Burkina Faso: Successfully scaling up nutrition in a digital world
Burkina Faso’s ten-year journey with the integrated e-diagnostic approach (IeDA) provides a rare and inspiring example of a digital health tool brought to scale. The country showcases good practice with this solution, as it covers 84 per cent of the country’s primary health care facilities and has over ten million consultations, supported by a digital job aid. This solution story offers valuable lessons on scaling up and sustaining digital health interventions for other countries considering digital solutions, as well as for countries in the process of implementing these solutions. It was in the spotlight during two webinars, bringing together nutrition stakeholders from 26 countries, co-organised by TASC and the SUN Movement Secretariat, held Wednesday 29 September.
Digital solutions are key to support equitable and comprehensive health and nutrition coverage of all communities, including hard-to-reach areas. Despite progress made in reducing child mortality over the last two decades, preventable and treatable conditions such as diarrhoea, pneumonia, malaria, and malnutrition remain the leading cause of death for children under 5 years old in low-income countries.
Although strategies have been developed for the Integrated Management of Childhood Illness (IMCI) and community-based management of acute malnutrition (CMAM), health care worker adherence to these protocols tends to be low, and IMCI and CMAM services are not well coordinated, resulting in poor-quality treatment of sick girls and boys. Digital solutions offer the possibility to systematise approaches, improving protocol adherence significantly, as well as reducing manual errors and supporting nutrition service delivery.
Burkina Faso’s digital journey to fight malnutrition and improve health outcomes
Burkina Faso has a good practice to share. Despite having adopted the IMCI strategy in 2003, implementation remained a challenge as health care workers were poorly trained and lacked supervision. This, along with low literacy rates, a high burden of paper-based reporting, and a high turnover of staff in facilities deemed hard-to-reach and under-resourced, led to poor quality diagnosis and treatment of children under five years.
In 2014, the Integrated e-Diagnostic Approach (IeDA) was developed by Terre des hommes (Tdh), in partnership with the Ministry of Health. The aim was an equitable and comprehensive coverage of all communities, including hard-to-reach areas, harnessing the power of technology. It takes a four-pillar approach, using a digital health solution that aims to improve the quality of care at PHCs using a digital job aid, quality improvement processes, e-learning and data exploitation.
Today, their integrated digital health solution covers 84 per cent of the country’s primary health care facilities (PHCs) and has over ten million consultations supported by a digital job aid. Burkina Faso’s adherence to this system makes this initiative one of the largest-scale in sub-Saharan Africa and will be handed over to the Ministry of Health, for finalisation, by the end of 2021, after a 3-year process.
The Government took the decision to take responsibility for this initiative after a presentation held in 2018 by London School of Hygiene and Tropical Medicine, which looked at impact and quality improvement, buy-in from all stakeholders and efficiency.
Shifting approaches, shifting paradigms for lasting impact
The approach can also be seen as an important shift in paradigm for users, moving from a heavy reporting burden often experienced by health care workers, by consolidating data and information, ultimately helping end users and ensuring reliable information. This approach also relies heavily on using data for evidence-based decision-making, at the policy level.
What started 10 years ago as a pilot, is now close to full scale, with key lessons that should be in the spotlight: stakeholder engagement, successful geographic expansion across the country (and beyond), but also thematically – making the generated cards the new ‘patient file’ in primary health care facilities.
Next steps include developing the nutrition component even further (with a pilot planned for Mali next year) for a digital nutrition continuum of care –from community management of undernutrition cases to the referral level of with acute undernutrition with complications. This will improve the overall management of undernutrition cases at all levels, in communities and in health care centres, which can only be seen a momentous step in Burkina Faso’s fight against malnutrition.