E-Heza Data Solutions

E-Heza Data Solutions is the first point-of-care digital tool designed alongside frontline health workers to optimize high quality care for families across the entire spectrum of primary care from villages to health centers and hospitals while building community trust and utilizing collected clinical information to identify emerging outbreaks. 

The Covid-19 pandemic intensified preexisting global inequities and health system failures. 176 million people have been infected by Covid-19 and 3.8 million people have died. Disruption of routine primary care services has led to decreased engagement in antenatal care and childhood immunizations, skyrocketing rates of childhood undernutrition, and delayed diagnosis and treatment of other infectious diseases like malaria.

E-Heza has a proven track record of improving the quality and efficiency of primary care, supporting continuation of care during health crises, and providing early warning about emerging outbreaks. E-Heza will transform primary health care and establish strong, resilient health systems around the globe. 

The Covid-19 pandemic revealed and intensified deep preexisting global inequities and health system failures. Nearly 175 million people have been infected by Covid-19 and over 3.73 million people have died. Disruption of routine primary care services have led to decreased engagement in antenatal care and childhood immunizations, skyrocketing rates of childhood undernutrition, and delayed diagnosis and treatment of other infectious diseases like malaria. In one study that evaluated  India, Pakistan, Nigeria and South Africa, maternal and newborn mortality was estimated to increase by 31% due to fractured health systems caused by the pandemic- translating to 766,180 additional maternal and newborn deaths in these four countries (Health Policy Plus. July 2020). Medical distrust further complicated the pandemic response by delaying community uptake of prevention measures.

Frontline health workers are critical to establishing resilient health systems because of their access to real-time information regarding emerging trends, their understanding of existing and evolving barriers to engagement in care and the trust that they have established within their communities. Current digital tools fail to effectively support meaningful and reliable information flow because they are not designed to incentivize data quality, ease workloads, improve the quality and efficiency of care or build trust within communities.

E-Heza Data Solutions is the first point-of-care digital tool designed alongside frontline health workers to optimize high quality care for families across the entire spectrum of primary care from villages to health centers and hospitals while building community trust and utilizing collected clinical information to track key indicators and identify emerging outbreaks. 

E-Heza incentivizes data quality by utilizing data trends to provide personalized care, improve engagement in care, celebrate successes and identify emerging challenges; all while preventing health worker burnout by decreasing workloads, supporting workflows and maximizing opportunities for meaningful interactions with patients. 

E-Heza's modular design supports adaptation to evolving needs. During the pandemic, for example, new functionality allows health workers to screen, isolate and refer patients with Covid-19 risk factors prior to initiating routine primary care. This strengthened health workers' confidence to resume routine primary care, and communities can quickly identify increasing numbers of Covid-19 suspects. 

E-Heza's dashboards are filterable to provide national, district, health center, and village level insights that highlight progress towards key indicators like malnutrition, malaria, and high-risk pregnancies, as well as emerging trends like unexplained fever or diarrhea. National governments have access to real-time actionable information to identify emerging outbreaks and to drive decisions. 

E-Heza Data Solutions improves health outcomes in Low and Middle Income Countries (LMICs)  by prioritizing the needs of frontline health workers and the families they serve as the starting point for effective and resilient local and national primary health care systems. Health workers need to be able to prioritize direct patient care while protecting themselves and building trust among their patients, and families need positive reinforcement that investing in their health now will lead to a positive future outcome. Local leaders need to identify emerging health challenges in their communities before they become crises.

Frontline Health Workers:

Frontline health workers- nurses and midwives in health centers and community health workers in villages- are trusted community leaders who provide critical primary care services that keep our families healthy and serve as our first line of defense against emerging outbreaks. Unfortunately, according to the World Health Organization (WHO), as much as 40% of a frontline health worker’s time in East Africa is spent on data reporting rather than direct patient care- increasing their workloads, decreasing their ability to engage and retain patients in care, and diminishing their ability to gain the trust of their communities. Additionally, frontline health workers often feel the pressure of choosing between protecting themselves against exposure to a deadly infection or providing much needed health services to their communities. This working environment places frontline health workers at high risk of burnout. In fact, burnout rates among frontline health workers are as high as 70% in Sub Saharan African countries. Burnout is well documented to negatively impact the quality of care frontline health workers provide to their communities.

E-Heza frees frontline health workers to focus on direct patient care by integrating critical tasks into care workflows, automating time-consuming calculations, providing clinical decision support, optimizing opportunities for positive interactions between frontline health workers and families, and utilizing dashboards to track the health of communities.

Families

Women are primarily responsible for the health of their families, and are most likely to engage in primary health care for themselves and their family members. Women engage in antenatal care to promote a healthy pregnancy and childbirth, bring children for nutritional assessments and immunizations, maintain healthy birth spacing through family planning, advocate for adoption of health recommendations for families, and encourage health care visits when family members are ill. Women living in financial poverty, especially in settings where men control the family’s finances, struggle to balance immediate needs with investing in the adoption of new health recommendations.

E-Heza provides women with personalized information about their health and the health of their families, celebrates their health successes, and alerts them to early signs of declining health status. E-Heza utilizes current and historical individual data to visualize data trends that engage mothers in care, provide early evidence of challenges such as declining growth trends, and opportunities for early interventions to prevent further complications. This builds trust, decreases stigma, increases motivation to invest in the future, provides evidence to convince family members of the importance of this investment, and improves health outcomes.

Communities

E-Heza integrates the most common primary care services for families provided at both the village and health facility levels, provides decision matrices for easy diagnosis, treatment, or referral if needed, and enables community health worker (CHW) case management to support ongoing care. By optimizing the roles of frontline health workers at each level of care and streamlining information flow between these levels, E-Heza improves the entire ecosystem of care in communities.

While local health systems are expected to report data to the national government, community leaders are often unable to utilize this data for local needs.  E-Heza gives community leaders the opportunity to visualize the health of their communities in real-time and to act upon information that they receive in real-time. Because E-Heza simplifies data reporting and integrates into any national data reporting system, national health systems have the information they need to better serve their entire population.

Health security and pandemic prevention must prevent pandemics while ensuring ongoing primary care when health crises occur. Frontline health workers are our first line of defense against outbreaks and our most critical resource for effective primary care delivery. E-Heza allows health workers to evaluate and treat the most common conditions in primary care while tracking outbreaks of known diseases and emergence of new clinical findings in real-time to facilitate rapid responses at the local and national level. Prioritizing high quality individual care as the pathway to establishing successful public health measures ensures effective, efficient, inclusive and trusted public health responses.

E-Heza's ease of use and effective training  strategy supports rapid expansion of E-Heza into new communities. In 2020, despite the pandemic, E-Heza expanded from 11,000 unique patients in nine health centers to over 50,000 in 23 health centers. This was accomplished while increasing E-Heza's functionality four-fold to ensure a shelf-ready product that is prepared for rapid expansion. E-Heza Data Solutions currently serves the full ecosystem of primary care that includes villages supported by CHWs and both health posts and health centers served by nurses and midwives. E-Heza has now been implemented in 33 health facilities and 41 villages in 3 district hospital catchment areas in Rwanda.  By the end of 2021, E-Heza will be implemented in 46 health facilities and 190 villages in five district hospital catchment areas in three provinces of Rwanda. E-Heza will serve 100,000 unique patients in 2021 and 250,000 by the end of 2022.

E-Heza Data Solutions recognizes the critical role that data plays in establishing effective and resilient health systems. National governments must have access to timely and high quality data for effective decision-making and to rapidly respond to emerging threats. This is only possible if the tool being used by frontline health workers incentivizes- rather than discourages- quality data collection. E-Heza's design process begins by working closely with frontline health workers to understand their motivations and barriers to providing high quality care, and then ensuring alignment of our design with the expectations and goals of national governments.

E-Heza is designed to ease health workers’ workloads, improve their interactions with patients, and provide real-time data trends that facilitate individualized health education that motivates patients to engage in ongoing care. E-Heza promotes adherence to clinical care guidelines for the identification and treatment of the most common infectious diseases in Sub Saharan Africa (ie. malaria, gastroenteritis, and pneumonia), as well as antenatal care, family planning, childhood growth and development, and immunizations. E-Heza’s decision-support is based upon collected data from a combination of individual symptom reviews, clinical findings, and laboratory tests such as the rapid diagnostic test for malaria. Accurate data collection at the point-of-care is incentivized because it is utilized for diagnosis, treatment and health education. 

E-Heza will revolutionize health security and pandemic prevention by utilizing real-time high-quality individual data collected at the point-of-care to provide critical information to identify emerging infectious disease outbreaks, make rapid data-informed decisions, and preserve ongoing primary health care functions.

E-Heza has 50,000 patients registered, serving a combined catchment area of 400,000 people in two districts in Rwanda. By the end of 2021, E-Heza will serve 100,000 people in a combined catchment area of 600,000 people in five districts. By the end of 2022, E-Heza will have 250,000 registered patients in Rwanda and at least one additional East African country. By 2026, E-Heza will serve as the premier primary health care platform for 2 million patients by 2026.

The patients registered on E-Heza will be directly impacted through the quality of care they receive and personalized health education that drives engagement in care and leads to improved health outcomes.

Primary care is an approach to individual care that emphasizes prevention, early diagnosis, early intervention, and continuity care. E-Heza utilizes individual-level data to inform community health to create a new 'primary care for communities' approach that provides insights into key health indicators such as maternal and child wellbeing while also providing an early warning system for acute challenges. This allows communities to identify outbreaks or other challenges quickly, establish an appropriate response, and quickly evaluate the impact of this response on the emerging challenge. 

Quality of Care

Our 5 Pillars of Quality Care Observational Check List (OCL) provides an objective assessment of clinical skills, mother-centeredness, health education, data management and logistics. The quality of care at each facility will be evaluated at baseline and at least every six months for the first eighteen months after implementation.

Efficiency of Care

E-Heza utilizes a framework to analyze the lead time for data to move from the point of care to the Ministry of Health and to identify the cost associated with data reporting- including revenue lost, and to evaluate the quality of data being reported. This is conducted at baseline and then twelve months after implementation of E-Heza within a subset of health centers in each new catchment area. 

Adoption of Health Recommendations

This measured in terms of the number of pregnant women who receive at least four antenatal visits during their pregnancies and the number of women choosing modern family planning methods. Dashboards allow for easy analysis.

Health Outcomes

The following health outcome indicators are evaluated: incidence and prevalence of stunting and underweight for children under five, prevalence of maternal anemia, incidence of severe maternal hemorrhage, uncomplicated malaria treated in the community prior to development of complications, and maternal mortality.

Outbreak Identification

Dashboards are designed to provide alerts when indicators such as fever of unknown origin, malaria, and malnutrition increases 20% beyond the previous month. We will track the frequency of these triggers and the speed at which these alerts are addressed.

E-Heza has fourteen full-time staff members. This includes our Chief Technology Officer, Director of E-Heza, Software Developer, User-Experience Designer, Director of Implementation and six Implementation support staff, E-Heza's Project Manager, IT Troubleshooter, and Director of Clinical Quality. An operational strategy advisor provides 20% FTE through Johnson & Johnson's secondment program.

E-Heza Data Solutions' team embodies a truly unique and comprehensive cross-section of expertise in digital health, frontline healthcare delivery, social enterprise and supply chain in East Africa. 

Design for Frontline Health Workers

The E-Heza team is comprised of Rwandan and United States-based physicians, nurses, and user-experience designers who bring a wealth of knowledge regarding clinical care and hands-on experience with using of digital tools in healthcare settings.  Our design model includes engagement of frontline health workers throughout the design process.  The end result is a product that is “pre-vetted” and that has significant buy in from community stakeholders. 

Software Development

Gizra Internet Solutions has provided software development serves since E-Heza's inception. This dedicated team of developers, project managers and data science experts are deeply committed to E-Heza and provide critical mentorship to our Rwanda-based software developer and project management team.

Implementation

E-Heza's implementation team has established a streamlined, standardized implementation process that includes a week-long interactive training that is followed by one-on-one support until users score at least 95% on proficiency scores. The team refines the process after each implementation based upon feedback from our implementation partners.

E-Heza is a member of the WHO Health Workforce Readiness for Digital Health working group. Team members contributed critical guidance to the WHO policy brief Digital education for building health workforce capacity.

Our approach to gender equity is deeply intertwined with the design and implementation strategies of E-Heza. Metrics used to track the effectiveness of E-Heza are disaggregated by gender and socioeconomic status. The Herth Hope Index is tracked for both frontline health workers and those who engage in care with E-Heza. E-Heza is used to track engagement in care among pregnant women, as well as nutrition status for children disaggregated by socioeconomic status and primary care giver (father, mother, grandparent, sibling).

In 2020, our team conducted an in-depth analysis of gender inequities facing both healthcare recipients and healthcare providers to determine the critical gender-related issues most relevant to E-Heza Data Solutions. We laid out four clear priorities and an actionable implementation plan to achieve improvements toward gender equality.

1. Build a women’s confidence to educate family members about health needs
2. Prevent burnout among female frontline health workers
3. Inform the global health community on the additional responsibilities that primary health care systems place on women
4. Advocate for female representation at all policymaking levels of global health

A detailed workplan with associated timeline has been established for each of our four priority areas to ensure that we achieve our goals of gender equality. In 2021, our team will undergo a similar process to establish a meaningful Diversity, Equity, and Inclusion Strategy for E-Heza Data Solutions.

E-Heza has significantly expanded in both function and reach over the past three years. MIT Solve offers access to critical networks- financial, technical, and implementation partnerships- that will support our next phase of growth.

E-Heza has tremendous potential for global impact.  A partnership with MIT Solve will provide access to critical global networks required to build out our implementation partnerships, build brand recognition, and strengthen our financial sustainability.

In East Africa, 50,000 women die every year from complications of pregnancy and childbirth. Yet, less than 55% of women receive the 4 antenatal care visits recommended by the World Health Organization in East Africa and this decreases to 39% in Rwanda. The frontline health workers expected to provide high quality care and encourage return antenatal visits are suffering from burnout rates as high as 80%. Seventy percent of these frontline health workers are women. 

TIP Global Health developed E-Heza Data Solutions to ease the workloads of frontline health workers, engage mothers in care, and improve health outcomes for mothers and children. E-Heza allows health workers to collect clinical data at the point-of-care in a way that supports their typical workflows and simplifies data reporting. E-Heza utilizes data trends to provide personalized health education and positive reinforcement to pregnant women and mothers. This enables mothers to be active participants in the health care decisions of their family, engage fathers in their children’s health, and advocate for healthy choices that benefit all children in their communities.

While 70% of frontline health workers are women, only 25% of health leadership roles are held by women. E-Heza contributes to resilient health workers, informed women, and improved health.  E-Heza will serve 250,000 mothers and children in hard-to-reach communities by 2022. E-Heza elevates the voice and expertise of women at the frontlines of healthcare, demonstrating that local innovation led by women is both scalable and essential for effective primary healthcare delivery.

E-Heza utilizes real-time high-quality individual data collected at the point-of-care to provide critical information to identify emerging infectious disease outbreaks, make rapid data-informed decisions, and preserve ongoing primary health care functions. The individual data is utilized to provide clinical decision support in a way that supports experiential learning, to offer personalized health education to patients through the use of meaningful data trends, and to generate dashboards that give critical insights into the health of communities. E-Heza allows essential data points to be calculated one time and utilized in a multitude of ways- reversing the current setting in which frontline health workers are expected to report the same data into multiple different systems. 

E-Heza is designed to ease workloads and support workflows for frontline health workers- including community health workers (CHWs), nurses, midwives, and physicians- by integrating all activities that occur at the point-of-care in villages and health facilities.  This includes rapid diagnostic testing for malaria and HIV, as well as medication, mosquito bed net, and immunization distribution. Currently, we are able to manage malaria RDT test kits for CHWs by taking a photograph of the lot number each test kit as it is being used. We are able to track the number of kits each CHW has been given, the number of kits that she has remaining, and when she will need additional kits. Additional alerts occur through our dashboards. When a community experiences a decrease in cases of malaria or an increase in cases of 'fever of unknown origin' of more than 20% from the previous month, the CHWs and health centers receive an alert that highlights the concern. This prompts further investigation regarding stock outs.