Dauda is the country director for Data.FI in Nigeria. He holds a master's degree in pediatric surgery from Ternopyl Medical University, Ukraine, and a doctorate in medicine from National Pirogov Memorial Medical University, Vinnytsia, Ukraine.

In 2019, when Palladium began implementing the Data.FI project in Nigeria―a country we’d long worked in on a range of public health and development issues―we encountered a fragmented array of health data systems.

Each implementing partner funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID) maintained its own system for collecting and analysing HIV data, but few of these systems were talking to each other or sharing data. There were very few standard definitions for HIV indicators—the key data points that provide a window into what’s happening with the epidemic.

The country’s health information systems lacked a solid architecture to provide a structure for housing and using their data, which made it difficult to analyse client electronic medical records (EMRs). On top of that, the USAID implementing partners providing support on the ground to health facilities and HIV testing centres had few ways to exchange data with Nigeria’s National Data Repository, the country’s central repository of patient-level data for diseases.

So, why were these systems issues so important?

Controlling HIV with a Community of Practice

The availability of timely, accurate patient information is crucial for HIV epidemic control. Strong EMR systems allow the health sector to share information among laboratory, dispensing, supply chain, and community health systems, and give health providers the information to better understand an individual patient’s history and needs. Policymakers need timely, high-quality data to support better resource allocation decisions.

In 2019, USAID/Nigeria requested that Data.FI lead the enhancement of the existing EMR system used by most USAID implementing partners to meet both user requirements and international standards. To engage key stakeholders, we established a health informatics “community of practice,” which brought together informatics staff from seven partner organisations funded by USAID under the PEPFAR program in Nigeria.

Drawing on the community’s collective insights, the team worked to improve the EMR system, allowing for higher quality data and better clinical decision making. The team developed terms of reference for the enhanced EMR system and a charter to facilitate a governance protocol outlining the process of gathering, prioritising, and building consensus on system user requirements.

Data.FI then organised a series of informatics bootcamps, hackathons, and health informatics community of practice meetings to develop a set of data modules for incorporation in the enhanced system, called LAMISPlus. In each bootcamp, teams of informatics staff from across the implementing partners worked independently to develop different modules.

Each module outlined stages of the software development process for several program focus areas—including HIV, orphans and vulnerable children, key populations, prevention of mother-to-child transmission of HIV, and laboratory data. Most importantly, all programming code was shared openly using GitHub, a collaborative approach that reinforced teamwork across the partners. The project management software, Jira, was employed to assign and monitor progress and completion of assigned tasks, and Slack was used to communicate across teams.

With the systems governance protocol approved by the Ministry of Health, we also worked to ensure that third-party owners of information systems for laboratories, pharmacies, and commodity management aligned their systems to the interoperability standards the project developed. The resulting open-source, modular EMR system enables all USAID implementing partners to link client records through a facility-level interoperability layer and for implementing partners to exchange data with the National Data Repository.

The creation of an interoperability layer may sound overly technical, but in fact, this is an enormous achievement for any country.

We also incorporated the World Health Organization’s integrated tool for COVID-19 surveillance in LAMISPlus to enable monitoring of the effect of COVID-19 on HIV programming. This unified technological platform will soon allow health providers the ability to access comprehensive information on an individual client and thereby provide better care.

Through user testing, we have confirmed that the enhanced system will be able to capture comprehensive client records for HIV services at the facility level, allowing program managers to monitor the completeness of data across test results, laboratory test orders, pharmacy prescriptions and dispensation, HIV viral load orders and results, and linkages of clients to commodity management systems.

Once implemented, clinicians will have a more complete picture of the care their patients are receiving, and Ministry of Health staff at all levels will better understand which sites are high performing and which require additional assistance in the continued fight in controlling the HIV epidemic.

Palladium implements Data.FI for USAID. For more information, contact info@thepalladiumgroup.com.