Active Search for COVID-19 Cases during Integrated Supportive Supervision Using an Electronic Platform to Improve Healthcare Workers Performance in Niger: The Legacy of the Polio Eradication Program

"Developing and deploying a professional workforce to undertake eradication activities has been a core component of the Global Polio Eradication Initiative (GPEI) in Niger."

In polio-affected countries, a lack of qualified human resources is described as a major challenge to polio eradication. Integrated supportive supervision (ISS) is one tool for addressing this problem. The ISS checklist is an android-phone-based real-time data collection checklist developed using the Open Data Kit (ODK) tool. Supervisors use it at operational level to promote improved communication, teamwork, and mentorship, thereby driving healthcare workers to supervise, monitor, and improve their individual and collective performance. The implementation of electronic data collection during ISS visits using ODK in Niger has not only helped monitor the performance of the polio eradication programme (PEP) and the immunisation programme but was used during the COVID-19 pandemic. This article describes a 6-month (May to October 2020) joint ISS-COVID-19 surveillance programme to improve and monitor healthcare workers' performance to efficiently investigate COVID-19 cases in eight provinces.

The study analysed the effect and challenges of the joint ISS-COVID-19 surveillance program using mobile phones under the ODK platform to improve and monitor healthcare workers' performance to efficiently investigate COVID-19 cases. Overall, 1,378 ISS visits were performed through 390 health facilities, during which 4,638 health workers were trained and 527,151 medical records were reviewed, of which 28 suspected cases of COVID-19 were found. The ISS visits provided for a rapid investigation of these cases and for community-level contact tracing, which allowed better management and reintegration of these patients into the community at discharge. Building on the tradition of the PEP, a problem-solving process, feedback, and on-the-job training on COVID-19 surveillance were established to enhance notification in subsequent weeks and months. This process was facilitated by accurate use of ODK Collect for real-time data surveillance. Other topics in the ISS visits included fundamentals of infection prevention and control for COVID-19 (e.g., washing hands, wearning masks, watching distance, and windows open) for both health professionals and community leaders.

Various issues were encountered and overcome through the course of the project. These problems ranged from those related to human resources (e.g., a low proportion of qualified healthcare workers (HCWs) and hard-to-reach HCWs across conflict areas) to those related to patients (e.g., pandemic-induced hysteria that led to a decrease in patient attendance at health facility level). Ultimately, however, the experience of the joint project demonstrated that the low-cost technology underlying ISS's use of ODK will facilitate the implementation of planned supervisions, allowing for the transfer of expertise and skills and encouraging local capacity building, all of which will strengthen the fundamentals of COVID-19 surveillance, just as it did for the PEP. In short, the ISS has emerged as a key component of COVID-19 surveillance, especially in regions with a fragile health system.

In conclusion, during ISS visits, "thousands of health professionals got on-the-job training in COVID-19 surveillance...[which] directly enhanced routine notification in Niger. Supportive management has prompted employees to continually improve their own job performance. This was beneficial during the early months of the pandemic, as it supported healthcare professionals in a supportive and non-authoritarian manner in time of high professional stress and on developing team methods that promote problem-solving."