E-Heza- Local Ingenuity Driving Global eHealth Solutions

A low-cost, quality-driven digital health record to dramatically improve maternal and child health outcomes, designed for scale throughout East Africa.

Alongside front-line health care workers and the Rwanda Ministry of Health, The Ihangane Project is creating Rwanda’s first point-of-care digital health record. This digital health record, called E-Heza, will dramatically improve maternal and child health outcomes by giving nurses the tools they need to adopt evidence-based clinical care protocols, provide high quality care and utilize real-time data trends to both tailor health education to individual family needs and to improve the health care delivery system while simultaneously satisfying Rwanda Ministry of Health data reporting requirements. E-Heza is designed for replication throughout the continent of Africa.

Existing eHealth solutions are not adequate to support the needs of rural health centers, where most antenatal and childhood care is provided throughout Africa. Current digital health records were designed for simplicity of technology and national data reporting requirements. Our user-centered design approach avoids the traditional barriers to adoption of new eHealth strategies by engaging nurses and mothers in the entire design process to ensure that E-Heza maximizes their ability to interact and simplifies national data reporting requirements. E-Heza builds upon nurses' existing workflows, provides real-time individualized data trends to tailor health education, and supports the data requirements of national governments. Nurses can enter individual data and track both individual and family health trends over time. Users can shift between individual and group health assessments depending upon the work flow of the health facility. E-Heza makes complicated z-score calculations used by nurses to diagnose malnutrition. A mother can track her family's health status through periodic 'health reports' that include photographs of her child over time that can be printed and taken home.

Progressive web application technology addresses internet latency by allowing storage of data on individual electronic devices until the internet is available. Once internet is available, the application will connect directly to the Rwanda Ministry of Health’s District Health Information System 2 (DHIS2) reporting platform. The system will minimize delays, remove redundancy, and improve quality and efficiency of reporting. Data will be accessible from any device, thus laying the foundation for a robust national health record that provides facility-independent access to individual health information.

The concept of E-Heza emerged from The Ihangane Project and Rwanda Ministry of Health's desire to sustain and replicate our successful quality improvement program initially created to improve the quality of care for HIV-positive pregnant women and their children. Quality of care improved by 120% in three years, leading to elimination of mother-to-child HIV transmission and a 60% drop in new cases of malnutrition. Nurses and mothers became actively engaged in collecting, analyzing and responding to health data. Nurses are now empowered with skills to improve their systems of care and mothers are inspired to adopt and sustain healthy behaviors.

The Ihangane Project is working with the Rwanda Ministry of Health to scale our locally-developed digital health record throughout Rwanda. The East Africa Health Research Commission, facilitator of the East Africa Digital REACH Initiative, considers E-Heza to be an essential tool for rural health centers throughout East Africa.  

Designing eHealth solutions alongside frontline healthcare workers ensures effective and efficient utilization by the end-user. We begin by assessing the needs of healthcare workers and community members while ensuring relevance to the larger health system. E-Heza is standardized to reflect data national requirements and is relevant to any country who has adopted World Health Organization guidelines as their protocols. E-Heza links to DHIS2, a data-reporting platform used by over 60 countries. The result is an innovative digital health record that strengthens healthcare workers’ ability to provide high quality healthcare, delivers essential information to national governments, and supports global scale.

E-Heza Digital Health Record will revolutionize the way in which eHealth solutions are developed and implemented around the globe. The Ihangane Project and frontline healthcare workers created E-Heza because no existing digital health records were designed to support nurse workflows at rural health centers or for nurses to utilize real-time data trends to tailor health education to their patients’ needs. E-Heza utilizes technology to improve the quality and efficiency of care at the local level, while promoting the adoption of national health protocols, compliance with national reporting requirements and achievement of lasting improvements in health outcomes.

The Rwanda Ministry of Health recognizes the importance of a digital health record designed by and for health care workers that also satisfies Ministry of Health needs, and has requested expansion of E-Heza to health centers across Rwanda by mid-2020. Over the next nine months, our team will expand E-Heza from nine health centers to all twenty-one health centers in Gakenke District, link the database to DHIS2, and refine our implementation strategy based upon our experience with the initial 21 health centers. We will deploy fifteen implementation teams and work with local partners to expand E-Heza throughout Rwanda by mid-2019.

Over the next five years, E-Heza will expand to support high quality maternal and child healthcare throughout East Africa and beyond. Because our software is designed to support national protocols based upon World Health Organization guidelines, it can be shared with minimal adjustment to other national health programs. We will add modules to improve care of other conditions in rural health centers, such as diabetes, heart disease, HIV and Tuberculosis. Our vision is for E-Heza to serve as the primary care digital health record utilized in rural health centers serving millions of people across Africa.

E-Heza digital health record customers include national governments, government consortiums, and non-governmental organizations, while E-Heza beneficiaries include healthcare workers and mothers.

To support customer needs, E-Heza supports interoperability and has the capacity to interact with other data reporting systems such as DHIS2 and OpenMRS. To respond to beneficiary needs, E-Heza is designed to support work flows common in many resource-limited settings and has the flexibility to be adapted to new contexts. Our implementation strategy is user-centered, and our experience in Rwanda will inform our ability to scale at national levels while maintaining our focus on healthcare worker needs.

E-Heza is being piloted in nine health centers in Gakenke District and will be refined based upon user feedback. During the pilot period, developers are continuing to add functions and work with the Ministry of Health to connect our database to their data reporting system. By the end of 2018, E-Heza will be expanded to 21 health centers, serve the entire spectrum of antenatal and early childhood care, and link to DHIS2. This will improve the quality of care provided to 12,000 mothers and children. We will refine our implementation strategy based upon our experience with our initial roll-out.

Expansion of E-Heza throughout Rwanda will begin mid-2019. This will allow us to improve the quality of care to 480,000 mothers and babies in 2020. We aim to increase the quality of care provided to mothers and children by at least 50% one year after E-Heza implementation, leading  to significant improvements in maternal and child morbidity and mortality. During this time, The Ihangane Project will work closely with the East African Health Research Commission to prepare for the expansion of E-Heza throughout their member countries, thus improving the quality of care to over 6.8 million mothers and children by 2023. 

Our team is comprised of a diverse and complementary group of experts in clinical care, public health, health informatics, and human-centered design that provides expert viewpoints from a wide array of fields. Our Rwandan leadership has expertise in rural health needs and national health requirements, while our Executive Director’s extensive experience as an end-user of electronic health records in the United States allows our team to draw upon the successes and failures of US-based digital health records. The Ihangane Project works closely with the Rwanda Ministry of Health to guide or national scale strategy.

E-Heza digital health record will be made available through an Open Source software platform, and this source code is being requested by non-government organizations and eHealth leaders. The Ihangane Project, Rwanda Ministry of Health and expert-user nurses from Ruli, Rwanda will continue to maintain the software and implementation strategies. Our team will be well positioned to generate revenue to sustain our work through the provision of code support and support contracts, implementation and design expertise, and creation of new modules and integrations for clients.

The Ihangane Project achieves lasting improvements in health outcomes by promoting local innovation within national health systems. E-Heza digital health record is being sought after at a pace that we had not anticipated, largely because of our ability to integrate the needs of frontline healthcare workers with the expectations of national governments. We are applying to Solve because we would greatly benefit from assistance with our scale and revenue models, as well as our ability to validate the impact we are achieving.  This partnership would also further our goal of becoming a thought leader in health system design. 

E-Heza digital health record is being requested throughout Africa because it serves a critical role in providing effective and efficient care at the level of rural health centers where most primary care is provided. The Ihangane Project must accelerate the pace at which we establish a strong business model, implementation strategy, and impact assessment. Although we have experience in these areas, The Ihangane Project has not previously had the opportunity to work at such a large scale and at such a rapid pace. A Solve partnership would provide essential guidance as we establish these components of our work.