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Health service delivery points
Stronger together: Partners in Uganda
A bold and long-lasting partnership
Uganda has always been a special place for Shifo, as this was where the idea of Smart Paper Technology (SPT) originated and was first piloted. In 2013, Shifo began a collaboration with the Ministry of Health of Uganda (MoH) to implement and evaluate a point-of-care electronic immunisation registry system in Mukono and Wakiso Districts. Assessments showed that point-of-care eHealth solutions were not timely in Uganda and could not replace the existing systems. This was largely due to a lack of infrastructure in most health service delivery points (HSDP), a lack of technical support structure at district and facility levels, and high operating costs which were not sustainable for the MoH.
Based on an external evaluation in Mukono District in 2018, we discovered that an SPT alternative offered a more sustainable and scalable solution. The MoH decided to shift from the existing system, to the exclusive use of SPT in all the health facilities in Uganda, for immunisation and child growth monitoring programs. This was a momentous decision for initatiing systems change and institutionalising the SPT solution in Uganda. In 2019, the MoH proposed to extend the use of SPT to support the entire reproductive, maternal, new-born and childhood health (RMNCH) service area, which consists of Family Planning, Antenatal, Delivery, Postnatal, Immunisation and Nutrition services.
We have always set our sights on SPT being utilised nationally in Uganda, and in 2021 we took another step closer to achieving it. It was clear from the start, that as we undertook the largest implementation of SPT that Shifo has seen so far, it would not be possible, or applicable, to copy and paste how we had developed and implemented the solution elsewhere, due to the sheer magnitude of the scale. We therefore had to change the way we operated, starting with the development of our systems, and even impacting on how we finance and administrate the implementation activities.
In November 2021, we began a long term partnership with CordAid to build a solution for Results Based Financing (RBF), using SPT-generated data as the foundation. A memorandum of understanding was signed between Shifo and CordAid to enable our partnership to continue long into the future in Uganda.
What we have done
The following data use interventions have been integrated into the health system:
At the community level, families with children receive an SMS one day before they are due to visit a health facility, to remind them about the visit.
Health workers receive key performance indicators that highlight the performance of health facilities, and supports them to identify actions to improve service delivery.
Decision-makers and planners at municipality and district levels, review the performance of each health facility using the integrated dashboard, and support health facilities to make changes to improve the quality of health services.
In order to strengthen the data use culture at central level, we have partnered with Karolinska University to enrol a PhD student and created a study plan that will support the PhD student to incorporate learning into their day-to-day tasks at the central level.
External Evaluation results
During external evaluations in Uganda, data quality assessments based on WHO's data quality review toolkit indicated that data completeness, timeliness, and internal consistency was 100% and that data recording error was between 0.9-3.8%.
With the SPT solution, health workers have been shown to spend less time on all stages of data management tasks with the biggest reduction in post-session data administration - 96%, 49% and 85% during the service delivery.
Cost analysis undertaken in evaluations have showed that, when considering the monetary value of administration time reduction for frontline health workers over the course of five years, the SPT solution saves around 2,072,752 USD compared to printing the existing HMIS forms. When the administration time was excluded from the analysis, the HMIS forms cost less (349,247 USD) compared with the SPT solution (383,111 USD).
Currently, 84% of processes essential for managing the SPT solution, have been transferred to the existing health system structure. In most cases where these processes have been transferred, they have been performed in a way that is both accurate and sustainable. Remaining processes are planned to be fully transferred when the solution is scaled-up at the national level.
Voices from Uganda
Here's what our partners in Uganda say about us.
MyChild External Evaluation Uganda
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