Here is a presentation of our current projects in Rwanda, Uganda and Ethiopia, and past projects in Palestine and Bangladesh. We conduct implementations and research in close collaboration with country partners, and together with Master and PhD students.
This project has two focus areas childhood immunization and child growth and nutrition. The team has conducted assessments of the health information systems for the two programs and is currently implementing improvements based on user feedback. We use qualitative and quantitative methods in our research.
What did we find?
- Rwanda’s electronic immunization registry has been introduced throughout primary healthcare. Health workers and other stakeholders suggest several areas of improvement in system design and data use.
- As of 2021, only 1 or 2 immunization indicators were reported from the e-Tracker. Parallel documentation in paper and digital was time-consuming and compromised data quality.
- Nutrition and immunization health workers work together to serve the same clients (children) but they enter data into different unconnected systems. Based on our students’ findings and recommendations, Rwanda is now working on integrating the Nutrition and Immunization DHIS2 Tracker systems into one Child health system which will be prepopulated with their national IDs from a connection to the national CRVS.
Funding and partners: African Development Bank, Rwanda biomedical center, University of Rwanda, University of Bergen
- Thaoussi Uwera, PhD student – University of Bergen (current)
- Enock Rukundo, PhD student – University of Bergen (current)
In this project, we combine implementation research and intervention research to introduce a digital registry for antenatal care in Uganda and support transition from 4 ANC visits to 8 ANC contacts. We are currently implementing the Antenatal Care DHIS2 Tracker in Mukono district, Uganda. Starting with the Digital Adaptation Kit for Antenatal Care released by the WHO as a basis, we have customized content and software for the Ugandan context. Implementation research theories will guide training, user support, roll-out and monitoring of health workers and promote ANC utilization by clients.
We are also working towards strengthening Civil Registration and Vital Statistics in Uganda, with a specific focus on better integration of health systems data with the CRVS. In this implementation research project, we will first map the current birth and death registration systems, co-design strategies for improvement, implement and finally conduct assessments.
- Kiran Bhutada, Medical student – Albert Einstein College of Medicine (current)
- Maureen Atim, PhD student – Makerere University School of Public Health (current)
- Flavia Namagembe, PhD student – Makerere University School of Public Health (current)
- Evelyn Asio, PhD student – Makerere University School of Public Health (current)
- Sandra Nabatanzi, PhD student – Makerere University School of Public Health (current)
- Lucy Singh, Specialist in training obstetrics and gynecology – Kings College (starting 2024)
In this EU-funded project, the ENABLE project, we will establish a program to promote healthy eating habits, increase physical activity, and reduce exposure to pollution within urban communities in Ethiopia. Using evidence-based interventions tailored to local situations, we aim to prevent non-communicable diseases and promote positive behavioral change among pregnant women and their children. The programme will be delivered by health care providers to individuals and community groups in four Ethiopian cities: Addis Ababa, Adama, Harar, and Jimma.
The ENABLE project is an excellent example of how synergy within the fields of public health, health care access and environmental health, supported by digital tools, can be used to improve the health of a population.
Funding and partners: EU Horizon Europe, Ethiopian Public Health Institute, Lunds University, Uppsala University, Wageningen University, Vital Strategies, University of Oslo, Haramaya University, Addis continental entrepreneurs PLC, and Nigerian Institute of Medical Research.
Students: Yet to recruit.
We implemented a DHIS2-based digital health information system for maternal and child health (the MCH eRegistry) in primary healthcare. More than 350 primary healthcare clinics in the West Bank and Gaza Strip were provided with the MCH eRegistry on desktop computers that allowed them to enter client-level data during consultations. We explored several research questions throughout the implementation and conducted a series of cluster-randomized controlled trials, assessing different digital health interventions.
What did we find?
- Data quality and changes: the availability of individual-level clinical data allows for better and more accurate reporting, monitoring indicators and epidemiological analysis.
- Clinical decision support effectiveness: a digital registry with clinical decision support is effective in improving quality of care compared to paper-based systems.
- Developing digital health interventions: theory-driven approaches can be useful to design and implement SMS messaging for pregnant women and quality improvement dashboards for health workers.
- Time saved and workflow changes: a digital registry with automated reporting saves time for the health workers.
- SMS/Quality improvement dashboard effectiveness: SMS and quality improvement dashboards for health workers appeared to have no effect on quality of care but this trial was interrupted by the COVID-19 pandemic and lacked precision.
Funding and partners: European Research Council, The Research Council of Norway, Norwegian Representative Office, University of Oslo (DHIS2), entre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, World Health Organization, Ministry of Health, Palestine, and Palestinian National Institute of Public Health.
- Mahima Venkateswaran, PhD student – University of Bergen, Thesis title: Attributes and consequences of health information systems data for antenatal care: Health status, health system performance and policy
- Binyam Bogale, PhD student – University of Bergen, Thesis title: Digital Targeted Client Communication for Effective Coverage of Antenatal Care: Assessment, Development, and Evaluation
- Marie Hella Lindberg, Master student – University of Oslo, Thesis title: Efficiency of an Electronic Health Information System for Antenatal Care A Pilot Time-Motion Study
We implemented a DHIS2-based digital registry for antenatal care in Matlab North and South sub-districts, Bangladesh. Fifty-nine primary healthcare clinics were included. Health workers at facility-level and community-level were provided with browser-based DHIS2 Tracker and DHIS2 Android App respectively. For the first time, our project attempted to create complete records on pregnant women starting from home pregnancy registration and capturing all antenatal care visits at health facilities. We conducted formative research to design and implement digital health interventions and a cluster-randomized controlled trial to assess effectiveness.
What did we find?
- Coverage of 4 timely antenatal care visits was low at baseline and several sociodemographic factors affected utilization.
- By using theory-driven approaches, digital health interventions such as SMS messaging to pregnant women can be co-designed to be suited for the context.
- An eRegistry with digital health interventions does not improve quality of care or referrals compared to an unshared client record. The intervention appeared to have an effect on perinatal health outcomes, but several implementation challenges preclude definitive conclusions.
Funding and partners: The Research Council of Norway, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), University of Oslo (DHIS2), Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen
- Jesmin Pervin, PhD student – University of Bergen, Thesis title: Targeted client communication to improve timely antenatal care utilization: Assessment, development and evaluation