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The Trypelim project: digital tools to help eliminate Sleeping Sickness

Sleeping Sickness is a parasitic disease transmitted by the tsetse fly. It is lethal in most cases and has been an important cause of death in sub-Saharan Africa over the past century.

Professor Marleen Boelaert and her team from the Institute of Tropical Medicine (ITM) in Antwerp, Belgium, recently launched a new project to reach the global targets for eliminating sleeping sickness. ITM researches new ways to combat the disease and is in charge of an international elimination initiative in DRC, financed by the Belgian Development Cooperation and the Bill & Melinda Gates Foundation. They are working with several partners. One of them is PNLTHA, the National Program against Sleeping Sickness in the DRC.

The project is focused on improved medication and testing, smaller and more effective fly traps and on digital data processing. You can read more about the ITM project here: https://www.itg.be/E/sleeping-sickness

Bluesquare has been working with ITM to develop and enhance the existing data processing tools, which includes two main parts:

  1. A mobile application

The mobile application is used on Android tablets to collect data about diagnostic tests that are performed in villages in DRC.

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The paper based processes that have been in use, with good results, in the DRC over the years, have the drawbacks of requiring that all the information be gathered physically at a central level and letting spelling errors in names of places slip through. These factors make it more difficult to produce geographically grouped reports.

The mobile application replaces those processes and provides multiple advantages:

  • It enforces improved encoding by for example providing prefilled lists of places and checking that encoded ages are realistic.
  • It allows transfer of data over the internet when connectivity is available, avoiding difficult travel for the PNLTHA teams across the country, and drastically shortening the time to collect data centrally.
  • It can take pictures and videos (through microscopes) of test results. These are taken to  double check the results at health zone, provincial or national level, in order to increase the quality of the testing.

These advantages are very important and justify the use of digital tools over the traditional paper approach, but the use of a tablet application has its own challenges to overcome.

First, it requires electricity. This has been solved by using solar panels.

Second, it needs to work offline, with the absence of internet connection in most of the DRC. Then when the tablet user reaches a place where internet connectivity is available, it needs to be able to synchronize all the collected data with a central server, securely.

Third, the process must not break the workflow of existing testing teams, and be, whenever possible, as convenient as the paper based processes.The teams  are used to working in parallel with encoders for the patient names, with the testers when collecting blood and finally with the verifiers to proceed to additional tests in case of a first positive diagnostic test. We are tackling these problems by using NFC and Bluetooth synchronization between tablets to avoid multiple encoding at the different stages of the process. The advantage of these technologies is that they do not require internet connectivity to transfer data between devices.

  1. An online dashboard

The dashboard offers many features aimed for use by the PNLTHA members.

First and foremost, it collects all the data about the tests performed in the field, that have been encoded either through the mobile application or through various Microsoft Access files over the years. This makes it a comprehensive electronic record of all recent sleeping sickness cases in the DRC. Our team worked hard to ensure that this data are as clean as possible, allowing us to match cases with the location where they have occurred and been diagnosed, and to ensure that no case is either forgotten or encoded twice. We are also making progress on making links between various tests performed on a given patient.

In the end, the keyword here is traceability: we want to allow users to easily recover any information on a test that has been performed. For example, in which village, by which PNLTHA member and on exactly which date. Dates and GPS coordinates are collected by the tablets during encoding and are used in the dashboard to navigate test information.

Second, it includes tools to track the progress of the testing work in the field, by displaying which tablets have been doing which test, when and where. Statistics about the tests campaign can be viewed online in these tools.

Third, in the very near future, the dashboard will allow us to proceed to quality controls at various levels, by allowing officials of the PNLTHA to see pictures and videos of tests completed in the field and double check the diagnoses that have been performed.  

Fourth, the dashboard offers tools to plan the work of testers in the field, while optimizing the travels of the teams and the epidemiological efficiency. This is crucial in the last steps of elimination of the sickness, where tracking down the last cases requires a level of accuracy that was not really needed in the past, when more broadly cast surveillance networks have done their job efficiently.

All these features are provided while ensuring a fine grained access control where all users of the systems only get access to the parts that are relevant to their work responsibilities. Notably, they only have access to the geographical regions that they are in charge of.

Tools used (for the technology wonks out there):

For the android application, we use Cordova, React, and various libraries for NFC, USB storage (for backup) and external USB camera support. The data is stored in Couchdb, which allows relatively easy replication between devices and the servers.

The online dashboard is written in Python using the Django framework, with the frontend using React, Leaflet for the maps, and d3.js for data visualization.

We are making progress on all aspects of the digital tools for the elimination of the sleeping sickness in the DRC project. Overall, we seem to get a good adoption rate of the tools by the different teams, which is always a major challenge for any digitization project. This is attained through constant feedback loops with people in the field and rapid adaptation of the tools to the needs expressed. Already, hundreds of thousands of tests have been recorded and made available for statistical analysis.

We would like to thank the members of the PNLTHA for their willingness to test the tools and to give feedback and the ITM for trusting us with this important and challenging project.

You can now manage your Dataviz directly in DHIS2

Do you use dataviz to demonstrate your program results? Today we are pleased to announce that you will be able to manage your dataviz directly in DHIS2. Thanks to our new DHIS2 Data Viz app!

Access to the app will allow you to easily make changes to your platform. You can configure all display settings, sections, change their order, …

The app is available directly via the app menu on DHIS2.
 

For a tour of the app, or if you have trouble finding the app in DHIS2 contact your project manager or our DataViz product owner.

Continued updates to the design

Thanks to your continued feedback and our user analysis, we have made a few additional updates to the Data Viz layout. Here’s what’s new:

  • Main content placement. Most visitors to the site are interested in the national level results. So we have moved this information to the left for ease of reading.  
  • Health Center attributes. The number of sub-zones, the attributes describing the health centers, the photos and the grouping, were not visible enough. We have added a dedicated space for the attributes describing the health zones and increased the visibility of the photos of the health centers.

We hope you find these changes helpful as you continue to use Data Viz to articulate your program needs to your various partners and stakeholders.

Example of groups display in RCA

Boris Rorsvort
Dataviz Product Owner
dataviz@bluesquarehub.com

Digital Investment Principles – a simple approach to coordinated efforts in global health

While it may not have made waves in international news, there is a new development in digital health that is very exciting for us at Bluesquare: The Digital Investment Principles.

If you have not heard of them yet, they are 10 guidelines that donors can endorse to demonstrate their commitment to working together towards improved collaboration in digital health. Created by leading players – the World Bank, the European Union, USAID, Unicef, WHO, the Bill and Melinda Gates Foundation – these 25 key donors and foundations are making their commitment known.

Principles 1-5 focus on collaboration, sustainable alignment in investments and a commitment for donors to make these investments a priority. The last five provide guidance on where the investments should go: creation and evolution, country capacity and peer-learning to call a few out.

At their center is an urgent call. One that we at Bluesquare have championed for the last 5 years – and that is alignment of investments to the national digital health strategies already in place in each country.

We have worked with Ministries of Health in over 25 countries. Our work has focused on integrated health information systems. Health information systems that support decision making from existing data while finding the most cost-effective ways of collecting additional data. We have seen and experienced the challenges to accomplishing this first hand.

These principles could not come at a better time. While they are simple in nature, they demonstrate how far we have come in the last few years for a meaningful dialogue on the importance of coordinated efforts in digital health in developing countries.

We are eager to continue to be part of the important work in this space.

Bluesquare is happy to release the new ORBF : effectively managing RBF & strategic purchasing on top of your DHIS2 platform(s)

After more than a year of hard work, and months of testing and improvement, we are very pleased to officially release the new ORBF tool to help manage RBF and strategic purchasing on top of DHIS2 platforms.

Since 2012, Bluesquare has been developing and deploying OpenRBF in many countries. OpenRBF was a separate and stand alone software platform. In 2016, we decided to re-build the software, and split it into several modules, while maintaining our focus on technology that would enhance the health financing capability of DHIS2. This led to the development of three software modules that are plugged into DHIS2: DataCollect (an ODK to DHIS2 offline mobile android app), DataViz (a data visualisation interface used for RBF portals), and ORBF, a health financing rule engine.

Over the coming months we will share more on these modules. For today we will focus on ORBF and its great capabilities.

From lab coat to tablet

The first impression you get when you meet Romain is his discreet nature, attention to detail, commitment to quality and a dedication to the work he does. So when we asked him to tell us about himself, it was clear we wanted to understand how he got where he is today.  

While his journey was not linear we immediately notice a central theme: his commitment to understanding complex problems and his desire to make an impact.

Another year for Bluesquare – The same vision, different ways.

Another year for Bluesquare – The same vision, different ways
At Bluesquare, what drives us is the desire to make the world a better place. Our goal is to ensure that every citizen on this planet has access to a minimum package of health services. Unfortunately, we are not there yet. The community surrounding the Tipo health center in the DRC has benefited from barely any substantial Global Health investment over the last years. So, helping Global Health players allocate their resources in a smarter way, so that it goes where it matters most, is where we can continue to make a difference. How will we get there? We believe that technology and data can influence this allocation in two ways : increase efficiency of existing investments through better data insights and financial disintermediation, and make Global Health a more attractive investment for countries and citizens looking to invest in this space.    

But how do we translate this vision into operational priorities? Here is our focus for 2018.

Data Collect in the DRC: Patient feedback & monitoring socio-economic status

Health RBF programs typically evaluate patient satisfaction quarterly to verify the information declared by health centers about the services offered. Every quarter, a sampling of patients who visit the health facility are interviewed usually by Community-Based Organizations (CBO). Once data has been collected, a “community satisfaction score” is calculated for each provider, which impacts the payment/bonus allocated to that provider. In most countries, this process is paper-based.

Data Collect in Benin: near real-time service availability and readiness data

In early 2016, Benin’s Ministry of Health scaled up its Results-Based Financing (RBF) system. This move has ensured that all health care providers (all public, most faith-based, some private) are surveyed quarterly to externally assess service availability and quality of care. To aid Benin’s government, Bluesquare has been providing strategic support to their RBF data system.