Terre des hommes Foundation

Saving millions of children through digital health

Lead Organization

Terre des hommes Foundation

Lausanne, Canton de Vaud, Switzerland

http://www.tdh.ch/en

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Project Summary

Adherence to clinical guidelines contributes to quality of care and decreased morbidity and mortality. Only a low percentage of HCWs follow the clinical protocols. The Integrated e-Diagnostic Approach is designed to mitigate this problem by assisting HCWs during consultation of children under 5 and adhering to clinical protocols. Information exploitation is often an afterthought in digital health projects and leads to inefficient data use. Understanding incentives and responsibilities of data managers and discussing what information could support decision making is key to improving data use. IeDA’s participative and iterative approach uses this route to improve data use for decision making.IeDA intervention is designed to improve quality of care, and therefore to reduce mortality. Improving data use leads to better performance management and resource allocation. Making both of these happen at the PHC level ensures marginalized population solely dependent on public health systems receives quality and complete care.

Problem Statement

Every year 5.9 million children under-five die worldwide from preventable and treatable causes. Many more fail to reach their full potential in terms of healthy growth and development. Integrated Management of Childhood illness (IMCI) was developed by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) in the 1990s and is an excellent way to improve the quality of child health services and prevent such mortality and morbidity. It is currently implemented in 50+ countries worldwide. However, IMCI suffers from a low level of adherence by health workers. As an example in Burkina Faso, only 8.2% of children benefited in 2012 from a consultation using IMCI guidelines(Before IeDA). Moreover, an analysis of children’s records showed that only 15% of IMCI consultations were being correctly delivered and only 34% of children with pneumonia who needed an antibiotic were prescribed the correct treatment. The obstacles to IMCI adoption in Burkina Faso (as in other countries) are diverse and include inadequate training methods, shortage of materials, lack of quality supervision at the primary level, inadequate data quality and lack of integration between IMCI monitoring tools and the national health information system. Proliferation of killer diseases like Dengue in the 21st century and increasing importance of Tuberculosis management has made the job of frontline HCWs complex, especially in remote locations and adds to the challenge. Digital technologies represent the greatest opportunity to transform primary healthcare in LMICs by addressing many of these challenges and saving lives.

Solution Overview

In May 2019 IeDA crossed the 5 million consultation threshold. Since 2014, IeDA has been used by over 5,400 healthcare workers in Burkina Faso. This is a major achievement for the health of children, diagnosis has improved, and treatment is more adapted to the children’s medical needs. With five million children consulted through IeDA, Tdh has made strides towards guaranteeing the right to health of children in Burkina Faso. With the proposed five-year project Tdh aims to take IeDA to four additional countries (2 in Africa, 2 in Asia) and adapt the IeDA strategy for other diseases like tuberculosis, dengue and jaundice based on the epidemiology of under-five sickness, in respective countries. The android based IeDA application is being positioned also as a real-time data collection tool, providing essential information to track epidemic outbreaks. The solution includes e-learning, coaching and supervision systems, that enables improvement of healthcare workers' training, improving efficiency of diagnosing and treating patients.LSHTM has evaluated IeDA’s impact and cost in Burkina Faso. Results show a significant improvement in diagnosis, in particular for severe cases. The study proves a high acceptance of the tool and a reduction between 6 and 15% of antibiotics over-prescription. There is a 50% improvement in adherence to IMCI protocol and when scaled up to the whole country, there would be at least USD $33 to $66 savings per center each month. Tdh aims to replicate similar results in the new countries and increase the IeDA assisted consultation to a million under-five children.

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Project Funders

  • Bill & Melinda Gates Foundation 2014 - 2018
  • Global Fund 2017 - 2020
  • UNITAID 2019 - 2022

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