GAMBIA

Progress to Date in The Gambia

Real-time indicators provided by Smart Paper Technology Solution
Real-time indicators

Provided by Smart Paper Technology Solution

Children Registered*

276467

Children Fully Vaccinated

83557

Children Followed-up with SMS

170705

Currently, 110 health service delivery points* are using Smart Paper Technology Solution

* fixed and outreach sites

In 2016, Ministry of Health and Social Welfare in The Gambia signed a Memorandum of Understanding together with ActionAid International The Gambia and Shifo Foundation to establish a new form of Health Management Information System (HMIS) in The Gambia. The intervention is implementing a novel hybrid paper-digital solution that collects, shares, stores and distributes data for the Expanded Programme for Immunisation (EPI) using Smart Paper Technology. The data is digitised and stored in an electronic register from which HMIS reports are generated and shared at health facility, regional and national level.

The key stakeholders in the implementation project are Ministry of Health and Social Welfare The Gambia (MoHSW), ActionAid International The Gambia (AAITG), The Vaccine Alliance (GAVI), IKARE, Swedish Postcode Foundation (PKS), af Jochnick Foundation (af Jochnick) and Shifo Foundation (Shifo).

An external evaluation of data quality and operating costs of Smart Paper Technology (SPT) in The Gambia was conducted in 2018 when the solution was being used in 4 fixed and 14 outreach health service delivery points in Western Region 1 and Western Region 2. Based on the findings, the external evaluators recommended the scale-up of the solution in the two regions, which was subsequently agreed on by MoHSW, AAITG and Shifo. In July 2018, the scale-up of SPT was commenced in Western Regions 1 and 2 and the solution was scaled up in all health service delivery points.

A further independent evaluation on the scale-up of the solution took place in 2019, and focussed on the themes of: Data quality; Data use; Administrative time efficiency; Total cost of ownership and transition of work processes; Perceptions and experiences.

After successful evaluation results, MOHSW decided to scale-up SPT to other remaining regions, starting from Central River Region.

The Smart Paper Technology (SPT) Solution has been successfully integrated with DHIS2.


The following data use interventions have been integrated across the health care chain:

At the community level, families with children and women of childbearing age receive SMS messages one day before their visit reminding them about their due date to visit the facility.
Health workers receive their key performance indicators and develop strategies to improve coverage, equity and quality of immunisation services in the underperforming areas.
Automatically generated request forms are used by provincial medical stores to deliver vaccines and other supplies to each health facility.
Decision-makers and planners at regional and national levels review the performance of each health facility/area using the integrated dashboard and reports. The insights help decision-makers identify and close the gaps in health service delivery points.
More About Smart Paper Technology Solution
External evaluation results
The data quality assessment, based on WHO's data quality review toolkit, indicated that the data completeness, timeliness, internal and external consistency is 100%; the incidence of recording errors were 2%, and the data accuracy was 98%.
With Smart Paper Technology, the time spent on data administration per child fully vaccinated and receiving the required vitamin A and de-worming services were decreased by 59%.
The cost analysis indicated that Smart Paper Technology Solution cost only USD 364.51 more compared with printing the existing HMIS tools; USD 3,227.42 and USD2,862.91 respectively.
Three themes emerged from caregiver interviews: the usefulness of SMS reminders, the practical benefits of MyChild Solution for caregivers, and caregivers’ wishes related to immunisation activities overall. Themes emerging from stakeholder interviews included the easing of work by MyChild Solution for health workers and their supervisors, the suitability of MyChild Solution for the local context, the desire to scale-up the solution and include more service areas, the improved data quality the solution provides and additional issues for consideration moving forward.

Based on the results of external evaluations, we are working with our partners to scale up the Smart Paper Technology solution.

Resources

Voices from The Gambia
Families with children
Health Workers
Ministry of Health
Snapshots from the Field
By creating a record with a unique ID number for every registered child in a health facility or outreach site, Smart Paper Technology solution provides an accurate population count for every health facility and the region
Because of reduction in paperwork by 60%, health workers like Saikou have more time to provide counselling and care to children and families which is a big gain in the health system and the right thing to do.
Parents receive SMS reminders one day before the due date, to bring their children in time for vaccination sessions. SMS reminders sent automatically to the families is a great way to improve timeliness and coverage to services and all mothers love it!
Shifo team works with front-line health workers using our innovations during care delivery. Observing the care delivery process and listening to families and health workers help us to understand how our solutions are used in the field and what can be improved.
Based on strong leadership and support from The Government of The Gambia and ActionAid International The Gambia, we managed to shift/retire the existing paper forms (big bulky register books, tally sheets and manual reporting forms in the health facilities)
Ownership and support of The Expanded Program for Immunisation is key to bring systems change and sustainability to Smart Paper Technology Initiative in The Gambia
It takes a village to raise a child. It takes a strong partnership to bring systems change and make health systems stronger. We are thankful to ActionAid International The Gambia for their support and conducting regular capacity building sessions at the national, regional and health facility levels.
Almamo Barrow, Program Director at ActionAid International The Gambia awarding a Certificate to Zaid Muhammed Bah, among the first participants who became certified users of Smart Paper Technology.
Leadership Team from the Ministry of Health and Social Welfare of The Gambia and ActionAid International The Gambia learning about Sweden and its culture - the country where Smart Paper Technology originated from

Partners in The Gambia

Coat of arms of The Gambia Ministry of Health & Social Welfare and Regional Health Offices

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