In a previous job, I was involved in making a bid for a grant which would have laid the foundation for remote updates of immunisation records. The proposal, for which my colleagues and I had developed a prototype, was that a community health worker could remotely update vaccine records using a USSD and Voice-to-Text Systems. This would in turn update into a server within the local health centre systems.
If you have a child or have received a vaccine from a public health facility in Kenya, you are then familiar with the “library system” or better yet counter book system- The records are updated in multiple counter books. Despite having a desktop, sometimes, even two in the room, the nurse would retrieve the first book, record and then retrieve another book, record and depending on the facility, there was probably a third book.
Our company, at the time, thought we had cracked it. An innovative system that could also work with USSD eliminating the need of a smartphone with local health workers working hand in hand with community health volunteers to save time, money and lives.
Furthermore, countries such as Estonia, with one of the highest rankings in digital health systems, had paved the path to implementation.
In a pre-covid era, as this was circa. 2017, the challenges our company encountered while testing the prototype were numerous. What struck me and remained with me to date, was a health worker who remarked, “Bora amechanjwa. Mnatuongezea kazi (as long as they are vaccinated, it is okay. You are complicating our work).”
At the time, I didn’t understand how it is that the health worker thought it was easier to work with multiple paper records with so much room for error, not to mention the children who would not get vaccinated and simply fall through the cracks as there was no alert or reminder system in place.
I now understand. There’s an art to health innovation that goes beyond the problem one is addressing - just because you are helping doesn’t mean you would be considered useful.
We did not win the innovation challenge.
I reached out to GAVI to learn of the progress of some of the proposals that went through but a quick glance at their website, one such company uses a hybrid approach - smart paper technology, or SPT. Local health workers still complete paper forms, but far fewer than before. The forms are taken to a regional scanning station, where the company’s software reads the written notes and uploads them to a central system.
The case for digitisation of immunisation records, was not simply making data collection efficient but improving on data accuracy. Knowing the number of children vaccinated was not enough, we needed more than the bio details. Put simply, we needed actionable information to improve outcomes.
In the post-covid era, I hope Departments of Health, both public and private, have realised the urgency in digitisation of health records with remote access.