Health Workers Use mHealth to Strengthen Reporting and Service Delivery to Vulnerable Children in Nigeria's Gombe State

 {Photo credit: Adedayo Adeyemo/MSH}CUBS staff explore the mobile application.Photo credit: Adedayo Adeyemo/MSH

By Obialunamma Onoh, Zipporah Kpamor, Ugboga Adaji,Benjamin Akinmoyeje, Hope Ohiembor, Irene Amadu, Steven Shadrack, and Tokara Kabati 

HIV & AIDS impacts millions in sub-Saharan Africa, contributing to a steady growth in the population of orphans and vulnerable children (OVC). In 2008, data from Nigeria’s Federal Ministry of Women Affairs showed that 25 percent of Nigerian children were orphans or considered vulnerable due to unmet needs for nutrition, education, shelter, care, or support.

Since it began in 2009, the PEPFAR-funded, USAID project, Community Based Support for OVC in Nigeria (CUBS), has had difficulty obtaining accurate and timely data from health workers providing OVC services in the project-supported states. Reporting efforts have been inhibited by paper-based data collection tools, poor internet access, frequent power failures, and Nigeria’s increasing insecurity and corresponding travel risks. As a result, field data arrives incomplete, late, or not at all, making it difficult for CUBS to measure the impact of its interventions and improve programming. To fill this gap, CUBS’ staff often travels through dangerous areas to collect the missing data and retrain staff on data collection procedures. 

Fortunately, in 2013, CUBS developed an innovative strategy to address these challenges. The strategy uses Dimagi Commcare, a simple, low cost, mobile phone and cloud-based application that facilitates accurate and real-time data reporting. CUBS’ customized Commcare to accommodate the project’s OVC data collection tools and installed it onto smartphones. The team then trained 25 community-based volunteers from Gombe State to use the phones to record data on OVC program enrollment, services rendered, and child health status. Once entered, this data populates a web-based platform that feeds into databases run by CUBS’ implementer, Management Sciences for Health (MSH).  To ensure data quality, CUBS provided the volunteers with regular supportive supervision and hands-on mentoring throughout a two-month pilot period.

At the end of the pilot phase, all of the trained volunteers were using the phones to submit data to the CUBS office and the Gombe State Ministry of Women Affairs, each time they provided a service. In addition to improved timeliness, the volunteers were also submitting more robust data, including details on each child’s health status and the specific services they received. Previously, volunteers had only submitted summary data, but the smartphone system allowed them to enter individual details on over 1,500 children. 

More complete data has allowed CUBS to assess its field interventions on a daily basis to ensure all volunteers are performing as expected and all OVC are receiving the services they need. 

“[With this system], data can truly come in—even from our remote communities,” said the OVC desk officer at Gombe State Ministry of Women Affairs. 

The system’s ability to improve timely, quality data collection has inspired CUBS to explore opportunities to expand the intervention across the 10 remaining project-supported states. To do so, the project team is advocating for support from donors and partners to fund training activities and smartphones for 50 additional volunteers. If funded, CUBS estimates that this intervention will improve data collection and service delivery to over 6,000 OVC within one year. The team also plans to work with the other state ministries of women’s affairs to expand the intervention to OVC programs throughout Nigeria. 

Contributors to this story include: Obialunamma Onoh, CUBS’ Associate Director M&E; Zipporah Kpamor, CUBS’ Project Director;  Ugboga Adaji, CUBS’ Associate Director OVC; Benjamin Akinmoyeje, MSH’s IT Advisor; Hope Ohiembor, MSH’s IT Officer; Irene Amadu, CUBS’ Program Associate; Steven Shadrack, CUBS’ M&E Specialist; and Tokara Kabati CUBS’ Senior Program Officer.