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"Member Spotlight: Evelyn Castle and eHealth Nigeria".

By A/Prof. Terry HANNAN Moderator | 10 Apr, 2012

We are happy to have is Evelyn Castle join us for this Member Spotlight, next week from April 16th to 20th. Evelyn is the founder and director of eHealth Nigeria, an NGO based in Kano, Nigeria that works with government and NGO's to implement, manage, and evaluate health programmes and interventions. They specialize in integrating technology (both mHealth and eHealth) into health projects and use all open-source platforms, which they enhance and modify to meet the needs of their projects. These have included RapidSMS, OpenMRS, Open Data Kit, iHRIS, DHIS2, and TileMill. You can go to www.eHealthNigeria.org for more information.



IYABO OBASANJO Replied at 10:49 AM, 12 Apr 2012

Evelyn, Its good to know of the work you are doing in Northern Nigeria. How do you deal with the recent anti-western posture by militant groups in the area especially Kano and has this affected your work in any way? How are you able to effectively deploy some of the IT tools given the extreme lack of health workers and increasing reduction in education attainment in the population.

Evelyn Castle Replied at 3:37 AM, 13 Apr 2012

Hi Iyabo. Thanks for your interest. The issue of Boko Haram and their effect on Nigeria, especially the North, is incredibly complex and I hope in my following response I do not over-simplify too much. But, Boko haram was in Nigeria before we began working here and although their violence in the country as increased dramatically in the past year, in general, I do not believe their support has increased in the same magnitude (at least not in the communities we work in). We present ourself to the community as a local NGO and all of our staff (who are normally the ones in the field) are all Nigerians.

However, the insecurity that they have caused has influenced many NGOs to remove staff from the North as well as to discontinue or relocated projects. This has effected us in 2 ways. We have needed to take on more project management in some of our projects as we have the ability to continue working in the North. And, we have had to postpone projects or relocate some of our other projects to areas that may not have been our first choice to implement in order to continue working with these NGOs.

In response to your question about health workers; We know the major issues we face when implementing in a health facility are lack of staff, lack of education, lack of supplies, and lack of electricity. These have been problems from the beginning and therefore we work to introduce our IT tools with these limitations in mind. When we design our IT solutions, the first thing we look into are the type of people who will be using them. In general, at a general hospital, we have semi-skilled, literate workers, who have some experience with technology. This group is able to use computers and smart-phones (with training). At a primary health center, we are normally looking at lower skilled staff who may not be very literate, and have limited experience with technology. For this group, we would want to introduce more basic IT support if possible (such as basic cell phones), or design into our program an extended amount of time for training as well as follow-up trainings.

In addition to looking at which type of technology is appropriate and the capability of the staff, we have to look at the feasibility of the implementation. For example, in a rural health facility that may only see 10 pregnant women each day, it is feasible for us to ask the health workers to record point-of-care information on each woman. However, for an urban health facility that might see over 300 women in a day, this might be impossible. So, we would determine if it was necessary to record point-of-care or if the health staff could send summaries of patient data instead. If it was not necessary, then we could implement a system using summary data. If it was necessary, then we would have to modify the system to be done very quickly so it was not a burden on the health staff. In general, if we can design a system that integrates well with the skills of the health staff and the work they are doing, if the health staff understand the reason behind the implementation of the system, and if the health staff are motivated, then we will have created a successful and sustainable system.

Hopefully that covered the majority of your questions but please let me know if you want more information on anything I mentioned.

Kurfi Abubakar Muhammed Replied at 6:58 AM, 13 Apr 2012

@ Evelyn the work you are doing sounds challenging...which states of northern Nigeria do you work with , having come from that region and working in the development /public health sector too, i know the intricacies of providing services in this region.. As Iyabo asked you I believe the security situation is now one of the major challenges impeding the smooth flow of donor activities in the north. What can you say are the other major obstacles you face ? And how have you been able to devise some cost effective measures to addressing them? Has poverty played any role in impeding the utilization of your services??

IYABO OBASANJO Replied at 8:35 AM, 13 Apr 2012

Thanks Evelyn for your reply and you addressed my questions very well. I have been concerned about how to get effective health interventions into the area given the 2 constraints, paucity of health workers/education and security situation. There is very little data but what is available indicates incredibly bad health indicators and we just cant fold our hands and do nothing so its good to know there is still some NGO's in the area.

Kurfi Abubakar Muhammed Replied at 2:12 AM, 14 Apr 2012

@ Iyabo; The numerous challenges in that location should not deter you but rather serve as an encouragement; development work always comes with its own hazards and complications; but you can use the available man power in that area to provide some tailored interventions aimed towards improving the health of the people. I suggest you go into the area of maternal and child health mortality and morbidity reduction; with your good will , you can mobilize a lot of support for the betterment of humanity.

IYABO OBASANJO Replied at 6:16 AM, 14 Apr 2012

Kurfi, Thanks for the advice. I already did some work on maternal health in Northern Nigeria and actually the Midwifery Service Scheme was something I initiated in a discussion with Amina Ibrahim (MDG Advisor to the President). I organized an annual awareness program on maternal mortality in Abuja with NGOs (IPAS, PPRINN, etc) on Mothers Day until last year when I moved to Boston. I am contemplating what other interventions to emphasize and what works amid my personal commitments (Children to raise).

Sandeep Saluja Replied at 6:32 AM, 14 Apr 2012

I feel it would help to pool international resources in the field of telemedicine.There should be a central agency which provides inputs.The inputs may include education of health care workers,patients and more importantly clinical inputs specific to any case where the health care workers/doctors have problems.
The local agencies for each country or region may focus on delivery of these inputs to the right quarters in the right way.Most of the input can be drawn from the international agency and some may be tailor made for local needs.

IYABO OBASANJO Replied at 6:40 AM, 14 Apr 2012

Sandeep, Your idea is very important. Its possible that same mistakes are repeated over and over because people dont know what others have done. There is the MHealth Alliance under WHO but I dont how much information they have about everything going on everywhere.

Kurfi Abubakar Muhammed Replied at 3:34 PM, 14 Apr 2012

@ Iyabo; I suggest you organize a kind of competition among local and indigenous NGOs working in these area, requesting them to design some novel and break through ideas that could save mothers and children; choose the best one or two and support them..

deborah van dyke Replied at 4:11 PM, 14 Apr 2012

I wanted to let members know that we are developing clinical videos for frontline health workers in low resource settings. Our current series is on newborn care. We have ~ 35 topics that bring alive newborn care clinical guidelines. They are shot for the small screen of mobile devices and voiced over to enable translation in many languages. We filmed last fall in Kano in partnership with Jhpeigo-Nigeria and have 10 videos out now for field testing. You can see the rough cut videos on a private YouTube channel through the link. Once they go through final edits, they will be available for free download on our website through a Creative Commons license. We hope they will be helpful.

Attached resource:

Megan McGuire Replied at 1:56 AM, 16 Apr 2012

Hello Evelyn, recently read through the Wired article highlighting your work, congrats, very interesting! I am working on a mhealth project for decentralized HIV/ART monitoring in rural sites in East Africa. Could you detail the experience eHealth Nigeria has had with process of deciding what information is captured, how information is used and online/offline challenges for mHealth applications. From your website, if I understand correctly, all information flows back to a central server, how is decentralized HIV care monitoring information handled? Looking forward to your contributions.

A/Prof. Terry HANNAN Moderator Replied at 4:30 AM, 16 Apr 2012

Evelyn, within the IT component of all our discussions I am listing 3 questions that I hope have a more personal (socio-technical) element to them. Terry
What were your initial person to person experiences related to the introduction of health information in this resource poor community?
The 12 month development of the project appears to have been on an almost paperless foundation. Would you like to comment on aspects of why this is so?
It is now three years since you began this work so I am interested in the following points.
What has the project done for you as a person?
What are the local community expectations in Nigeria following your initial successes?
What are Ibraham’s (star of the second video) current roles in the HIT developments locally?

Evelyn Castle Replied at 5:22 AM, 16 Apr 2012

@ Kurfi. We are currently running projects in Kano, Kaduna, and Nasarawa states however we have groups that are using our tools in many other states. I agree with you that the security situation is impeding the smooth flow of donor activities and will be a challenge as it doesn't seem that the violence is going to end any time soon (there was another bomb explosion in Sabon Gari, Kano last night). However, I actually still think the major problems we face in all the projects we do is the lack of education of the people we are working with and the lack of reliable electricity. We can work around the security issues but we actually have to overcome the issues with education and power. We normally have to come up with different solutions to overcome these challenges in each of our projects however in general, we can over come the challenge of power by installing micro-solar systems (see www.wecaresolar.org to view the systems we have put in over 30 hospitals in Kano and Kaduna) and overcome the issue of education by making our tools simple and easy to use and putting a major focus on training during implementation. I think poverty plays a huge role in all of our work, both positively and negatively. When I talk about poverty though, I mean specifically poverty of the people, not of the country, government, NGOs or businesses. Poverty can play a positive role when you introduce a tool which can help the people in their everyday life and they see an immediate impact (ex: a solar system in a health facility, access to a drug, etc). However, poverty (paired with a lack of education) can play a negative role when we try to implement projects that don't have a tangible product that people can see (such as a research project). In cases like this, we are asking people to do something for us (data collection or performing a task) so that we can understand a situation which we can then design a project or intervention around. But, asking people to do additional work without them seeing immediate benefit is difficult and many times people are reluctant to do so.

What kind of work have you done in the North? Are you still working here?

Evelyn Castle Replied at 5:38 AM, 16 Apr 2012

@ Iyabo. It is a bit of an on-going joke that we have in the office regarding data collection because we find that health care workers write down everything, yet the complete lack of system design makes all that information useless. This is good for us because it means that people are willing to do data collection, we just need to give them the tools they need to actually analyze and use that data. It is also bad for us because if we want to get any sort of baseline, it is virtually impossible. So, I completely understand your frustration with the lack of information.

It is great to hear that were part of creating the Midwife Service Scheme. It is a wonderful program and has really made a huge impact in the health care centers here in Kano. When we go out into the villages with the MSS workers, the community sings their praises. We chose many of the MSS sites to install solar systems in the maternity wards because we knew that those facilities had educated and dedicated staff and the light would really appreciated in those facilities.

Evelyn Castle Replied at 5:42 AM, 16 Apr 2012

@ deborah. That is wonderful! These will be incredibly useful. Since we put so many smart-phones in facilities, we were looking for ways to add educational material that would be useful for the staff. These videos are exactly that. We are beginning a few projects in the next few months so if you would like us to help field-test any of the videos, we would be more than happy. Otherwise, we will just wait till they all come out and upload them to the smart-phones. Please let me know if you would like any help with field-testing.

Evelyn Castle Replied at 5:55 AM, 16 Apr 2012

@Megan. Thanks, we were very excited to have Wired Magazine do a piece on our work. When we do mHealth projects, we are normally integrating them into an already existing system. So the first thing we do is gather all the paper forms that are being used, organize them, determine where data is being duplicated, and then start talking about how to transform them into electronic forms. We have not yet had to develop a system from scratch and decide on the data points to collect. However, one of the things we talk about with our clients is what information is REALLY needed. We go through all their different reports and determine what form(s) those data points are located on. We also work with the clinicians and discuss what data points they use to diagnose a patient or determine what type of care to give them. From that, we have our essential data points. Then we can start going through the forms and getting rid of erroneous data that is being collected. Since the electronic systems can be a bit difficult and time-consuming in the beginning, we like to start our systems off as easy as possible. From there, we can always add more data points are they are needed.

All of our systems run offline. In Nigeria, having an online system is just not an option. The mobile networks are not reliable enough yet. Currently, our systems run on a local server or a local computer and synchronize with a main server located at our office in Kano. These synchronizations can happen every minute, every hour, every day, etc. It all depends on the access to the internet. Also, there are some locations that do not have any access to internet at all. If their system is running on a phone, then they can travel to a place with service and synchronize. If it is running on a computer, then we can synchronize via flashdrive. The data is then accessed on the main server by the group (NGO, government, etc) over the internet. They can do analysis on that data via our systems or download raw data onto their own computers to imput it into SPSS or something similar.

Please let me know if you have more specific questions.

Evelyn Castle Replied at 6:03 AM, 16 Apr 2012

Hi everyone,

I am happy to participate in the Member Spotlight this week. We got things started off last week and I hope the conversation continues. Below is some more information on two of our current projects. Unfortunately maintaining our website has not been my strong suit so this information is not up on the web yet.

Since September of 2010, eHealth Nigeria has worked with the Institute of Human Virology, Nigeria (IHVN), in the design, development, and deployment of a Clinical Information System, based-on OpenMRS, for 27 health facilities in Nasarawa State, Nigeria. The Clinical Information System went live in November of 2011 and synchronizes the health data collection across all 27 sites, providing near real-time access to on-demand data analysis, decision support, and detailed analytic capabilities for IHVN, State, and Federal Health Agencies. The “system” allows for direct synchronization with District Health Information System, Version 2 (DHIS2)1, through the World Health Organization's SDMX-HD2 (data exchange format). eHealth Nigeria has provided the Software development and customization, Design of solar systems for Primary Health-care Centers and Hospitals with limited access to reliable power, Design of synchronization protocols and software, powered by GSM network providers, Negotiation of service provision from GSM carriers, SMS providers, and broadband service providers, and equipment provision from International suppliers, and Training, Ongoing Support, data and server hosting.

In May 2011, eHealth Nigeria developed a customized SMS data collection system for the West-Central Africa Regional Office of UNICEF. The system, which is being piloted by UNICEF Cameroon, provides SMS data collection service for reports of stock control, urgent reports, and routine beneficiary data. The Nutrition Surveillance System also provides suite of web-based analysis tools to provide local health agencies and UNICEF staff with up-to-the-minute information on the state of the nutrition and food security programs. The beneficiary data and inventory information allow UNICEF to make targeted deliveries of life saving supplies in the case of stock-outs or during emergencies. In March 2012, eHealth Nigeria was awarded the contract to extend the Cameroon pilot and support the implementation in other West and Central African countries.

Thank you and I look forward to answering any questions.

A/Prof. Terry HANNAN Moderator Replied at 6:10 AM, 16 Apr 2012

What an amazing project. So many achievements and almost innumerable lessons to be learnt and to be documented. Terry hannan

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Evelyn Castle Replied at 7:47 AM, 16 Apr 2012

@ Terry. For everyone in the discussion that does not know me, let me first give a little background before answering Terry's questions.

I began working in Nigeria in 2009 at a primary health center in Kaduna. I came on an internship with a very vague idea of “using technology to enhance health care”. That later turned into working with the staff to create an electronic medial record system (based on OpenMRS) to collect immunization and maternal health data. We worked with the university attached to the clinic to purchase 2 low-power computers and battery back-ups and had the system running in about 3 months time. Since then, they have continued to use the system but mostly for immunization records. They are a small facility with limited staff and entering the maternal health data became too much for them. So, they decided to focus on using it for immunizations.
After that experience, I got hooked to working on health information systems and my partner, Adam Thompson, and I created our company which is currently in the processes of getting its non-profit status. We have been working in Nigeria full time for almost 2 years now and have expanded our work to many different types of mHealth and eHealth projects (again, see www.eHealthNigeria.org for more information).

Ok, so now to answer your questions:

My initial person to person experiences were great and the main reason why I got hooked into this line of work. When we discussed introducing a computerized system at the health facility, some of the staff were hesitant because they had little experience with computers but decided they were willing to try and learn. The process of creating the system with the staff at the facility was fantastic because I got to really understand how they were using the information they were collecting and discuss with them how it should be displayed and arranged. Once we began testing out the system, it was interesting to hear the comments and suggestions I got back from the staff. Many people wanted to add to the system after seeing how it was used and what its potential was. That initial experience of creating a system with staff members influences all of the projects I do now since I learned so much about the health care system, peoples fears over technology, and how best to introduce a new data system.

I would not say that it was on a paperless foundation. They were using logbooks, charts, registers, etc. But the information was “organized” in such a way that it was virtually useless to the staff. A woman would have all of her ANC information written down on her card only for that card to “go missing” on the day of delivery. Data was being collected, and the staff knew that they should be using that data, but they just didn't know how. We find this same problem time and time again at facilities in Nigeria. Data is always being written down, it's just never being looked at or used again.
Coming to Nigeria and working on our initial project definitely played a huge role in my development as a person. I have always been interested in health care and knew that I would end up in the health field. However, I never thought this is where I would be. It was what inspired us to create our company, has given me the opportunity to travel to other African countries, meet some really amazing people, and work on some challenging and exciting projects.

In all of our projects, we work on how it will be sustainable once we leave. In some cases, it is difficult as there is no more donor funding and the local community can not afford to keep a project going. However, for other projects where that is not an issue, it is expected that the local community continue the work. Normally this is not an issue as we are helping the community meet one of their own needs so they have the motivation to continue. Unfortunately, it normally seems like money is the deciding factor, not the communities willingness to continue.
Ibrahim is still the records in-charge. The system has not changed much since we initially began in 2009. We have done upgrades to the system and have worked on integrating more forms. We would like to introduce more computers into the facility as well as a solar system to power it. Unfortunately though, the head of the university who supported us initially has since moved out of that position and we have not been able to meet with the new head. We are always looking for donations which can help support this facility and hopefully we can get a donor that would be interested in seeing the system expand and improve. However, until then, the system is still meeting the needs of the clinic and performing well.

IYABO OBASANJO Replied at 8:07 AM, 16 Apr 2012

Evelyn, Two good information from your repy. 1. The training of healthcare workers is effective,i.e. they write everything down although there is no process to review what is written (lots of potential there) 2. MSS is having some impact, ie more of such can be done and more innovation along those lines will help. Thanks for all the good work you are doing. Hope to come and see your work on the ground sometime.

Kurfi Abubakar Muhammed Replied at 9:00 AM, 16 Apr 2012

@ Evelyn..Great work i must say...I currently work with a management sciences for health in a USAID/Funded project that aims to build the capacity of local civil society and public sector institutions working in the area of HIV and AIDS; Maternal and Child Health as well as malaria in rural areas. We are based in Gombe, FCT and Akwa Ibom. ... ..

Joaquin Blaya, PhD Moderator Replied at 9:57 AM, 16 Apr 2012

Deborah, these videos are great and ways to incentivize the use of smart
phones. Please let us know when they are finalized. Also, what is the best
way to have these translated into French and Spanish?

Gerente de Desarrollo, eHealth Systems <http://www.ehs.cl/>
Research Fellow, Escuela de Medicina de Harvard <http://hms.harvard.edu/>
Moderador, GHDOnline.org <http://www.ghdonline.org/>

Evelyn Castle Replied at 10:17 AM, 16 Apr 2012

Deborah, I second Joaquin's question about translation. When we work in PHCs, the staff are not going to be able to understand the English in the video. We would be happy to translate into Hausa.

Evelyn Castle Replied at 10:20 AM, 16 Apr 2012

@ Iyabo and Kurfi, glad to hear about your work. We are based in Kano and travel to Abuja frequently. I would love to meet up and discuss if the opportunity ever presents itself.

deborah van dyke Replied at 10:14 PM, 16 Apr 2012

Hi Joaquin and Evelyn,

Once the videos are finalized, the scripts can be translated into other languages. We have worked with Translators Without Borders for this. Thanks for offering to translate them into Hausa Evelyn. The next step would be to find "voice-experienced" narrators for the languages. We have found one for Spanish so plan to voice over in that language ourselves. As a young organization we don't have the funding to voice over in many languages. Perhaps the Ministries of Health or other NGOs could support that. Audio files are easily sent on-line.



Deborah Van Dyke, Director
Global Health Media Project

A/Prof. Terry HANNAN Moderator Replied at 11:59 PM, 16 Apr 2012

Deborah, as the Moderator for this Member Spotlight your generosity in sharing the videos and the support you have received to make them "multilungual" is wonderful. It also reflects the ingrained charitableness within this community. Thank you. Terry hannan

Evelyn Castle Replied at 4:41 AM, 17 Apr 2012

Hi Deborah, what would qualify as someone with "voice-experience"? We know some people that are in Hausa movies. Would these be ideal people? I am sure we could get them to donate their time if that is what you are looking for.

Joaquin Blaya, PhD Moderator Replied at 10:19 AM, 17 Apr 2012

I had another question, in what ways have you found that you can
collaborate with other organizations to improve both of your capacities?
Are there ways perhaps individuals or organizations on this list could
collaborate with you in a win-win situation?

Gerente de Desarrollo, eHealth Systems <http://www.ehs.cl/>
Research Fellow, Escuela de Medicina de Harvard <http://hms.harvard.edu/>
Moderador, GHDOnline.org <http://www.ghdonline.org/>

Evelyn Castle Replied at 11:05 AM, 17 Apr 2012

Hi Joaquin,
For all of the projects we do, we are doing them in collaboration with at least one other partner. We normally work with other organizations on the project development, grant writing, and then project implementation. Partnering with other organizations has great advantages for us. For one thing, we are a fairly new organization and partnering with more established organizations gives us a better chance to win grants. Also, we are not a huge organization so being given access to the staff we need to implement large scale projects allows us to expand more quickly then we could on our own. Organizations benefit from partnering with us for a few different reasons as well. We have the technical skills they need to implement eHealth and mHealth projects as well as the knowledge as to which solution will work best in each situation. We also have the infrastructure to host all of these e/mHealth projects (at our data center in Kano) which gives organizations the ability to host their data locally. For some organizations, the fact that we are located in Nigeria (especially since we are located in Kano) is very useful since we have the ability to manage the project implementation on the ground which some international organizations don't have the ability to do. So in those way, I believe we build each others capacities.

Another way that we collaborate with organizations is that all of the software and resources we create are open-source. We also try to use as much open-source tools as possible and provide feedback to the organizations whos tools we use. In this way we all get to benefit from each others work.

There are tons of ways we could collaborate with individuals and/or groups on this list. We are always looking to participate in new projects either in Nigeria or in West Africa. We also try to offer as much support and advice to people who are doing similar work.

Taking into account my answers above, does anyone else have more ideas on ways to collaborate? Or situations/projects you would like to collaborate on?

LIZZY IGBINE Replied at 12:46 PM, 17 Apr 2012

Dear Evlyn
Weare awomen farmers group and we are concerned about our 70% rural poor., We are into rural health interventions and we will be interested in what you are doing.
We congratulate you and request for your profile.



Joaquin Blaya, PhD Moderator Replied at 4:48 PM, 17 Apr 2012

Evelyn, I think that's a great question. And I think it would be great if
others who found space for collaboration would reply.

Lizzy and others, GHDonline doesn't provide the email address of its
members to others. So if you would like a direct conversation with Evelyn
after describing the collaboration, I would email her directly at the
address she gave before

Gerente de Desarrollo, eHealth Systems <http://www.ehs.cl/>
Research Fellow, Escuela de Medicina de Harvard <http://hms.harvard.edu/>
Moderador, GHDOnline.org <http://www.ghdonline.org/>

ALABI OLUSHOLA Replied at 3:28 AM, 20 Apr 2012

Looking at your work gives me great joy that outsiders are more concerned about our progress than we ourselves.the question i will like to ask are as follows
1.how do you ascertain the truthfulness of data input
2.how were you able to educate them to adapt this novel idea
3.what challenges did you face while trying to educate these health care workers on the need for these new method

Evelyn Castle Replied at 6:13 AM, 20 Apr 2012

Hi Alabi,
Thanks for your interest in our work. Let me try and answer your questions below:
1. We have not had a situation (yet) where people have tried to falsify data, mostly I think because of the types of intervention we have done. We have not had a project where people get rewarded for any sort of outcome (good or bad) so there has not been an incentive for people to lie about data. However, I know this is a HUGE problem for a lot of programs which by nature have to give incentive (either through money or number of drugs or number of staff, etc). Because we are aware of this problem and will probably face it in the future (most likely in our child nutrition project we are beginning with UNICEF, see above), we have started building in simple checks that look at the validity of data. This includes comparing collected data with DHS data for that region, looking at individual patient data to see if the data report is possible for a patient (ie: the height, weight, and age combination is plausible), and looking for constantly repeating numbers which could indicate that a person is making up the information. These types of checks can be programmed into an electronic system so that flags can come up that will alert administrators of the possibility of false data. So in this way, we can at least identify that false data is being reported and then the hard task of figuring out how to stop it follows.

2. One of the reasons I love working in Nigeria is that I always find that people are looking for ways to make their country better. Health care workers know that the health system is flawed and they tell me that they are “just trying to mange” with what they have to provide their patients with care. So when we go into a facility to introduce a new tool, most people are very perceptive to the idea. The main push back we get is when people are nervous to try a new tool, such as using a smart phone or a computer which can be very intimidating for people that have never used one, or if they think the tool is going to cause them extra work without providing them with a benefit. The first issue is solvable by increasing training for staff members until they feel comfortable using the new tool. The second issue is more difficult to solve and we try not to have an issue by considering the current work flow in a hospital and adapting our tool to be integrated within that system.

To illustrate my point on creating tools that integrate into current systems:
We recently had a project where we provided solar systems to hospitals and primary health centers in Kano and asked the staff in a few of the facilities to record information on deliveries via smart-phone. The staff was trained on how to use the smart-phone and everyone was able to submit the reports correctly. However, the staff at the general hospital and the PHCs were asked to fill out the same form, which was quite detailed for each delivery. At the PHC which sees about 60 deliveries a month, they were able to successfully fill out and submit the forms on a regular basis. At the general hospital which sees about 300 deliveries a month, they were too overwhelmed to fill out the forms on a regular basis and when they did submit forms, many times they were incomplete. So in this case, the tool and system was well developed for the PHCs and we were able to get the data that we needed. However, we should have altered the form for the general hospitals to be shorter so that they could actively participate in the data collection. We would not have been able to get as much detail on each delivery, but at least we would have been able to get constant and accurate data.

3. This is a bit of a hard question. In my personal opinion, one of the biggest challenges I face is the lack of trust health care workers have in foreigners/NGO intervention. It seems as though many groups have come into these hospitals, introduced a new drug/tool/procedure etc, trained the staff how to implement it, given them the tools they need, and then left. No follow-up training is done, no new supplies are delivered, and after a few health workers get transferred, no one is left that has the desire or knowledge to continue implementing whatever the group introduced. So why should they go through the hassle of learning this new tool only to have it gone in a few months?

So the first thing we have to do is overcome this mentality and gain the trust of the health workers by spending time at the facility, learning how their facility works, and explaining to them how the tool is going to help them and how it will be maintained in the long run. Once we gain this trust, the the education aspect becomes much easier as the health care workers become active participants.

I would love to hear other people answers to Alabi's questions, specifically question 1. Does anyone have other ways that they determine truthfulness of data?

Evelyn Castle Replied at 6:16 AM, 20 Apr 2012

Hi Lizzie,

I would be happy to talk about your work and any possible collaboration. Where are you based? Please give me an email at . If you are based in Kano, also feel free to stop by our office at 25 Race Course Rd (Electronic House / Samanja).

IYABO OBASANJO Replied at 8:04 AM, 20 Apr 2012

Evelyn, Great comments. In my experience, health workers are some of the most overlooked part of the health system. Everyoone says how they dont turn up in rural areas and are rude to patients but nobody ever asks about their wellbeing. Also, it extends to how NIgerians underrate other Nigerians in general. We so easily discount whatever any other NIgerian is doing and expect every Nigerian to be underhanded. People will react to how you treat them. Of course one needs to put in the checks and balances aganist data fraud but in the end if people believe that the data generated will ultimately be useful for them or the health system in general they will do their best.

Navindra Persaud Replied at 8:16 AM, 20 Apr 2012

Evelyn, the only thing I will add is that health workers will only make up data if there are incentives to do so. If there is a strong suspicion that the data reported may not be consistent with the services provided, another thing that can be done is to implement a routine data quality assurance mechanism which has built into it the verification that persons have actually accessed services. The verification can be done by taking a small sample of names and visiting them in their homes to verify that they have actually accessed the service(s) reported and their sociodemographic data.

ALABI OLUSHOLA Replied at 8:10 PM, 20 Apr 2012

Thanks Evelyn for your great work out there,looking forward to seeing these product first hand some day.

Marie Connelly Replied at 8:22 AM, 23 Apr 2012

On behalf of the moderators of the Health IT community, I'd like to thank Evelyn for joining us in this discussion, and all of the members who contributed their thoughts and questions. Below you'll find a summary of the key points addressed over the course of the last week, compiled by community moderator Terry Hannan:

This summary begins with an expression of thanks to Evelyn and her enthusiastic contributions and responses in the Spotlight and to all those who responded to her messages. As the Moderator for this discussion this Spotlight session emphasises how active the GHDonline site is as a medium for collaboration amongst people around the world. My summary will essentially be in point fashion to maintain brevity and clarity. I suspect also I will have not covered all issues raised but hope that these will be an adequate summary.

* From the Nigerian project it can be seen when the need for effective clinical information is so great not even war can stop its implementation. [See AMPATH experience in Kenya].
* Crucial to the first point is the involvement and ownership of the Health IT projects by the local communities. Without these people nothing will work.
* In the case of the Evelyn’s and her team’s project their bravery needs to be recognised.
* Another point is setting attainable goals. This is summarised in the statement “if we can design a system that integrates well with the skills of the health staff and the work they are doing, if the health staff understand the reason behind the implementation of the system, and if the health staff are motivated, then we will have created a successful and sustainable system”.
* I also found that Evelyn’s perspectives on poverty were enlightening. She wrote on the “poverty of the people, not of the country, government, NGOs or businesses”. I liked her imagery of the ‘tangible’ nature of projects within the poverty concepts. First the solar power system and its effects compared with a relatively non tangible research project.
* Within this discussion there is the open generosity of project managers and researchers. This was shown in the sharing of the maternal m-Health videos that will be available after editing to a broad range of communities.
* On data collection we still see the need for linking e-systems with paper forms and still have tangible health measurement outputs. As one famous quotation stated. “Your hospital will be paperless when your toilet is paperless!”
* A final point is the need to involve end users, literate, poorly literate and clinicians to make Health IT projects work.

So finally thanks to all involved in the Member Spotlight with Evelyn Castle.

Kenolisa Onwueme Replied at 11:02 AM, 23 Apr 2012

Dear Evelyn, fantastic work! (perused your website. I would be happy to exchange ideas and discuss ways of collaborating. There is a growing number of individuals with relevant talent now interested in this topic in Nigeria and I think there is plenty of untapped human resource potential available. I will contact you offline via your website in case you are interested in talking further sometime. -keno (http://obalafoundation.org)

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