health Forum, December 4-7, to discuss how we can partner to achieve the future we want.

Answering the most impactful business questions often requires more than one database.

Let’s face it, a lot of reporting systems in global health are built for donor reporting or national government monitoring rather than improving local program implementation. One can argue this came about out of necessity as the development sector grew and regulatory control is essential. But now we have an opportunity to shift our perspective and re-use data to answer some of our most critical business questions.

IntraHealth implemented the USAID Regional Health Integration to Enhance Services in Eastern Uganda (RHITES-E) program from 2018-2023. We had a seemingly simple question: how many lay workers needed to be employed and could we dynamically redistribute their workload to improve retention? Our data science team had to merge four siloed databases to answer this question: data on the total staff by cadre at health facilities (PEPFAR HRH inventory), percent of those positions filled to proxy for workload (iHRIS), retention data and GPS locations of facilities (DHIS2), and the size of the cohort (DATIM High Frequency Reporting). We determined that if each lay worker had 50 clients they would have enough time to engage with them, helping to promote their long-term retention. Mapping the actual ratios let us see where we could redistribute workload. Since a lot of engagement is via phone, we could redistribute client lists without having to physically move any staff.

Having an internal data science team at IntraHealth has reduced the lead time from good ideas to great results. We have refined our approaches through several projects since 2019; you can read about our lessons learned from applying machine learning to messy, real-world data in LMICs here.

Generative AI can help cope with software developer and health worker shortages.

The world is not only facing a shortage of health workers. There is also a shortage of FHIR-literate software developers in global digital health—we don’t have estimates but anecdotally it is a lot.

At IntraHealth we’re excited about the opportunity created by large language models and generative AI like ChatGPT to support and upskill health workers and software developers who can help build FHIR-compliant global goods software. And the data from other industries is backing it up.

Early studies are showing that ChatGPT-like support for college-educated professionals and developers can help in two ways. When college-educated professionals were given a writing task and randomly assigned to use ChatGPT or not, those who used ChatGPT improved the quality of their work and reduced the time spent on the task. Interestingly, those with lower baseline scores improved their scores more while the benefit for more skilled professionals was to reduce time on the task and maintain high quality. Similarly at GitHub, their AI-based CoPilot boosted productivity of software developers by 55%!

What could this look like in a busy, understaffed inpatient nursing ward? We know that turnover among nurses is high due to systemic burnout caused by understaffing and lack of support. What if ChatGPT-style interventions could be that mentor providing support and advice for a young nurse who finds themselves alone in the inpatient ward before they’re ready? If she feels supported, maybe she’ll stay.

Come check out our presentation at GDHF where we’ll present the results of using ChatGPT to iterate on our iHRIS software. Monday, December 4, 1:30-2:45 pm in the Oakley Conference Room at the Bethesda North Marriot in Bethesda, MD. Full GDHF agenda is here.

The foundation of any AI use case is good data.

We’ve all heard the saying “garbage in, garbage out” to make the point that the data going into an AI model impacts the utility of the results you get out. Imagine you have a program delivering HIV care to clients in Uganda and you want to use electronic medical record (EMR) data to predict which clients are at risk for interrupting treatment.

How should you deal with inevitable missing data? If values are missing, it could be because the visit got cut short and the data didn’t get entered or some other reason that could be correlated to the outcome of missing an appointment. Some machine learning algorithms will automatically impute data but if the data is not missing at random, you should model the missingness and use it in the analysis (e.g., feature engineering).
How often should you update the model in production? When the results of the model can be pushed back to the EMR, this could be as easy as running the model at the beginning of each week. However, as you intervene with clients to reduce interruptions in treatment and those clients’ results go back into the model each week, the model’s accuracy can drift. Let’s say your intervention is successful and all 25-year-old males that got your intervention are less likely to interrupt. Is a 25-year-old male in your dataset now less likely to interrupt, or is the model learning from your intervention and becoming less accurate about typical 25-year-old males?
Can you make AI work in a paper-based world? EMRs may not be available during the visit for clinicians to check on the status of a client at risk for interruption in treatment and intervene. Can you create a paper-based tool that curates the model output into an assessment so that clinicians can evaluate clients sitting in front of them and provide support? Palindrome has had success doing that in South Africa.
Who ensures that global good open source software powering EMRs and other necessary tools is maintained? The EMRs we’re talking about are often open source software that is maintained at a loss by the original developers and without sufficient investment in security and maintenance, open source software can pose significant security risks. How can we ensure better coordination in the open source software space with sustainable business models?

IntraHealth is among a small group of companies working to develop AI models that can predict which HIV clients are going to interrupt in treatment before they do. You can read more about these efforts here and here.

Check out IntraHealth’s presentation at the GDHF to hear how we addressed these issues in the USAID-funded HIV Care & Treatment Project in Central America. Wednesday, December 6, 1-2 pm in the Forest Glen Conference Room at the Bethesda North Marriot in Bethesda, MD. Full GDHF agenda is here.

How do we solve some of these challenges?

1. Create a data use architecture plan for how data is going to be used

Any data scientist worth their salt will tell you that data science isn’t magic, it’s driven by good questions and good data. Projects can start today by assessing their monitoring and evaluation (M&E) data used for reporting (i.e., telling stakeholders what’s been done) and figuring out how to turn it into strategic information (i.e., telling program managers what to do next). Donors can work with implementers to reduce the burden of M&E reporting.

At IntraHealth, we call our overall approach to data use READI: Rapid, Efficient, and Data-Driven Implementation. READI’s guiding principles are real-time, granular, automated data; re-use of donor reporting and secondary data for implementation where possible; and working with governments to review their data and make decisions through a Data to Action (D2A) process.

In READI, we re-use as much donor reporting M&E data as possible for implementation. When the data we need isn’t an M&E indicator, we leverage free, publicly available secondary data (e.g., hyper-local 1x1 km estimates of socioeconomic and population indicators) to help increase the efficiency of our programs. We also engage with communities of practice to re-envision M&E data to support program implementation and have developed a standard set of indicators our projects can choose from for family planning, maternal and child health + nutrition, and non-communicable disease implementation.

2. Invest in open source software

You may have seen various versions of this image around the web. While many open source communities have created great enhancements to software over the years, the complexity and needs of the global goods community are often beyond what can be managed and maintained by volunteers. Better investment is needed in global goods to ensure that the software being provided is being maintained, incorporates standards, is secure, and evolves with advances in technology. This is particularly essential where reasonably priced, commercial alternatives do not exist.

3. Create markets for health information system (HIS) components

A fully functional HIS supports innovation and entrepreneurship by reducing transaction costs so that innovators can build technology able to leapfrog physical infrastructure barriers (like telemedicine apps) with APIs to high-quality health worker and facility lists maintained by a single, public entity. In a perfect world, governments would be able to implement a fully interoperable HIS already using existing architecture specifications like OpenHIE, and digital health sandboxes would allow entrepreneurs to easily introduce new innovations to the ecosystem. However, there are markets that are decades away from this model and there are transitional approaches that might be easier to achieve in the short-term. Markets could benefit today from middleware business to government (B2G), government to business (G2B), or business to business (B2B) models to build, maintain, and license the registries needed to build telemedicine apps to innovators rather than each innovator building and verifying their own. What other opportunities are there for B2G, G2B, or B2B use cases that can support public health? And what non-traditional funders (e.g., health tech investors) might be interested in starting up middleware companies to create the market needed to make health tech profitable? Read more in our blog.

Digital Health Global Digital Health Forum

In Francophone West Africa, 3,000 More Nursing and Midwifery Students Are Benefitting from Competency-Based Training Matching Local Needs

cbales — Mon, 20 Nov 2023 16:19:57 +0000

In Francophone West Africa, 3,000 More Nursing and Midwifery Students Are Benefitting from Competency-Based Training Matching Local Needs cbales November 20, 2023

November 20, 2023

IntraHealth is partnering with Takeda Pharmaceutical Company Limited to improve maternal and child health in Mali, Senegal, and Niger by sustainably increasing the number of skilled nurses and midwives ready to serve rural communities.

Through the Classroom to Care (C2C) project, funded by Takeda's Global Corporate Social Responsibility (CSR) Program, IntraHealth International is improving access to high-quality maternal and child health care in Mali, Niger, and Senegal by strengthening the preservice training of nurses and midwives in 12 private health schools. Now at the end of the second year of the project, more than 3,000 nursing and midwifery students—75% of whom are women—are benefiting from updated curricula adapted to local clinical practice.

The project is responding to several pressing issues. There is a critical shortage of health workers (nurses, midwives, and doctors) available in the three countries, with only 6.1 health workers in Mali, 3.9 health workers in Niger, and 4.3 health workers in Senegal for every 10,000 people. The shortage is even more acute in rural areas. Currently, traditional preservice education curricula have not prepared health workers for real-life work conditions, and many health training institutions are inadequately equipped and unaccredited. Furthermore, women are disproportionally disadvantaged when it comes to enrollment and graduation due to a variety of factors, such as family responsibilities. Discrimination against women and gender inequalities directly impede development of the health workforce to provide equitable and accessible health services.

Meanwhile the maternal mortality rate remains very high in the three countries, with 315 deaths per 100,000 live births in Senegal, and more than 500 deaths per 100,000 live births in Mali and Niger. And in Mali and Niger, approximately 10% of children die before their fifth birthday.

Competency-Based Approach

Competency-focused preservice education is critical for the provision of high-quality maternal and child health services that meet local needs. Since 2006, the West African Health Organization (WAHO) has pushed to harmonize training curricula for nurses and midwives in the Economic Community of West African States (ECOWAS) region that addresses current disease patterns as well as intra-regional migration. The curricula use a competency-based approach (CBA) that considers population and student needs to replace classic training. Many health schools in the region, however, have still not started the process of implementing the WAHO standardized curricula or been able to train a critical mass of teachers on CBA.

From 2017-2020, the USAID/Mali Human Resources for Health Strengthening Activity, led by IntraHealth, supported the use of competency-based curricula in 10 schools and strengthened policies and practices related to recruitment and retention of students, leading to improved performance of health workers.

The five-year C2C project builds on this work and supports four private schools in each country to strengthen preservice education of nurses and midwives through enhanced competency-based curricula; train teachers and others in the CBA, achieve the appropriate accreditations; and promote diversity, equity, and inclusion (DEI) to increase the number of nursing and midwifery graduates, particularly women from marginalized communities and vulnerable groups.

C2C partners with a diverse set of stakeholders, including WAHO, government bodies including the ministries of health and education in each country, government units such as the Human Resources Division and the Division for Mother and Child Health, private school associations, health professional associations, and Empower School of Health.

Preliminary results

C2C conducted an in-depth needs assessment to identify the baseline for each school, then developed capacity-building plans for all 12 schools to address gaps in national accreditation standards, purchased essential teaching equipment for competency labs, and digitized eLearning modules harmonized with the WAHO curricula.

At the end of Year 2, the project has:

Supported the development and validation of CBA teacher training documents at the national level, including a reference manual, trainer’s guide, and participant workbook.
Through updated CBA training programs, improved the skills and knowledge of 3,721 students, teachers, and school management staff:
- 398 teachers acquired skills and knowledge in adult teaching techniques.
- 250 teachers and clinical supervisors received training on competency-based curricula.
- 3,073 students (2,361 women) benefited from updated curriculum content with tools adapted to clinical practice.
Developed an Accreditation and Quality Assurance Roadmap for all three countries, established internal quality assurance and accreditation units in each school, and oriented 62 educational advisors on quality assurance—laying the groundwork for the accreditation process.
Digitized 33 maternal and child health teaching modules and developed an eLearning platform in collaboration with Empower School of Health. This platform is a comprehensive learning management system tailored to each country, and the modules cover topics such as pediatrics, anatomy, community health, and obstetrics. The eLearning platform incorporates DEI considerations in its design, audio and visual features, and mobile and offline options.
Established inter-ministerial technical working groups in the three countries and initiated a regional private sector community of peers and a community of practice on medical sciences training.

What’s next

C2C is currently conducting DEI situational analyses in all three countries, and in the next year will use them to develop school-specific DEI plans that apply DEI best practices, such as providing nurseries and lactation rooms, to make partner schools more inclusive for women students and boost well-being and academic performance.

C2C will launch the eLearning platform and over the next three years will expand the platform to also include management and leadership courses and solidify it as the standard in health care education across West Africa. C2C will ensure each partner school receives the necessary equipment and technical support to set up competency and computer laboratories. C2C will deepen engagement with stakeholders, from government bodies to local communities, ensuring that the project's impact is sustainable and far-reaching.

The project will also continue its Private Sector Community of Practice, strengthen public-private partnerships through the technical working groups, and oversee implementation of action plans in each school.

By the end of the project, C2C aims to have 580 teachers trained on the CBA, 9,720 students benefiting from quality training, and all 12 private health schools accredited.

Learn more about the Classroom to Care project in three short videos produced by IntraHealth’s Mali team for a virtual visit this month with Takeda.

Want to Unleash Pent Up Health Tech Innovation in Africa? Invest in Health Worker and Facility Registries

cbales — Wed, 04 Oct 2023 14:43:00 +0000

Want to Unleash Pent Up Health Tech Innovation in Africa? Invest in Health Worker and Facility Registries

, Deputy director of data science

, Former chief digital health officer

cbales October 04, 2023

October 04, 2023 12:00 PM

Earlier this year, IntraHealth International connected with a company that’s using artificial intelligence (AI) and machine learning to dynamically redistribute the health workforce in Liberia. We quickly got into the weeds—how are you setting it up and how much does it cost? No surprise, it’s like any data science project—80% of the work is wrangling the data. In this case, the firm had to create a list of all the health facilities and the providers working at those facilities and their training and skillset—using available, messy data and at times visiting health facilities to collect data from scratch—before they could even begin to use AI.

Registries are an essential building block of a health information system.

It wasn’t long before we realized the startup had created their own custom health worker and facility registry. What’s a registry? Registries are an essential building block of a health information system. Simply put, they are lists of entities that have been verified with some criteria. However, registries don’t get the attention they deserve. Let’s see how integral they are to the health tech ecosystem in Africa.

Health tech investing in Africa has reached over half a billion dollars in the last 18 months according to a 2023 report from Briter Bridges. Telemedicine companies are leading the pack—and registries are critical to a telemedicine startup in the same way they were critical to the AI company redistributing health workers in Liberia. When a client connects with a health worker virtually, they may need a referral to another provider or to a pharmacy nearby to pick up a prescription. Behind the scenes is a registry of health care providers, pharmacies, and in stock medicines, and if it’s a repeat customer a client registry can help identify existing prescriptions and any interactions.

Just like that, telemedicine has leapfrogged infrastructure barriers to health care access in Africa—but not without registries.

A customized registry could cost between $100-300k.

Like any startup, a telemedicine startup needs to generate revenue quickly with limited funding runways and most startups never get past the early stages if they cannot generate revenue. If there is no national registry, having to create a customized registry could cost between $100-300k and require ongoing maintenance of between $10-40k per month, depending on the scope and scale. If a startup dies, its custom-built registry dies with it.

Established national registries not only reduce the startup costs and barriers to entry but can accelerate the time from startup to revenue generation when companies can pour money into reducing customer acquisition costs (CAC) rather than recreating and updating registries for their own use. A market with an up-to-date and well-maintained health worker, facility, and client registry can lower startup costs and potentially attract new investors to fund innovation in these markets.

Open source global good software is on the shelf and ready to be implemented.

The great thing about registries is that the global health community has produced guidelines for developing and maintaining facility, health worker, and client registries, and open source global good software is on the shelf and ready to be implemented. IntraHealth has developed and maintains three canonical, open source, and standards-based registry tools. iHRIS is a health worker registry that stores information on health workers across a health system, including their demographics, training, and certifications; GOFR, the Global Open Facility Registry, is a tool that allows facility reconciliation and the creation of a master list of facilities; and OpenCR is a privacy preserving client registry tool. At scale, registries built on such open source tools could power tomorrow’s health tech growth in Africa but not without further investment and governance.

Why not develop and maintain registries through a B2B, business-to-business, model? Venture capitalists could consider funding an NGO, or a social enterprise based in a low- or middle-income country, to enter the market and maintain an application programming interface (API) to an up-to-date and well-maintained health worker and facility registry. Startups could pay a fee to the company rather than recreating the list each time, customers could be assured that they are getting referrals to the most qualified individuals, and the government could have access to the data for free.

With national health worker and facility registries, promising health tech innovations we haven’t even thought of yet could have a running start at revenue generation.

Digital Health