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On the frontlines of public health, the cliché that “it takes a village” often rings true. Doctors and nurses must coordinate with hospitals and government bureaucracies—supported by nongovernmental and international organizations—all in service of patients in need of effective, accessible care. For Solver E-Heza, each of those participants has played a critical role in building and scaling their electronic health record system in Rwanda.
E-Heza is a simple tablet-based reporting app that makes it easy for nurses to report accurate, meaningful data—and the Rwandan Ministry of Health was so impressed that they asked how they could leverage the app to make the government’s systems work in a similarly user-friendly way.
“That was the ‘a-ha!’ moment,” recalls Dr. Wendy Leonard, Executive Director of the Ihangane Project, which created E-Heza. “It was a chance to create a national system that worked for everyone, not just our specific needs.”
Today, E-Heza offers Rwanda’s first point-of-care electronic health record focused on family care, integrated with both hospital systems and the national government’s District Health Information System 2 (DHIS2) reporting platform.
User-centered design ensures providers can easily input and track metrics, while patients can understand the realities of their health and the impact of the care they receive. Critically, algorithms allow nurses to help diagnose certain conditions, track families’ health statuses, and make recommendations in real time.
The system is effective and popular with users. Already, nurses in Rwanda using E-Heza successfully fulfill 91 percent of patient screening requirements, a 50 percent improvement from before. On the very first day of one pilot, Leonard says, “the data manager came up to us, handed the tablet back, and said, ‘This is so easy, I don’t need your help anymore.’ And that’s our whole intention!”
But scale remains a challenge. E-Heza may be integrating into the Rwandan healthcare system, but national and frontline challenges vary by country—as does existing software. Duplicative efforts and uncoordinated systems abound.
Enter the Solve community. After E-Heza was selected for the 2018 Frontlines of Health Challenge, their team of just ten people discovered opportunities to rethink how to present their work and connect with new and impactful innovators.
“It was a chance to talk and share our work with people who wouldn’t otherwise know about us,” Leonard recalls. “The thing I can’t emphasize enough is the value [Solve] brings in connecting people on the ground to people that can move their ideas forward…We’re a tiny organization, and now we’re getting attention and interest from really high-level organizations.”
Chief among E-Heza’s new fans was the Global Fund. Dr. Marijke Wijnroks, its chief of staff and a member of Solve’s Frontlines of Health Leadership Group, approached Leonard shortly after E-Heza’s selection was announced. “She said she had been looking for me and really wanted to talk. I just thought, you must have the wrong Wendy!” Leonard explains with a chuckle.
“I was so pleasantly surprised to learn she was actually interested in E-Heza—she could really see that there was value in thinking about the end user, [and that] was the moment we realized, wow, this is something unique that we’re doing. Something that’s needed at a much wider scale.”
Wijnroks and the Global Fund’s Chief Information Officer Michael Johnson soon traveled to E-Heza’s headquarters in Ruli, Rwanda to see E-Heza in action—and, says Leonard, “They fell in love.” Johnson now provides technical assistance to the project as the E-Heza system is integrated into Rwanda’s national Health Management Information System (HMIS).
In addition to the Global Fund’s support on the frontlines, Wijnroks, Johnson, and their team have connected E-Heza with additional partners, including the World Health Organization and Save the Children. With support from these new relationships, E-Heza is poised to scale upward and outward—both to new countries and new areas of service. By the end of 2019, E-Heza will have impacted 250,000 lives across sub-Saharan Africa and counting.
Leonard says the Ihangane Project’s nurse partners came up with the name “E-Heza” as a play on the solution’s digital nature. But in Kinyarwanda, the term also loosely translates to “a bright future”—in other words, exactly what the E-Heza team is creating.
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Group photo with clinical staff at Coko Health Center. Image courtesy of the Global Fund.