Digital Technology Improves Health Campaigns in Benin
For many years, health workers in Benin have gone door-to-door with oversized health registers and ballpoint pens, recording the names and details of every person who receives their annual doses of ivermectin to prevent onchocerciasis, more commonly known as river blindness.
River blindness, a parasitic tropical disease, is caused by repeated bites of the black humpbacked fly commonly found in many rural African villages. The infection, which first affects the eyes and skin, can lead to blindness and is fatal if left untreated. But there is a known preventive treatment: ivermectin. While it made controversial headlines during the COVID-19 pandemic, this antiparasitic drug, which kills fly larvae before they can do damage, has been used successfully for decades to treat onchocerciasis infections and has been the preferred preventive treatment in Benin since 1988.
Each year, the Neglected Tropical Disease Control Program at Benin’s Ministry of Health, along with other CRS partners, launches a nationwide campaign to deliver doses of this drug to every person living in affected areas.
But not everyone who needs treatment gets it—and this is not due to a shortage of medication. The biggest obstacle to treatment is outdated tracking methods.
In central Benin’s Glazoué commune, a community health worker enters the details of a family receiving their doses of ivermectin into a mobile phone as part of the county’s newly digitized annual onchocerciasis control campaign.
Photo by Jennifer Lazuta/CRS
At each household, health workers must first sift through dozens of unalphabetized pages, searching through often illegible names from prior campaigns, to see if the family and all its members were previously registered. Often a name is not found—even if it has been previously written—and the household is registered again. It is a time-consuming and frequently inaccurate process. There is no easy way to ensure whether someone is being missed or has received a double dose.
“These registers, they are heavy, they weigh a lot in your hands, walking around all day from home to home in the hot sun. And with time, the ink disappears and the paper deteriorates,” says Thon Theophone Isodor, a community health worker in central Benin’s Glazoué commune for more than three decades.
At the end of prior onchocerciasis control campaigns, compiling and analyzing the handwritten data from tens of thousands of health workers across the country would take several months. This is the same process that has been used for all the country’s health campaigns, including routine vaccinations and screening children for malnutrition.
But now, Benin’s health campaigns are going digital through projects piloted by Catholic Relief Services.
Following successful digital trials for the distribution of insecticide-treated bed nets in 2019 and the Seasonal Malaria Chemoprevention campaign in 2020, community health workers went door-to-door using mobile phones instead of paper registers for the first time during a 15-day, country-wide onchocerciasis control campaign.
In 2021, through funding from the Bill & Melinda Gates Foundation, CRS partnered with Benin’s Ministry of Health and Family Health International 360 to introduce the use of digital tools and dashboards for data collection. The goal was to improve campaign effectiveness through real-time monitoring of coverage, thereby maximizing the distribution of preventative treatment to the eligible population in the affected communities in the country.
“Today, we have these mobile phones, which are small and light and easy to use—even for an old person like me!” Thon says. “I thank whoever invented this modern technology, as it is changing the way we work for the better and helping us better perform our jobs.”
To track coverage rates, a specially designed application is installed on each phone, allowing individual and household data to be easily searched, entered and viewed in real time—by both the teams on the ground and supervisors monitoring virtually from afar.
“The benefits of switching from a paper-based system to a digital system are enormous,” says Elijah Egwu, senior program manager for CRS’ Benin Digitization Project. “In past campaigns, health managers at different levels didn't have a lot of visibility as to how the campaigns were progressing. Now, in real time, supervisors and health officials have access to data showing geographic, programmatic, operational and therapeutic campaign coverage information to track the progress of the campaign.”
The Health Campaign Management System application, which was co-developed by Elijah and his team, and powered by a data collection platform built especially for humanitarian work, is a singular digital platform that can implement multiple health campaigns simultaneously using the same population database. This means that household data from one campaign can be leveraged by another, without re-registering the households—and new information, such as births or deaths, can be updated.
This ensures that each eligible person in a household receives their preventive medications, and those that are yet to receive it are identified and targeted, to remain healthy and protected from this communicable disease.
For onchocerciasis, the application instantly calculates the number of pills a person should receive, based on inputs of their age and height.
Before launching the campaign, in partnership with Benin’s Neglected Tropical Disease Control Program and Family Health International 360, CRS trained more than 16,000 people, including community health workers, proximity health supervisors, and district doctors and managers to use this application, which can be accessed offline in areas with limited or no connectivity.
In total, the first-ever digital onchocerciasis control campaign reached more than 2.6 million people, targeting the general population ages 5 and older, living in 32 targeted zones across five departments in the north and central parts of the country.
Local health officials say it is a success.
“Though there have been a few challenges, including, resistance to change and connection issues, the use of digital tools helps improve accountability because you can tell who is being treated, which location, and the specific time that the teams visit the household,” says Bertrand Memenou Satognon, an epidemiologist and head of the Mass Treatment and Epidemiological Surveillance Unit at the National Communicable Disease Control Program within Benin’s Ministry of Health. “With the use of digital tools, we are able to save more lives because digital tools help to identify more people who are yet to be reached.”
As the government of Benin pledges to go increasingly digital in future health campaigns, this latest onchocerciasis campaign is just one of several digitized health campaigns now being implemented by CRS around the globe.
“We recognize the power of digital tools, and one of the many ways that digital can add value is that when we're collecting data on what we're doing, and we're analyzing that data, we get the evidence of what works and what doesn't work,” says Nora Lindstrom, senior director of CRS’ information and communications technologies for development team. “And that way we can take action to improve our programming, increase our reach, and ultimately increase our impact.”
Following the successful implementation of the Benin 2020 Insecticide-Treated Bed Nets Mass campaign and the 2020 and 2021 Seasonal Malaria Chemoprevention campaigns, the Bill & Melinda Gates Foundation engaged CRS to support the Benin Ministry of Health’s Neglected Tropical Disease Control Program to digitize its national 2021 onchocerciasis control campaign. After nearly 40 years of onchocerciasis campaigns in Benin, in November 2021, CRS supported the Neglected Tropical Disease Control Program to digitize its annual onchocerciasis campaign in 32 of the 51 targeted communes for the very first time. To do so, CRS piloted its flagship Health Campaign Management System digital tool that uses a national population database created during the bed-net campaign, updates household data, and allows for integration with simultaneous or consecutive health campaigns. Digitization allows national health experts to see coverage rates and identify bottlenecks in real time, facilitating targeted and timely decision-making. The digital campaign reached nearly 3 million people, targeting the general population ages 5 and older living in the 32 targeted zones.