Impact of Extending Health Services to remote populations in Nigeria using Satellite Communication

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Overview - Health systems challenges in Nigeria include chronic infrastructure deficits, difficulty in attracting frontline health workers to work in remote areas, weak and irregular training and deficient data management. These challenges severely affect health care delivery to Nigeria’s population, especially those living in remote areas. However, there is growing international interest in using information and communication technologies (ICTs) to stimulate improvements in health and well-being of marginalized populations and encourage sustainable development.

This project addresses a key development need by extending the reach of basic health care services into remote areas of Nigeria, delivering high quality professional training, data management and disease monitoring into areas which are inaccessible by conventional methods. The project seeks to address the last mile challenge (i.e. logistic and technical challenge of providing care to those hardest to reach), by using Inmarsat’s Broadband Global Area Network (BGAN) satellite communication (SatCom) technology to host communications infrastructure in order to improve health worker access to reliable health information and improve health systems management and governance.

The project will operate at 122 health facilities in three states of Nigeria (Kano and Ondo states and the Federal Capital Territory—FCT), bringing the national standard of health care provision to the most remote communities. 84 of the 122 facilities are in areas without terrestrial network coverage, which without SatCom, will have no alternative means of accessing these e-Health solutions. In addition, SatCom technology will support the piloting of an early warning outbreak recognition system to enable the provision of real time situational awareness data to allow the monitoring of disease outbreaks, their distribution and spread, and enable more effective government responses. Selecting three States from different regions of Nigeria provides an opportunity to examine different contextual factors that can affect the processes of implementation and outcomes of the e-Health interventions while simultaneously accounting for identified contextual variations.

The project forms part of the UK Space Agency’s International Partnership Programme; a £152 million programme which uses the UK Space sector’s research and innovation strengths to deliver a sustainable, economic or societal benefit to undeveloped nations and developing economies.

Aims & Objectives  - The aim of the project is to better understand the extent to which and under what circumstances extending e-Health innovations to remote areas in Nigeria, contributes to improved health systems functions and to achieving health outcomes. The specific objectives are:

  1. To strengthen service delivery and data management through using tablet-optimised video training (VTR) to increase health worker knowledge and skills, and using the CliniPAK data Application to promote efficiency in data management and utilisation.
  2. To improve standards of health care in rural areas by using SatCom to overcome connectivity challenges as a pathway to addressing Sustainable Development Goals 3 (SDG3) i.e. to ensure healthy lives and promote well-being for all ages.
  3. To test feasibility of using an early warning outbreak recognition system to strengthen health system responsiveness to epidemic(s) and future public health crisis. This objective will specifically be implemented in two states only (Ondo and Lagos states).

  4. To promote sustainability of e-Health innovations through enhancing governance and promoting greater stakeholder adoption of innovations and participation in ongoing projects

Methodology - This 2-year project will be implemented by an experienced Nigerian health solutions company, InStrat Global Health Solutions (http://www.instratghs.com/), in close collaboration with the Federal ministry of health (MOH), and State MOH in the FCT and in Ondo and Kano States. The project will promote a sustainable approach based on the use of satellite technology to complement available terrestrial connectivity that allows cost efficiencies to be gained and shared amongst multiple service users and beneficiaries.

Study design - The project adopts an evaluation design that enables: i) process evaluation of satellite connectivity and the video training and CliniPAK interventions being scaled-up in the 3 states; ii) evaluation of the influences of contextual factors (both internal and external) on implementation of the interventions; and iii) impact evaluation of results of the project. 

The evaluation will comprise of three phases (baseline, mid-line and end-line assessments) and makes use of a multi-disciplinary, mixed-methods approach comprising of longitudinal non-randomised, before and after control design comparing intervention facilities with non-intervention facilities to understand the impact of e-Health innovations on frontline health workers, the health systems and health outcomes.

This multi-dimensional evaluation will use different qualitative and quantitative methods of assessment as follows:

  1. Documents review of relevant literature, health policies and contextual factors that may promote or hinder processes of implementation of e-Health innovations in selected states.    
  2. Quantitative assessment of change in health workers understanding of training content (i.e. mother and child health) as well as assessment of changes in health indicators and outcomes.  
  3. An interrupted time series using secondary analysis of quantitative data from the health management information system, and the EXTEND project's M & E performance data to assess the impact of e-Health solutions on standards of health care provision, utilization of reliable/accurate data for health system management and health outcomes for achieving the SDGs.     
  4. Qualitative analysis of opinions and experiences of service users, health staff, facility managers and policy-makers to identify key contextual factors that determine the effectiveness and benefits of e-Health solutions for strengthening workers understanding of MCH, improving health systems functions in Nigeria.

Impact - We will ‘embed’ the project into policy and practice, working with policy actors. Decision-makers at different levels (LGA, State MOH, and Federal MOH) will be continuously engaged during the project in a ‘research-implementation-policy’ partnership, drawing on InStrat’s extensive experience working with the government. As majority of e-Health studies are criticized for being pilot activities that provide little information on effectiveness of e-Health solutions for improving quality and efficiency of health systems functions and/or client outcomes, this project will make a timely and important contribution to addressing this knowledge gap through:

  1. Clarifying how using SatCom to scale up e-Health interventions strengthens health systems and improves standards of healthcare delivery.
  2. Improving understanding of the effectiveness, acceptability and benefits of e-Health solutions for staff training and data management.
  3. Clarifying key contextual determinants of success of e-Health solutions in low and middle income countries.
  4. Providing policymakers with the evidence base for improved decisions for future health systems planning and implementation, including adoption of e-Health solutions at project end

Project Consortium Partners
· Inmarsat Global Limited
· InStrat Global Health Solutions Ltd
· Nuffield Centre for International Health and Development, University of Leeds (NCIHD)

Other International Partners
· Federal Ministry of Health,
· State Health Ministries in Ondo, Kano and the Federal Capital Territory,
· Bayero University Kano, University of Abuja, University of Lagos,
· Private Sector Health Alliance of Nigeria,
· Galaxy One.

Funding Agency: The UK Space Agency through its International Partnership Programme Award

Project Period: February 2017 - February 2019

Further information - For more information please contact any member of the project team directly.

University of Leeds:
Dr Bassey Ebensob.e.ebenso@leeds.ac.uk
Dr Tolib Mirzoev   - t.mirzoev@leeds.ac.uk
Professor James Newell - j.n.newell@leeds.ac.uk
Dr Joseph Hicks - j.p.hicks@leeds.ac.uk
Dr Matthew Allsop  - m.j.allsop@leeds.ac.uk

Inmarsat Global Limited:

Tolga Ors - Tolga.ors@inmarsat.com
James Cemmel - james.cemmel@inmarsat.com
Steven Obaditch - steven.obaditch@inmarsat.com

InStrat Global Health Solutions Ltd:
Okey Okuzu - okey@instratghs.com
Ijeoma Anya - ijeoma@instratghs.com

University of Lagos:
Dr. Babasola Okusanya (Lead researcher) – bokusanya@unilag.edu.ng
Dr. Kehinde Okunade – sokunade@unilag.edu.ng
Dr. David Akeju – dakeju@unilag.edu.ng
Dr.  Adegbenga Ajepe - adegbengaajepe@yahoo.com

University of Abuja:
Dr. Godwin Akaba (Lead researcher) – godwin.akaba@uniabuja.edu.ng
Dr. Osasuyi Dirisu – osasuyidirisu@gmail.com
Dr. Ramsey Yalma – ramsey.yalma@uniabuja.edu.ng

Bayero University, Kano:
Professor Jamilu Tukur (Lead researcher) - tjamil.gynae@buk.edu.ng
Professor Abubakar Isa Sadeeq - abubakari3096@buk.edu.ng
Mrs Amina Adamnu - aminamadamu@yahoo.com

Updated 18.5.2017