Shifo Foundation's Smart Paper Technology can be a Game Changer for Emerging Countries

Scanning the smart paper forms

Shifo Foundation's Smart Paper Technology enables countries to have all the benefits of point of care eHealth Solutions bypassing the infrastructural challenges.

Shifo Foundation started in response to a lack of quality healthcare data in low-income countries. The data quality was poor, and the indicators were not in place to inform decision making.

"The foundation was created with a vision of a day when no mother or child dies or suffers from preventable diseases. We see achieving the vision by working together with the key partners by identifying and closing the gaps based on reliable and relevant data and information," says Nargis Rahimi, co-founder and director of partnerships at Shifo Foundation.

Smart Paper Technology Solution

After seeing these issues first-hand, Shifo developed a Smart Paper Technology (SPT) Solution. This new use of technology is a hybrid of paper and digital systems and enables countries to have all the benefits of point of care eHealth Solutions bypassing the infrastructural challenges mentioned above.

How will Smart Paper Help Policy Makers?

The SPT Solution allows the health system to generate and use high-quality data to inform evidence-based decision making to ensure actual gaps in health service delivery are identified and closed.

How does Shifo's paper technology digitise health data? And how's the data used?

Shifo's Smart Paper Technology is based on paper forms which are completed by health workers at health facilities to capture health care information of clients. Each form has pre-determined fields, which, when completed, can be scanned and read by our systems to digitise the data.

The first step is to register each new client with a unique ID number. Following this, the client is provided with the health services needed and the health workers complete the health form capturing the health services administered to the client. Health facilities also complete stock management forms to keep record of medicines and supplied used.

Plotting the KPIs which health workers receive automatically by SPT on a monthly basis. 

The completed Smart Paper Forms are taken to an identified, nearby scanning station. These are usually located at a bigger health facility with reliable infrastructure or a sub-national level (e.g. district level). Here, the forms are scanned and the information becomes digitised, thus automatically generated up to date electronic health records of clients, based on their ID numbers.

The data is used in a variety of ways. At the facility level, health workers monitor their performance through Key Performance Indicators, and a Data for Action feature supports facilities to identify and improve upon areas for improvement. At a district, regional and national level, decision-makers can use this data to improve the quality of health services based on the actionable data at their level.

Many countries still employ a regular paper and pen/pencil for data reporting. What are the advantages of smart paper over this, in terms of streamlining this process and cost-effectiveness?

The Smart Paper Forms are designed to capture the same information which health workers have always captured in traditional record book formats. So they are not asking for any more information, it's just captured in a more comfortable, much more efficient way without duplicated efforts. The health workers use pens and regular paper as they always have. The difference is that the forms have pre-determined fields which are quick and easy to complete. When these forms are scanned and digitised, they generate data that is quicker and simpler for health workers to utilise. When health workers use Smart Paper Forms during the care delivery, they do not need to compile daily, monthly or other types of reports as they all are generated automatically by SPT.

During the independent evaluation, the results show that the SPT process decreases administration time for health workers by more than 50 per cent. In terms of costs, the solution becomes an investment for countries for all that work-time saved, ultimately giving the health worker more quality time with patients. Cost analysis indicates that the governments can sustain the costs of the intervention based on the budgets they have to print the existing paper forms.

Key Mile Stones

The external evaluations have indicated that Smart Paper Technology has a 99% data quality, as well as it saves administration time for health workers by more than 50 percent. This means that health workers can focus more on the patient and less on administration, and utilise the digitised data to track the health records of clients efficiently.

The SPT system has numerous additional features, including the ability to automatically send SMS messages to the client to inform them of their upcoming visit.

"We have started working with strengthening health management information system; however, since 2018, we are all strengthening logistics and supply information system to ensure demand and supply sides are working effectively," says Nargis Rahimi.

Challenges

Shifo is currently working in Uganda, Afghanistan, The Gambia, Kenya, Tanzania, and Haiti.

The solution is flexible enough to meet the needs of the country it is operating. "Challenges vary from security in Afghanistan to a shortage of health workers in many countries. Seeing and knowing the issues first-hand helps us design context-specific interventions which can work, bring value, and, can be sustained and further improved," adds Rahimi.

An external evaluation was conducted on the work in The Gambia found that mothers and health workers find it easier to receive SMS reminders for vaccinations of children, that the administration time for health workers is reduced by more than 50 percent, that data quality is improved and all monthly reports are generated automatically.

She also points out that as they started to look into a solution to the data quality issue, the significant challenges are always to adapt the solution to the existing system. "If no infrastructure supports a digital solution, there needs to be a solution that solves the issue based around the existing infrastructure in the country. In some of the countries we have worked with, security has been an issue during capacity building. Therefore, the challenge is to develop alternative solutions for capacity building in such situations," she adds.

Data Error?

But what are the chances of data error with digital paper reporting? "The quality of the data generated is currently at 99%, so the possibilities for data errors in this regard are less around 1 per cent," says Rahimi.

Would they consider foraying into facility care reporting?

"At Shifo, we work to improve data quality to strengthen data culture in health services. To date, our focus has been on facility-based reporting. However, we are always interested in exploring how our work can be used to support improvement in community health programmes, especially in countries where it is institutionalised," explains Rahimi.

Collaborations

Shifo's plans in the future are to continue working with existing partners in the current countries we are working in and to scale up and expand in countries with similar issues.

Would they consider partnering with India?

"We believe data use and data quality is essential in healthcare, and we are always looking for partnerships to improve health services worldwide. We work on strengthening all levels of health systems for services to operate as seamlessly as possible. We would be extremely interested to learn more and discuss this idea further as India is a country where we could bring added value," concludes Rahimi.