Amref takes a digital leap forward with GSK and Cognizant
The COVID-19 pandemic further exposed the challenges to healthcare in sub-Saharan Africa. Amref Health Africa was already digitally astute, but now its capabilities have leapt ahead thanks to the combined support of GSK and Cognizant.
Amref Health Africa has been working for more than 60 years to advance access to quality healthcare in sub-Saharan Africa. They partner with communities in 35 countries to sustainably strengthen health systems and improve access to vital care and services. This work is at all levels; from the grassroots with communities on the ground to influencing policy at the highest levels of national government and in global policy spaces. They enrol and train thousands of community health workers, establish health facilities, deliver treatment, direct investment in health infrastructure, and engage with health ministries throughout the region to drive progress.
The outbreak of the COVID-19 pandemic, however, exposed the scale of the task they continue to face.
“The pandemic reminded us of the challenges that were already existing,” says Amref’s Diana Mukami from the organisation’s headquarters in Nairobi, Kenya. “One of them is in terms of access – whether that’s basic awareness of healthy living, affordability, facilities and infrastructure, or to health workers delivering good services.”
A perennial challenge facing health systems in the region has always concerned its healthcare workforce, a fact exacerbated by the coronavirus pandemic. Mukami says that most nations within Amref’s reach fall a long way short of the World Health Organisation’s minimum recommended ratio of health workers to population size.
“How do you get the right number of health workers, even with a growing population in Africa? We have about 1.4 billion people currently, and that’s projected to double in the next couple of decades. So how do you actually make sure that you have enough health workers and how do you make sure that they have the right education and training? How are you going to determine what the right education and training is?” she adds.
“And then there’s the management. You have hundreds of thousands of healthcare workers in a country – how do you measure what they are doing and if they are deployed in the right place?”
As Digital Learning Director, Mukami has witnessed a transformation over the last 10-15 years in Amref’s ability to leverage rapidly expanding mobile connectivity in the region. Amref has achieved notable success with three digital platforms that together have helped them overcome issues of a lack of physical training facilities. Jibu (meaning ‘answer’ in Swahili) is a training service delivered to smartphones. Leap is another, but geared towards the lower-end devices commonly used throughout the region; it uses SMS and interactive voice recordings. Finally, M-Jali is a data collection tool health workers use on the ground can use to patch information such as referrals into government Health Information Systems.
But as the COVID-19 pandemic took hold in 2020, Amref began to understand a vital weakness in its digital capabilities: none of its tools talked to each other. Essential data concerning the substance, quality and distribution of its training services was not integrated with healthcare data collected within the communities it served. As the outbreak stretched resources further, gaps in their knowledge became a pressing concern as they sought to target and measure the effectiveness of their activities and flatten the curve of the disease’s spread.
GSK + Cognizant
Biopharma company GSK has been a prominent supporter of Amref’s mission for more than 30 years. For the last decade, GSK have partnered with Amref and ministries of Health to train frontline health workers in prevention and treatment of infectious disease, immunisation, maternal and child health and hygiene/sanitation, connecting the often low-income communities they serve to the public health system. The arrival of COVID-19 hugely increased demand on Amref, so when it approached GSK for further support, the company responded to help find solutions.
While GSK’s pre-eminence is in developing and manufacturing medicines and vaccines, it focuses considerable effort on building the systems for their delivery around the world. As Fiona Smith-Laittan, Head of Global Health Strategy and Operations at GSK, tells Tech for Good, innovating treatments without thinking about how they get to the people who need them is “pointless”.
Upgrading Amref’s digital infrastructure to help it manage surging demand became an immediate objective. But, as Smith-Laittan readily admits, GSK isn’t a technology services provider: “It was clear to us that we didn’t have the capabilities to do this on our own. We are not tech experts. But we did know a lot of tech experts.”
A hackathon was organised by Amref and GSK to develop the problem and potential solutions further, and Cognizant, one of GSK’s longstanding strategic technology partners, took part. Its team would emerge from the exercise with a mandate to proceed on a basis much broader than the immediate priority of flattening the COVID curve. What they would go on to do would transform Amref’s digital capabilities for the long term.
Cognizant assembled a multitalented “A-Team” of product managers, analysts, and engineers who had worked on similar projects in the past, focused on the public good. They were led by Chief Architect Sathish Kumar Manickam.
“It was an interesting challenge that was thrown at us,” he recalls.
“The challenge was to flatten the curve of the COVID outbreak, but when we got closer to the problem we understood Amref doesn’t only take care of COVID. They work in the public health sector in 35 countries.
“They have a training platform, they have a service delivery platform that takes care of what they do on the ground, but they didn’t know what’s the demand and supply that they manage. All the tools they had were working in silos, so they weren’t able to correlate the data they had and make meaningful inferences and make better decisions.”
Cognizant’s team imagined a “single pane of glass” for Amref. A system that would integrate all Amref’s tools, but do so with a relentless focus on ease-of-use and cost effectiveness. Beyond the integration, Grafana was used as an open-source platform for data analysis and visualisation that would not burden Amref with ongoing technical or financial overheads, while engineered to provide the NGO with the intelligence they needed.
The work is already making a significant difference to Amref on the ground.
Radhika Ghambir, a key member of Manickam’s ‘A-Team’ at Cognizant, summarises what Amref is now able to achieve: “They can predict their training requirements, they can predict how well it will work. They can make more strategic decisions, which is driven by data now – they are solving various problems based on what particular communities really need, so they can have targeted volunteers working in the places that need them.
“The solution we have developed is scalable, secure and open source. So the platform can be rolled out in all the countries that Amref is operating in. It can be easily used to extend functionalities by whoever wants to do it. We hope it holds a great future.
Mukami is clear that the partnership between GSK and Cognizant on the organisation’s behalf represents a step-change in their ability to meet the many challenges they face. Now the platform is in Amref’s hands, onboarding by Cognizant has given them the tools it needs to extend it independently according to its evolving needs.
“What it has done is to create a one stop shop that’s able to tell us different things. We will be looking at taking those learnings to a level where we’re advocating with governments to influence policy and practice. For me, this is what I think is really exciting about the work we’re doing with Cognizant and GSK,” she says.
Cognizant’s single pane of glass brings together multiple forms of differently structured data into one dataset, accessible via a dashboard, closing the loop to tell Amref a powerful story about the effectiveness of training materials and how well they’re being used in practice at both the individual and national level. From that, Amref can glean best practices and challenges, and adapt training content, processes and systems.
The M-Jali household level data was integrated with government health information systems, adding enormous value in drawing insights at the individual health worker level, as well as aggregated, in real time. This feeds into planning for training systems, and project learning for the future.
The work represented a labour of love for Cognizant’s team, involving long hours working at a frenetic pace. “These are a talented bunch of people that I got to work with. I feel grateful and lucky I got to work with such a great team on this,” adds Ghambir.
It’s the sort of high-impact work that Cognizant is seeking to undertake on an increasingly significant scale, says the company’s Head of Life Sciences UK and Ireland, Rohit Alimchandani. He talks to Cognizant’s mission of – improving lives by engineering outcomes – and the fact a simple brief from Amref and GSK was developed and expanded into something with which his team could make a larger, lasting impact.
“When GSK approached us and said that this is a great opportunity for you to come in and engage and really make a difference in the world, we took on the challenge with gusto,” he says.
“That’s our focus – we work very closely with organisations and focus primarily on how we can collaborate to solve problems. And when you see what the team have done here, it’s mind-bogglingly cool.
“As far as I’m concerned, the team are now looking at how can we do more of this, and we certainly want to be engaged in healthcare,” he says.
Smith-Laittan sees the work GSK has done with Amref with Cognizant as a powerful testament to a purpose that is core to the company’s mission to “get ahead of disease”. GSK aims to reach 2.5 billion people over the next ten years, a very large proportion of whom are currently underserved in their communities.
Fiona Smith-Laittan, Sathish Kumar Manickam, Rohit Alimchandani
“At GSK we use our science, technology and people alongside long-standing partnerships to address the world’s greatest health challenges and improve health globally. We are very proud at GSK of our 34 year partnership with Amref Health Africa. Together, we have contributed to building stronger healthcare systems, training healthcare workers, and improving treatment and diagnosis of high burden diseases. But we’re always looking at ways of improving things and getting further ahead, particularly with the new opportunities now available through more improved technology,” she says.
“It was just a beautiful marriage I think – when the three organisations came together to do something pretty special.”
Mukami concurs: “This partnership is more than just about training health workers and collecting data. It is about the services that these health workers will provide to millions of people across the region towards our vision of lasting health change in Africa.”