A web-based polio eradication monitoring platform was devised from an existing widely-used paper-based questionnaire and uploaded to an Open Data Kit (ODK). The application contains questions related to surveillance that are routinely administered by surveillance officers and health workers to access active surveillance in predefined, prioritised health facilities.
The study reviews a retrospective prototype data from an online interactive visualization platform representing real-time active case searches (ACS) conducted in 44 of the 47 countries in the African region from 2017 to 2020(8). The study participants are country program managers and frontline health workers in countries conducting electronic-based active surveillance, using mobile phones and interacting with visualised data. The visualised data is displayed via smart screens and touch wall projections for decision making and gap analyses. The tool was evaluated using an informal user experience evaluation method. The method involves the users of the platform interacting with active case search and AFP surveillance data via visual displays for their programmatic interventions focusing on accountability. The study collected their feedbacks through interviews.
The study developed a decision support tool (Analytica) that aggregated the data from countries and automatically displayed it on maps, charts and dashboards and with complex datasets parsed through Action Programming Interfaces(API) (9,10) to Business Intellegence (BI) platforms (i.e. Tableau, Power BI) and ArcGIS online (11–14). To interactively harness these data, the African regional office rolled out interactive smart screens to be used to display the data to be panned, sliced and diced by simple touching on the screen(15).
In developing these systems for digitisation and visualisation, the polio program considered the bridges between Science, Society and Policy to harness the implemented technologies. The illustration for the design methodology is shown in figure 1, from goal settings to design to implementation and outcomes, then measuring the impact on the surveillance programme (16).
Choice of Open Data Kit
Open Data Kit ( ODK) has been the first software of choice for collecting large data on mobile phones, especially in low-resource settings, such as Africa (17)(18)(19). The active case surveillance forms were translated from paper format into ODK format and uploaded on mobile phones for all countries in the region through selected focal points. The selected focal points have good knowledge of the active surveillance processes and are able to manage minor ICT procedures. Data aggregation servers (DAS) were utilized using documentation guidelines built from the Nigerian experience of large data expeditions to harness all these data from mobile phones in the hands of health workers in the region in real-time(8). ONA-ODK server software was installed on the servers to receive the data for all countries into a regional server called Analytica with considerations of security and data integrity at the heart of the deployment.
Managing the surveillance data- processes
Data Management is vital in guiding public health interventions (20). It is important to ensure that all the data from the surveillance interventions are validated, secure and accessible across all devices and operating systems (OS) from mobile devices (e.g. phones to desktops and laptops. Thus, all the countries can access their data through their secure administrative and read-only profiles in all formats, such as XLS, CSV, OSM, KML among othersImportantly, simple analyses of the data is done and previewed in charts and dashboard, using clojure (21) and pre-implemented on the web platform, emphasising the geography of the visits automatically aggregated into interactive maps. The program primed the preliminary visualisation tool as part of the server installation to ensure that maps and charts can dynamically display the data as it arrives at the data aggregation servers.
The preliminary visualization tools embedded in most data aggregation servers were limited in displays and decision-making capabilities (10). Hence, the system utilized Application Programming Interfaces (APIs) on the servers to tunnel and export data to the third party visualization servers capable of triangulating complex data and presenting in a-very-easy-to-understand-formats and improved decision-making. Business Intellegence platforms (i.e. Tableau and Power BI) connectors were developed and automatically installed on the servers to manage big data from active surveillance reporting. The polio program further harnessed the innovation of bringing real-time data from active surveillance using light operating system hardware in integration with interactive Smart Television. WHO trained Data and ICT Managers, installed two smart Televisions with these capabilities to render active surveillance visits in real-time in all the countries in the WHO African Region. WHO installed Smart Televisions at the Ministries of Health and at the WHO Country Offices (WCO) in designated user areas to allow for discussions and interactions with these data (10)
Gap analyses were automatically configured by maps and overlaid data, and it is visualized in real-time on the smart screens, and it is also available on personal computers and mobile phones. Also, alerts are disseminated as e-mail triggers and Short Message Service (SMS) of shortfalls or changes in important variables being tracked at the field level are received. An illustrative example is the case of missed AFP case(i.e., not notified by health workers at the visited health facilities) once the data records are submitted to the server, the server triggers generate an e-mail and send it to the involved focal person(s) and other accountable officers responsible for processing or managing the AFP surveillance system to take the proper action(22).
Training and monitoring
Furthermore, the study trained country teams on the use of these technologies. Surveillance officers, specifically, District Servielance Notiviation Officers (DSNOs), are trained on the use of mobile phones at the health facility level to conduct active surveillance. Senior surveillance officers and data managers are sensitised at national and sub-national levels on the aggregation servers and activating accountability frameworks to improve staff accountability.
At the WHO African Regional Office, the use of the data for action is also being evaluated via feedback shared with member States using the aggregated data to tease out the surveillance gaps and assess surveillance staff accountability at all levels. This web-based feedback is monitored for traffic, utilisation and retention of users by countries.
The study downloaded the summarised and digitised data generated from 44 African countries for key data variables showing the changes, improvements and gaps in surveillance. The study used a paired Sample t-Test to compare the data for digitized active surveillance and paper-based active surveillance (before digitized surveillance). The study also aggregated the digitised surveillance data to produce regional, national and sub-national (i.e. provential and district) level maps to illustrate silent areas and poor performing levels. To gain a better perspective on surveillance processes to output performance, the polio program superimposed the Non-Polio AFP rate (NPAFPR). Figue 2 illustrates the adopted workflow process, utilized servers and tools for achieving electronic active surveillance.