E-Surv: Sustainable Data Collection Through Community Engagement

E-Surv AEFI Reporting Dashboard

The Government of Ekiti State is working with the Massachusetts Institute of Technology Governance Lab (MIT/GOVLAB) and has developed a community-based reporting system called “E-Surv”. E-Surv enables the participation of community members in public health surveillance by reporting public health events/emergencies, to activate a time-efficient government-led responses. This E-Surv which has been piloted in the State will create an early warning system for disease surveillance and laboratory diagnosis.

Innovation Summary

Innovation Overview

In January 2022, 25 children living in Ekiti State Nigeria presented clinical signs of rashes, conjunctivitis, cough, and fever. During the investigation, five (5) other cases with similar symptoms were discovered, and unfortunately died before the disease was reported. Upon further investigation and laboratory diagnosis, it was discovered that there was an outbreak of measles in the community. In March 2020, the State rolled out a response to the COVID-19 outbreak which included the vaccination of over 1,000,000 eligible persons beginning on March 2021. However, vaccination roll-out was hampered by the inability of the State's teams to adequately monitor for Adverse Effects Following Immunisation (AEFIs) as recommended by the WHO.

From both scenarios, it was apparent that poor surveillance due to the administrative burden of following up on AEFIs and delays between disease exposure and laboratory diagnosis were key drivers of vaccine hesitancy, poor health outcomes, and preventable deaths due to disease outbreaks. This birthed the need for a technology-driven platform for pro-active surveillance of disease occurrence and health events, and for the management of laboratory samples to shorten the turn-around time for disease diagnosis. To address the problem of poor surveillance and delayed laboratory diagnosis, the Government of Ekiti State, working with the Massachusetts Institute of Technology Governance Lab (MIT/GOVLAB) developed a community-based reporting system called “E-Surv”, leveraging human-centred design. E-surv is a web application that consists of a USSD and WhatsApp Chatbot interface for post-vaccination tracking and it also contains a Laboratory Information Management System (LIMS) to monitor diagnosis in the same web application.

The post-vaccination tracking system (PVT) ensures the effective follow-up of persons who have received the COVID-19 vaccine for any side effects by allowing them to dial the USSD code or respond to a WhatsApp Chatbot, and then give answers to periodic screening questions on any possible side effects or allergic reactions. The Laboratory Information Management System (LIMS) allows for effective management of the flow of laboratory samples and associated data to improve lab efficiency and turnaround time while providing accurate controls of the process. The PVT and LIMS are the first phase of a broader plan to fully deploy the technology as a tool that engages members of the community in disease outbreak surveillance not just for COVID-19 but for all other infectious diseases.

The objectives for the E-Surv solution are as follows:

To efficiently follow up on COVID-19 vaccinees by sharing timely screening questionnaires to detect AEFIs using the USSD and WhatsApp Chatbot interface technology.
To increase by 50% the number of persons reporting AEFIs through the E-Surv platform by the end of 2022.
To manage COVID-19 samples, tests, laboratory users, documentation, and creation of a management report via the Laboratory Information Management System.
To improve reporting of disease outbreaks through community involvement.
To reduce preventable illness and death from disease outbreaks.
To reduce the cost of disease surveillance and investigation by the government

This innovation will benefit the people of Ekiti State by enabling easy reporting of disease outbreaks and health events such as AEFIs to the health authorities. It also benefits the government by providing timely information on disease outbreaks, reducing the cost of surveillance, and improving laboratory efficiency leading to shortened diagnosis time. The E-Surv has been piloted among 37,884 persons in the State and lessons learned from this pilot phase will be used to scale the project to the entire State, leveraging the existing State Public Health Emergency Operations Centre (PHEOC) structure.

Innovation Description

What Makes Your Project Innovative?

The E-Surv community-based reporting system is innovative because:

It was conceptualised and designed by the Honourable Commissioner and developed by Civil Servants in Ekiti State using the Governance Innovation Framework that is grounded in human-centred design.
The E-Surv is the first of its kind in Nigeria that attempts to improve government effectiveness and efficiency for disease outbreak response by using technology to expedite laboratory diagnosis while engaging citizens in disease reporting and surveillance.
The USSD code and WhatsApp chatbot used by the E-Surv are simple technologies that are widely available in low-resource settings.

What is the current status of your innovation?

This innovation is already institutionalised as it is domiciled in the Ministry of Health’s Department of Public Health. Its administration is led by the State Epidemiologist who oversees the Public Health Emergency Operations Centre (PHEOC), responsible for coordinating all disease response activities including surveillance, laboratory, monitoring, and evaluation, among other pillars.

A total of 2,059,489 persons are eligible for the COVID-19 vaccination in Ekiti State and 57.1% (1,176,728) of the total eligible persons have been vaccinated so far. As of July 2022, the USSD and WhatsApp chatbots had been piloted among 3.2% (37,884) of the total vaccinated population. Insights and lessons learned from this pilot are currently being gathered and will be used to scale this innovation to the total eligible population by July 2023. The Statewide scale of the E-Surv technology will be backed by adequate communications and awareness campaigns that will drive the utilisation of the technology.

Innovation Development

Collaborations & Partnerships

The State Government of Ekiti partnered with the Massachusetts Institute of Technology Governance Lab (MIT/GOVLAB) and Co-creation Hub (the technical partner) to launch the Governance Innovation Lifecycle Challenge and Accelerator in December 2021. Working under the leadership of the Honourable Commissioner, E-Surv innovation was developed by Civil Servants in the Ekiti State Ministry of Health, who participated in the Governance Innovation Lifecycle Challenge and Accelerator, and were supported by MIT/GOBLAB and Co-creation Hub. The Governance Innovation Lifecycle Challenge and Accelerator partnership was possible because of the strong political will of the State Government to improve health outcomes.

Users, Stakeholders & Beneficiaries

Ekiti people benefit from the E-Surv by reporting health events/emergencies directly to the State health authorities, which triggers a quick response from the government. The government benefits from the E-Surv by collecting information on public health events e.g AEFIs directly from the community while saving costs and time from not having to physically deploy response teams unless required for investigation. The LIMS also allows for efficient management of laboratory samples and data.

Innovation Reflections

Results, Outcomes & Impacts

The E-Surv was introduced in January 2022. As of July 2022, the USSD and WhatsApp chatbots had been piloted among 3.2% (37,884) of the total vaccinated population. Of this pilot group, 2,251 persons responded to the USSD code and 48 persons responded to the WhatsApp chatbot making a total of 2,299 persons (6.1% of the pilot group) who responded. Of this number, 744 persons (32%) reported AEFIs. Using this data, the State surveillance team has been able to provide post-vaccination follow-up to identify severe AEFI cases and refer them to hospitals for observation and treatment. This follow-up is also used as an opportunity to provide correct information on AEFIs, to avoid the spread of false information to persons yet to be vaccinated. This data is recorded in the State surveillance system and will be used to monitor trends in AEFIs for use in research and decision making.

Challenges and Failures

During the E-Surv co-creation phase with MIT/GOVLAB, the State teams encountered challenges in selecting the most suitable user experience for all stakeholders. There were challenges with prioritizing features on the E-Surv platform. Over 35 feedback responses were received from the relevant stakeholders during the prototype testing using the governance innovation criteria, the teams were able to decide on what feedback to integrate. Also, finding a suitable service provider to handle the WhatsApp Chatbot services for easier integration was challenging. The team had difficulty engaging a value-added service (VAS) provider who could meet the project requirements, and this affected the pilot timeline and results.

Conditions for Success

Strong leadership involvement is a key ingredient for driving innovation, especially in the public sector. The Honourable Commissioner for Health led the conceptual thinking and design of the E-Surv. Aligning with him on the project goals and implementation plan throughout the project lifecycle was critical for the success of the pilot. Support from MIT/GOVLAB and Co-creation Hub in facilitating the Governance Innovation Framework with the State Civil Servants was essential to the prototype development and creation of the E-Surv platform. As the project has been piloted and will be scaled in the coming year, working with State and Local Government public health teams to create awareness of the technology among community members and ensuring that the data gathered from the platform is used to improve surveillance, laboratory efficiency and decision-making is critical for success.

Replication

The E-Surv is a novel innovation in Ekiti State. The Governance Innovation Framework from which the E-Surv was developed is the first of its kind in Nigeria. Before the pilot of the E-Surv, the State was only able to monitor and get feedback from 5% of the vaccinated population. However, with the E-Surv, the State will be able to monitor and receive feedback from at least 90% of the vaccinated population when the innovation is fully scaled. The E-Surv has great potential to be replicated in the future as the technology used is simple, available in low resource settings, and reduces the cost of disease surveillance while improving laboratory efficiency. These are benefits that can be utilised by other States in Nigeria as even the Nigeria Centre for Disease Control (NCDC) faces similar issues in surveillance and laboratory effectiveness.

Lessons Learned

Strong political will and leadership involvement is a key ingredient for driving innovation, especially in the public sector. Aligning all plans with the Honourable Commissioner for Health was critical to the success of this pilot. The Governance Innovation Framework approach to problem-solving was new to State Civil Servants, hence, there was a need for MIT/GOVLAB to adapt the training methodology and content based on feedback from the State teams which made learning easier. Working with the partners, the State teams were able to scale down big ideas to lesser, more achievable, and cost-effective solutions that were feasible for low resource settings. For subsequent innovations, an impact-feasibility framework will be useful in achieving this more quickly. Finally, to ensure risks were managed properly without affecting the project, pre-developed risk analysis and mitigation plans were useful in addressing issues that would have delayed the completion and pilot of the E-Surv.

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