HADDA

Health Alliance for Digital Development and Action

Health Alliance for Digital Development and Action, HADDA, is a project aiming to strengthen the health care information system, HIS, in Somalia. It was started in 2019 as a collaborative four- year project between Somalia, WHO, the Swedish International Development Agency and the SPIDER center, based at Stockholm University. In addition, SPIDER recruited Somali partners; for research, SIDRA, and for implementation, NomadiLab.

HADDA means “Now” in Somali. As for now, Somalia predominantly has a paper-based health information system, as most of sub-saharan African countries, and the purpose of digitalizing the HIS is in short to improve the circulation of health information. Timely and accurate information eases the bureaucratic burden from health care workers and enables them, instead of filling in blankets, to tend to patients. Moreover, the possibility to track a patient, to access patient history, is crucial to enable the right treatment which improves radically through an Electronic Health Record, EHR.

In Somalia, antibiotic resistance is a common and severe problem and one of the issues that could be helped by better surveillance opportunities; for doctors to access to information about previous prescriptions. Also on the political level one benefits from an efficient health information system; the HIS serves to streamline management and decision making for policy makers and eases the allocation of resources, thus the opportunities to ensure good and accessible healthcare to all Somali individuals increases. A national interoperable and integrated HIS improves knowledge sharing and management on all levels of society, but as mentioned; the need for collaboration and integration with the large private sector is necessary. The pandemic made the importance of management and administration, data collection and immunization surveillance, i.e the need of an effective HIS, hard to doubt for anyone, as well as the moment to implement it: HADDA. Below the project and the process of its’ implementation is described together with its’ Somali partners.

The project and its partners

SPIDER is the lead agency for the HADDA project and is an organization working with digitalization development within different fields, other than health within telecom and education for instance. SPIDER works with needs- based development and seeks to support and strengthen local capacity. For the HADDA project it was underscored that a baseline assessment of the needs within the health care sector and among its’ workers in Somalia was necessary. The Somali based research institute SIDRA came on board as SPDIER’s local research partner to make the baseline assessement and determine the technical and human resource needs in the three selected regions Banaadir, Galmudug and Puntland. Additionally, SIDRA found that a total of seven HMIS platforms were used for various health programmes and services in different locations. SIDRA recommended the integration of the various platforms that cover different functions within the health sector across the country. Specific recommendations included completing national indicators, standardising HMIS tools and harmonising the interventions that support these platforms so that the planned digital HMIS adequately covers the range of health services offered in all levels of the health care. With the baseline assessment and recommendations in place, the project initiated its’ more technical phase.

The digitalisation of the HMIS tools included the creation of an interoperable system that electronically captures data at health facilities and share an anonymised summary with the national HMIS platform (DHIS2). The technical developing organisation KasmoDev, initiated the project but to develop and implement the software, the Somali- Swedish technological innovations center NomadiLab was brought on board. NomadiLab developed an interoperable Electronic Health Record named RAAD which you find more information about on its own page, länk till RAADs informationsruta. RAAD was to be tested in six health facilities in the selected regions Galmudug, Puntland and Banaadir. Then, based on the evaluation made by SIDRA, the initial upscaling of the project to include additional facilities could be considered. The electronic HMIS system has now been fully developed, and the application mirrors the paper registers for maternal and child health services and fulfils all the paper-based HMIS requirements, there is some ongoing customisation to resolve some discovered flaws such as repetitive data entry e.g. So far, two clinics in Banaadir have been equipped and started to use the RAAD system and the clinics in Puntland and Galmudug will be in a near future.

Additionally, to create circumstances in which the HIS can be strengthened and the goal of the project accomplished- the government needs to be involved and supported in all steps of the process, from the development of the software to capacity building and training of personnel. Therefore, there has been established a capacity team within the Ministry of Health. Collaborating closely with the that capacity team as well as with the end-users through focus groups, the HMIS is tailored the to meet all requirements, ensuring its effectiveness and success.

Next year, 2025, the lead- and continued implementation of the HADDA project will be handed over to the Somali Federal Government’s Ministry of Health. As the ownership is transferred, the strengthening of local capacity, and institutions is essential for the sustainability of the project, the future of the Somali health care lies in the hands of local politicians, nurses and entrepreneurs. This is of importance as research has shown that too much external steering and intervention can have unintended negative effects. In Somaliland for instance, different HIS implementors inserted too many core indicators to measure and different mechanisms for reporting and evaluation that made the burden on health care workers heavier instead of lighter. Similar problems occurred in Ethiopia and Kenya where external organizations complicated the process by focusing on measurement of too many- or too much on their own indicators (Asker et al 2017:769). The need for private sector engagement remains an area of concern, as the exclusion of private clinics limits the capture of their health data. Recent discussions indicate a shift towards engaging with the private sector, aiming to enhance data capture and improve access to essential services. Additionally, securing financial resources for scale-up and sustainability is crucial. Addressing these challenges will require strategic planning, adequate resources, and continued engagement with stakeholders. Despite these obstacles, the successful implementation of a digital HMIS marks a significant milestone in Somalia’s healthcare sector.

Ogow Health

Ogow Health provides mobile health solutions for governments and health care providers in low resource settings. Ogow makes such as scheduling systems for hospitals, electronic medical records, vaccine information management systems, just to mention a few of their services. Ogow also encourages investments within child- and maternal health care as that is needed in Somalia to lower mortality rates. One of the efforts made by Ogow within this field is the increased information dissemination regarding maternal health care, and connectivity with mothers and health care facilities, through the use of mobile texting. Ogow strives to make care and health information easy to access and well updated. To gain from this is better health care as is well informed staff is enabled to a larger extent to make correct decisions, whether they work at a health care center or with management on a governmental level. Ogow Health works closely with their clients to guarantee that their products are well suited for them and for different cultures and contexts, for the products to be of human centered design is important and central to the accomplishements of the Ogow Health team. If you want to read more, you’re welcome to visit their own.

RAAD
RAAD, which means “to search” in Somali and “explorer” in Arabic, is an Electronic Health Record, EHR, developed by the technical innovation organisation NomadiLab. The software is made from the open source platform Bahmni, and is easy to customize and configure for variating and specific needs at different clinics. RAAD includes client and patient registration, the opportunity to prescribe and track medical prescriptions, management of laboratory tests and results, and the possibility to summarize data and report and integrate with the national Somalia HIS to give som examples. RAAD is interoperable and accessible for health care workers as well as administrators and policymakers within the Somali Ministry of Health, to integrate the systems and bridge the current gaps within the HIS. NomadiLab has made other important projects within health care, such as a Covid-19 Monitoring System Dashboard. This platform enabled the Ministry of Health to act and save lives to a larger extent during the pandemic. The data assembled through the platform was in addition shared with the WHO and other development organizations.
NomadiLAb also take on challenges posed by the Somali climate, such as drought. The Abaaraha, drought in Somali, is a mapping platform that displays victims of drought through the use of crowdsourcing, thus overcoming existing information gaps. Victims can be traced through texting, emails, calls and social media and displayed on the map for rescuing authorities.
If you want to read more about NomadiLab and its’ different projects, you’re welcome to visit NomadiLab’s own page.