African countries are increasingly using digital solutions to streamline and resolve health challenges. Digital-health solutions come in many forms, from drones used to deliver blood to remote areas to contact tracing and Covid-19 tracking apps and digital-health financing platforms. The key enabler underpinning all these applications is digitalised data.
The necessity of quality, up-to-date and accessible data was never more evident than when the Covid-19 pandemic hit the continent. African countries have faced challenges using data throughout the pandemic, from the lack of quality data on Covid-19 cases and related deaths to the identification of priority groups for vaccine rollouts. The most successful examples of pandemic management, including Covid-19 vaccine campaigns across Africa, were those informed and enabled by quality, real-time and accessible data.
Covid-19 highlighted that data are integral in helping governments make better and faster decisions. It has also created an opportunity for lasting change through the increased political will to make a concerted investment in the systems and skills, and tailored data-management tools. This will not be the last pandemic or emergency so capitalising on Covid-19 to create robust data-management systems that underpin not only emergency responses but health systems too is critical to countries’ health security.
Today, the Tony Blair Institute is supporting African governments to strengthen their digital infrastructure and data-management systems through its Africa Vaccines Programme (AVP). This work is the natural extension of what the Institute has been doing for many years with African governments, supporting leaders with strategy, policy and delivery to implement their priorities.
The Data-Management Challenge
Policy and decision-makers rely on clear and reliable data to analyse and understand trends, and empower evidence-based policy and decision-making. This has been a challenge for African countries since the beginning of the pandemic when reliable data on Covid-19 testing, cases and deaths were difficult to find.
Up until recently, many African countries did not capture data on priority health groups. The gaps were especially evident once vaccine rollouts extended beyond urban centres to rural and remote areas. This meant that when vaccine rollouts began, information identifying priority and other eligible groups was patchy and unreliable, which undermined rollout speed and constrained the ability of governments to make data-informed decisions. Many African governments recognised that to incrementally improve the impact of their Covid-19 vaccine rollouts, robust data-management systems manned by trained staff, and informed by reliable and standardised data from all communities, would be needed. Such data-management systems would break down bottlenecks, enabling faster vaccine delivery and thereby saving more lives.
Through the AVP, the Tony Blair Institute has been supporting six African governments with embedded Vaccine Delivery Advisors (VDAs) who have deep expertise in digital infrastructure and data management. The embedded advisors have been working hand-in-glove with governments to identify bottlenecks and areas of frustration, gaps in the system that can be filled and programmes or systems that can be improved for Covid-19 vaccine delivery. While the support includes strategy and planning, social mobilisation, supply chain and logistics, all these are underpinned by strengthened data management, an enabler that cuts across all areas of support.
Our VDAs on the ground have identified three cross-cutting data-management challenges currently hindering vaccine rollouts:
Weak connectivity and infrastructure: Unreliable internet connectivity and poor technological infrastructure are critical challenges in accessing quality data for both effective vaccine delivery and strengthening health systems. This was evident as governments struggled to collect and report data during the early phases of the pandemic and again as they attempted to track vaccine distribution. The lack of data-collection equipment, such as SIM cards, cell phones and tablets, and poor connectivity in remote districts were key obstacles.
Poor data-management systems: There are limited systems that can gather, harmonise and analyse data at all levels for timely decision-making. While multiple reporting tools exist, many efforts are not well-coordinated and data are not integrated into a single system or platform. Where there are multiple systems, there is a lack of interoperability to share and interpret data across various systems. Much of this was evident in Ethiopia where data was collected at district-health facilities in different forms: Excel spreadsheets, DHIS2 and administrative reports. There was similar issue in Kenya, which resulted in the duplication of efforts and compromised data quality. These factors subsequently have an impact on the monitoring and evaluation of vaccine rollouts, making it difficult to measure the performance of vaccination campaigns against targets.
Shortage of trained workforce: There are chronic shortfalls in the health workforce across Africa, which has impacted its ability to perform regular data-management tasks alongside their urgent tasks. In addition, the health workforce is often not well-equipped or trained to collect and manage data in a standardised manner.
How Is the AVP Supporting?
The AVP has embedded VDAs working in Ministries of Health across six countries and the Africa Centres for Disease Control and Prevention. These advisors are all strongly interconnected through the hub-and-spoke approach, enabling this group of experts on vaccine delivery, logistics and supply-chain management, monitoring and evaluation, and public health to exchange products, learnings and advice. This model helps governments to learn lessons from other countries and test interventions, find common solutions and exchange learnings and networks.
Improving Data-Management Systems and Skills in Ethiopia
The VDA in Ethiopia is working alongside the Essential Programme on Immunisation (EPI) unit in the Ministry of Health to identify and resolve data-management and monitoring and evaluation challenges faced during the country’s vaccine rollout. To improve the use of data for evidence-based decision-making, the VDA has created and delivered data-visualisation dashboards to track Covid-19 vaccination progress. These are regularly used to inform the ministry’s leadership and other stakeholders.
The VDA is also supporting on the integration of multiple parallel data collections and analysis tools available from district to central level. Prior to the arrival of the VDA, data on immunisation were organised through a central vaccination-reporting system (DHIS2) that monitored the supply and administration of vaccines across the country. One year ago, less than half of Ethiopia’s districts were recording data using the DHIS2 for Covid-19; today this has risen to 90 per cent. The VDA has directly supported this through the integration of data and analysis tools, mobilising resources, facilitating training at the district level – including at vaccination points – and developing guides, manuals and standard operating procedures (SOPs) on how to use the tools effectively and record backlogged data. The trainings, manuals and SOPs developed will serve beyond the pandemic to create stronger systems and skills both at district and central levels for future vaccination efforts.
Tracking Performance and the Results of Vaccination Campaigns in Burkina Faso
Our VDAs in Burkina Faso are using a similar approach to support the country’s Ministry of Health to track the performance and results of vaccination campaigns. After observing poor communication on vaccination-coverage progress within government and the different health entities at national and subnational levels, our advisors supported the development of tools to rectify this. Now, daily communications enable the easy identification of issues faced by task forces.
Leveraging Existing e-Health Work and Partnerships in Senegal
The AVP also has VDAs supporting the government of Senegal, leveraging the Institute’s existing work on e-health in the country. Prior to the AVP’s presence in Senegal, the government required a digital-immunisation registry to identify priority groups for the Covid-19 vaccine rollout. To identify and digitally capture priority groups, the president’s team collaborated with Oracle, the Ministry of Health and the Institute to launch the eVaccin project.
By early 2022, more than 1.5 million Covid-19 doses had been delivered in Senegal and recorded on the Oracle Health Management System (OHMS). The digital-health infrastructure underpinning Senegal’s international vaccine pass allowed the country to become one of the first in Africa to provide Covid-19 vaccination QR codes to citizens. More than 25,000 passes were issued to travellers in the first month alone.
Today, the VDA is embedded in the Ministry of Health and leverages contacts across the Institute’s existing programmes of work in Senegal to augment the AVP, demonstrating the value-add of the programme.
Conclusion
The embedded, side-by-side support the AVP provides has enabled many African governments to gain a dividend from the pandemic by streamlining data-collection methods, and boosting adoption and integration of data-management tools, to enable the rollout of Covid-19 vaccines. This strengthening of data-management systems today will better enable the rollout of other vaccines for adults, such as human papillomavirus (HPV), and prepare for a future where effective vaccines for malaria and dengue are available.