Background or problem statement

Maternal mortality is a major public health problem in Burkina Faso. Indeed, maternal and neonatal mortality rates remain high in Burkina Faso (330 per 100,000 live births and 23.2 per 1,000 live births EMDS 2015) despite the efforts made by the State and its partners. Taking care of pregnant women through quality prenatal consultations could help solve this problem. However, this preventive activity aimed at the target population of pregnant women remains unsatisfactory (ANC1 coverage: national 74.10% ;Toma : 60.9%[1]) and few of them manage to reach 4 ANCs (ANC4: national: 38% ;Toma: 34.8%[2]) and of variable quality. 

Also, Burkina Faso adopted the PNP/SR in 2018 taking into account the new WHO recommendations on ANC but implementation remains weak. In response, Terre des hommes and the Ministry of Health are piloting the digitization of maternal care with five forms including the ANC form in Toma district since November 2020. The Maternity REC was developed based on existing WHO guidelines for maternal and neonatal health.

Tdh adopted a pragmatic approach consisting of developing consultation workflows inspired by the field, developing forms similar to those used in health facilities, while using the advantages of digital technology to facilitate the work of health workers and improve the quality of consultations. The result is a contextualized tool that is perfectly aligned with the practices of health workers, achieving the goal of improving the quality of care.

IeDA IMCI and then IeDA maternity were precursors in Burkina Faso. In a digital context with few standards, it was necessary to create patient registers, a register of health centers, a register of HCW, a register of drugs and medicines, map business processes and digitize forms in a very short time. Terre des hommes went to the essential by bringing together these different bricks within the same tool. Interoperability with DHIS2 has been developed in a peer-to-peer manner. Furthermore, the development process chosen did not guarantee an exhaustive implementation of the recommendations related to the ANC. All this makes the ANC form of IeDA Maternity a very specific implementation in Burkina Faso, achieving its objective of improving the quality of care, but not very interoperable and above all difficult to replicate.

The project is an ongoing project within the framework of IeDA Maternity. This project aims to redevelop IeDA Maternity and more specifically its ANC form in compliance with the WHO DAK, the HL7 FHIR implementation guide while implementing the OpenHIE Framework for data. 

The work will be done by the Tdh delegation team in Burkina with the support of the health team in the region and at headquarters. Also, IT4LIFE will provide technical assistance on certain topics. The aim will be to develop a standard reference tool (a complete version of the DAKs) and to adapt it to the Burkina Faso RH NIPs for local testing.

 

Digital health technologies

The implementation of the ANC OMS DAKs will be done on the CommCare platform with FHIR services. Different methodologies will be used such as SCRUM for the development. Tools like TestRail, Testlodge will be used for testing and Productboard for user requirements management.

 

Use Cases and User Stories

The main use cases of the application to be developed are the following:

• Authenticate yourself
• Manage patient records
• Provide prenatal care
• Manage references
• View statistics
• Manage users

 

1. Use case diagram

 

Figure 1: Use case diagram of the application

1. Description of the different use cases

The detailed description of the use cases can be found in the attached table.

 

Objectives and activities

Work package 1: Adaptation of ANC according to WHO DAK

Objective 1.1 The aim is to build the capacity of Tdh teams by strengthening their technical ability to ensure a design according to international standards.

• Activity 1.1.1 Capacity building session on the Agile SCRUM method

The training will focus on theory and practice and will equip the staff to master this method. This training will bring together staff involved in the development of applications, monitoring and evaluation, the medical team and the project management team. It will be facilitated by IT4LIFE.

• Activity 1.1.2: Capacity building session on FHIR

The session will bring together the application development, monitoring and evaluation, medical, team and project management teams. The training aims to equip the project management staff on FHIR standards, fundamentals and good implementation practices. It will be provided by experts in this field.

Objective 1.2: Develop the ANC form in Commcarre according to the recommended standards (WHO DAK)

Activity 1.2.1: Workshops to design, develop and validate a CNA form according to WHO DAKs

Work sessions in the form of workshops will allow us to define the architecture and the development stages. The validated architecture will be implemented in CommCarre according to international standards. The ICT, medical and monitoring and evaluation teams will work on developing an ANC form according to WHO DAKs and also international standards and good practices for application development.

 

Activity 1.2.2: Conducting tests

Two peripheral health centers will be identified for field testing with patients. Health workers will be identified in these centers to use and test the application. A total of four agents will be used as investigators to test the tool during the design phase over a 40-day period. Supervision will be carried out by the project team (ICT, medical and M&E) to strengthen the capacity of the interviewers and to correct residual problems. Feedback will be provided by the interviewers and integrated into the application.

 

Activity: 1.2.3Presentation and validation of the final CNA form

A workshop will be organized for the validation of the designed application.

 

Activity 1.2.4: Adaptation of the data dictionary to DAKs

The aim will be to develop a data dictionary according to the DAK recommendations. This development and adaptation will bring together the monitoring-evaluation, ICT and medical teams during working sessions and workshops.

 

Activity: 1.2.5Development of monitoring tools

The team will develop a dashboard to track statistics and indicators on prenatal care. This development will be done through work sessions/workshops.

 

Activity 1.2.6: Workshop to develop and validate the implementation guide

This workshop will allow the development of a user guide/manual for the application. This document will be validated and used by different actors for a better understanding

 

Schedule

Activity	Team Location Month/Quarter	[Month/Term
		[M]	[M]	[M]	[M]	[M]	[M]	[M]	[M]	[M]	[M]	[M]	[M]
		1	2	3	4	5	6	7	8	9	10	11	12
Capacity building of teams on good development practices and product management
Capacity building session on the Agile SCRUM method in 1 week	Tdh, BFA	X
Capacity building session on FHIR 10 days	Tdh, BFA	X
Design, development of the CNA form according to the standards
Workshops for the design, development and validation of a CNA form according to WHO DAKs including field feedback on the amendments	Tdh, BFA		X	X	X	X	X	X	X
Testing (health workers for application testing)	Tdh, BFA							X	X
Presentation and validation of the application	Tdh, BFA									X
Adaptation of the data dictionary according to the DAK	Tdh, BFA										X
Development of monitoring tools	Tdh, BFA											X
Elaboration and validation of the implementation guide												X

 

The duration of this project will be 12 months divided into 3 main concomitant or successive stages:

• Design of the tool architecture and the OpenHIE integration environment
• Development of the tool and integration in its environment.
• Test of the application in 2 health centers

 

 

 

Deliverables

 

Deliverable	Month/Quarter Due Date
[Work package 1, Objective 1.1, Activity 1, Output 1 "Capacity Building Report"]	[M3]
[Work package 1, Objective 1.1, Activity 2, Output 2 "Capacity Building Report"]	[M3]
[Work package1 , Objective1 .2 , Activity 1,2,3, Output 3 " ANC form"]	[M9]
[Work package1 , Objective1 . 2, Activity4 , Output "Adapted data 4dictionary"]	[M12]
[Work package1 , Objective1 .3, Activity5 , Output "5Dashboard ANC"]	[M12]
[Work package 1, Output 6 "ANC form user manual"]	[M12]

 

Global Good Maturity Model Assessment

https://docs.google.com/spreadsheets/d/1kFXaJGaN87ecsu_nybagI5hvOw-k2V9CCc63N8TA_NI/edit#gid=249752520