Uganda implements new health system integration technology

In a world of rapidly changing digital technologies, eHealth has become a major enabler for government to deliver quality services to the population using digital information and communication technologies.  

To further this front, UNICEF Uganda in conjunction with IntraHealth International and GoodCitizen have supported the Ministry of Health to deploy a groundbreaking technology that will seamlessly integrate two of the Ministry of Health’s Community Health Information Systems, the RapidPro based FamilyConnect and the iHRIS based Community Health Worker (CHW) Registry. 

The two community health information systems, despite being intrinsically interrelated had been operating as standalone systems causing an unnecessary delay in data transfer and processing that affected the efficiency and effectiveness of service delivery, particularly to women and children in rural areas. 

The groundbreaking innovation known as the mHero Connector makes it possible to automatically synchronise and verify data from the Community Health Worker Registry with FamilyConnect. When the first cases of COVID-19 were confirmed in Uganda in March 2020, an opportunity was also identified for the solution to support SMS communication with all CHWs registered in the Community Health Worker Registry countrywide. The SMS function is expected to facilitate fast and easy communication between the Ministry of Health and the country’s 179,000 CHWs during emergencies such as COVID-19, as well as general support supervision and coordination. 

FamilyConnect is attached to the Ministry of Health’s Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) Sharpened Plan to register and send targeted lifecycle messages via SMS to pregnant mothers, new mothers, heads of household and caregivers about what they need to do to keep babies and mothers safe in the critical first 1,000 days of life. The registration is done either by CHWs or through self-registration where a mother or her partner can register themselves by sending MOM in an SMS to 8900. To ensure the District Local Government has a record and have verified all CHWs who are registering pregnant mothers, the CHWs have to be registered into the CHW Registry, before being enrolled into FamilyConnect. The CHW Registry is a national system developed to support the Ministry of Health and District Local Governments to track, manage, deploy, and map their health workforce where it is needed most in the community. 

The new technology, developed in 2019 facilitates the electronic synchronization between the two Community Health Information Systems, fast-tracks and eliminates redundancies associated with manual extraction of data from one system to the other enabling the Ministry of Health to ensure that the records of CHWs who register pregnant women into FamilyConnect are accurate and up to date.

The technology also allows instant information sharing via SMS between the Ministry of Health and the country’s CHWs (the government’s Village Health Teams as well as the partner supported CHWs – any CHW registered in the CHW Registry) to improve coordination and healthcare delivery at the community level. 

The mHero Connector was built off the SMS-based health communication platform, mHero, which was launched in 2014 by IntraHealth International and UNICEF amid the Ebola crisis in West Africa to help health ministries connect with frontline health workers via SMS messages to collect and share information helpful for a rapid response to Ebola. Funded by Digital Square, the mHero Connector was launched in 2020 to further support the use of mHero by enabling integration between multiple systems, for example RapidPro, DHIS2 and iHRIS. Uganda has now become the first country to implement the mHero Connector to enable an integration between the RapidPro based, FamilyConnect, and the iHRIS based, Community Health Worker Registry.

Uganda is still lagging behind on a number of key Sustainable Development Goals (SDGs) specifically Goal 3 on good health and well-being.  According to the 2019 UNICEF Annual Report, more than 1.2 million children suffered malaria, pneumonia or diarrhoea in at least 28 districts in Uganda classified as “high-burden”. Similarly, mothers – so important to the survival of children – are still being lost to preventable deaths. According to joint UNICEF and World Health Organisation (WHO) child and maternal health estimates for 2020, maternal deaths are nearly 50 times higher for women in sub-Saharan Africa. 

Uganda is the first country in the world to implement the mHero Connector and many other countries are now expressing interest to IntraHealth International as the opportunities for how the mHero Connector can support the COVID-19 response and mitigation are being realised. 

According to Paul Mbaka, the Acting Assistant Commissioner Division of Health Information in the Ministry of Health, the ministry realised the need to use innovative approaches after the 2014 National Housing and Population Census to support evidence-based interventions and fast track Uganda’s journey to attaining universal health coverage. Some of the innovative approaches have been digital technologies that increase quality and coverage of services to women and children. 

“During the FamilyConnect National Review in May 2018, there was strong consensus that the two Community Health Information Systems; FamilyConnect and the CHW Registry be integrated and implemented together to the greatest extent possible. The CHW Registry serves as a critical underlying registry for FamilyConnect which streamlines the registration of CHWs into FamilyConnect,” he explained. 

The integration of FamilyConnect and the CHW Registry would make the new phases of both projects more cost-effective and would reinforce other areas of the health system that the Ministry found worthy of strengthening such as reaching women and children in hard to reach areas. 

Before the two systems were integrated, Alfred Bagenda, the ICT Unit Manager at Ministry of Health explained that data had to be manually extracted from the iHRIS system and uploaded to FamilyConnect on RapidPro using a Microsoft Excel template. The delays caused by this process affected the project implementation and crippled their efficiency. 

Ultimately, the implementation of this interoperability technology, will support the Ministry of Health to deliver on the Health Sector Development Plan 2015/16 – 2019/2020 which strategic plans include; strengthening community health services such as referrals and direct engagement with household heads about antenatal care using the available technology of Short Messages (SMS) and USSD codes.