1. Thierry Agagliate – 16 May 2017 - Hyderabad

2. 1 out of 10 children in Burkina Faso does not reach age 5…
…mostly because of curable diseases
(malaria, diarrhea, pneumonia, etc.)
Why?
Social déterminants (health seeking, nutrition, health education etc)
Low quality of care in PHC Only 40 % of children visiting a PHC are properly diagnosed!

3. Integrated e-Diagnostic Approach
is a strategy to
improve quality of healthcare at scale, using technology,
Quality Improvement
and data for decision making
How does is work?

4. What has IeDA
achieved to date?

5. IeDA Preliminary Results (April 2017)
80% of clinical consultation follow WHO IMCI standard
Significant improvement in accuracy of diagnosis and treatment for children under 5*
Reduced over-prescription
Implemented at scale
(*) RCT, London School of Hygiene and Tropical Medicine (LSHTM), results to be published by end 2017

6. IeDA scale
April 2017
272
1800+
Primary healthcare facilities use IeDA
HealthCare Workers (HCW) have used the REC
900,000+
Consultations recorded since December 2014

7. Primary healthcare facilities equiped
Early 2018
Consultations
every month
120,000+
Primary healthcare facilities equiped
600
3400+
HealthCare Workers
1 million
Children

8. IeDA strategy

9. E-Diagnostic: REC Powered by CommCare (Dimagi)
Human errors in: - evaluating,
- classifiying,
- prescribing,
- reporting
- Patient record - Diagnostic algorithm - Automated prescription - Typing errors detection - Pedagogic aids - Automatic reports

10. Data Management - No data analytic culture
- Health information system built on paper registries & hand made reports
- Fist hand data by REC & COACH, synchronized & compiled
- Quarterly dashboards - Indicators selected with district teams and MoH
- Identification of individual outliers (clinics & health workers)

11. Quality Improvement and Coaching
- Too many clinics, too far, to supervise properly - Cost of the supervision - No qualitative tools & data to measure individual and team performance
- Change Package (QI) - Coach App to collect qualitative data - Coaching sessions in the clinic, to discuss challenges and solutions - Quarterly sessions at the district discuss data and plan

12. Learning strategy
- Inadequate pedagogy - Costly training habits - Lack of motivation to learn «for free»
- Shorter initial training - Short e-learning modules - Focus on most frequent mistakes - Stories & Visuals - Quiz - Performance board

13. Buy-in by Health Workers Parents want their child «in the machine»!
I feel supported, it helps me feel safer when I prescribe
It’s a cool tool, easy to use!
It’s give me prestige and credibility
My performance is visible, it’s rewarding!
I can’t prescribe freely any-more!!!
It takes time, too much work! !
This is more control on my day to day work
Central Leadership
Data for decision
Informed Management
Peer-to peer learning
Transparency of data : accountability
Emulation between units QI
Coaching
e-learning
User center design App’s
Parents want their child «in the machine»!
community / medias

14. Buy-in by MoH IeDA is implemented jointly with the MoH
MoH support IeDA’s scale-up and channel funds
Currently working to use IeDA as a component of the Information System for the Universal Healthcare system in Burkina Faso & the P4P incentive scheme
IeDA connected to DHIS2 to improve data availability at national level

15. Most important Remaining challenges
IMCI protocol limitations
Toward a new version of IMCI (WHO)
Technological limitations
Collaboration with Dimagi on platform evolution
Cost of the coaching & and qualitative supervision
Introduction of Artificial Intelligence for fast feedback?
Absence of data management culture at the MoH
Creating “addiction” to data by making data more accessible?

16. Who is behind IeDA?

17. Stakeholders and Roles
Implementing team
Sponsors

18. IeDA Implementing Team
IeDA in Burkina Faso
IeDA at HQ
Team:
Project Manager
Field Coordinator
ICT Coordinator
IMCI expert
M&E specialist
9 Field Managers
Support from
Innovation Accelerator
Health Department

19. Where is IeDA heading to?

20. Next steps Integrate additional medical protocols
(peri-natal, immunisation, nutrition)
Full national scale-up in Burkina Faso
Deploy IeDA in news West-African countries through new partnerships (WV, ICRC, ACF, SCF etc)
Deploy IeDA to humanitarian contexts with ICRC and the Global Humanitarian Lab

21. IeDA in a nutshell… IeDA added value: Increase quality of care
Improved data management at all levels of the health system
System ready for scale up
Huge untapped potential:
National healthcare systems
Vertical programs
Humanitarian interventions
Expansion in West Africa:
In search for operational partners and sponsors

22. Thanks for your attention!
Thierry Agagliate