Introduction

Since time immemorial, Community Health Workers (CHWs) have had to bear the burden of carrying heavy registers from door to door, registering households, assessing, and treating children with common childhood illnesses, as well as making referrals for cases they cannot manage. One of the hardest things we have faced as lay health workers has always been the use of bulky books to do our work. Just like me, thousands of CHWs in Uganda face similar or worse challenges, and this needed to change as soon as yesterday! A digital solution had to be found to make our work less burdensome, hence “the electronic Community Health Information System (eCHIS)”.

Objectives

• To explore the role of eCHIS in ensuring accurate and timely collection of data.
• To share experiences in regards to how eCHIS has simplified CHW activities.

Methodology

Nama Wellness partnered with UNICEF, MoH-Uganda, and Mukono district local government to digitize over 1,200 CHWs in Mukono. The CHWs were given smartphones and trained on how to use the eCHIS platform as a ‘CHW toolkit’. eCHIS facilitates entry, storage, sharing, and retrieval of community health data. This system was designed to enhance the coordination of care, streamline administrative processes, and ultimately improve the quality of community healthcare services.

Results

I am excited to share that as CHWs, we will no longer have to worry about carrying heavy registers under the scorching Namawojjolo sun to reach and treat a sick child! The rollout of eCHIS in Mukono presents a significant step towards improving the working conditions of CHWs, which will sooner than later translate into better healthcare services and achievement of Universal Health Care Coverage!

Conclusion

Although eCHIS solves one of the major hurdles in community health services, CHWs still face significant challenges as they unwaveringly serve their people. For example, only between 14-15% are paid for their work (Eason & Marcus, 2023). They are hardly supplied, nor supervised, and seldom receive training. For us to make ‘Health Care for All’ a reality, concerted efforts are needed from governments, International, and Local Organizations to improve the working conditions of CHWs; otherwise, our celebrations will continue to be cut short!

Introduction

RehabConnect is a digital health intervention piloted in Uganda, designed to facilitate the provision of rehabilitation services at the primary care level and improve coordination of care across various levels of the health system. Utilizing a task-shifting approach, it enables primary healthcare (PHC) providers to deliver basic rehabilitation services within the communities they serve. This approach addresses a significant gap in low- and middle-income countries (LMICs) where rehabilitation services are often limited to specialized, tertiary care centers in urban cities.

Methodology

The app is being piloted in selected health centers in Lira, Gulu, Iganga, and Mayuge in Uganda. This ongoing pilot phase aims to evaluate the app's effectiveness in these regions, which have been selected due to their unique healthcare challenges and the limited availability of rehabilitation services. By focusing on these areas, the pilot seeks to gather data and insights to inform the broader implementation of RehabConnect across Uganda and other LMICs.

RehabConnect is built on the CommCare platform, an open-source tool and recognized digital public good. CommCare offers integration with OpenMRS and DHIS2, enabling seamless data management and interoperability within existing health information systems. This integration ensures that RehabConnect can efficiently synchronize with other digital health tools, enhancing the overall digital healthcare delivery infrastructure and enabling more comprehensive data tracking and reporting.

Results

In the digital health landscape, RehabConnect addresses a critical need for integrating rehabilitation services into PHC systems. This integration is vital because many individuals who could benefit from rehabilitation services are unable to access them due to geographical and logistical barriers. By bringing rehabilitation care to the PHC level, RehabConnect ensures access to these essential services, leading to improved health outcomes for a broader population.

RehabConnect improves health outcomes by digitizing the WHO-developed Basic Rehabilitation Package Clinical Resource (BRP-CR), which includes clinical pathways for motor function and mobility, pain, and self-care.

Conclusion

By providing PHC providers with digital tools and resources to assess, deliver, and monitor rehabilitation care, RehabConnect enhances their level of functioning. The solution also facilitates referrals to rehabilitation facilities, ensuring continuity of care.

Introduction

Uganda’s phone-based electronic Community Health Information System (eCHIS) aims to enhance quality service provision and provide health information in real time. Malaria Consortium collaborates with the Ministry of Health (MOH) in eCHIS development, implementation, and research. In Buikwe district, 801 Village Health Teams (VHTs) were trained and equipped for this initiative.

Methodology

Quantitative and qualitative cross-sectional research was conducted during four time points in 2022 and 2023. User perceptions, acceptability, feasibility, health vulnerabilities and behavior, and impact on malaria, pneumonia, and diarrheal child health outcomes were assessed. Additionally, in 2023, 430 VHTs were onboarded using a Luganda application version, which was compared to 426 VHTs utilizing an English version.

Results

Acceptability and usability were high, with 97% of users agreeing that the eCHIS is time-saving and enables correct diagnosis and treatment, and 99% recommending the application be scaled nationally. The application was shown to be usable by VHTs across tested metrics and age groups. Comparing baseline and endline results in Buikwe and a control district, Kayunga, and controlling for confounders, Buikwe communities demonstrated higher increases in care-seeking behavior, with a six-fold increase in fever cases [DID: 6.525 (1.002, 42.475)] and a three-fold increase in cough and fast breathing cases [DID: 3.344 (1.237, 9.043)].

In terms of health outcomes, facility-based outpatient attendance among children under five declined from 46% to 33% (p-value: < 0.001) in Buikwe compared to a decrease from 47% to 42% in Kayunga (p-value: 0.073). Malaria admissions declined from 16% to 12% (p-value: < 0.001) in Buikwe, compared to a non-significant decline from 16% to 15% in Kayunga.

Language comparisons were mixed. Improvements in application usability and assessments for Luganda versus English were only seen in malaria, with 75% versus 59% (p-value: 0.01) in endline capacity for malaria assessment and a 76% higher increase in correct use of the malaria assessment tool [DID: 1.762 (C.I: 1.03-3.0, p-value: 0.05)]. Additionally, compatibility and comprehension issues were noted.

Conclusion

eCHIS has high acceptability and has supported increased quality and uptake of care. Improvements in related facility-based attendance were also observed compared to the paper-based approach. Digitalization can enable improved community health in Uganda. Further work to ensure the utility of translation is required.

Background

Early Antenatal Care (ANC) attendance is vital for maternal and neonatal health in Uganda but is often hindered by lack of information, limited access, and cultural and socioeconomic barriers, especially in rural areas. To address these challenges, the USAID Social and Behavior Change Activity (SBCA) piloted a robocall system in March 2024 to remind pregnant women of their ANC appointments across six districts: Kampala, Luuka, Kaberamaido, Kabale, Yumbe, and Kapchorwa. The robocalls, which automatically delivered pre-recorded appointment reminders, were assessed in June 2024 to determine their effectiveness in increasing ANC clinic appointments.

Methodology

A cross-sectional study design was employed with a minimum sample size of 100 to achieve meaningful results. Respondents were selected randomly and interviewed using phone calls. Eligible respondents were pregnant women who had received a robocall at least once before their ANC appointment date. Data collection was conducted from May 20 to June 12, 2024, and data entry was done electronically using Survey CTO. Descriptive statistics were conducted to generate proportions and frequencies.

Results

Among the respondents, 43% were from urban areas and 57% from rural areas. The majority (97%) found the robocall messages helpful for remembering and keeping their appointments. Following the messages, 96% attended their clinic appointments, and all respondents (100%) reported receiving ANC services.

Implication

Robocalls effectively boost ANC attendance, with nearly all recipients finding them helpful and attending their appointments, leading to full-service uptake. Robocalls should be integrated into Social and Behavior Change (SBC) programming to enhance the uptake of promoted behaviors and improve health outcomes.

Conclusion

Robocalls significantly improve ANC attendance and service uptake.

Introduction

The aim of the Ethiopian Electronic Community Health Information System (eCHIS) is to enhance equitable provision of promotive, preventive, and basic curative health services at the household level. It focuses on empowering communities through platforms like Women Development Groups (WDGs) and School Management Committees (SMCs); improving access to essential health interventions at the village level; and enhancing health literacy to strengthen disease prevention activities.

Methodology

Its major objectives are decreasing maternal and child mortality, improving maternal and child health, as well as increasing utilization of peripheral health services by linking communities with healthcare facilities through Health Extension Workers (HEWs). Additionally, eCHIS strives for gender equality in accessing health services.

In Ethiopia, mobile health (mHealth) has always been piecemeal, with sporadic digitalization often limited to specific programs like antenatal care.

Results

Initially, these early programs were short-term in nature with a narrow scope, such as CHAI ENAT Messenger in 2012, which was a text-based messaging system. The services were disconnected and lacked a central database, leading to a lack of integration and coordination.

Introduction

Community health systems are poised to play a critical role in the delivery of essential healthcare goods and services, such as vaccines, to remote and underserved populations. Community health workers (CHWs) bring extensive knowledge and reach to the communities they serve. The advent of digital health technologies, such as digital forms and mobile biometrics, has introduced unique modalities to synergize with and optimize CHWs' output by enhancing information efficiency. Biometrics technology allows for the unique identification and verification of each vaccine beneficiary, improving the authenticity and integrity of data collected by CHWs and enabling accountability for each vaccine delivered through community health systems.

This study aimed to assess the acceptance, user experience, and impact of integrating mobile biometrics technology into a digital community health tool during the community-based delivery of Covid-19 vaccines.

Methodology

A mixed-methods, controlled community intervention study was conducted in Buikwe District, Central Uganda, involving one intervention site and two non-uniform control sites. Each study arm had 10 CHWs working with and reporting to a Health Center III.

Data were collected using a semi-structured questionnaire, data abstraction form, user survey tool, observation guide, community focus group discussion guide, and key informant interview guide. Quantitative data were anonymized and entered using ODK, while comparative frequency and descriptive statistics analysis was conducted using Microsoft Excel. Qualitative data was analyzed thematically.

Results

A total of 2,500 biometric enrollments and 249 non-biometric enrollments were recorded, 69% of which were women. There were 566 biometric enrollment rejections, 92% of whom couldn't be enrolled due to age considerations. After registration and biometric enrollment, 454 beneficiaries received Covid-19 vaccines.

The intervention site saw a 161% year-to-year increase in Covid-19 vaccine delivery. Increases of 13%, 19%, 888%, and 23% were observed in 1st, 2nd, and 3rd dose coverages, and total vaccination coverage, respectively, at the intervention site, compared to 3%, 3%, 95%, and 4% for the 1st control site and 7%, 5%, 238%, and 9% for the 2nd control site. Reported satisfaction by CHWs ranged from 80-90%, while biometrics acceptance among community members was reported at 90%.

Conclusion

The study demonstrated that mobile biometrics are acceptable, easy to use, and can significantly contribute to improving vaccine delivery efforts in last-mile communities.

Introduction

Community health workers (CHWs) are vital in health promotion and disease prevention as they bridge the gap between communities and healthcare facilities. However, their effectiveness in low-and-middle-income countries like Uganda has been subpar for several decades. Studies have linked this performance level to factors like inappropriate tools, limited capacity and training, inadequate supervision, and heavy workload without compensation.

Methods

In an effort to enhance the effectiveness of CHWs and aid in building more resilient health systems, Amref Uganda collaborated with the Ministry of Health to roll out the electronic Community Health Information System (eCHIS) in Moyo district. This entailed digitizing 100% of CHWs (472) and 17 health assistants in the district with smartphones, training and onboarding of 472 CHWs on the electronic Community Health Information System. Routine support supervision, mentorship of CHWs, compensation through monthly performance-based pay incentives, and support for routine eCHIS reporting through data bundles and whitelisting were also provided.

Results

Community health workers' reporting timeliness, accuracy, and consistency have improved significantly. On average, 81% of CHWs in Moyo are submitting monthly reports via eCHIS, a notable increase from the monthly average of under 60% prior to eCHIS implementation. This is crucial for timely evidence-based decision-making, which improves health service provision. Additionally, through mentorship sessions, capacity building, and performance-based pay incentives, CHWs feel valued and appreciated, inspiring them to fully commit to providing health services to their communities.

Lessons Learnt

The eCHIS ensures that CHWs receive comprehensive support services, including adoption of digital technology, ongoing training, mentorship and supervision, and remuneration. This approach yields several benefits, such as prompt reporting, better task organization for CHWs, and increased capacity and motivation among CHWs. Ultimately, these factors contribute to improved community health outcomes, enhanced health promotion and disease prevention, and the provision of higher-quality health services.

Conclusion

To accelerate digital health transformation and achieve sustainable improvements in community health system performance, the government, civil society, and private stakeholders should fully embrace the electronic Community Health Information System.

Background

Digital payment systems involve more than just transferring funds; they encompass processes like beneficiary registration, verification, validation, and payment disbursement. In 2022, Uganda adopted the E-Cash platform for large-scale, urgent transactions such as immunization campaigns. This system relies on a multi-step process: an initiator requests payment, a verifier ensures accuracy, and an approver confirms compliance with policies. However, these manual and time-consuming processes often result in payment delays. Despite government mandates for digital payments in campaigns, there's a need for innovative approaches to streamline the verification process. Insights can be drawn from other Sub-Saharan countries, like Benin Republic, where digital payment processes are fully automated. Additionally, the system must be optimized to prevent organizations from working in silos when processing healthcare worker payments.

Aim

To identify the challenges in developing health worker databases in Uganda and propose solutions for creating a unified database to enhance digital payment verification.

Methods

A mixed-methods approach was employed, including a literature review on digital payment verification processes in Uganda and other Sub-Saharan countries. Semi-structured interviews were conducted with stakeholders such as government officials, healthcare workers, and organizations involved in immunization campaigns to identify challenges in database development. A survey was also distributed to healthcare workers to assess their experiences with the current system, focusing on verification efficiency.

Results

The study revealed significant challenges, including inconsistent health worker data across districts, delays in payment associated with the protracted verification processes, and poor communication among stakeholders. A lack of standardization in database management further complicates maintaining accurate records. Countries like Benin Republic, with fully automated processes, report greater efficiency and timely payments. The study suggests that automation and a centralized health worker database could resolve these issues.

Conclusions

Manual and fragmented verification processes hinder timely payments for healthcare workers. A unified database and automated verification processes could enhance efficiency, reduce delays, and ensure prompt, accurate compensation. These improvements would motivate healthcare workers and contribute to the success of immunization campaigns.

Background

The Ugandan Health Information and Digital Health Strategic Plan (2020/21-2025) serves as a blueprint for the country’s strategic direction, goals, and objectives in leveraging digital health to improve health outcomes. The COVID-19 pandemic highlighted existing disparities in health access and outcomes across Uganda, particularly among rural, low-income, and marginalized communities. Research shows that there is a growing focus on ensuring that digital health initiatives do not worsen these inequalities but instead reduce them. As such, this paper analyzes the extent to which digital health equity is included in Uganda's digital health strategic plans and objectives, while suggesting successful examples to follow.

Method

The Ugandan Health Information and Digital Health Strategic Plan (2020/21-2024/25) was reviewed to assess the inclusion of digital health equity. The analysis was guided by key principles derived from the (WHO) guidelines on digital health, the Global Strategy on Digital Health (2020-2025), and equity-focused frameworks such as the Health Equity Assessment Toolkit (HEAT). These principles served as the primary focus areas for evaluating the strategic plan.

Results

The Strategic Plan failed to integrate the principle of digital health equity into its framework. Although the plan included provisions for improving health outcomes through digital tools, it largely overlooked the specific needs of rural, low-income, and marginalized communities. The plan lacks targeted strategies to address the digital divide, with little to no emphasis on ensuring that digital health initiatives reach and benefit these vulnerable groups. Additionally, there were no references to equity-focused frameworks, which are critical for systematically assessing and promoting health equity within the digital health landscape.

Conclusion

The Strategic Plan failed to address digital health equity, particularly for rural, low-income, and marginalized communities, and is indicative of the need for a review. Given that it is due for review in 2025, future revisions should integrate successful practices from other countries, like Rwanda’s use of community health workers to extend digital health services and Ghana’s equity-driven strategies. It should prioritize targeted strategies to bridge the digital divide and involve vulnerable communities. These will enable Uganda to make progress towards more equitable health outcomes through digital health innovations.

Introduction

Digital health has grown exponentially in Uganda. Increased internet penetration and access to affordable gadgets such as mobile phones have facilitated the rapid adoption of these systems in both public and private health sectors. Examples of the use of digital health include prescription, diagnosis, delivery of medicines to hard-to-reach areas, and electronic health records. One unique feature of digital health platforms is the use of both personal and sensitive data. However, the value and sensitivity of health data make it susceptible to various data protection and privacy challenges, such as misuse and security breaches, and illegal international transfers of data, which negatively affect data subjects, organizations, and health systems.

Methodology

It is important to establish systemic and structural health data protection mechanisms throughout the data lifecycle within digital health systems. Privacy by Design and Privacy by Default are examples of such mechanisms under the Data Protection and Privacy Act, 2019, requiring organizations to adopt technical and organizational measures to ensure that data protection is embedded within all systems that collect, process, and store data.

Privacy by Design means embedding privacy into systems and technologies to protect the privacy of users, while Privacy by Default means that only necessary personal data for a specific purpose should be processed. This research investigates and examines the extent to which these two concepts are embedded in Uganda’s digital health systems. We examine the legal frameworks for these two concepts and the extent to which they are embraced by digital health systems and platforms.

Results

This paper makes a case for the systemic and structural entrenchment of the two principles of Privacy by Design and Privacy by Default in Uganda’s digital health systems to ensure protection and sustainable utilization of personal health data. This enhances trust in digital health interventions, innovation, data security, privacy, quality, and accountability, which will ultimately improve policy and health care responses in the country’s health sector.

Introduction

Digital health technologies aimed at strengthening health systems and improving population health have received significant attention. However, less focus has been directed toward healthcare workers’ informal use of their own mobile phones to perform their duties and address challenges within health systems. This research aimed to explore the views, experiences, and practices of healthcare workers and managers regarding their informal uses of mobile devices to support their work.

Methods

Firstly, we conducted a systematic review of qualitative studies exploring healthcare workers’ and managers’ views, experiences, and practices regarding informal uses of mobile devices for work purposes. Secondly, we undertook a qualitative study in the Ugandan health service, including interviews with patients, caretakers, and healthcare workers from two districts in central Uganda, as well as other stakeholders, including policymakers.

Results

We included 30 studies in the review, published between 2013 and 2022, covering a range of healthcare settings and worker cadres. These studies revealed that healthcare workers in Uganda and globally experience a gap between expectations and available resources. To bridge this gap, workers sometimes resort to using their personal mobile phones, data, airtime, and personal time to address patient needs and communicate with colleagues. The qualitative study in Uganda indicates that healthcare workers use their phones to refer patients, handle emergencies, communicate, and consult on complicated cases. However, the informal use of mobile devices can compromise patient privacy, promote inequality in healthcare access, compromise data confidentiality, and may pose legal and ethical implications. Additionally, workers bear the financial and time costs associated with these informal practices. Policymakers acknowledged that, amid non-functional formal systems, healthcare workers rely on their mobile phones to fulfill their roles. While informal use, alongside formal systems, enables healthcare workers to function, improved guidance from the Ministry of Health may be necessary.

Conclusion

Amidst challenges in service delivery, healthcare workers find informal solutions to continue providing services, increasing efficiency and responsiveness. However, these informal solutions have downsides, and it is essential to consider how to minimize these negative impacts while retaining the benefits for patients and health systems.

Background

The widespread adoption of mobile phones, coupled with the rapid expansion of mobile money agents and supportive regulatory frameworks, has significantly advanced the implementation of digital payment systems across Sub-Saharan Africa. Recent studies from the Digital Health Payment project reveal that when the remuneration of health campaign workers via mobile money is carefully planned and effectively executed, it can lead to increased satisfaction, motivation, and performance among health workers, ultimately enhancing the outcomes of immunization campaigns. The adoption of digital payments for health workers not only streamlines the payment process but also provides financial security, improves accountability, and reduces administrative costs. Despite these benefits, there is a noticeable gap in the existing literature regarding the policy implications of digital payments for healthcare workers. Additionally, while several digital payment systems are in place, their integration into health policies remains underexplored.

Aim

This study aims to evaluate the digital health policies of Uganda and four other Sub-Saharan African countries—Nigeria, Kenya, Malawi, and Senegal—focusing on how these policies incorporate and support the use of digital payments for healthcare workers. By understanding the policy landscape, this research seeks to identify best practices and challenges in the integration of digital payments into health systems.

Method

A case study design was employed, involving a comprehensive desktop review and stakeholder interviews to analyze the digital health policies of Uganda, Nigeria, Kenya, Malawi, and Senegal. This approach allowed for a detailed examination of how these countries are integrating digital payment systems into their health sectors, with a focus on policies that impact healthcare workers.

Findings

Preliminary findings indicate that while digital health information systems and community digital information strategies are being implemented, there is a lack of explicit policy directives on the integration of digital payments for health workers. This gap suggests the need for more targeted policy interventions to fully leverage the benefits of digital payments in the health sector.

Conclusion

The study underscores the importance of embedding digital payment strategies within national health policies to ensure the effective remuneration of healthcare workers. As digital payments continue to rise in prominence, a robust policy framework will be crucial for enhancing health outcomes and achieving broader health sector goals in Sub-Saharan Africa.

Background

Traceability of health commodities is critical for ensuring the availability of safe and effective essential medicines and supplies in health systems. In Uganda, the national health supply chain system faces traceability challenges, resulting in several inefficiencies including stockouts and compromised patient care.

Objective

The purpose of this initiative is to describe the development of Uganda’s National Health Products Traceability Strategy 2024/25 - 2029/30 for the adoption of global traceability standards to enhance traceability and end-to-end visibility of health commodities in Uganda.

Results

A National Steering Committee was established in 2023 to lead the adoption of GS1 standards for Uganda’s health supply chain (HSC) system. An assessment of the country’s readiness for implementing a national track and trace system was conducted. Using a person-centered approach, the National Traceability Strategy was developed with a vision of delivering a supply chain that sustains availability, accountability, visibility, and traceability of quality health products in Uganda. This strategy encompasses six strategic objectives: regulation, governance, human resource capacity, technology infrastructure, and data access. The implementation of this strategy, which will deliver end-to-end traceability in Uganda’s health supply chain system, is estimated to cost $22.6 million over a five-year period. The strategy, along with the costed implementation roadmap, serves as a critical resource mobilization tool, ensuring the adoption of a GS1-based track and trace system across all levels of the HSC system.

Conclusion

A health commodity traceability system in Uganda's health supply chain will enable the tracking and verification of all medical products from manufacture to their use at health facilities. The National Health Products Traceability Strategy will be implemented in a phased manner across all levels of the health supply chain to ensure effective implementation and monitoring. As an overall outcome, the strategy, when implemented, will ensure transparency, reduce instances of stockouts and counterfeit products, and ultimately improve patient outcomes and trust in the health system.

Introduction

In the evolving landscape of digital healthcare, the integration of diverse technological solutions is crucial for achieving comprehensive, efficient, and patient-centric care. NANO Health Suite stands at the forefront of this transformation, offering an all-encompassing suite of digital health solutions that align seamlessly with the thematic tracks of the 2024 Uganda National Digital Health Conference. This abstract outlines how NANO's robust infrastructure and ecosystem can address each facet of the digital healthcare landscape.

Digital Healthcare Provision

NANO’s telemedicine platform enables remote consultations, real-time monitoring, and patient health management. Our remote monitoring tools and e-Triage systems ensure timely and effective care delivery.

Patient Selfcare

NANO empowers patients with tools for self-care, including digital diagnostics and patient support networks. Our disease-prevention and chronic-disease management tools facilitate proactive health management.

Paperless Processes

Our suite includes e-Appointment scheduling, e-Referrals, and comprehensive Electronic Health Records (EHR) management. The integration of Health Information Exchange (HIE) and electronic prescriptions (eRX) streamlines workflows and enhances efficiency.

Digital Compliance

NANO supports healthcare compliance through online exams, digital certifications, and e-Licensing processes. Our insurance compliance modules ensure that healthcare providers meet regulatory standards.

Digital Insurance

We offer a centralized hub for claims and policy management, coupled with a sophisticated claims management system. Our Pharmacy Benefit Management and Third-Party Administrator (TPA) systems optimize benefits administration. Fraud detection mechanisms and revenue cycle management ensure financial integrity.

Decision Intelligence Systems

NANO’s advanced analytics and dashboards provide actionable insights for clinical decision support. Our genetic testing and analysis tools, combined with patient flow management systems, facilitate precision medicine and optimized patient care pathways.

Digital Enablers

NANO’s digital onboarding, CRM platform, and digital communication tools enhance patient engagement. Our digital payments and ERP platform support financial transactions and resource planning. The integration platform and document management system ensure seamless data flow and information governance.

Through this presentation, we will demonstrate how NANO Health Suite's integrated solutions address the multifaceted needs of modern healthcare systems, driving digital transformation, improving patient outcomes, and enhancing operational efficiency. Join us to explore the future of healthcare with NANO, where technology meets compassion.

Keywords

Digital Healthcare, Telemedicine, Patient Selfcare, Paperless Processes, Digital Compliance, Digital Insurance, Decision Intelligence, Digital Enablers, NANO Health

Background

In Uganda, the healthcare landscape is characterized by diverse healthcare data implemented in various standalone Digital Medical Information management and surveillance systems. This has resulted in fragmented data, creating challenges in unified data analysis and decision-making processes. To address these gaps, interventions in line with the Health Information and Digital Health Strategic Plan 2020/21 – 2024/25 were undertaken by the Ministry of Health (MOH) and Partners, leading to the establishment of the National Health Data Warehouse (NHDW).

Methods

A comprehensive business analysis to assess the existing reporting processes and identify gaps in data integration, analysis, and reporting was conducted. This involved stakeholder engagements to ensure the NHDW addresses their needs. A comprehensive architectural design and a data integration plan were developed to consolidate information from source systems like HMIS, Uganda EMR, CHT, Open SRP, Joint Medical Stores (JMS) supplies, and the EIDSR system. Jaspersoft, Pentaho, Postgres, and Kafka were selected to integrate multiple data sources, provide user-friendly interfaces, and perform robust data manipulation and transformations. Hardware and software installations, as well as capacity building in areas of analytics, data storage, equipment operation, server OS, and VM setup, were conducted.

Results

The integration of diverse data sources into the NHDW has significantly improved data accessibility and the ability to generate comprehensive analytical reports for Uganda’s healthcare sector. Daily data pulls have enabled timely generation of information products, including over 10 dynamic reports and dashboards, such as the Surveillance Dashboard, SARI-LRI, and Community Health and Non-Communicable Diseases monthly reports, among others. By centralizing data management and standardizing processes, the NHDW ensures data integrity, security, and compliance with regulatory requirements. Comprehensive training provided to health informatics professionals has enabled them to harness the full potential of data analytics tools, resulting in timely and insightful analysis. Since the NHDW’s inception, over 95% of data from the systems is consolidated into a unified platform, reducing data fragmentation by 80%.

Discussion/Conclusion

It is envisaged that the establishment of the NHDW will be instrumental in shaping policy decisions and resource allocation, addressing the issue of data fragmentation, and significantly advancing data governance practices within Uganda's healthcare sector.

Background

Uganda has made significant progress in reducing maternal mortality, with a decline from 438 deaths per 100,000 live births in 2015 to 336 deaths per 100,000 live births in 2020 (World Health Organization, 2020). However, disparities persist in rural areas where access to quality healthcare is limited, and maternal mortality rates remain higher compared to urban areas (Uganda Bureau of Statistics, 2020). Digital health solutions have shown promise in improving healthcare outcomes globally, particularly in low- and middle-income countries (Peiris et al., 2020).

Objectives

The primary objective of this study is to assess the effectiveness of a digital health platform in improving maternal healthcare outcomes in rural Uganda. Specifically, the study aims to:

• Evaluate the impact of the digital health platform on antenatal care attendance.
• Assess the effect of the digital health platform on skilled birth attendance.
• Examine the influence of the digital health platform on postnatal care utilization.

Introduction

This study evaluates the implementation of a digital health platform that provides pregnant women with access to:

• Health information and education.
• Appointment reminders and scheduling.
• Emergency services and referrals.

The platform aims to improve maternal healthcare outcomes by enhancing patient-provider communication, increasing access to healthcare services, and promoting healthcare-seeking behaviors.

Methods

A mixed-methods approach was employed, combining:

• Quantitative data from the digital platform (usage metrics, appointment scheduling, and service utilization).
• Qualitative interviews with healthcare providers and beneficiaries (pregnant women and new mothers).

Results

Preliminary findings indicate:

• A significant increase in antenatal care attendance (p< 0.01) among beneficiaries.
• A significant increase in skilled birth attendance (p< 0.05) among beneficiaries.
• Qualitative findings highlight improved patient-provider communication, enhanced healthcare-seeking behaviors, and increased empowerment among beneficiaries.

Conclusion

Digital health solutions have the potential to bridge the gap in maternal healthcare access in rural Uganda. The findings suggest that the digital health platform can improve maternal healthcare outcomes, particularly in antenatal care attendance and skilled birth attendance.

Background & Purpose

The introduction and expansion of eLMIS systems at higher-level facilities such as Regional and National Referral Hospitals have improved stock and inventory management, particularly in data quality. However, lower-level health facilities continue to struggle with stock management due to poor data visibility and inadequate IT infrastructure.

To address this, the United Nations Capital Development Fund (UNCDF) partnered with Medical Access Uganda Limited, Signalytic, and the Ministry of Health to pilot and scale up a digital solution aimed at improving the stock management of essential medicines and health supplies in Uganda.

Content

The project developed the S+ platform, a digital solution integrating renewable solar power, strong signal connectivity, robust hardware, and custom off-grid distributed ledger technology. This platform connects remote health facilities to a decentralized network, operating without electricity and with intermittent internet connectivity. The S+ Platform aims to enhance equity and quality of health services, strengthen district monitoring and supervision processes, and support health facility quantification, ordering, reporting, stock management, and redistribution.

Key Messages

The S+ solution enabled consistent connectivity and power at 25 lower-level facilities in remote and hard-to-reach areas, ensuring timely redistribution of health commodities and preventing occurrences of stock-outs and expiries. Additionally, timely alerts were issued to districts and health facilities on indicators like stock status, stock variances, and device health. Furthermore, the project installed solar-powered boxes to communicate device health and any irregularities in real-time for easy troubleshooting.

Results

The S+ Solution offered a cost-effective, simpler, and faster approach to achieving supply chain visibility. By leveraging solar power as a sustainable energy source, distributed ledger technology for secure data synchronization, and system interoperability with sub-national and national systems, it supported the supply chain of critical pharmaceutical commodities. Among the 25 registered facilities, the maintenance of stock levels for essential commodities improved significantly, rising from 20% at the project's inception in 2020 to 60% by its conclusion in 2022. This improvement contributed to uninterrupted healthcare delivery and prevented potential shortages of vital medical resources.

Significance to the Track Area

Integrating the S+ platform into the national health system platforms such as DHIS2 would improve the availability of essential medicines in lower-tier health facilities.

Conclusion

Utilizing digital tools like the S+ platform in lower-tier health facilities in Uganda can significantly enhance the availability of essential medical supplies, ultimately improving patient care.

Background & Purpose

Before 2014, Medical Access Uganda Limited (MAUL) used a mix of paper documentation and MS Office files for information processing. Each project's and stakeholder’s data was managed independently, leading to a fragmented system without standardization. This lack of standardization hindered efficient data management. To address this, MAUL developed the Medical Access Supply Chain Management Information System (MASCIS), an online system designed to streamline programmatic information management.

Content

MASCIS includes modules for logistics management, client ordering, quality assurance, pharmacovigilance, and regulatory compliance. These modules streamline operations through a multi-user web-based ordering application, enabling clients to update and monitor order status. The system generates customized reports and facilitates pre-order physical counts for accuracy. Additionally, MAUL integrated the Supervision Performance Assessment and Recognition Strategy (SPARS) tool into MASCIS as SPARS+, transforming the paper-based supervision tools into an electronic data collection platform. SPARS+ offers real-time data capture, geolocation stamps, and seamless data consolidation, enhancing transparency and accountability.

Methods

MASCIS features an intuitive web interface for online commodity orders, with automated order tracking and intelligent alerts at each key stage. It also employs a three-phase Data Quality Assessment (DQA) approach to validate system data. The system's Android application improves logistics management by monitoring ART patient care, stock management, commodity traceability, store management, and expiry tracking.

Data & Results

Between 2015 and 2022, under the Procurement and Supply Chain Strengthening Project (PSSP) and Health Commodity Supply Chain Improvement Project (HSIP), order processing times reduced from 12 to 2 working days, and order allocation accuracy improved from 60% to 100%. The use of SPARS+ improved health facility performance, with the average health facility SPARS scores rising from 60% to 90% on average, and 98% of facilities achieved a SPARS+ score of 20 or above (out of 25) within the same period.

Significance to the Track Area

The transition from paper-based tools to MASCIS significantly enhanced the transparency and accountability of logistics information management within MAUL. By integrating digital solutions, MASCIS not only improved operational efficiency but also strengthened the infrastructure necessary for effective data management, thereby supporting a more resilient and responsive health supply chain.

Conclusions

The lessons learned and best practices from the implementation of MASCIS provide valuable insights for other stakeholders aiming to improve their digital health infrastructure. This initiative demonstrates how robust digital systems can optimize logistics information management, order processing, and overall supply chain processes, serving as a model for similar projects in the health sector.

Background & Purpose

Access to real-time stock data is vital for enhancing health system support, especially within the health supply chain. It provides timely information for planning, monitoring, evaluation, forecasting, and targeted technical support. During the implementation of the Health Commodity Supply Chain Improvement Project (HSIP), Medical Access Uganda Limited (MAUL) faced challenges in accessing real-time facility-level stock data, leading to reactive measures like emergency deliveries to address stock-outs and expiries. To mitigate these challenges, MAUL developed the Integrated Facility Data Management System (iFDMS), an open-source web-based platform that provides continuous stock status updates across the health supply chain. This system ensured end-to-end visibility by integrating with health facility-based electronic Logistics Management Information Systems (eLMIS), offering secure access to data for national and subnational stakeholders and strengthening reporting at all levels.

Methods

RxSolution, a desktop application used in health facilities, lacked an inherent Application Programming Interface (API). To enable real-time data sharing, a lightweight software component called the Facility Data Integrator (FDI) was developed and installed alongside the eLMIS. The FDI monitored stock status changes and transmitted data to the central warehouse in real time. Developed using open-source tools and frameworks, the FDI ensured interoperability with other eLMIS systems while adhering to open standards for integration.

Data & Results

Between 2018 and 2019, eLMIS adoption improved by over 90%. Stock status visibility and traceability were greatly improved, with a 14.94% reduction in reported expired drugs and a 16% reduction in stock-outs. Real-time early warning mechanisms, including SMS and email alerts, along with stock top-up and lend-out reports, facilitated inter-facility commodity transfers based on stock levels and expiration analysis. The completeness and accuracy of RxSolution data increased from 84% in 2018 to 93% in 2019 across all linked health facilities.

Significance

Built on a modular architecture, iFDMS emphasizes interoperability and data standardization, enabling seamless data sharing across the health sector. Its features—such as alerts for enforcing good pharmaceutical practices, advice on stock redistribution, and integration with national systems like DHIS2—facilitated coordinated actions among stakeholders. This interoperability ensured that accurate and timely data was accessible where needed, enhancing decision-making and resource allocation.

Conclusions

The iFDMS platform markedly improved stock data visibility and management under HSIP. By fostering interoperability and real-time data sharing, it not only ensured better availability of essential medical supplies but also enhanced coordination across various health sector stakeholders. This led to improved patient care and overall health system efficiency, serving as a model for similar initiatives aiming to integrate data systems in healthcare.

Background

Determining the fluid status and causes of respiratory failure in patients with Ebola disease is challenging due to concomitant severe diarrhea, vascular leakage, and multiorgan failure. Point-of-care ultrasound (POCUS) can guide fluid resuscitation for patients in resource-limited settings. This study presents the clinical application of POCUS during the 2022 Sudan Virus Disease Ebola outbreak in Uganda.

Methods

A clinical research team in Fort Portal, Uganda, was trained in advanced Infection Prevention and Control (IPC) to care for Ebola patients and in POCUS for septic shock. POCUS was used during the care of six patients with confirmed Sudan virus disease within two weeks of the outbreak declaration to make critical patient care decisions, such as fluid management. A handheld Philips Lumify scanning probe connected to a tablet was kept in the biocontainment area and used with full personal protective equipment. Scanning procedures included 12-zone lung ultrasound and 4-view cardiac ultrasound scans to determine causes of respiratory disease and evaluate fluid status. Images obtained were stored in the device and transmitted through a secure portal to a restricted database.

Results

Among six patients (age range 27 to 58 years; one female), five were in their third week of illness, and one was in his second week of illness. Lung ultrasound abnormalities not identified before included discrete B-lines (five patients), confluent B-lines (one patient), irregular pleural lines (three patients), and subpleural consolidations (one patient). Two participants in respiratory distress underwent cardiac POCUS. Both had hyperdynamic left ventricular function, and one had a small pericardial effusion. One patient had inferior vena cava (IVC) collapsibility < 50% (1.5 cm diameter), while another had>50% IVC collapsibility (1.3 cm diameter). These findings contributed to the decision to continue fluid resuscitation while lung POCUS helped identify and monitor disease progression.

Conclusion

Portable handheld ultrasound devices identified previously undescribed ultrasound features of Sudan virus disease. POCUS helped determine causes of respiratory failure and guided fluid resuscitation in a biocontainment ward without access to mechanical ventilation.

Recommendations

POCUS should be integrated into clinical management guidelines for Ebola and other similar infectious diseases for use in biocontainment areas to assess fluid status and diagnose respiratory failure.

Introduction

Since 2000, Uganda has experienced over 11 outbreaks of highly infectious diseases. Patients with high consequence pathogen infections like Ebola Virus are at high risk of developing sepsis and death, especially in austere settings. These situations necessitate close monitoring of patients' vital signs to avert any adverse outcomes in a timely manner, requiring healthcare workers (HCWs) to frequently don personal protective equipment (PPE). This process leads to fatigue among limited HCWs and increases the risk of exposure. This study aimed to evaluate the effectiveness of the Modular Wireless Patient Monitoring System (MWPMS) / Biosensor Technology in improving patient outcomes, as well as enhancing patient management experiences among HCWs in austere settings.

Methods

A comparative analysis was conducted between vital signs obtained using the MWPMS device and those measured manually. The MWPMS device can measure respiratory rate, temperature, oxygen saturation (SpO2), electrocardiogram (ECG), and motion. The device, equipped with a microcontroller with built-in Bluetooth capability, was attached to the patient’s chest and used for 72 hours. Data was stored in a database and transmitted through a secure and dedicated portal using mobile device applications. Results from the MWPMS were compared with manually obtained vital signs, measured every 2-4 hours for the first 72 hours of patient admission among 150 patients who provided informed consent.

Findings

The vital signs measured by the MWPMS device were almost the same as those obtained manually by the research team, with no outliers observed. The device was able to predict, through validated algorithms, those at risk of death during the first 72 hours. Additionally, none of the patients experienced allergic reactions or side effects from the device.

Conclusion

MWPMS technology is effective, safe, and provides rapid patient care in various environments.

Introduction

Limited data are available regarding the occurrence of Viral Rebound (VR) in Human Immunodeficiency Virus (HIV)-positive patients receiving antiretroviral therapy (ART), particularly in sub-Saharan Africa. Identifying patients who are most likely to experience VR is often delayed, posing a significant threat to HIV treatment and management. Furthermore, the contributing factors and feature interactions associated with VR in HIV-positive patients on ART remain largely unknown. Traditional Machine Learning (ML) models are often considered black boxes, making them difficult for healthcare professionals to trust and adopt for VR prediction.

Methodology

The objectives of this study were to develop ML models for the prediction of VR, examine the contributing factors and feature interactions related to VR, and to comparatively evaluate ML models using Explainable Artificial Intelligence (XAI) techniques in patients on ART. In this retrospective study, demographic and laboratory data of HIV-positive patients in Uganda were extracted from their medical records. Patients were categorized into groups with and without VR. Viral Rebound refers to an HIV treatment outcome where an HIV-positive patient taking ART (for at least 6 months) does not suppress in a current viral load test but did suppress during the previous test. The cleaned dataset was divided into three segments: 70% for training, 15% for validation, and 15% for testing the ML models.

Results

In comparison to other ML models, Light GBM demonstrated the highest performance on the test data, achieving an accuracy of 0.9926, a recall of 0.9968, a precision of 0.9676, and a faster training speed. This study provides insightful findings that can aid in optimizing healthcare resources by identifying patients who require closer monitoring and timely intervention.

Conclusion

By utilizing XAI techniques, this study enables medical professionals to accurately understand prediction results, thereby fostering trust in the model and offering guidance on how to enhance the best-performing ML model.

Introduction

Data Quality Assessment (DQA) is a crucial data quality assurance activity that measures accuracy, consistency, and completeness by comparing Health Management Information System (HMIS) register data at the health facility level to that submitted to the Ministry of Health (MoH) through the District Health Information System version 2 (DHIS2). The last DQA was conducted two years ago, and there have been assertions of incomplete and inaccurate data sent to the MoH by the district during performance review meetings.

Objectives

The objective of this study is to determine the accuracy and completeness of health data reported to the MoH by Gulu district.

Method

The Biostatistician and Health Information Assistants collected data for the year 2023-2024 (from the 1st quarter to the 3rd quarter) on Outpatient Department (OPD) visits, stock, laboratory, and Results-Based Financing (RBF) indicators from all six Health Center IIIs (HCIIIs) and one Health Center IV (HCIV). The data was then compared to that submitted to the MoH through DHIS2 using an error-to-data ratio calculated in Microsoft Excel. Data elements with a variance within +5% were deemed acceptable. An overall proportion of quality data was ensured if 95% of data elements fell within this +5% variance (indicating accuracy). A review of client records was conducted to assess completeness, and a report was compiled for the District Health Officer (DHO) for dissemination and action on recommendations.

Results

Of the seven health centers, only 70% of their data elements reported to the MoH through DHIS2 in 2023-2024 were within the +5% variance, falling short of the 95% target and indicating inaccuracies. All health centers had incomplete patient records in one or more registers. However, data accuracy improved from 57% in the 1st quarter to 70% in the 3rd quarter of 2023-2024.

Conclusion

The inaccuracy in data collection was primarily due to missing and partial patient records, missing HMIS registers, and incomplete data cleaning processes. Therefore, we recommend that regular DQA, periodic reviews, mentorship, and supportive supervision be implemented to enhance the accuracy of data submitted to the MoH.

Background

Maternal sepsis (MS) is a life-threatening condition related to pregnancy that can occur after infection during pregnancy, childbirth, following delivery, or after an abortion or miscarriage. In low-income countries, MS is responsible for 10% of preventable maternal deaths. In Uganda, MS caused 13% of maternal deaths in 2016. In 2019, the Ministry of Health set a target to reduce the proportion of sepsis-attributable maternal deaths to 8% by 2024. This study aims to assess the trends and distribution of the incidence of MS, case-fatality rate, and the proportion of maternal deaths due to sepsis in Uganda from 2018 to 2022.

Methods

We calculated the number of MS cases per 10,000 live births per year from 2018 to 2022 at the district, regional, and national levels using data from the District Health Information System version 2 (DHIS2). We also calculated the case-fatality rate and the proportion of maternal deaths attributed to MS. The Mann-Kendall test was utilized to evaluate the significance of linear trends.

Results

A total of 24,285 new MS admissions were reported from 2018 to 2022, with a case-fatality rate of 1.8%. The proportion of maternal deaths attributable to sepsis declined from 22% in 2018 to 8.6% in 2022 (p=0.005). The national MS incidence was 43 per 10,000 live births, with the Acholi Region being the most affected at 71 per 10,000 live births. High rates in the Acholi Region were driven by consistently high rates in Nwoya and Kitgum districts (both ≥112 per 10,000). MS rates declined from 48 per 10,000 live births in 2018 to 37 per 10,000 in 2022 (p=0.02). Significant regional declines were observed in 6 of the 15 regions; however, an increase occurred in Teso (p=0.049).

Conclusion

There was a significant decline in maternal deaths attributable to sepsis from 2018 to 2022, nearly achieving the target set for 2024. This reduction was primarily due to a decrease in MS incidence, rather than changes in case-fatality rates. Further studies to understand the high MS admission rates in the Acholi region may support targeted interventions to continue reducing MS in Uganda.

Keywords:

Maternal sepsis, Uganda

Background

Efficient and timely reporting is crucial in the healthcare sector for monitoring and improving public health outcomes. The Ministry of Health (MoH) Department of Health Information (DHI) has initiated the automation of some departmental reports; however, this has not been scaled effectively. Many departments continue to rely on manual procedures to generate reports, using Excel or data dumps by executing R scripts to create visuals compiled into a single report, which is then published manually. These methods are prone to errors, delays, and inefficiencies, hindering the timely dissemination of vital health information.

Methods

To address these challenges, Jaspersoft, a robust reporting solution featuring drag-and-drop report design capabilities, was implemented. This tool can produce several information products, including dashboards, PDFs, Word documents, and Excel files. The process involves extracting data from multiple MoH systems, such as the District Health Information System (DHIS2), community health tools, and Electronic Medical Records (EMRs), and archiving it into a centralized National Health Data Warehouse (NHDW). Jaspersoft is utilized to query the data, design, and automate report generation. The reports and dashboards are hosted on a Jasper server, where they are scheduled to run automatically at specified intervals. Additionally, reports are seamlessly distributed to relevant stakeholders via email, ensuring timely access to critical health insights.

Results

The implementation of Jaspersoft has significantly enhanced the efficiency and accuracy of report generation within the Ministry of Health. Once a report is designed, the time required to generate and distribute it has been reduced by 75%. Reports are now generated and distributed within 6 hours, compared to the previous process, which took up to 3 days. Automated processes have decreased human errors by 90%, resulting in more reliable and consistent data in the weekly and monthly reports, along with improved multi-system data completion comparisons. Stakeholders now receive up-to-date reports promptly, enabling quicker decision-making and more responsive public health interventions.

Conclusion

This intervention illustrates how leveraging Jaspersoft for automated report generation has streamlined the reporting process and enhanced the overall responsiveness and effectiveness of the Ministry of Health in addressing public health challenges.

Introduction

Digitizing health innovations is a global priority, with many initiatives leveraging cloud computing to address healthcare challenges. However, these innovations often fail to reach grassroots communities, particularly in developing countries. To close health system gaps in Africa, it's crucial to generate evidence that identifies challenges in the acceptance of these innovations (Stoumpos et al., 2023). Vaccines are highly effective in improving public health by reducing infectious diseases, yet routine vaccination coverage remains low in several African countries, including Nigeria, Ethiopia, Uganda, and Ghana. Service documentation gaps and challenges in tracking children's immunization schedules exacerbate the issue (Odone et al., 2021; Galadima et al., 2021). In Uganda, low-quality vaccination data prompted the Ministry of Health, with support from the Shifo Foundation, to scale up Smart Paper Technology (SPT) in 11 districts. This research explores the advantages and drawbacks of SPT implementation in Jinja District.

Objective

To explore the advantages and drawbacks of Smart Paper Technology in Jinja District.

Methods

The study employed a qualitative design based on the UTAUT and UTAUT-2 frameworks, reviewing recent journal publications on SPT and similar technologies. Data were collected through various communication channels, and traditional content analysis was conducted using NVivo software.

Findings

The findings show that SPT reduced the workload of health workers, improved tracking of Key Performance Indicators, enhanced data accuracy through automatic checks and Optical Character Recognition (OCR), and was adopted nationally for efficient Covid-19 vaccination data management. However, challenges included data losses, internet connectivity issues, interoperability problems with DHIS2, personal internet costs, server downtimes, perceived lack of ownership by the Ministry of Health, delays due to transitioning to on-premise servers, and reliance on Shifo for system revisions.

Conclusion

The findings align with the performance expectancy, facilitating conditions, price value, and hedonic motivation constructs of the UTAUT and UTAUT-2 frameworks. While the implementation of SPT in Jinja District showed several promising aspects, significant challenges hindered its long-term sustainability and scalability. For future deployment of similar technologies, it is crucial to ensure stakeholder involvement, provide timely technical support, and conduct thorough economic evaluations and rigorous assessments of viability.

Background

Uganda faces a significant disease burden exacerbated by climate change, impacting health systems through direct and indirect effects such as malnutrition and vector-borne diseases. To address these challenges, Uganda is integrating climate resilience into its development strategy, ratifying international agreements like the UNFCCC, and strengthening national policies. The National Development Plan III emphasizes integrating climate considerations into economic objectives. The Ministry of Health, Uganda, has initiated research to enhance system resilience, including prediction models for climate and disease risks, but these efforts have yet to be fully integrated into routine health information management. The DHIS2 software platform, used as Uganda’s Health Management Information System (HMIS) platform for 13 years, has been enhanced to incorporate climate data and advanced modeling capabilities. This improved platform is being piloted in Uganda to improve early warning systems for climate-sensitive diseases like malaria.

Objective

To pilot the integration of climate data into Uganda's routine HMIS, creating use cases for vector control, disease forecasting, public health planning, and health risk communication to strengthen national health system resilience to climate impacts.

Approach

Collaboration between the Department of Environmental Health, the Division of Health Information Management, Uganda National Meteorological Authority, HISP Uganda, and other stakeholders will facilitate this pilot. Key activities include installing climate data tools in DHIS2, uploading relevant data, and building user capacity for routine planning at national and subnational levels. Lessons learned will be shared to develop scalable global resources.

Results

Achievements include a collaborative needs assessment, installation of the climate application on the HMIS, and the importation of 10 years of district-level daily data into DHIS2. Prototype visualizations and dashboards have drawn significant interest. However, challenges such as capacity gaps and the lack of integrated health data like vector control remain. The lack of universal indicators for climate and health complicates analytical product development.

Conclusion

The ongoing pilot shows stakeholder interest in improving climate data analysis capabilities for early warning and preparedness. Recommendations include creating a national climate and health dataset, capacity building, and sharing lessons learned to support scaling up the initiative.

Background

A national health data repository, such as the envisioned data warehouse for the Ministry of Health, serves as a centralized platform for collecting, storing, and managing health-related data to enhance decision-making, policy development, and resource allocation for improved clinical and public health outcomes.

The data for this data warehouse would come from various disparate source systems resulting in a large amount of data (such as aggregate data, case-based individual clinical encounters, lab results, supply chain, interventions) that needs to be cleaned, merged, and processed to extract the relevant indicators for reports, visuals, and to be used for AI/ML.

Methodology

The source data is subject to changes in its structure. Requirements for the reports and visuals and interpretation of key indicators change over time; for example, the definition of retained in care and virally suppressed for HIV care.

Our Approach: Modular BI

Results

To address these challenges, we developed an ETL (Extract Transform Load) architecture called Modular BI (Modular Business Intelligence). Modular BI aims to simplify the complexities of ETL processes by dividing the process into five separate layers that can be managed and developed independently. These layers include sources, base, derived, and final. Each layer has a unique role:

• The source layer imports the sources and performs basic data quality checks (with a feedback loop).
• The base layer cleans and arranges the data into a dimensional model.
• The derived layer is used to make complex indicator calculations (for example, retention on treatment and virally suppressed).
• The final schema combines everything so that the data can be imported into a reporting tool such as PowerBI and used for AI/ML.

The derived and final schemas are agreed upon by the stakeholders (including indicator definitions) and present the One Truth we desire.

Conclusion

The abstraction presented by Modular BI facilitates parallel development, where different partners focus on a data source and/or a part of the derived database model. This is a significant step forward in reducing the time and complexity required to implement changes in source data, indicator definitions, and reports. Source data and indicators can be updated independently from each other.

Background

The Ministry of Health developed the CAST+ strategy to find missing TB patients. This strategy involves a 5-day biannual community screening for TB, leprosy, HIV, malaria, malnutrition, antenatal care for pregnant mothers, and immunization status through door-to-door community activities. However, this intervention has proven costly, with the cost to the provider to identify a single TB case being $66, and it has produced variable results. In 2020, Uganda adopted the electronic case-based surveillance system (eCBSS) for TB and leprosy surveillance, monitoring, and program reporting, providing patient-level data on a standard cohort of TB treatment and place of residence. The team describes how eCBSS data was used to develop geospatial maps to define TB hotspots for targeted CAST+ campaigns.

Methodology

Prior to the CAST+ campaign in March 2024, USAID LPHS-E scaled up eCBSS to 93% (166 out of 178) of the Diagnostic and Treatment Units (DTUs) in the Bukedi and Bugisu regions and supported entry to 103% (6,992 out of 6,860) of the patient backlog. This data was then used to map TB hotspots using Geographic Information System (GIS) technology, which were prioritized and actively screened during the CAST+ campaign in March 2024. A hotspot was defined as any village with more than two TB patients in the past year (March 2023 to February 2024).

Results

• A total of $5,783 was used during the March 2024 campaign, compared to $50,678 in the September 2023 CAST campaign.
• There was a 41% drop in the unit cost of identifying a TB patient from $66 in September 2022 to $37 in March 2024.
• During the CAST+ campaign in March 2024, 155 TB patients from the 109 mapped hotspots were diagnosed and started on treatment, compared to 764 TB patients identified in all villages in September 2022, with similar yields of 2.0% and 1.9%, respectively.

Conclusion

By focusing on identified hotspots, the intervention maximizes the impact of available resources, ensuring that interventions are both efficient and effective.

Recommendation

By leveraging eCBSS for geospatial mapping, TB programs can achieve more precise targeting of hotspots, leading to improved healthcare outcomes and cost-effective management of resources.

Abstract

The health supply chain system in Uganda faces challenges in ensuring the timely availability of essential medicines. Despite efforts to improve health supply chain (HSC) management, visibility of inventory levels and distribution processes is limited. The lack of real-time data affects decision-making and resource allocation at national and sub-national levels.

Purpose

The aim is to describe the development and implementation of health supply chain dashboards to enhance end-to-end visibility of health commodities across Uganda’s health supply chain system.

Results

Between July 2019 and June 2024, two dashboards were developed and implemented in Uganda’s health supply chain system. The dashboards were developed in collaboration between the Ministry of Health, USAID/Strengthening Supply Chain Systems Activity, and USAID/Strategic Information Technical Support (SITES)/Data Care (U) Ltd. Stock status data were extracted from the central medical warehouses (National Medical Stores, Joint Medical Stores, and PSAs) and the District Health Information System (DHIS2). Two stock status dashboards for the central warehouses and health facilities were then developed. The Warehouse Online Stock Status Report displays stock status, availability, supplier performance, and pipeline tracking. The Online Facility Stock Status Report displays stock status, availability, and expired commodities in facilities at national, regional, and district levels. The two dashboards are hosted on the online National Health Data Warehouse of the Ministry of Health and are fully automated (daily data updates). Stakeholders have now accessed these dashboards over 8,280 times for real-time stock status information from warehouses and health facilities, which enables close monitoring of performance metrics, tracking of availability and expiries, and identifying operational gaps.

Conclusion

Accurately capturing and reporting data using dashboards assists HSC stakeholders to make real-time decisions that ensure the availability of essential medicines in Uganda at the warehouses and at health facilities.

Background

Neonatal mortality is the leading contributor to under-five mortality in Low and Middle Income Countries. These deaths are preventable with timely administration of life-saving interventions. Post-training decay in knowledge and skills affects clinical management of sick and at-risk newborns. We tested whether use of the tablet-based clinical decision support tool (PRISMS) and the Augmented Infant Resuscitator (AIR) device would:

1. improve ventilation skills retention,
2. facilitate retention of clinical management abilities, and
3. decrease in-facility neonatal mortality.

Methodology

Four hospitals were assessed for training, PRISMS, and AIR deployment. All hospitals received training in Helping Babies Survive and AIR device use. The hospitals with the highest neonatal mortality and furthest from referral facilities were assigned PRISMS. Health providers were assessed before training, immediately after training, and 10 months later. We measured the time to achieve first effective ventilation (ttfev) and duration of effective ventilation (dev) in 120-second ventilation episodes in a simulated setting. Clinical management ability was assessed with a written neonatal clinical scenario. We compared in-facility neonatal mortality 6 months before and 6 months during the interventions for each hospital.

Results

Training with the AIR device resulted in significant ventilation skills acquisition. The ttfev decreased from 51.5 seconds before training to 16.6 seconds post-training (p=0.008) and was 11.3 seconds at 10 months. The dev increased from 20 seconds before training to 61.6 seconds immediately post-training (p=0.0004) and was 69.6 seconds at 10 months.

Neonatal management ability significantly improved in both intervention (PRISMS-using) and control facilities (not using PRISMS) with training (p=0.0000). Neonatal clinical management ability significantly decayed in the control arm from a mean score of 10 (sd=1.3) post-training to 7.8 (sd=1.7) at 10 months (p=0.0063). It was retained in the intervention arm from a mean score of 8.0 (sd=2.7) immediately post-training to 9.5 (sd=1.7) at 10 months (p=0.1453).

An 80% PRISMS utilization rate was associated with a 45% reduction in in-facility neonatal mortality from 8.6% pre-intervention to 4.6% during the intervention in Hospital A. A 31.5% PRISMS utilization rate in Hospital B was associated with a 23.2% reduction in in-facility neonatal mortality from 9.9% to 7.6%. In the two non-PRISMS utilizing hospitals, in-facility neonatal mortality reduced from 3.4% to 2.7%.

Conclusions

1. The use of the AIR device was associated with ventilation skills retention over a 10-month period.
2. PRISMS use was associated with retention of neonatal clinical management abilities to 6 months.
3. PRISMS utilization appears associated with a higher reduction in in-facility neonatal mortality, although this may be affected by the choice of hospitals for PRISMS use.

Background & Rationale

Effective management of HIV/AIDS relies heavily on consistent adherence to antiretroviral therapy (ART) to achieve and maintain virologic suppression. Interruptions in ART adherence (IITs) pose significant challenges, leading to poor virologic suppression and an increased risk of drug resistance. Timely identification and intervention for clients at risk of IITs are vital for improving ART adherence and virological outcomes. We describe an approach of using advanced predictive models and visualizations to provide healthcare providers with actionable insights, enhancing patient care and reducing the incidence of virologic failure.

Approach

We utilized a treatment dataset of 67,343 clients with 1,048,573 clinical visits. This dataset included ART initiation dates, regimen details, dispense records, number of interruptions, duration of treatment, age, WHO stage, advanced HIV, and viral load (VL) copies variables. A predictive model was developed to identify clients who are at risk of missing their treatment schedules based on these parameters. Interactive visualizations were also designed to illustrate adherence patterns and demonstrate the correlation between IITs and VL results.

Lessons Learned

These alerts will provide healthcare providers with timely insights and notifications, enabling them to intervene promptly, improve adherence, and reduce the risk of virologic failure. By integrating advanced analytics and visualization tools into the EMR, we can revolutionize HIV/AIDS patient care by providing actionable insights that optimize ART adherence and virologic suppression.

Next Steps

We plan to integrate the prediction model in EMR to predict IITs of a patient and evaluate their impact on virologic suppression. Real-time alerts and data visualization will be incorporated into the EMR to support proactive patient care.

Introduction

Uganda has an estimated maternal mortality ratio of 189 maternal deaths per 100,000 live births and a perinatal mortality rate of 22 per 1,000 live births. This is far from achieving the health-related Sustainable Development Goals (SDG). Civil Registration and Vital Statistics (CRVS) provide real-time data on deaths and are key to planning and monitoring the SDGs. Recording of deaths in health facilities in Uganda remains paper-based and partly digital with several redundant processes. The aim of this study is to identify waste associated with maternal and perinatal death registrations in health facilities in Uganda using value stream mapping.

Methods

Value stream mapping will be undertaken through Focus Group Discussions and Key Informant Interviews with health workers at the maternity wards, health facility data clerks, district authorities, Ministry of Health, and National Identification and Registration Authority (NIRA) personnel. We will model the process of maternal and perinatal deaths data capture by outlining activities and corresponding data and workflows; quantify time spent on each component and identify and quantify non-valued activities.

Results

Findings will be analyzed using the lean thinking approach, which focuses on increasing value and reducing waste. We will identify and quantify resources wasted in capturing maternal and perinatal deaths and data flow into the CRVS system, and aspects that add value to the health workers. We will identify specific ways to reduce the burden of health workers entering data on maternal and perinatal deaths. We will apply the learnings from our study to optimize, streamline, and improve the capture of maternal and perinatal death in the DHIS2 SMoLs app.

Discussion

CRVS are integral parts of country health information systems, and improving health facility registrations of maternal and perinatal deaths is key to strengthening CRVS. Our study will identify mechanisms to strengthen death registrations in DHIS2 informed by end-user perspectives. Lessons learnt will be applied in subsequent phases of the project using implementation science methods.

Key words

value stream mapping, maternal deaths, perinatal deaths, interoperability, civil registration and vital statistics, DHIS2, lean thinking.

Introduction

Smart Applications International Ltd is an ICT solutions company providing innovative and secure high-tech solutions across Africa. We have a presence in 11 countries across the African continent, including the East African region (Uganda, Kenya, Rwanda, South Sudan, DRC, Tanzania) and beyond (Zambia, Somalia, Cameroon, Malawi, Mauritius).

For the past 20 years, Smart has been a champion of digitization within the healthcare industry, serving over 1.7 million members with our system installed in over 7,200 healthcare facilities. In Uganda, through our flagship product, Smart Access, we have partnered with over 20 insurance companies, HMOs, in-house schemes, and Community Health Insurance Schemes, covering a membership base of over 280,000 lives. The Smart system is installed in over 796 healthcare service providers across 97 districts.

Methodology

Smart Access is a virtual solution for medical access that provides visibility into medical cover benefits, benefits utilization, and real-time claims delivery, along with biometric member identification and verification.

As part of the Smart ecosystem, we offer the Electronic Data Interchange (EDI), which enables seamless transmission of e-claims to scheme administrators with claims amounting to over 50 billion in 2024 alone, along with the validation of e-claims to ensure completeness in terms of diagnosis capture, supported by an inbuilt query/ticketing system.

Additionally, Smart has introduced the Smarthealth+ EMR system, which features key capabilities such as biometric identification, ICD-10 preloaded diagnosis, multitenancy, price control, accounting and finance management, claims management, stock and inventory control, role-based access, local and remote access, and interoperability. The system is customizable and scalable to meet the diverse needs of different healthcare providers.

The solution also supports reporting through the Smart Data Analytics platform, which provides insights into disease trends by gender, age, and patient traffic across different healthcare facilities. The Smart ecosystem offers integration opportunities with different systems. In Uganda, we have successfully integrated with 50 healthcare facilities using various systems.

Conclusion

We embrace collaboration with various stakeholders in the healthcare industry to foster innovation, establish a compliance framework that aligns with national health data policies, and ensure sustainable healthcare practices.

Introduction

The lack of standardized laboratory data sharing in Uganda poses significant barriers to effective disease surveillance, research, and patient care. To address this challenge, we have developed a comprehensive centralized laboratory data repository, integrating multiple Laboratory Information System (LIS) installations across the country. This solution utilizes advanced Extract, Transform, and Load (ETL) processes to facilitate real-time data exchange, enhance interoperability, and support evidence-based decision-making.

Methodology

The ETL methodology employs sophisticated data extraction techniques to retrieve information from heterogeneous LIS sources. We transform this data using a combination of rule-based algorithms and machine learning models to standardize formats, ensuring consistency and compatibility. The transformed data is then validated through rigorous quality control measures, including schema validation and anomaly detection, before being loaded into the centralized repository.

The centralized data repository is architected to support a wide array of data formats and structures, allowing seamless integration from diverse LIS installations. It provides a scalable and flexible platform for data sharing, enabling real-time analytics and fostering collaboration among healthcare providers. The repository’s design ensures data security and privacy, adhering to international standards and local regulations.

Key Features of the Centralized Data Repository include:

1. Enhanced Interoperability: The repository supports HL7 FHIR and other standardized data formats, enabling smooth data exchange among various healthcare stakeholders, including public health agencies, research institutions, and clinical facilities.
2. Real-Time Surveillance and Response: By providing real-time access to laboratory data, the repository enhances disease surveillance capabilities and facilitates timely outbreak response and intervention strategies.
3. Data-Driven Insights: The centralized repository serves as a comprehensive database for epidemiological research, enabling data-driven policy-making and public health planning.
4. Scalability and Flexibility: The use of open-source ETL tools, such as Apache NiFi and Talend, ensures the scalability and flexibility of the solution, allowing for easy integration of new data sources and adaptation to changing requirements.

This paper will delve into the technical aspects of the ETL methodology, the architectural design of the repository, and the security measures implemented to safeguard sensitive health data. We will also discuss the potential impact of this solution on Uganda’s healthcare system, highlighting the benefits of standardized data sharing, improved clinical outcomes, and enhanced public health initiatives.

Keywords

Laboratory Information Systems, Data Interoperability, Centralized Data Repository, ETL Methodology, Disease Surveillance, Digital Health.

Introduction

The integration of Electronic Medical Records (EMRs) and Laboratory Information Systems (LIS) is crucial for improving healthcare delivery in Uganda. This project aimed to integrate EMRs and LIS in four regional referral hospitals: Kayunga, Lira, Yumbe, and Kawolo. We employed a standardized approach, utilizing:

• HL7 standards for data exchange
• IHE-XDS for document sharing
• SNOMED CT (Systematized Nomenclature of Medicine - Clinical Terms) for standardized test mapping and terminology

Methodology

The standardization of SNOMED codes enabled seamless mapping of laboratory tests and results, facilitating accurate and consistent data exchange between EMRs and LIS. This integration enables:

• Improved patient care through timely access to medical history and laboratory results
• Enhanced collaboration among healthcare providers
• Streamlined clinical workflows and reduced manual data entry
• Better decision-making through data analytics and insights

Results

Moreover, this integration improves data sharing between different systems, allowing for innovations such as:

• Predictive analytics for disease surveillance and outbreak detection
• Artificial intelligence-powered clinical decision support systems
• Telemedicine and remote patient monitoring
• Research and development of new treatments and therapies

Additionally, we developed a machine interface for automated data exchange, enabling:

• Real-time data transfer between EMRs and LIS
• Automated triggering of laboratory tests and results
• Enhanced data quality and reduced manual errors

Conclusion

Our presentation will share the project's approach, challenges, and lessons learned, highlighting the impact of EMR-LIS integration on healthcare delivery in Uganda's regional referral hospitals and the potential for future innovations.

Keywords

Electronic Medical Records, Laboratory Information Systems, Integration, Standardization, SNOMED CT, Data Sharing, Innovation, Machine Interface, Healthcare, Uganda, Regional Referral Hospitals.

Background

Many of the 1.8 million stillbirths and newborn deaths caused by birth asphyxia can be avoided if birth attendants have the skills and confidence to ventilate babies quickly and effectively. We developed the Augmented Infant Resuscitator (AIR) device to enhance ventilation low dose high-frequency practice and build provider competence in ventilation skills. We aim to describe the features of the AIR device and platform and its optimization for quality improvement and collaborative learning.

Intervention

The Augmented Infant Resuscitator (AIR) is a ventilation platform that consists of the AIR device, an AIR app, and an online dashboard. The AIR device is an add-on to resuscitation devices, providing real-time feedback on four ventilation quality parameters:

• Blocked or patent airway
• Rate of ventilation
• Ventilation pressure (hash or gentle ventilation)
• Face-mask-seal integrity

These parameters are displayed using on-device iconography. The AIR device connects to the AIR app via Bluetooth, which analyzes the quality of ventilation practice and reports on:

• Time taken to achieve effective ventilation
• Duration of effective ventilation
• Total duration with a good face-mask seal
• Correct ventilation rate
• Patent airway
• Normal ventilation pressure (gentle ventilation)

Health managers can remotely view and compare ventilation frequency and quality over time within and across facilities. In a multi-center randomized controlled trial, birth attendants ventilating with the AIR device attained effective ventilation faster and maintained it longer than those ventilating without the device.

Impact

The AIR device platform is actively used in Uganda, Kenya, Tanzania, and India. With the aid of the AIR device, preventable morbidity and mortality from perinatal asphyxia can resume its decline after years of stagnation. The next step is to continue establishing implementation partnerships to bring the AIR device to health workers worldwide.

Background

In the district of Mukono, Uganda, approximately 30,000 women give birth every year. Among them, about 130 die during pregnancy, childbirth, or within 42 days of delivery, and about 1,400 experience the loss of their baby after 28 weeks of pregnancy or during the first week of life. Antenatal care (ANC) can prevent mortality and improve health, but gaps remain in ANC service delivery, such as suboptimal adherence to clinical guidelines by health workers. The current paper-based ANC data management approach, especially in lower-level (HCII & HCIII) primary healthcare facilities, is time-consuming, yet about 70% of women access ANC services from these facilities.

Methodology

This mixed methods study comprised qualitative and quantitative methods. Qualitative data collection methods included focus group discussions, in-depth interviews, and key informant interviews, while surveys were used to collect quantitative data. The research team followed a co-design process with users and stakeholders to transform the ANC health information system at HCII & HCIII facilities from paper to digital. The investigators designed and implemented an ANC eRegistry in DHIS2 corresponding to WHO’s Digital Adaptation Kit for ANC, adapted to fit into the Ugandan ANC ecosystem. The ANC eRegistry system serves as digital health records with clinical decision support for health workers, sends ANC appointment reminders to women via SMS, and generates automated monthly reports based on aggregate indicators.

Results

In collaboration with stakeholders, the team studied the context, identified barriers, and designed strategies to facilitate the transition from a paper-based register to an eRegistry that is feasible, appropriate, acceptable, and sustainable in a Ugandan health system setting. The ANC eRegistry is currently deployed in 23 HCIIs and 13 HCIIIs across Mukono District, with ongoing monitoring and user support provided by the team.

Background

UgandaEMR is an advanced electronic medical record (EMR) system designed to streamline the collection, collation, aggregation, and reporting of patient outcomes within healthcare facilities (HFs). It is built on the OpenMRS platform and customized to track the needs of healthcare providers in resource-constrained settings. In 2020, the coverage and functionality of UgandaEMR in the nine districts of Bunyoro were 50% (73/145) and 41% (30/73) respectively. A root cause analysis conducted revealed infrastructural gaps, inadequate data personnel at some facilities, and capacity gaps among Health Information Assistants (HIAs). Thus, we describe the process taken to improve the coverage and functionality of UgandaEMR in the Bunyoro sub-region.

Description

CDC, through Baylor Foundation Uganda, supported the procurement of computers, tablets, networking equipment, and biometric scanners for 140 facilities. Human resources for health (HRH) were recruited and attached to 102 facilities. Working with the District Health Officers (DHOs), District Biostatisticians, and facility in-charges, clinicians, HIAs, and HRH data staff were mobilized for targeted on-site mentorship at the 114 health facilities. Hands-on refresher skills training on data entry, cleaning, and extraction of patient-level extracts and audit tools were conducted. The entry of backlog data was used to demonstrate understanding of the skills.

Following the mentorship and skills training, facility teams were assigned daily targets for the amount of backlog data to be entered into UgandaEMR. Weekly progress reports for the data extracted were used to address data calls to districts, the Ministry of Health (MOH), and donors. The cluster teams leveraged WhatsApp group platforms to track the progress of UgandaEMR functionalization.

Results

There was a significant improvement in the coverage and use of UgandaEMR, increasing from 50% in 2020 to 79% (114/145) and from 41% to 96% (110/114) respectively by June 2024. The turnaround time for managing data calls improved from 5 days to less than 24 hours, leading to real-time generation of extracts and client-centered audit tools to guide client-centered care. This has strengthened patient-level service delivery and reporting outcomes at the HIV clinics.

Conclusions and Next Steps

Targeted on-site mentorship focused on skills building with leadership engagement is fundamental for the sustainability of digital health information systems, enabling accelerated client-centered care.

Introduction

Annually, over 17 million newborns worldwide develop hypothermia, increasing neonatal mortality risks. In 2019, Sub-Saharan Africa had 27 neonatal deaths per 1000 live births. Healthcare challenges, including inadequate staffing and high workloads, delay timely care for newborns. To address this, Autothermo was developed to help health workers monitor many newborns simultaneously, ensuring timely and appropriate care.

Objectives of the Study

1. Assess the feasibility and acceptability of Autothermo among health workers and caretakers of admitted newborns at the neonatal units of Mbarara Regional Referral Hospital (MRRH) and Holy Innocents’ Children’s Hospital (HICH).
2. Assess the performance of Autothermo in comparison to the Gold Standard.

Methods

This study uses a prospective observational design involving digital thermometers and the novel Autothermo device. Participants include health workers, caregivers, and newborns admitted to neonatal units at MRRH and HICH. Approved by the MUST-Research Ethics Committee and Uganda's Ministry of Health clearance, the study involves informed consent from health workers and caregivers. For Objective 1, 8 of 12 health workers and 60 caregivers will be recruited. For Objective 2, 2 newborns will be enrolled daily for 2 months, with temperatures continuously monitored by Autothermo for 8 hours and recorded by a digital thermometer every 4 hours. The recorded temperatures will be compared between the two devices.

Results

We hypothesize that Autothermo will achieve 80% accuracy compared to digital thermometers.

Discussion

The primary outcome measure is temperature. Performance metrics include accuracy, color codes, battery life, and transmission rate.

Conclusion

Autothermo can reduce health workers' workload and improve neonatal survival. However, the sample size of 60 newborns may limit the study's statistical power, making it harder to detect small but clinically significant differences in Autothermo's effectiveness.

Background

In the WHO GLASS report of 2022, Uganda had the second highest consumption of antibacterials among the 26 countries that submitted data. Further, a point prevalence survey of antimicrobial use in 13 hospitals across the country in 2020 found that 70% of the health workers were not adhering to the prevailing Clinical Guidelines. Hence, there is a need for a capacity-building program to improve Antimicrobial Stewardship (AMS). The tele-mentoring program is an online platform for AMS aimed at enhancing AMS knowledge, expertise sharing, supporting AMS teams to coordinate AMS activities, fostering collaboration and coordination, and improving data use and surveillance in AMS.

Methods

This was a quality improvement mentoring/training project rolled out using a Zoom-based ECHO learning platform. A baseline assessment was conducted in 15 regional referral hospitals to ascertain the capacity and training needs for AMS. The data was analyzed to guide the development of the curriculum for the sessions. A steering committee was formed at the national level to coordinate all activities for the project, including running the sessions. The sessions were delivered virtually on a bi-weekly basis with the participation of healthcare workers from across the country. Sessions were advertised on various social media platforms, including WhatsApp and emails. A post-session evaluation was filled out by each of the participants.

Results

The Ministry of Health (MOH) has conducted eight sessions since October 2023, with topics spanning clinical patient care, diagnostic stewardship, infection prevention and control (IPC), pharmaceutical services, and functionalizing the Medicines and Therapeutic Committee in health facilities. The average number of participants in each session was 114. Participants included medical doctors/specialists, pharmacists, laboratory personnel, counselors, clinical officers, administrators, and nurses. The survey feedback showed that 87% of participants will use what they learned in their work, and 93% found the content extremely or very relevant to their work.

Conclusion

The tele-mentoring approach has proven to be a fast method to reach a wider population of health workers across the country to optimize the use of antimicrobials in Uganda.

Public Implication

Tele-mentoring for AMS is an innovative project that is building the capacity of health workers to optimize the use of antimicrobials. It is envisaged that this program will improve diagnostic stewardship, adherence to the standard treatment guidelines, and optimize antimicrobial use.

Background

Uganda has made significant strides towards achieving the 95-95-95 HIV targets. Despite these advancements, identifying and testing individuals with the highest risk of HIV, particularly undiagnosed HIV-positive men, remains a challenge. Men are difficult to find because they often do not engage with the healthcare system regularly. This abstract presents findings from a pilot initiative utilizing telehealth-enabled risk assessment and screening to improve HIV testing prioritization and address this gap.

Purpose

The initiative aims to leverage digital health platforms to enhance HIV prevention efforts by optimizing the identification and linkages to HIV testing services of high-risk individuals through virtual screening and risk assessment.

Content and Methods

Implemented within the Uganda USAID Social Behavioral Change Activity, the initiative operates a 24/7 Telehealth Centre that offers a toll-free hotline and SMS platform. These services disseminate health messages and efficiently refer beneficiaries to HIV testing facilities. During interactions with health workers, virtual screening (probing for lifestyle risk factors related to HIV, assigning scores with higher scores indicating greater risk) is conducted to identify high-risk individuals, who are then referred to nearby health facilities within catchment areas for comprehensive HIV testing. Follow-up calls are made periodically to ensure service uptake and linkage to care for those who test positive.

Data and Results

From January 2022 to July 2024, an analysis of 15,000 calls and 10,000 SMS texts was conducted within the telehealth center. User engagement patterns indicated a preference for calls (75%) over SMS texts (25%). Gender representation was 60% males and 40% females, with a median age of 28 years (range: 18-45). Key risk groups identified included 15% men who have sex with men, 20% commercial sex workers, and 10% adolescents. The telehealth center effectively directed individuals for testing and facilitated follow-ups for those testing positive.

Conclusion/Findings

The data demonstrates that telehealth is an effective platform for screening, risk stratification, and optimizing HIV testing and care linkage.

Background

Mental health problems, such as depression and anxiety, affect one in four people globally, yet lack of awareness and stigma prevent timely care. The mental health treatment gap is significant, especially in resource-limited settings, where up to 35% of the population may have a mental disorder, and 15% require treatment. To address this critical issue, The Medical Concierge Group, through the Islamic Development Bank (ISDB) project fund, set out to demonstrate the feasibility and acceptability of digital health tools for alleviating the growing burden of mental health problems in Uganda, where a population with low access to quality healthcare nonetheless carries a high burden of mental health disorders.

Methods

From September 2022 to September 2023, participants from Kampala, Uganda consented to test a digital tele-psychotherapy platform called Neuroflow. This platform allowed clinical professionals to monitor patients' behavioral health and deliver personalized treatment. It included tools for screening, assessment, and monitoring of mental health conditions, evidence-based interventions, and patient engagement resources. The 12-month platform usage enabled participants to remotely connect with providers or engage with platform engagement resources based on their mental health needs.

Results

A total of 520 participants (mean age 24 years, 40% female, 60% male) were recruited in Kampala, Uganda. 79% used the Neuroflow platform to access remote mental health services. Most participants self-reported anxiety (10%), depression (46%), and loneliness (51%), with 4% requiring urgent care. After 6 months, the most common issues were sleeping disturbance (30%), and 70% had not sought prior mental healthcare. Participants' most liked features were videos (57%), mental health surveys (53%), remote consultations (7%), journaling (7%), and guided audio content (7%).

Conclusions

The findings underscore the substantial unmet need for mental healthcare in Uganda, as 70% of participants had never sought care before using the Neuroflow platform. The high engagement and positive feedback on the platform's features suggest that accessible digital mental health solutions can be crucial in addressing the treatment gap and improving mental health outcomes in resource-limited settings.

Introduction

The integration of telemedicine in Uganda's healthcare system offers a transformative approach to addressing the significant disparities in healthcare access, particularly in rural and underserved communities. This paper explores the role of telemedicine in enhancing healthcare delivery, focusing on its potential to improve patient outcomes, reduce travel burdens, and address healthcare workforce shortages.

Methodology

The advent of mobile technology, coupled with increasing internet penetration, has created a conducive environment for the deployment of telemedicine services across Uganda. This paper will present an in-depth analysis of the current telemedicine initiatives in Uganda, highlighting case studies where remote healthcare services have been successfully implemented.

The discussion will cover various modalities of telemedicine, including Teleradiology, real-time video consultations, remote monitoring, and mobile health applications.

The abstract will also address the challenges faced, such as digital literacy, infrastructure limitations, and regulatory barriers, proposing innovative solutions tailored to the Ugandan context. By leveraging partnerships between the public and private sectors, along with community involvement, telemedicine can be scaled effectively to ensure that even the most remote areas of Uganda receive timely and quality healthcare services.

Results

Case in point is the implementation of Teleradiology services by the Ministry of Health to support all regional referral hospitals with radiology services (CT scan reports), with a coordination center situated at Mulago National Referral Hospital.

Keywords:

Telemedicine, Remote Healthcare, Uganda, Digital Health, Rural Health, Healthcare Access, Mobile Health

Background

The majority, 73%, of Uganda's 45.9 million population live in rural areas. Hospitals, doctors, and specialists are primarily concentrated in urban areas (UBOS 2024).

Rural Ugandans lack 24/7 access to doctors and specialists, often traveling long distances to urban hospitals for healthcare. Statistics reveal that 1 in 4 adults (over 30 years) suffer from Non-Communicable Diseases (NCDs), 1 in 5 women (aged 15-49 years) faces reproductive health issues, and 1 in 5 children (aged 0-12 years) suffer from preventable childhood illnesses (WHO 2023).

Vision

To bridge Uganda’s rural healthcare gap.

Mission

To connect rural Ugandans to urban doctors and specialists.

Goal

To scale telemedicine outlets to underserved rural areas.

Objectives

• To enhance healthcare access in rural Uganda (SDG 3, Universal Health Coverage).
• To mitigate climate action by reducing carbon emissions and carbon footprints (SDG 13).

Methods

A pilot study was conducted, including focus group interviews, feasibility studies, and a cost-benefit analysis (2023). The Treatinet telemedicine center, rural outlet, and user-friendly telemedicine app were launched in June 2024 in the Ntotoro community, Bundibugyo district, Western Uganda.

Results

Treatinet telemedicine provides remote medical consultations, regular health check-ups, and flexible payment options.

Conclusions

Treatinet's operations are efficient, consistent, and patient-centered.

Keywords

SMARTDoctor card, rural outlets, telemedicine, carbon footprint, patient-centered