In 2016, the Ministry of Health of The Gambia signed a Memorandum of Understanding together with ActionAid International The Gambia and Shifo Foundation to establish a new form of Health Management Information System (HMIS) in The Gambia.
The intervention is implementing a novel hybrid paper-digital solution that collects, shares, stores and distributes data for the Expanded Programme for Immunisation (EPI) using Smart Paper Technology. The data is digitized through the SPT engine and stored in an electronic register from which HMIS reports are generated and shared at a health facility, regional and national levels. The key stakeholders in the implementation of the project are the Ministry of Health (MoH), ActionAid International The Gambia (AAITG), The Vaccine Alliance (GAVI), IKARE, Swedish Postcode Foundation (PKS), af Jochnick Foundation (af Jochnick) and Shifo Foundation (Shifo).
An external evaluation of data quality and operating costs of Smart Paper Technology (SPT) in The Gambia was conducted in 2018 when the solution was being used in 4 fixed and 14 outreach health service delivery points in West Coast Region. Based on the findings, the external evaluators recommended the scale-up of the solution in the two regions, which was subsequently agreed on by the MoH, AAITG, and Shifo.
In July 2018, the scale-up of SPT commenced in Western Regions 1 and 2 and the solution was scaled up in all health service delivery points. A second independent evaluation on the scale-up of the solution took place in 2019 and focused on the themes of data quality, data use, administrative time efficiency, the total cost of ownership and transition of work processes, and Perceptions and experiences of health workers.
After the successful evaluation results, the MoH decided to scale-up SPT to the other remaining regions, starting from the Central River Region. The Smart Paper Technology (SPT) Solution has been successfully integrated with DHIS2 which is the world’s largest Health Management Information System (HMIS) to store and analyze health data. Through this platform, the Smart Paper Technology engine feeds data directly into DHIS2 to avoid the manual data entry processes which are prone to errors.
By 2022, all 91 health service delivery points in the country, which include public, private, and not-for-profit clinics shifted to using the SPT solution.
Smart Paper Technology reduced administrative time spent by health workers during service delivery by at least 60%.
“Smart Paper Technology produced accurate data up to 99% compared to the previous manual system of data entry and reporting, Smart Paper Technology facilitates system data analysis by generating all reports needed by health workers and their supervisors, these reports include monthly immunization reports, automatic register updates, provision of defaulter lists (children due for follow up), Smart Paper Technology eliminated manual reporting and data entry at all levels, the perceptions of health workers showed that the solution was easy to use during service delivery, easy to make follow- ups on defaulting children.”
At the community level, families with children and women of childbearing age receive SMS messages one day before their visit reminding them about their due date to visit the facility.
Health workers receive key performance indicators and develop strategies to improve vaccine coverage, equity, and quality of immunization services in the underperforming areas.
- Automatically generated request forms are used by regional vaccination stores to deliver vaccines and other supplies to each health facility.
- Decision-makers and planners at regional and national levels review the performance of each health facility/area using the integrated dashboard and reports. The insights help decision-makers identify and close the gaps in health service delivery points.
For health facilities with adequate infrastructure, health workers can capture patients’ health information using the MyShifo App. This results in real-time data being available at all levels of the health system, at any given time. Through the MyShifo App, health workers are also able to access up-to-date patient records to support service delivery, as well as monthly reports.
Whereas improving the quality of data collection is crucial, improving how data is used is vital in achieving efficient health services that deliver better health outcomes. Shifo’s Smart Actions platform enables the data generated by the SPT solution (and by other electronic information systems) to be used as effectively as possible. Smart Actions facilitates the efficient and systematic continuous quality improvement of health services, making it easier to quickly identify low-performing health facilities and subsequently seek to understand the root causes of the underperformance. As a result, improvement plans are discussed, and actions are agreed to improve performance and maximize the efficiency of services.