Data integration and digital tools in 4 countries in support to COVID, malaria, RMNCHA and EOCs

Following the Covid-19 epidemic, a strong need to increase the capacity of Ministries of Health (MOHs) and Emergency Operations Centers (EOCs) arose in several countries. Not only to help mitigate the impacts of the pandemic, but also to strengthen EOC’s capacity to tackle future emergencies. In this context, data use is of particular importance to promote next generation, results-driven health policies.

Bluesquare received a $4.5M grant from the Bill & Melinda Gates Foundation (BMGF) project to help increase the availability and usefulness of operational and strategic data in four west-African countries: Burkina Faso, Niger, Cameroon and Ivory Coast. The project is set to run from November 2020 to October 2022.

Through the project, Bluesquare is actively improving data management and data use across stakeholders in order to foster better emergency response, strengthen health systems and support malaria eradication goals.

Beyond providing EOCs with data management systems, the project leverages our solid engagement with IT teams in local MOHs. It promotes structural improvements for health information systems in these countries.

It all starts with data

EOCs need to respond quickly to epidemics based on accurate information. To do so, they need to integrate data from multiple datasets, assess and improve the quality of the data, and identify, integrate, and use new data sources.

The good news is that a lot of data already exists:

• Ministries of Health generate their own data: use of healthcare services (in DHIS2), disease surveillance, logistics monitoring, campaign management, etc.
• Additional data is collected by nongovernmental partners such as NGOs and for-profit providers

However, these different data sources are not consolidated in a single environment, making it difficult for the MOH to paint an overall picture of the performance of the health system. Furthermore, the datasets also are riddled with errors, late reporting, missing data, and other quality issues.

Proper planning also relies on population data to accurately plan programs and evaluate impacts. Unfortunately, population and geographic data (aka geospatial data, such as boundaries of political or health areas) , used in routine by the MOH, are frequently inaccurate. A major component of this project for Bluesquare was therefore the establishment of clean georegistries and health facility lists in each country.

To support EOCs in building and using a reliable source of data, Bluesquare and the BMGF structured their work around three focus areas.

1. Building a data management & visualization toolbox

Since early 2021, we have been to improve Covid-19 response data collection and general disease surveillance tools. For instance, we supported the configuration of Covid-19 case tracking systems and helped the MOH to consolidate legacy data stored in various formats.

Through this process, we are building a data management toolbox, including best practices for the configuration of case tracking, early alerts and routine disease reporting data systems, mobile applications for alerts, data collection tools for weekly notifiable diseases reporting and dashboards.

These actions support the whole surveillance workflow and an assessment framework to help decide which tools to deploy in various scenarios.

2. Improving monitoring & resource allocation of Malaria and RMNCHA programs

Bluesquare is supporting the setup of a data integration infrastructure, data pipelines, and a data analysis capacity within the EOC and MOH. The team gathered existing data from different sources and fed it into dashboards co-designed with the EOCs. The intervention is directly supporting EOCs, RMNCHA and malaria programs, with the idea that the infrastructure could be used by multiple programs and disease areas in the future.

Through this work, the Bluesquare team developed dynamic strategic and operational dashboards that:

• Support national and program-specific strategy planning: resource allocation, prioritization of interventions and regions, …
• Monitor the performance of health policies: dashboards supporting monthly reviews, automated reporting tools,… In Burkina Faso for instance, our efforts are enabling the relaunch of the monthly malaria monitoring analysis.
• Prioritize resource allocation at national and decentralized levels: e.g. stock-out warning system, HR and equipment allocation management
• Monitor service availability and accessibility in real-time, especially to help accelerate emergency response.

These results enable EOCs to have a holistic view of key issues in their health systems, as well as real-time monitoring of ongoing availability of health services.

3. Enabling better campaign planning & monitoring

Bluesquare is focusing important efforts on improving the malaria prevention campaign planning and monitoring. These campaigns take on two forms: the distribution of longlasting insecticidal nets and of seasonal malaria prevention medications.
To support these campaigns, Bluesquare is undertaking three main actions in close collaboration with the MOHs & malaria programs:

• As much of the planning for health campaigns is dependent on population estimates, Bluesquare is working with the different programs as well as national census efforts to create ways of keeping population databases up-to-date. By using the data gathered in regular health campaigns, we hope to update the population dataset available to MOHs on a regular basis.
• Another important step is microplanning. During this phase, programs define how many doses of preventive drugs should be foreseen, when and where teams should be deployed, etc. Often done on paper or excel sheets, the process allows for mismatched information and human errors. Bluesquare is looking to automate part of this process.
• Finally, Bluesquare is working to develop visualizations based on campaign data that could help identify problems in real time.

This work looks to support several areas of strategic data for EOCs, from village reference data, to population estimates, to geographical reference data.

Ensuring a successful collaboration & implementation

Throughout this project, and especially during the inception phase, stakeholder engagement is key. Together with the MOHs, emergency teams and specific disease programs, Bluesquare was able to clearly define the needs in each specific country, and to propose useful tools that can efficiently improve EOCs’ capacities, strengthen countries’ health systems in the long run, and contribute to malaria eradication.
While the work is not yet done, with the project ending in November 2022, Bluesquare has already managed to consolidate several historical and current data sources, to set up multiple dashboards, and start the process of drafting accurate health maps. Some of these tools already support daily MOH activities in all four countries.