Using VoxMapp to monitor the spread of the pandemic and related needs in complex settings.
When we first started our COVID-19 program in April 2020, the virus was rapidly reaching Afghanistan. As of today almost 31,000 people have been confirmed to have the virus in the country. This number is likely to be even higher given the country’s poor ability to test.
While social distancing measures have been put forward by the World Health Organization (WHO) as the most effective way of containing the virus, countries like Afghanistan have little power to enforce these policies. Moreover, by doing so, they also put a heavy burden on their already very poor populations. Countries are highly advised to follow the 3T: “test, treat and trace”. Afghanistan’s health system capacity to do any of these is extremely limited.
Using VoxMapp tools and services we have been working in partnership with Integrity Watch Afghanistan and the Ministry of Public Health (MoPH) to close the existing information gap, helping to trace the spread of the virus as a third party monitoring, and helping to detect areas and facilities in need of materials and medicine.
Ensuring physical and health safety of the enumerators
Starting on the 19th of April, trained enumerators started collecting data on the main health facilities of the country using VoxMapp Baseline mobile app. All enumerators had some level of experience as they had all previously participated in Integrity Watch’s Community-Based Monitoring (CBM) programs. Before going to the field, all enumerators followed a two-day intensive training covering the use of our app for data collection, the questionnaire itself, as well as health security protocols. Special attention was given to this last part, namely on personal hygiene, material to be used, and distance. All enumerators went to the field with hand cleaning solutions, gloves, masks, phone pockets and a thermometer to regularly check temperature. All enumerators were closely monitored thanks to our real-time tracking system, and could reach out to the field coordinators through in-app messaging. They were assigned to specific areas, with the app recognizing if they were out of their polygone, thus avoiding overlapping.
Below is a photo of one of the enumerators, collecting data on a health facility in the province of Balkh.
Assessing the readiness of the health care system
The first part of this project consisted in sending enumerators to the most important hospitals of the country’s most affected areas. We have collected data of over 700 hospitals, in more than 60 districts. The idea was to create a baseline dataset containing: 1) general information on each health facility, including GPS location, name, construction date, funding, measures of overall conditions (infrastructure condition, access to water, electricity and toilets), measures of capacity (number of doctors, nurses, beds, daily capacity, etc.); and 2) a first layer of information related to COVID-19, including number of positive cases, intensive care patients, recovered and deaths, as well as availability of protective equipment for the doctors, basic medicines, and intensive care medicines and equipment.
The following map and graph show a preliminary analysis of the availability of respiratory machines and intensive care equipment in a subsample of the biggest hospitals of 13 provinces.
We have also crossed our data with MoPH provincial level data to do further preliminary analysis on the pressure and readiness on the Afghan health system. We find that there is a correlation between having more health workers’ cases of COVID-19 (MoPH data), and not having implemented screening procedures at the hospital entrance to separate symptomatic patients (VoxMapp data). Although we cannot make any strong conclusions, the data confirms our intuition: it does seem to be important to implement these procedures at the hospital level.
Daily updates by health facilities
The second phase of this project is currently on-going and consists of having health facilities directly using VoxMapp Feedback mobile-app to daily update their COVID-19 data in a simple and rapid way.
Each facility is assigned a unique id and password that allows them to be the only ones updating the data for their hospital. Every day we thus get updates on number of available test kits and protective equipment needs (alcoholic solutions, soap and water, P2 masks, vinyl gloves, visors, aprons, shoe covers, protection hats), as well as on the number of available intensive care machines, oxygen reserves, anesthetics and antipyretics. This data is then rapidly treated by our analysts and published on a daily-basis in the form of dashboards in a dedicated website: www.covid19.af. We add a layer of monitoring by sending community monitors to check major health facilities once a week and report their own assessment of needs.
The health facilities are also asked to update the data on the number of cases, deaths and recoveries on a daily basis. This data is not made publicly available as we understand its sensitivity. We act solely as a third party monitoring and will be directly in touch with the MoPH if we find major discrepancies in the numbers. Instead of publishing disaggregated data on the specific number of cases, we publish aggregated data in the form of heat maps that show the most affected areas of the country.
We believe that this information is crucial in many ways: 1) generally informing the public on the country’s COVID-19 situation, 2) specifically informing the public on each health facility capacity to receive more patients, 3) coordinating governmental and humanitarian actions in a more efficient way by identifying areas and specific hospitals that need support.