IeDA

Annually, 5 million children under five (U5) die from preventable and treatable causes (2020). To address this, WHO and UNICEF developed Integrated Management of Childhood Illness (IMCI) in 1995 as an integrated approach to increase coverage of evidence-based, high-impact interventions to reduce under five mortality rate (U5MR), prevent illness and disability, and promote development and growth of children U5. A Cochrane review found that IMCI has been associated with a 15% reduction in child mortality (Gera 2016),1 and other research has shown positive effects on healthcare worker (HCW) practices and quality of care.2 There is near universal adoption of the IMCI strategy by target countries; however, countries continue to have challenges in adherence to and scaling up IMCI, which limits the potential impact on U5 morbidity and mortality. Evidence has indicated that electronic technology using digital job aid for IMCI (IeDA) improves adherence, including the completeness and consistency of clinical assessments.3 

Integrated e-Diagnostic Approach (IeDA) was developed in 2013 with the Ministry of Health of Burkina Faso to significantly improve the performance of primary healthcare workers in using national guidelines for the management of sick children. IeDA is integrated with DHIS2, the health management information system deployed in Burkina Faso by the Ministry of Health (MoH), and sends regular data to that system.

IeDA improved quality of care at the primary healthcare facility, as well as supervision and decision making at district and central levels through the four components described below:

• Digital Job Aid, through REC (Registre Electronique de Consultation in French). REC is used by healthcare workers to perform consultations to children under-five. It is built on a  decision algorithm. Healthcare workers are guided through the IMCI clinical protocol (WHO) and introduce the relevant data into the tablet, which provides the diagnosis and treatment adjusted for age and weight. The REC also provides audio, visual and text-based support to healthcare workers which reduce errors and help improve workers’ skills. The system is in full compliance with the national policy and protocols for IMCI.
• Coaching and Quality Improvement. The electronic job aid is complemented with a coaching application and quality improvement methods to help healthcare workers improve their performance. Through regular visits from coaches and the provision of performance data to healthcare workers through a dashboard on the tablet device, areas for improvement are identified and healthcare workers are supported to develop solutions to their challenges.
• Continuous Learning. Terre des Hommes has implemented a Continuous Learning module on the tablet device, with a learning app through which healthcare workers perform regular quizzes and receive training in those areas where they need more support. This way, in addition to supporting the consultation process, the digital tool improves the knowledge and skills of healthcare workers using adult-learning techniques.
• Data use. Data from the digital job aid is sent to the servers (through the mobile network) and analyzed in order to produce a Quality Assurance (QA) dashboard with 10 key indicators. The dashboards are used by district management teams to monitor the performance of the healthcare centers in the district and provide them with the necessary guidance and support. At the central level, the data is sent to DHIS2 which gather each month 60 indicators from the REC.

To date, IeDA has been deployed in 1200 clinics (including 40 in Mali) and supported nearly 6,000 healthcare workers to deliver over 6 million consultations to children under five. The approach is used in over 90% of consultations performed in the 1200 facilities. Final results from the evaluation study by the London School of Hygiene and Tropical Medicine show an improvement of healthcare workers’ performance, high acceptability by healthcare workers and district managers.

From 2020 to 2023, a pilot implementation of IeDA was carried in the Ranchi district (Jharkand state) in India, reachinng 6,059 children and with results motivating its scaling-up.

IeDA does not only improve the recording of data but also the quality of the medical consultation and the prescription, and does so in the peripheral health centers the least equipped but the most frequented of the health system. In addition to offering a digitized patient record and an a diagnosis aid, IeDA has the specificity to make possible to close the information loop by enabling district management teams to identify the profile of consultations conducted in each health center and by each agent, spot outliers and conduct targeted supervisions on centers the most likely to commit misdiagnosis or enter wrong information. Thus IeDA offer the opportunity to the health worker of an individualized and remote support, over time.

A London School of Hygiene and Tropical Medicine (LSHTM) evaluation of IeDA showed significant improvements in quality of care, a 50% improvement of primary HCWs’ adherence to IMCI clinical guidelines, and an operational cost reduction after initial investments.