The COVID-19 pandemic and its aftermath has demonstrated the limitations of a reliance on global production systems and long-distance supply chains that shift production control away from communities impacted by disasters. Moreover, the pandemic highlighted the need for a long-term strategy for resilience, so that communities are able to handle a wide range of future shocks and challenges.

This blog shares key lessons learned from COVIDaction Local Production Local Solutions (LPLS), a UK FCDO funded programme that supported a portfolio of innovators to use distributed manufacturing and circular economy approaches to address demand for PPE, medical supplies, and other unavailable goods. Through this, LPLS identified that localisation of production, distributed manufacturing, and circular economy approaches can help increase resilience to emergencies and improve the responsiveness of production systems to community needs. These approaches can also help to reduce waste, limit carbon emissions, and mitigate the impact of production systems on the environment.

Working with innovators and partners, COVIDaction Local Production Local Solutions (LPLS) identified six interrelated pillars to enabling resilient production systems which meet the needs of local communities, help them thrive and respond quickly to systemic shocks.

1. Flexibility

Flexible technologies, practices and process allow companies to adapt their range of products in response to market demands, without making extensive changes to their operations of infrastructure. As we saw early during the pandemic, hyper efficient but rigid modern supply chains are unable to respond to rapidly changing needs of communities globally. The LPLS portfolio showcased two types of innovative flexibility where businesses in LMICs were able to pivot and respond to COVID-19:

Intrinsic flexibility: Increasing internal flexibility of production without input from outside the company e.g., using digital fabrication equipment to produce items at a lower cost, helps democratise and localise innovation and subsequent production globally.

Extrinsic flexibility: Activities occurring outside the business which increase its flexibility e.g., via mutually beneficial collaboration between businesses that allow for new products to be produced with minor changes to each business’ practice.

2. Collaboration

Collaboration among different producers and with consumers within an ecosystem can create flexibility, as well as increase the overall potential outputs of the system. There are a range of ways that collaboration within supply chains and production ecosystems can be better supported. Two key approaches tested by LPLS were:

Local collaborative manufacturing: This can include directly facilitating collaboration between different local producers, such that the strengths of the parties can be retained, while offsetting their individual weaknesses. This can also involve supporting online and offline collective manufacturing platforms, which help give different producers and consumers visibility of each other’s needs and capacities, serving as a basis for connections and partnerships.

Peer-to-peer learning communities: As learnings from LPLS’ own online peer-learning community for innovators show, developing such a network enables rapid identification and replication of beneficial practices.

3. Local Materials

If materials are sourced and processed locally, then supply chains are less reliant on distant economics and more revenue can circulate and benefit the local community. This prevents value concentration overseas and reliance on imports, for which dependent, lower-income regions often pay a heavy price as evidenced by the breakdown of global logistics during the pandemic. LPLS grantees showcased two ways to enable identification and utilisation of local materials:

Biomaterials: These are sustainable, renewable materials which biodegrade safely within the natural environment and provide alternatives to conventional and petroleum-based materials that presently dominate global production.

Material recovery and reutilisation: Local economies also benefit from better identifying and materials already found within supply chains. Once materials have entered the local arena, their use should be maximised as much as possible.

4. Human Potential

Nurturing human skills, potential and agency are key to a self-sustainable and resilient community. The information sector and ‘gig economy’ is a highly under potentiated sector that could be better incorporated into wider industry. LPLS found a number of key ways to better facilitate and tap into human potential for resilience, including from a donor perspective, providing direct offline engagement for funding calls. Here, as part of its attempt to find innovations responding to the pandemic, LPLS focused on engaging with offline communities in 7 countries across Africa, through using local scouts, to visit hard-to-reach communities, and seek out grass root innovators, who could not be reached with an online media push. In the process, LPLS discovered remarkable innovative responses to dealing with local demand for unavailable goods — including hand washing stations, sanitisers, and PPE products. The exercise highlighted the limitation of typical grant funding cycles, and a gap in the reach of funders in an area that could hold great potential impact to local communities.

5. Retention of Value

To meet the continued needs of local communities, the length of time that products give value to the community must be maximised. Many products — particularly those produced overseas — have a short life cycle and product replacement is a considerable financial burden or simply may not be possible in low-income communities. For this reason, LMICs tend to have a strong informal repair economy. In building local production, a stronger focus should be placed on repairable design and additional routes to value retention. This can be done through providing training for repairing and maintenance, advocating for repairable design (including more modular design), and facilitating collaboration between producers and the informal sector — which offers great potential for enabling repair and retention of value.

6. Transparency and Visibility

To enable resilience, it is vital to provide ecosystem actors with system-wide data and intelligence, transparency, and visibility, to enable identification of opportunities, good decision-making, and risk analysis. This is true for both producers and investors.

Transparency: A lack of transparency in the ecosystem around ventures, results in missed opportunities to collaborate or access resources; and prevents investors from fully comprehending the ventures they may support.

Visibility: Innovators need to be visible, beyond typical marketing and branding. They must be visible to potential collaborators as well. By making their capacity and skills visible, their potential for business can be shown without being transparent enough to jeopardise their competitive edge.

The learnings shared here on ‘6 routes to building resilient production systems’ form a summary of a more detailed report, that can be found on the FCDO Frontier Technologies Hub website here. This more in-depth report shares case studies from innovators supported by LPLS, and the different ways they worked to support more resilient local production systems.

6 routes to building resilient local production systems via distributed manufacturing and circular… was originally published in COVIDaction on Medium, where people are continuing the conversation by highlighting and responding to this story.

As the world moves its focus from an ‘emergency response’ towards building resilience against future crises, our focus has also had to shift, as we consider the best way to build on the incredible achievements that came out of the COVIDaction programme in the last two years.

With funding provided by the FCDO, two streams of work that began under this programme, will now move into their next phases as part of the Better Futures CoLab platform.

The Oxygen and Vaccine Data CoLabs will be delivered by a consortium including Brink and DT Global, and each CoLab will have their own constellation of strategic partners, experts and collaborators.

There’s more information on the next phase of our work in this blog post, and you can follow our journey at the Better Futures website, or via @FuturesCoLab.

Finally, we would like to say how grateful we are that we had this opportunity to work with some amazing partners, funders, and meet some great friends, and how much we’re looking forward to continuing to work with many of them during this next phase.

Announcing the next phase of Oxygen CoLab and Vaccine Data CoLab was originally published in COVIDaction on Medium, where people are continuing the conversation by highlighting and responding to this story.

Oxygen concentrators are capable of supplying continuous medical grade oxygen in low-resource settings. In May 2022, we visited Tanzania where FREO2 is piloting their O2aaS programme to learn how oxygen can be sustainably supplied in rural health clinics.

Background

In 2021, the Oxygen CoLab awarded 3 UK Aid funded oxygen-as-a-service pilot (O2aaS) grants to test innovative business models that support the sustained provision of medical oxygen in low-resource settings. These were awarded to FREO2 in Tanzania, and Sanrai and Philips, both in India. We look forward to sharing the learnings from each of these programmes.

In May 2022, the Oxygen CoLab team travelled to Tanzania at the invitation of FREO2 to learn about their pilot programme’s impact first-hand (read about the background here). We visited the health centres where FREO2’s oxygen concentrators are installed, attended parliament as guests of the Deputy Minister for Health, and met with members of the British High Commission.

In just 6 months, the FREO2 team scaled to 12 under-resourced health centres across the rural northern part of Tanzania. These remote facilities now have access to sustainable, medical grade oxygen despite the many challenges they face securing a continuous supply of oxygen: the high cost of purchasing, transporting and refilling of oxygen cylinders, and in a context of stretched government funding.

We were astounded by the layers of impact FREO2’s pilot programme has had in such a short period of time. The solution integrates product, installation, education and social enterprise, and has already treated 1473 children, trained 77 health workers and employed 11 local staff.

This blog highlights key learnings and outlines the value of O2aaS after 6 months of work.

The problem

Many children in Tanzania die as a result of premature birth asphyxia, a condition where the baby cannot breathe, or pneumonia due to a lack of oxygen. Oxygen provision is difficult and often not prioritised in rural health centres.

Rural health centres struggle with regular power cuts, which typically last 1–12 hours, and rely on oxygen cylinders as their main source of oxygen. These are very expensive to purchase (approx. USD 450–500), refill, and transport over long distances and difficult dirt road terrains.

If there is no local source of oxygen available, the only option is referral to a larger facility often found in the main cities. In the areas we visited this could typically be anywhere from 3–9 hours away. Many babies do not survive these long journeys, else risk suffering brain damage.

For many mothers the death of their newborn is inevitable; oxygen is not available as standard and as a result it is not expected. This has meant that parents may not recognise the need to demand access to oxygen and better treatment.

In addition, health centre budgets are heavily stretched, requiring difficult decisions about where to allocate funds. Oxygen is frequently not prioritised because its value is poorly understood against other treatments.

The impact on people who require oxygen

There is clearly a strong need and demand for oxygen in these rural areas. In Karatu, a government health centre, 10 premature babies had been treated with oxygen, significantly improving their life chances, since the FREO2 oxygen concentrators had been installed in January. This health centre previously had no oxygen provision for prenatal births. These babies would not have survived before FREO2’s pilot. We heard similar stories elsewhere. In Mong’ola, the most rural health facilities we visited, 50 neonatal and paediatric patients had been treated using FREO2 oxygen.

Through word of mouth, news of these successes has been spreading throughout the community. Expectant mothers are choosing to travel from further away to give birth in facilities which have oxygen, giving them the best chance of survival. The increase in patients visiting some facilities has raised concern about the ability to provide care with limited resources.

Demand is clearly increasing across the region. This is the signalling that we have been looking for. We know there is a need for oxygen in these areas due to high infant mortality but so far the exact demand has been unclear. In order to trigger investment into concentrator product development we need to demonstrate sufficient demand to innovators in this space.

Services wishing to provide oxygen are more capable

There is an increased capability in the region where clinicians are more able to provide high quality assessment and oxygen treatment for babies using the correct equipment and knowledge.

As part of the oxygen service, FREO2 provides pulse oximeters and training to clinicians on how to use the equipment upon installation. This training enables them to correctly identify when oxygen is required and how to manage the flow as their patient’s condition changes.

FREO2 also offers to either fix concentrators on site or replace them if a quick fix is not possible. This means that clinicians can focus on the needs of their patients and no longer worry about maintenance and upkeep of the concentrators.

Dr Samuel at the Karatu health centre explained how a guaranteed supply of oxygen has meant they no longer have to make difficult choices about who can access oxygen. Clinicians who have received FRE02 concentrators and training are also supporting each other through a regional whatsapp group to enable peer-learning.

O2aaS is not just a technical solution. It provides vital value-add services which address the needs of clinicians, improving their confidence and capability in providing oxygen therapy.

Communities are benefiting from oxygen services

FREO2 Tanzania has been set up to build capability in the community. In order to maintain a high quality service and operationalise the ‘swap-and-go’ model, FREO2 Tanzania has employed and trained local Tanzanians as engineers.

This contrasts with other oxygen contractor business models, which often just sell equipment with no support for in-country maintenance. Once they are no longer in use they often end up in equipment graveyards. Such a short shelf life does not justify the cost of a regular concentrator at a health centre.

The ‘swap-and-go’ model is a much more sustainable, cheaper and eco-friendly solution. Moreover it strengthens the local economy by creating jobs and resilience in the health system.

This has brought new incomes to Tanzanian families and has improved their quality of life. They have also become proud ambassadors for the work and spread the word about the value of oxygen.

Governments are supporting oxygen policy and funding at the national level

The Government of Tanzania is in support of the FREO2 pilot programme and O2aaS business model. FREO2 were invited to meet the Minister of Health and visit parliament on the day they presented their National Health Budget.

This government-level engagement was made possible through the prenatal advocacy work of the Doris Mollel Foundation and support from the regional government official where FREO2 is operating.

FREO2 has clearly demonstrated the impact that O2aaS can have which complements the Government’s health care policy on neonates. The Minister of Health recognised the value for money that O2aaS provides. The government has committed to support FREO2 to scale to further health centres in the country.

Securing government support is not easy for innovators. The combination of piloting the service and technology concurrently with wider advocacy has accelerated traction at the national level. This an example of how the Oxygen CoLab aims to bring together different actors in the sector to enable a collective response by leveraging each part of the system for accelerated action.

Key learnings

• Context is key: go where people are in order to understand the problem at all levels of the system (patients, health care workers and policy-makers)
• Build in-country capacity: through education and social enterprise. This is vital to ensure reliable and high standard health care provision.
• Do-to-learn: through piloting in 12 locations FRE02 was able to uncover and quantify the unmet demand revealing the true market need post-covid19
• Always look up and out: by collaborating with actors across the sector you can gain visibility and leverage your collective voice to unlock funds and create impact

What’s next

There were many stories that we’d like to share from our trip, learnings from across the wider Oxygen CoLab and our plans for further work. Stay tuned!

All photography by Bony Kazi @iambonykazi_

Oxygen-as-a-service is saving young lives was originally published in COVIDaction on Medium, where people are continuing the conversation by highlighting and responding to this story.

The COVID 19 pandemic emphasised the need for strong and resilient health systems which can respond to emerging crises, while maintaining essential health services and quality of care. COVIDaction Resilient Health Systems (RHS), is a UK FCDO funded programme that explores the role of technology and innovation in supporting countries to build resilient health systems as they respond to the COVID-19 pandemic.

From mid 2020–21, the programme funded nine grantees who leveraged technological innovations to address health system challenges and contribute to increased resilience. These innovations focussed on two key areas — (i) telehealth (innovations that provide access to health services via digital and telecommunications technologies); and (ii) data innovations (which improve the collection, quality, availability, and use of health data, allowing for better decision-making and response to systemic shocks like COVID 19).

Findings from the RHS portfolio highlighted four ways in which these technologies can help increase overall health system resilience.

1. Improved Access and Continuity

Globally, many health systems — particularly in LMI countries — struggle to reach vulnerable and disadvantaged populations, and this was exacerbated during the pandemic. Telehealth innovations can adapt models of service delivery to overcome access barriers and ensure continuity of essential health services. RHS findings showed two ways in which this can be achieved:

Point of access: Tech innovations can shift the service delivery space away from brick-and-mortar facilities to households and communities i.e., moving services closer to beneficiaries. Some examples include remote or virtual access to care via phone or telemedicine applications, and low-cost tech and low- or no-cost innovations like toll free call centres connecting people to health providers.

Process innovation: Innovators can test and support creative process innovations — combining telehealth with processes like remote triage and emergency vehicle dispatch, to identify and provide care to those in urgent need. When partnered with facilities like hospitals, clinics, and pharmacies, this can help connect users to quality in-person care and even manage bi-directional referrals.

2. Democratisation of Healthcare

COVID-19 has further exposed that many populations — particularly in rural or remote areas — lack access to reliable health information, and are consequently unprepared to deal with health issues. Innovation can help overcome these issues, by empowering individuals with knowledge and tools that help them manage their health, thereby democratising health care. Through RHS we found 2 ways in which telehealth innovations can help to empower individuals:

Disseminating Health Information: Telehealth technologies can help disseminate timely and easily accessible information, especially via mHealth platforms that use low-tech SMS messaging and toll-free hotlines, to reach lower income or remote populations. For those with smartphones, more complex applications can empower users with health knowledge, including for instance, facility contact details, schedules, information on symptoms, etc.

Self-Management: mHealth and telehealth can provide a range of tools to enable people to successfully manage their conditions, improve health literacy and health behaviours. From platforms offering self-screening tools on basic phones, to smartphone applications that combine other digital tools like telemedicine, interactive voice response and appointment reminders, to more advanced technologies like chatbots. These tools made a critical difference for those with chronic conditions like HIV — especially during the pandemic.

3. Enhanced Health Workforce Efficiency and Capacity

COVID 19 showed how quickly health systems can be overwhelmed in acute crises, preventing healthcare workers from providing routine care or responding to other needs. Given that workers typically face the “double burden” of data collection, reporting and administrative tasks that limit their time to provide health services, telehealth and data technologies can improve their capacity and enable them to deliver quality services efficiently, even in times of crisis. The RHS portfolio shows 4 ways in which this can be done:

Improved demand management: By process innovations like virtual triage and shifting the first point of service away from facilities, innovations can help prevent overcrowded facilities and overwhelmed healthcare workers.

Task shifting: Redistributing specific tasks from highly qualified health workers at facilities, to other health system actors like pharmacists and community health workers, with shorter training and fewer qualifications, can make more efficient use of human resources. Digital tools help to support this task shifting, by better connecting these actors and integrating them with national health information systems.

Capacity development: Innovators can offer direct capacity development, via training or e-learning modules to health systems actors, helping them to deliver high quality and evidence-based telemedicine. This can also include training on soft skills like listening and empathy. In the context of task shifting, this further offloads some of the burden from healthcare providers to other actors within the community.

Time efficiency innovations: All the above have the potential to contribute to improved time efficiency of the health workforce. Innovations can streamline and digitise burdensome administrative tasks like data collection, thereby saving time for healthcare workers to focus on providing health service delivery.

4. Generation of Data and Evidence

Many countries face challenges with measuring health system performance due to a lack of, poor quality, or fragmented data. This prevents health system managers and decision-makers from obtaining a comprehensive picture of the status of their health system and makes it harder to identify spaces for improvement. Telehealth and data innovations can help with this in three ways:

Improved data collection: Innovations can help streamline and improve data collection in several ways such as guiding health workers in digital data collection methods, digitising and streamlining facility based reporting processes or collecting patient-level data via telehealth applications and creating comprehensive electronic medical records.

System interoperability: Health systems are often fragmented, with different components owned by different institutions or actors. Data and telehealth innovators can help address this by integrating into and promoting interoperability between existing health management and information systems, and their own digital platforms. For instance, innovations focussed on direct service delivery via telehealth are typically linked to national health management and information systems, to generate high quality data that supports decision making.

Targeted evidence generation: Data innovators have great potential to help governments and health systems generate targeted evidence to inform decision making and planning, especially in times of crisis, as seen during COVID 19. Innovators used mHealth platforms and innovative surveying technologies during the pandemic to generate timely evidence on issues like public trust in the health systems, vaccine confidence and uptake, and collection of covid data. When designed in collaboration with decision-makers, these efforts can be a powerful tool for responding to crises and strengthening health systems over time.

The learnings shared here on ‘4 ways in which data and telehealth innovations can improve health system resilience’ form a summary of a more detailed report, that can be found on the FCDO Frontier Technologies Hub website here. This more in-depth report shares case studies from innovators supported by COVIDaction RHS, and the different ways they worked to support more resilient health systems.

Four ways in which telehealth and data innovations can increase health system resilience was originally published in COVIDaction on Medium, where people are continuing the conversation by highlighting and responding to this story.

We make this happen by providing data tools and technical assistance to help identify and target under-immunised and vulnerable communities for more effective behaviour change campaigns and vaccine strategies.

Would you like to book a 1:1 consultation to find out more about how we could support your work? Click here.

Siobhan Green, Programme Lead at Vaccine Data CoLab and Director of Digital and Data Governance and Transformation at DT GLobal

Digital Development Professional & Data Social Scientist, with expertise in digital inclusion, data ethics, and responsible data. I also love ICT4D entrepreneurship, supporting women in technology, and how technology and digital data can be used for social good.

Email: siobhan.green@dt-global.com

Time zone & location: Eastern Daylight Time (Washington DC)

Gita Luz, Innovation Lead at Vaccine Data CoLab and part of Brink, the behavioural innovation people

Innovation and health specialist with expertise in starting and scaling new ventures in health (vaccines, maternal mental health, workplace wellbeing & burnout etc). I’m always looking for ways to scale social impact through quick experimentation so we fail fast and make evidence-based decisions.

Email: gita@hellobrink.co

Time zone & location: British Summer Time (London)

Vaccine Data Help Desk was originally published in COVIDaction on Medium, where people are continuing the conversation by highlighting and responding to this story.

Written by Helium Health

At Helium Health, we are building critical digital infrastructure to power and optimize healthcare across global markets. Established in Lagos, Nigeria, in 2016, we launched our flagship product, a comprehensive, reimagined, and intuitive Electronic Medical Records/Hospital Management Information System (EMR/HMIS) engineered specifically with consideration for the unique challenges in emerging markets. It is now one of the most widely used hospital software products in Africa, deployed at 250 facilities. Today, Helium Health now provides an interconnected suite of technology solutions that serves all healthcare stakeholders and tackles: inefficiencies in healthcare delivery, the healthcare financing deficit, and the inaccessibility of healthcare data healthcare for decision making.

Over the last two years, we’ve developed several solutions to support the public and private healthcare sectors’ response to the COVID-19 pandemic. In 2020, we developed a Test & Release solution that enables international travelers flying into and out of Nigeria’s busiest airport to book and pay for their COVID-19 testing and hotel quarantine fees. Through this solution, the state can seamlessly keep track of travelers and their COVID-19 test status and limit the spread of imported strains within the local population. Further, we supported the private health sector’s COVID-19 response by launching our telemedicine platform and making it available to health facilities at no cost for the first few months. This telemedicine solution enables healthcare providers to have virtual, hassle-free consultations over voice or video with their patients.

Comprehending the unprecedented scale of the COVID-19 vaccination campaigns to come, the ongoing bottlenecks with routine childhood immunization, and the limitations of existing vaccination-oriented digital health solutions, we began to build VacciTrace, a robust, interoperable end-to-end technology solution for coordinating, executing, and monitoring vaccination campaigns. It has modules that address the needs of all stakeholders across the COVID-19 vaccination value chain, from the manufacturers and government regulators to the healthcare providers and patients. Some VacciTrace modules include Vaccine Administration, Scheduling & Reminders, e-Vaccine Records, Pharmacovigilance, Logistics & Inventory Management, and Analytics.

In January 2022, Helium Health emerged amongst the winners of COVIDaction’s open call for solutions to improve vaccine delivery and strengthen data-driven health systems, which received over 199 applications from 54 countries across 5 continents. We received a grant to stabilize VacciTrace and optimize it for use by one of our partner states in Nigeria, Ekiti State. Given that we were already working with the Ekiti State Ministry of Health on a project to deploy our EMR to three specialist hospitals, one of the objectives of our COVIDaction award was to break down programmatic silos and work toward a unified health information system in the state by integrating VacciTrace with our EMR.

With support from COVIDaction, we conducted a needs assessment survey in Ekiti State to better understand the challenges COVID-19 vaccination stakeholders in the state had. Before this needs assessment exercise, we were aware of the limitations of the digital tools used by staff working on vaccination campaigns. However, interviewing key personnel helped us learn how these limitations affected the execution of their responsibilities and uncover the other non-technology-related issues they faced. Insights from this need assessment have informed updates to VacciTrace and the development of new features, one of which is our microplanning module.

There are some limitations — such as the lack of devices and funds to purchase internet data — that our software cannot solve. Thankfully, COVIDaction is working to help us find in-kind support to overcome these barriers to deployment. The grant we received also facilitated the creation of a deployment plan and training manual for VacciTrace, and these essential documents will enable us to hit the ground running and seamlessly deploy our VacciTrace once devices and data are available.

We are grateful to COVIDaction for this grant, which made it possible for us dive deeper into the issues surrounding both COVID-19 and routine childhood immunization in Nigeria, get first hand perspectives of stakeholders involved in the process, and improve our solution to better address their needs. We strongly believe that our learnings from developing VacciTrace have provided us with some unique insight that can influence immunization coordination at a national level, and look forward to deploying our solution with the continued support of COVIDaction.

Helium Health receives Support from COVIDaction for its End-to-End Vaccine Campaign Management… was originally published in COVIDaction on Medium, where people are continuing the conversation by highlighting and responding to this story.

Senegal is hardly alone in experiencing challenges with their COVID-19 vaccine roll out. Like many countries, much of the challenge has been related to hesitancy and demand. Recognizing that having ready access to COVID-19 vaccination-related behavior indicators can inform a better understanding of why coverage is not reaching saturation and to whom additional resources and efforts should be directed, Akros (in collaboration with Fraym and GRID3) worked with Senegal Ministry of Health and Social Action (MSAS) departments and in-country partners to build a custom geospatial dashboard that demonstrates these data.

Hesitancy and lack of demand issues for vaccines can stem from a number of causes. For example, rural communities far from health facilities administering vaccines may require significantly extra effort and expenses to travel to get the intervention, resulting in a demand challenge. The response to this demand-driven low-coverage problem will be different than hesitancy-driven challenges and the data required to respond effectively is likewise different. In this example, understanding: 1) Which communities are farther than a reasonable traveling distance to the health facility, 2) where exactly those communities are, and 3) how many people are expected to be found there, is valuable information that can be used to maximize the chances of a successful response. However, access to these types of granular geospatial demographic and health data that promote this level of evaluation to allow progress against such bottlenecks, has not been widely available or accessible to staff needing to make critical resource prioritization decisions.

The solution — hyperlocal geospatial data for COVID-19 vaccinations

With vaccination hesitancy and demand as the major challenges to achieving higher coverage, the data prioritized for this dashboard were proxy indicators for providing more insight into these challenges. Further, in order to decentralize decision making and empower district and health facility staff to make decisions that drive up coverage, this data was made accessible through the dashboard at 1km x 1km cells that can be aggregated up to health facility and district-level

indicators. The dashboard interface allows this hyperlocal data to be, quickly and easily, geospatially explored before downloading for further analysis or input into external planning tools.

This work was built upon a history of collaboration among these partners — which has had success in providing detailed microplanning services utilizing granular spatial data to government malaria and neglected tropical disease (NTD) programs, with demonstrated examples for malaria in Zambia, Nigeria, and Senegal and for NTDs in Rwanda and Kenya. Building on that technical capacity, the dashboard in Figure 1 (showing COVID-19 vulnerable populations against health facility catchment areas) was built to display modeled COVID-19 vulnerability data to enable more informed decisions within vaccination planning workflows.

Figure 1: The geospatial dashboard allows users to filter out key COVID-19 planning data at a granular level.

The geospatial dashboard consolidated a wide variety of data and relevant COVID-19 vulnerability and risk models into the visualization to be filtered by region, district, and health facility to inform all levels of health planning. Largely using demographic and health surveys, the data includes statistically sound high-quality, geo-tagged household survey data, satellite imagery-derived data products, health metrics, and health infrastructure. This hyperlocal data, down to 1km grid cells, allows for the visualization of the spatial distribution of priority groups and classifies individuals within priority groups using WHO-guided indicators of vulnerability. These include elderly population groups and groups that receive a high vulnerability score generated within the COVID-19 vulnerability model. Other COVID-19 indicators within this model included vaccine allocation, exposure, comorbidities, information access, prevention activities, and vaccination likeliness — all of which were able to be filtered, displayed, and extracted for all levels of the health administration hierarchy to inform microplanning.

To visualize this vulnerability score and other selected relevant data, the user simply selects the region, district or grids they are interested in and a summary of the required data is displayed for that location and the level above it. Figure 2 displays an example of this wherein a user is displaying modeled COVID-19 vulnerability, elderly populations, female HIV prevalence, and female vaccination data for Kédougou District within Kédougou Region.

Figure 2: The Senegal dashboard showing selected COVID-19 vulnerability data indicators in Kédougou District.

These indicators can help understand where vaccination-related activities, such as vaccination uptake drives, hesitancy surveys, or direct community health worker services, should be prioritized to increase coverage. The dashboard maps can also be styled to visualize a specific indicator on the map by choosing from a selection of color schemes.

Potential next steps

Overall, the dashboard was well received, notably because of the ease of data selection, spatial navigation, and quick summaries of data against selected areas of interest. The ability to compare multiple data against each other for analysis along with getting detailed disaggregated population estimates within a particular area was highlighted frequently. Other features that received positive feedback included the ability to download data, interrogate different levels of the hierarchy, have some control over styling the map, and access to a user manual and data model descriptions. With additional investments, Akros envisions that enabling sustainability and scale up of this dashboard and its supportive tools to assist COVID-19 vaccination planning across Senegal could include the below three themes.

1. Embedding the solution within program microplanning processes
2. Technical solution improvements
3. Sustainable management

Akros believes the process and approach being developed under this program has significant relevance not just for COVID-19 programming, but also for other vaccination and disease control programs. Akros plans to document the solution developed, lessons learned, and challenges encountered, and to share openly with government partners and relevant stakeholders in order to promote learning and gather interest for further funding to carry these approaches forward. Akros also envisions growth of the dashboards to further guide intervention planning and delivery. For example, extending tools to support behavior change communications or vaccination delivery tracking in the field. With further funding, these dashboards have the power to be flexible, dynamic, and inclusive across a wide range of planned or envisioned health interventions. Mapping how data could enhance vaccine distribution decisions on the ground in Senegal is just the first step in unlocking the potential these geospatial dashboards have to offer.

Hyperlocal geospatial data to guide COVID-19 vaccination in Senegal was originally published in COVIDaction on Medium, where people are continuing the conversation by highlighting and responding to this story.

Hesitancy and lack of demand issues for vaccines can stem from a number of causes. For example, rural communities far from health facilities administering vaccines may require significantly extra effort and expenses to travel to get the intervention, resulting in a demand challenge. The response to this demand-driven low-coverage problem will be different than hesitancy-driven challenges and the data required to respond effectively is likewise different.

In this example, understanding:

1. Which communities are farther than a reasonable traveling distance to the health facility
2. Where exactly those communities are, and
3. How many people are expected to be found there, is valuable information that can be used to maximize the chances of a successful response.

However, access to these types of granular geospatial demographic and health data that promote this level of evaluation to allow progress against such bottlenecks, has not been widely available or accessible to staff needing to make critical resource prioritization decisions.

The solution — hyperlocal geospatial data for COVID-19 vaccinations

With vaccination hesitancy and demand as the major challenges to achieving higher coverage, the data prioritized for this dashboard were proxy indicators for providing more insight into these challenges. Further, in order to decentralize decision making and empower district and health facility staff to make decisions that drive up coverage, this data was made accessible through the dashboard at 1km x 1km cells that can be aggregated up to health facility and district-level indicators. The dashboard interface allows this hyperlocal data to be, quickly and easily, geospatially explored before downloading for further analysis or input into external planning tools.

This work was built upon a history of collaboration among these partners — which has had success in providing detailed microplanning services utilizing granular spatial data to government malaria and neglected tropical disease (NTD) programs, with demonstrated examples for malaria in Zambia, Nigeria, and Senegal and for NTDs in Rwanda and Kenya. Building on that technical capacity, the dashboard in Figure 1 (showing COVID-19 vulnerable populations against health facility catchment areas) was built to display modeled COVID-19 vulnerability data to enable more informed decisions within vaccination planning workflows.

The geospatial dashboard consolidated a wide variety of data and relevant COVID-19 vulnerability and risk models into the visualization to be filtered by region, district, and health facility to inform all levels of health planning. Largely using demographic and health surveys, the data includes statistically sound high-quality, geo-tagged household survey data, satellite imagery-derived data products, health metrics, and health infrastructure. This hyperlocal data, down to 1km grid cells, allows for the visualization of the spatial distribution of priority groups and classifies individuals within priority groups using WHO-guided indicators of vulnerability. These include elderly population groups and groups that receive a high vulnerability score generated within the COVID-19 vulnerability model. Other COVID-19 indicators within this model included vaccine allocation, exposure, comorbidities, information access, prevention activities, and vaccination likeliness — all of which were able to be filtered, displayed, and extracted for all levels of the health administration hierarchy to inform microplanning.

To visualize this vulnerability score and other selected relevant data, the user simply selects the region, district or grids they are interested in and a summary of the required data is displayed for that location and the level above it. Figure 2 displays an example of this wherein a user is displaying modeled COVID-19 vulnerability, elderly populations, female HIV prevalence, and female vaccination data for Kédougou District within Kédougou Region.

These indicators can help understand where vaccination-related activities, such as vaccination uptake drives, hesitancy surveys, or direct community health worker services, should be prioritized to increase coverage. The dashboard maps can also be styled to visualize a specific indicator on the map by choosing from a selection of color schemes.

Potential next steps

Overall, the dashboard was well received, notably because of the ease of data selection, spatial navigation, and quick summaries of data against selected areas of interest. The ability to compare multiple data against each other for analysis along with getting detailed disaggregated population estimates within a particular area was highlighted frequently. Other features that received positive feedback included the ability to download data, interrogate different levels of the hierarchy, have some control over styling the map, and access to a user manual and data model descriptions. With additional investments, Akros envisions that enabling sustainability and scale up of this dashboard and its supportive tools to assist COVID-19 vaccination planning across Senegal could include the below three themes.

1. Embedding the solution within program microplanning processes
2. Technical solution improvements
3. Sustainable management

Akros believes the process and approach being developed under this program has significant relevance not just for COVID-19 programming, but also for other vaccination and disease control programs. Akros plans to document the solution developed, lessons learned, and challenges encountered, and to share openly with government partners and relevant stakeholders in order to promote learning and gather interest for further funding to carry these approaches forward. Akros also envisions growth of the dashboards to further guide intervention planning and delivery. For example, extending tools to support behavior change communications or vaccination delivery tracking in the field. With further funding, these dashboards have the power to be flexible, dynamic, and inclusive across a wide range of planned or envisioned health interventions. Mapping how data could enhance vaccine distribution decisions on the ground in Senegal is just the first step in unlocking the potential these geospatial dashboards have to offer.

Background on the COVIDaction Vaccine Data Co-Lab

The Vaccine Data Co-Lab, a component of the Frontier Technology programme, is an FCDO-led collaboration supporting actionable solutions that improve data-driven prioritisation, allocation, and distribution of COVID-19 Vaccines. This work builds on the success of the Data Challenge for COVIDaction, which was launched at the beginning of the pandemic. COVIDaction invested in and supports a portfolio of tools that address COVID-19 data needs for Ministries of Health, National Statistics Offices, and others to provide evidence-driven policy decisions. As COVID-19 efforts shifted from detection and prevention to vaccine distribution, COVIDaction worked with the COVAX GIS Working Group to launch the Vaccine Data Co-Lab to support LMIC decision-makers with tools required for equitable, transparent, and efficient vaccine delivery. To view that call and learn more about the outcomes visit: https://medium.com/covidaction/data/home

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Hyperlocal geospatial data to guide COVID-19 vaccination in Senegal was originally published in COVIDaction on Medium, where people are continuing the conversation by highlighting and responding to this story.

Date: March 22nd 2022.

Venue: Hanoi, Vietnam.

In March 2022, PATH and implementing partners hosted a dissemination workshop to reflect a six-month collaboration with Vietnam MOH to support the development of Vietnam’s COVID-19 digital vaccination certification. Under this project, Vaccine Data Co-Lab and PATH supported the Ministry of Health to align Vietnam’s vaccination certificate system with the World Health Organization’s, European Union’s, and United Kingdom’s standards to open up travel for citizens and international travelers from around the world. This project contributed to the acceptance of Vietnam’s COVID-19 vaccination certificate by 14 countries, including the United Kingdom.

The workshop was in collaboration with The Vietnam Ministry of Health (MOH) and the UK Foreign, Commonwealth & Development Office (FCDO) and was attended by the Deputy Minister of the Vietnam MOH, Tran Van Thuan and the British Ambassador to Vietnam, Gareth Ward.

Speaking at the workshop, Deputy Minister Tran Van Thuan discussed the importance of this initiative: “COVID-19 significantly accelerated the shift to information technology for a multitude of functions such as the collection of data for disease prevention. This global moment is an opportunity to explore how innovative approaches taken during this time can accelerate shifts toward more responsive, digitalized systems and services as the world enters the new normal”.

British Ambassador Gareth Ward shared, “The UK is very pleased to support PATH’s and the Vietnam MOH’s work on Vietnam’s COVID-19 vaccine certificate system. The project has demonstrated how a partnership between public sector, private sector, and civil society can bring good results. This is also a big step forward in Vietnam’s digital transition, providing data transparency and allowing data-driven policymaking.”

PATH’s approach

PATH worked with the General Department of Preventive Medicine and Electronic Health Administration, Vietnam MOH, as well as the Viettel Business Solutions Corporation to standardize data elements and data types to deliver this project. PATH provided

• Technical assistance to implement and enhance system performance;
• Support in developing COVID-19 digital certificates on existing electronic health record applications to include printable and electronic certificates, compatibility for domestic travel, and linkages to global COVID-19 vaccine data;
• A video package of promotional materials and self-training videos for health workers and users to navigate the certificate. Check out one of the videos developed by PATH for international entrants into Vietnam.

Prior to this project, PATH had collaborated with Vietnamese government agencies and international partners to develop and roll out COVID-19 vaccines, enhance electronic disease surveillance and reporting systems, and assess and address gaps in medical oxygen access and respiratory care during the pandemic and beyond. As COVID-19 spreads around the world, PATH is partnering with governments to lessen its impact by establishing emergency operations centers; advising on testing, treating, and managing the outbreak; and standing up digital and data systems that support real-time disease surveillance. Click here for more about how PATH responds to COVID-19.

About COVIDaction Vaccine Data Co-Lab

The Vaccine Data Co-Lab, a component of the Frontier Technology program, is an FCDO-led collaboration supporting actionable solutions that improve data-driven prioritization, allocation, and distribution of COVID-19 vaccines. This work builds on the success of the Data Challenge for COVIDaction, which was launched at the beginning of the pandemic. COVIDaction invested in and supports a portfolio of tools that address COVID-19 data needs for ministries of health, national statistics offices, and others to provide evidence-driven policy decisions. As COVID-19 efforts shifted from detection and prevention to vaccine distribution, COVIDaction worked with COVAX GIS Working Group to launch the Vaccine Data Co-Lab to support low- and middle-income country decision-makers with tools required for equitable, transparent, and efficient vaccine delivery. To view that call and learn more about the outcomes, visit https://medium.com/covidaction/data/home.

Dissemination workshop: PATH collaborates with Vietnam MOH to Internationalise Vietnam’s COVID-19… was originally published in COVIDaction on Medium, where people are continuing the conversation by highlighting and responding to this story.

Written by Nilmini Herath, Alex De Figueiredo, Heidi Larson & the Vaccine Confidence Project

In March 2021 many people reflected on a year of living with the pandemic and wondered what the future would hold. One-year-on documentaries were aired, tributes were made to lives lost, articles were written, and essential workers were acknowledged. After a year of lockdowns, losses, isolation, home schooling, quiet birthdays, muted religious celebrations, and countless other strains on daily life, a myriad of emotions surrounding the pandemic had emerged. Some were disillusioned with their political leaders. Some were cautiously hopeful for a way out through vaccination. Some feared or lamented the continued measures for controlling COVID-19, while others welcomed them. Public sentiment everywhere was deeply mixed and quickly evolving, and Nigeria was no exception.

By this point, Nigeria’s death toll had proven to be relatively low, but the country had endured many of the same fears, restrictive measures and economic impacts faced in other parts of the world. The Nigerian experience of the COVID-19 pandemic had also interacted in complex and region-specific ways with its recent encounters with the Ebola epidemic, concerns about its healthcare system, ongoing regional conflict, economic hardships and differential levels of trust in authorities. Parts of the country additionally had to contend with a troubled history with vaccinations that in 2003 escalated into a three state Polio vaccination boycott and that has fuelled lasting concerns about all vaccinations. The country was in some ways and some areas more prepared and responsive, and in others more fearful, sceptical or distrusting. The Eta variant, thought to have originated in Nigeria, had recently been detected and the country was just exiting the peak of deaths in its second wave. Opinion at this point varied tremendously on whether COVID-19 should continue to be prioritised, whether policies or environmental factors were responsible for Nigeria’s relatively low death-toll, and on the benefits and risks of the COVID-19 vaccines.

In this context of division and uncertainty, the roll out of COVID-19 vaccination programmes dominated headlines in Nigeria, as they did around the world. At this time only 2% of the world was at least partially vaccinated, and they mostly lived in Europe, the USA, and a small handful of countries in Latin America and Asia. Nigeria had only just received its first 4 million doses, an important but small step towards vaccinating the 7th most populous country in the world with an estimated 212 million people. In this gap between COVID-19 vaccine roll-outs of different nations — a particularly long gap for Nigeria and many other Low and Middle Income Countries — the Nigerian people were watching the world. They watched as every version of every vaccine was analysed, as every side effect was scrutinised, and as every rumour was circulated. And of course, based on what they had seen abroad and at home, the Nigerian public, media and authorities shared information and opinions of their own, creating a complex vaccine information ecology. It was a crucial time for sentiment towards the COVID-19 vaccines to take shape and it was important to understand how and why different views around vaccines were forming.

Thanks to the support of COVIDaction and the Foreign, Commonwealth and Development Office, a team of researchers were able to measure the evolution and drivers of Nigerians’ willingness to vaccinate against COVID-19 over the important period of Nigeria’s early stages of roll-out. From March to October 2021, PREMISE and the Vaccine Confidence Project conducted seven rounds of longitudinal data collection. Using the PREMISE mobile phone application as an innovative, safely deployed and cost-effective digital data collection tool, 38,000 interviews were conducted with over 15,000 participants situated throughout Nigeria’s 37 states and territories. This data collection effort sought to understand

· what proportions of Nigerians intended to vaccinate,

· how certain they were in this intention,

· how this differed over space and time, and

· what was driving these trends.

A wide range of potential drivers of vaccine sentiment were included, such as socio-demographic attributes, emotional and psychological factors, COVID-19 knowledge and perceived susceptibility, trusted sources, and other vaccine confidence barriers. The interviews also explored attitudes to (and determinants of) perceptions of childhood immunisations, in particular the DTaP, polio, and measles programmes. Including these measures would allow exploration into whether vaccine confidence in the set of COVID-19 vaccines is related to vaccine confidence in these other immunisation programmes.

While analysis of the data is still underway, it is clear that Nigeria faced persistently high levels of uncertainty throughout the survey period, in contrast to the general increases in vaccine confidence seen in many Western countries. And although a majority of Nigerians surveyed would likely accept a COVID-19 vaccine if offered to them, there are notable sub-national variations in both levels of likely COVID-19 vaccine acceptance as well as trends about these levels.

As of today, Nigeria continues to lag behind much of the world in its COVID-19 vaccination coverage with only 9.4% of its population at least partially vaccinated. While some of this is due to limitations in supply, this work suggests that ultimately the demand for vaccinations may become a limiting factor.

Overall, the findings from this work illustrate the importance of routine monitoring of sub-national attitudes to COVID-19 vaccines to detect emerging trends and to identify, explore, and address losses, or forgone gains, in vaccine confidence.

Racing the pandemic: collecting data on drivers and levels of vaccine confidence in Nigeria at a… was originally published in COVIDaction on Medium, where people are continuing the conversation by highlighting and responding to this story.