South Sudan: Health eVillages Technology in Healthcare Program

1. Ongoing support of all health workers in Respectful Health Care
2. Ongoing support of all target health workers in use of mobile tablets with Health eVillages suite
3. Improved Data Tracking in Maternal Mortality
4. Improved service delivery
5. Improved Patient Satisfaction
6. Continue Maternal Near-Miss Audit

Summary of RMF/WCF-sponsored activities carried out during the reporting period under each project objective:

1. Ongoing Data Tracking in Maternal Mortality
2. Qualitative interviews with health workers completed for month #2
3. Patient Satisfaction survey administered to month #2 sample
4. Ongoing Near-Miss Audit interviews and quantitative data collection

Results and/or accomplishments achieved during this reporting period:
 
Improved Data Tracking in Maternal Mortality
 
The RMF research study on “Near Miss” in Pregnancy at JTH has continued for the second month.
 
Activities for the past month have included:
 

1. RMF staff continue to come every morning (7 days a week) to look at log book and identify any maternal deaths and facilitate proper reporting via the OB department chief, and any morbidity cases.
2. Trained South Sudanese data collectors continue to conduct Near Miss interviews when cases are identified

 
Since the project began, we are already seeing a dramatic improvement in proper reporting of all births and morbidity and mortality specifically. Having the support of key people (Ministry of Health, head of the OB department, all of the OB/Gyns on staff, and the head midwife, has helped tremendously. 12 interviews, each taking about 60 minutes,  have been completed thus far and 500 births have been recorded accurately in total. This may seem like a small feat in a nation of over 9 million people, but accuracy in birth registry is the first step in measuring accurate health outcomes and has never been done there before.
 
The interviews continue to reveal some cultural, economic, political, gender inequality, health infrastructure, and emotional reasons for Near Miss and maternal death. These will all be categorically analyzed and reported once the interviews are complete.
 
Improved Service Delivery and Improved Patient Satisfaction
 
Patient Satisfaction (PSAT)
Samplings of 20 patients with different admissions diagnoses and from different wards were surveyed by the Master Trainers before discharge during month #3. The following diagnoses were from the PSAT sample:

1. Malaria and anemia in pregnancy
2. Pediatric/neonatal malaria
3. Pediatric malnutrition
4. Pulmonary TB
5. Missed abortion (miscarriage)
6. Ectopic pregnancy
7. Pregnancy induced hypertension
8. Stillbirth
9. Obstructed labor
10. Cesarean for breech presentation
11. Cesarean for macrosomia (suspected large baby)
12. Routine Antenatal Care in the outpatient clinic

 
The main identified themes for patient recommendations to improve the care at JTH were:
 

1. No access to free or subsidized medications and lab tests
2. Lack of cleanliness in units (particularly bathrooms)
3. Not enough staff for the volume of patients, long waiting times, no proper shaded waiting area
4. Poor communication between health workers and between health workers and patients
5. No blood in the blood bank and no mechanism to find donors

 
Of the 20 patients surveyed, only 2 of them said a health worker used a tablet for patient education or medical reference while they were being cared for, 18 said a tablet was not used directly as part of their care.
 
After seeing a similar low usage rate during the last reporting period, Master Trainers discussed this directly with participants. The main issue is that the materials are all in English and while the health workers can speak and read English, most patients cannot. As you can see below, this is also probably a sample error issue whereby the people asked to do PSATs were more likely to not understand the content which is not only in English, but also of a fairly high educational level.
 
All 20 said they would recommend Juba Teaching Hospital to friends and family. However, it should be noted that 18 of the PSAT forms were filled out by the Master Trainers themselves using an interviewing format with patients due to the fact that the patients were not literate and could not record their own responses even on translated PSAT forms. This leads us to believe that the increased positive responses of this reporting period over others is due to the cultural norm of wanting to please the person interviewing them and not insult them with their honest negative experiences perhaps.
 
18 patients said their medical diagnosis and plan of care was explained to them well, 1 said it was somewhat explained and 1 said it was not explained at all.
 
Health Worker Survey (HWS)
 
89% of health workers report using the tablet to aid their work at least 3-5 times days per week with 56% of them saying they use it every day. The remaining 11% report using it at least once or twice a week.
 
This is a significant increase in use from the last 2 reporting periods.
 
The most popular features used:
 
       Omnio–  Disease/diagnostic tools: 100% of health workers have used this
                 Drug reference tools: 100% of health workers report having used this
                 Calculators: 56% of health workers report using this (a 30% increase since last reporting period)
                 Textbook reference: 44% health workers used this feature
 
      Videos– 100% of health workers used videos on the tablets in the past month
 
Only 1 participant used the ‘Front Page’ feature. This has not been a popular feature throughout the program. Master Trainers asked participants if this was due to lack of training but 100% replied that they understood how to use it but basically did not save things for reading later via this feature but rather used devices mostly as immediate reference.

Some suggestions and feedback from health workers:
 
What is the best thing about having the eLibrary device available to you?
 

• Instant reference
• It is portable
• It has calculators for medication
• Video education

 
Do you have any suggestions or observations to improve the program?
 
“I am so grateful for this program. I wish it to be extended.”
“The first 3 months has been a learning phase. Now we need the program to continue so we can become super users.”
“Please extend the program further. It will be better also if you can make all the staff have training.”
“There can be more pediatric videos.”
“I think we need to include the med-surg staff. It is better if they also have the device.”
“It is very hard to use the videos but they are good. The patients do not understand English though.”
“We need this in Arabic.”
 
Real use success examples:
 
The devices were used this month for:

1. Drug dose calculation for malaria
2. Malaria management
3. Epilepsy management
4. MgSo4 dose calculation for eclampsia
5. Birth in the Squatting Position video shown to patients as well as nursing students
6. Health education in the antenatal unit: family planning, danger signs of pregnancy, Safe Motherhood
7. How to properly care for a septic infection in the foot of a diabetic patient
8. Neonatal Resuscitation steps (refresher for nurses)
9. Proper management of post partum hemorrhage

1. To familiarize staff at the only national referral and teaching hospital in South Sudan with digital reference, data collection, and decision support tools.
2. To get an accurate estimate of the scope and cost for building a Center of Excellence in Juba.
3. To get an accurate estimate of maternal morbidity and mortality in Juba Teaching Hospital, which presumably represents the most high risk obstetric cases in Central Equatoria.

Project Objectives during this reporting period:

1. Ongoing support of all health workers in Respectful Health Care
2. Ongoing support of all target health workers in use of mobile tablets with Health eVillages suite
3. Improved Data Tracking in Maternal Mortality
4. Improved service delivery
5. Improved Patient Satisfaction

Summary of RMF/WCF-sponsored activities carried out during the reporting period under each project objective:

1. Ongoing Data Tracking in Maternal Mortality
2. Qualitative interviews with health workers completed for month #2
3. Patient Satisfaction survey administered to month #2 sample
4. “Near Miss” research project was launched

– See more at: http://realmedicinefoundation.org/initiative-reports/south-sudan/archives/2015/06/30/health-evillages-program-report-march-20-april-20-2015/#sthash.ign28rmC.dpuf