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The Promise and Limits of Technology: Information Technology for Decision-Making in Nigeria
In this video, Eme Owoaje explores a case-study of how technology was successfully used in vaccination campaign decision making in Nigeria (Step 3.18)
EME OWOAGE: In this section, we’ll be looking at the promise and limits of technology, and information technology for decision-making in Nigeria.
So we’ll be looking at auto-visual AFP detection and reporting, AVADAR. As you may know, AFP stands for acute flaccid paralysis. There’s a link there regarding the WHO collaboration rollout for this mobile application, and we expect that you would have read this and reviewed this particular document before this lecture. So how does AVADAR work? What does it add? I’d like you to ponder on this questions and then answer them before we go on. So it’s an alternate surveillance method relying on community members, rather than the health system. What would be the pluses and minuses of collecting surveillance information this way? It goes directly to you, but might miss a lot of AFP.
And potentially cases, as well as nearly all cases of polio, will end up at the health center at some point in time. And the random community member might be less likely to see them. In the end, one person with experience with AVADAR noted, essentially it was supposed to be health facility based. Community based surveillance added to complete this at some places, but with excess reporting and bad quality. Another technology that can be used for data collection is the geographical information systems, which is GIS. So we’ll be talking about GIS data in Nigeria. We have a quote from a global-level policymaker.
“Kano, a city in northern Nigeria, is so dense and there was much effort and so many resources going into it, and we were still seeing cases. And it was kind of like, well heck, what else are we supposed to do. We thought, what if we tried to map out our communities and double-check that they’re all getting covered.” On the slide you can see hand-drawn and digital versions of maps of the same community. And you can see that the digital map is able to capture some areas that have been missed by the hand-drawn map. So a comment was made that even good hand-drawn maps have missed settlements. And not everything was where we thought it was.
I’d like to ask you, what are the pluses and the minuses of using maps that are hand-drawn by campaign workers, versus maps created from aerial photography and GIS? Can you think of any pluses to the hand-drawn maps over the GIS maps? A possible answer might be that they are reflective of the health workers mental maps, and may be more useful to them. Also, the act of making maps can help local health workers learn about their areas. I’d like to ask you some more questions. What are the cost implications? Should public health programs be more cost sensitive? The work and quality has to be delivered on the ground.
People may use aerial technology, but ground forces have to be aware of their area of jurisdiction and the populations there. Also, they need to take care of population movements, and temporary populations or changing dynamics there. In this slide, we are looking at improving maps in important geographies. It really doesn’t require highly trained or sophisticated devices. You can see from this map that was taken from a local government Katsina State in Nigeria, the improvements in the number of settlements that were identified based on the GIS map. So on the right-hand side, you can see the final map, which is more detailed. In this slide, we’ll be looking at global positioning systems, which is GPS tracking of vaccination teams.
And post campaign reports include geo-coverage, settlements visited and percentage of total, target population visited and percentage of total, heat map showing visited and missed settlements. So I’d like to ask you, what are the implications of GPS tracking of vaccination teams? In your opinion, is this appropriate? One person with familiarity with this commented, technology and tracking is fine for monitoring the complete coverage. Tracking might have a negative effect on vaccinators morale, that their movements are being tracked. Finally, what matters is two drops in the mouth of every eligible child. Here’s another example from Nigeria. And from the tracking, improved coverage of border settlements is highlighted. So you can see that GPS is important in the polio program.
This slide was showing that the GPS can direct field workers to address gaps. In Nigeria, the chronically missed settlements identified, thanks to mapping and tracking, were located using a geographical information systems, GIS map app running on a rugged field tablet. The app has a set of online imagery and base map layers, and helps with navigating to the unknown settlement. The local polio officers are coming along on these exercises to make sure the settlements gets included in the microplanning for the fully campaigns. However, if there is a good system and ownership, vaccinators should know their area on ground. Technology use can be supplementary. So we’re going to talk about a success story. And this story is given by a global-level policymaker.
So I think it just brought a measure of precision to the Nigeria program in terms of microplanning and identify missed settlements, that literally had been missed by all services for years, hundreds of settlements that just had never been in microplans for the entirety of the polio eradication efforts in Nigeria. And those communities also weren’t associated with any particular health center in the public health planning system. That really changed things. And I’m still working on routine immunization in Nigeria. And I still see the knock-on effects of that. They are now using the same GIS maps to create microplans in routine immunization outreach. So this is a success story.
I’d like you to think about, why had these settlements been missing from the microplans. What does this tell us about local knowledge, government knowledge, international knowledge, and the efforts to eradicate disease? What would have been alternate old-school strategies to the GIS methods? What would have been the pluses and minuses of these methods? So in this slide, we’ll be talking about how technology doesn’t eliminate the importance of politics. We have a quotation from a global-level policymaker, and it says, “It took years, I mean, from 2011, 2012 to 2014, 2015, I’d say that finally they, the GIS data, were being used effectively. And I think had we done it another way, the government would have owned the maps a bit better.
And they would have been adopted a lot easier. But that’s kind of how it came about, just like, OK, what’s our last-ditch effort to get this done?” This quote from a global partner is about how this information did get integrated into the government right away. The mapping was initially done by Gates Foundation and others. As this interviewee describes, it was conceived by them as part of a last-ditch effort. Think about why might it be that this scenario would lead to government resistance to using the maps. The interviewee adds, that was our fault. And the way we went about funding that through the partners meant that it was a whole public good for Nigeria as a country.
I mean, they could use that for education, planning, infrastructure. But it wasn’t set up within the government system. And then getting the government to trust that data and take it on, has been the whole process. It’s still ongoing.
So in this slide, we’ll be talking about how data doesn’t eliminate the importance of context. We have a quote from a global-level policymaker. “The question you had about why is it GIS mapping can’t be applied elsewhere. I mean, in Pakistan and Afghanistan, the fear is around government and/or international surveillance are just too high. In Nigeria, it’s accepted and it’s OK. And in Pakistan and Afghanistan, the fake vaccination campaign by the CIA or the American intelligence agency and all that, just makes it too high stakes to make it possible.” So I’d like you to think about, given what options you know from other portions of this class or this model, why would this be the case?
Why might what worked so well in Nigeria not work in Afghanistan? What does the interviewee mean by high stakes? A culture of data, so what do we mean by culture of data? So we’re looking at data for decision-making, or data for data. And then we’ll also be looking at data surge. Polio has a strong culture of data. This is, as we have discussed, a strength. And it has been something other programs have drawn from. It can also lead to some complexities. First, why is data being collected and used? Data collection and analysis can and do become ends in themselves, without always enough consideration of how this data will actually be used in day to day decision-making.
Sometimes a great deal of effort is expended to collect data that is never used. A related issue is the data surge. There may actually, in some cases, be too much data to use effectively.
Eme Owoaje, MBBS, MPhil, FWACP College of Medicine, University of Ibadan, Nigeria
The following quote from a global partner describes how critical data wasn’t integrated into Nigeria’s national strategy right away. The mapping was initially done by The Gates Foundation and other GPEI partners.
“It took years, I mean from 2011, 2012 to 2014, 2015, I’d say that finally they [the GIS data] were being used effectively. And I think had we done it another way, the government would have owned the maps a bit better and they would have been adopted a lot easier, but that’s kind of how it came about just like, ‘Okay, what’s our last-ditch effort to get this done?
That was our fault. And the way we went about funding that through the partners meant that it was a whole public good for Nigeria as a country. I mean, they could use that for education, planning, infrastructure. But it wasn’t set up within the government system. And then getting the government to trust that data and take it on, has been a whole process. It’s still ongoing.’”
—Global-level policymaker
Reflect on this quote, and Best practices in innovations in microplanning for polio eradication.
- Why were the data collected and maps generated through GIS not immediately used by the government?
- Does this add to or change your comments on GIS vs. administrative data in the last step of the course?
Post your thoughts in the discussion. Read other learners’ posts and provide one argument that could be used to convince the government of the utility of GIS data.
This article is from the online course:
Collecting and Using Data for Disease Control and Global Health Decision-Making
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Collecting and Using Data for Disease Control and Global Health Decision-Making
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