The effective and efficient delivery of child health services is a pressing issue in low-income countries. Both preventive care measures (such as vaccines) and routine check-ups need significant improvements in coverage and consistency.
One of the biggest challenges for low-income nations is the use of paper-based systems for health data collection and storage, which are needlessly time-consuming for health workers, and prone to errors in recording. In addition, despite significant global commitment, in many cases immunisation rates of children still remain below targets – in large part because the actual gaps are not closed and children are not systemically followed up and miss out on scheduled vaccines.
To tackle these issues, Shifo Foundation has developed MyChild Solution (earlier MyChild System), first as a point-of-care electronic system, and then subsequently introducing “MyChild Card” based on Smart Paper Technology, as Shifo focused on regions with low resources and irregular access to electricity and internet.
MyChild Card is provided to every child who receives preventive health services. Thanks to the Smart Paper Technology, the cards can be scanned into a database which generates reports (per child, health centre or district), as well as follow-up lists for efficient mobilisation and reliable data for better decision making across the healthcare chain.
Today, all the reports which earlier had to be manually compiled by health workers are automatically generated. Along with SMS reminders sent to families, a defaulter list –indicating those families who missed their scheduled visit– ensures that children can be followed from birth to five years old.
KEY SOCIAL IMPACT FIGURES
Number of children fully immunised in Dokolo
Reduction of time spent on administrative tasks by health workers
In 2014, through a mutual contact, IKARE was introduced to Shifo, a start-up with people who had broad experience in public health and ICT. IKARE learnt about MyChild Solution and appreciated Shifo’s approach of going to the root of the problem.
IKARE had been engaged since 2006 in the district of Dokolo (Uganda) in the control of sleeping sickness through the establishment of the 3 V Vets network. The VPO was therefore acutely aware of the general lack of health services infrastructure and reliable data, making early detection of epidemics, diagnosis, treatment and follow-up very challenging. IKARE thus agreed to sponsor Shifo in undertaking a six-month in-field evaluation to see if and how MyChild Solution could be adapted to work also in a low-resource setting like Dokolo. As a result, Shifo came up with the Smart Paper based version of MyChild Card.
After the pilot project, IKARE decided to fund the first-ever district-wide implementation of the Smart Paper based version of MyChild Solution, which Shifo undertook during July-December 2016. As of January 2017, all 16 operational health centres in Dokolo have transferred to the system.
IKARE funded the first pilot (six-month project 2015-2016) with a €52,000 grant. An additional grant of €230,000 was then agreed for the implementation of MyChild Solution in Dokolo including IKARE’s share of the operational and maintenance costs during the “hand-over” period to the local government. The implementation of the system in additional districts in Uganda is also supported by IKEA Foundation, Swedish Postcode Foundation and Plan International.
Inspired by IKARE’s 3 V Vets exit case study and various discussions held during the pilot project, Shifo adapted their product and their business model to make it more sustainable. Shifo also innovated on their scale-up strategy by working through and together with locally based NGOs and other partners. Where a country is unable to fund the implementation of the MyChild Solution on its own, but has the funding for the operating and maintenance costs, then donors support the implementation of the system (in this case, IKARE for Dokolo), while gradually reducing their share of the operating and maintenance costs over a five-year period, as the local government takes an increasing portion.
Not only does this ensure an exit for Shifo and donors like IKARE, but also sustainability and systemic change as the system is then operated and paid for by the local government. Local governments have been willing to do so since the cost for operating and maintaining MyChild Solution is equal to or less than that of their existing system, while having the advantages of massively reducing the time health workers spend on administration and reporting while improving data generation and accuracy.
As a next step IKARE is also part of the consortium funding the first-ever country-wide implementation of the system in The Gambia, with a €150,000 grant. This implementation includes an inventory management system for vaccines (to ensure that no vaccines are discarded due to lapse of best before date, while other districts have been in shortage).
Non-financial support at a glance
September 2017, in Dokolo:
# of children fully immunised
Improved reporting system
# of children registered
SMS reminders sent
# follow-up reminders sent
Reduced data gaps
# indicators available
Reducing time spent on administration and reporting
# forms filled in during EPI (Expanded Programme on Immunisation) service delivery
Both the number of children born in Dokolo each year as well as the number of under-fives are unknown, but IKARE and Shifo have catered for registering, on an annual basis, 20,000 newborns and other children under five or 100,000 children by June 2021.
“Thanks to the support and advice from IKARE, Shifo was able to innovate on the product, business model and scale-up strategy. I would particularly like to point out IKARE’s contribution regarding the importance of having a viable business model and the importance of testing the model with key actors. Because of IKARE’s methods and previous experience in building social enterprises, it has helped Shifo to not only develop a business model, but also to test it with local governments and other key actors and identify the business model that is a win-win for everyone involved.”
– Rustam Nabiev, Shifo
“We are very happy to partner with Shifo in the roll-out and scaling of MyChild Solution. Not only does it provide a solid base for registering all children at birth and ensuring they are immunised on a timely basis, but it also allows for systemic change in health services delivery and follow-up in low resource settings. Combining smart paper technology with digitalised reporting and gaps analysis, the administrative work-load of health workers is significantly reduced allowing them to spend more time on health education for families and preventive care.”
– Anne Holm Rannaleet, IKARE
Shifo is continuously working on scaling up the implementation of MyChild Solution to other countries that are struggling with the same issues. To do so rapidly, while keeping their own focus on product innovation and adaption, Shifo works with NGOs (e.g. ActionAid, Plan International, Swedish Committee for Afghanistan etc.) that have long-standing local presence and are trusted by the government and local health authorities, and builds their capacity on MyChild Solution, work processes and systemic changes.
By working with all these partners, Shifo has managed to spread knowledge about this system worldwide, and to have it implemented in many countries at the same time. The latest countries to have asked Shifo to come and visit are Rwanda, Kenya, The Lao People’s Democratic Republic and Vietnam.
It is also important to note that the Smart Paper based version of MyChild Solution can easily be upgraded to the fully electronic version without losing any data. Therefore, whenever technology and enabling ICT and electricity infrastructure catches up in low resource areas, and as people become more computer literate, the upgrade can easily be done as everything is already prepared.
Over time, Shifo can see similar process improvements and systems expanded to other health service points beyond maternal and child health, such as out-patient or HIV clinics. It would lead to much improved and reliable data on health, which could, in turn, inform governments on appropriate measures to take in the continued closing of gaps in their health services delivery and in achieving their SDG targets.