Here we are with some updates on the Integrated Refugee Health Information System (IRHIS) project that aims at monitoring UNHCR’s public health activities in Refugee Camps worldwide.
https://his.unhcr.org/

Fig.1 iRHIS Landing page

The mobile and web application designed to collect and report refugees medical records is up and running with a renovated look and it’s currently being used in 4 countries: Tanzania, Rwanda, Zambia and Ethiopia, involving over 1300 users and serving over 355.700 refugees.

While Tanzania, Rwanda and Zambia have also participated to the pilot phase, the system has been introduced to Ethiopia only in the last month, where over 500 new users have started to collect data.

While Data is collected daily and mostly offline on tablets by health staff, data synchronization and aggregation is performed weekly to update indicators on dashboard, reports and landing page. In some locations, such as in 2 Refugee camps in Zambia and one camp in Kenya, individual data collection has not been possible due to internal constraints. In order to overcome the challenge, the system provides the possibility to also enter already aggregated data directly into the application using a specific online form at health facility level.

Once information has been entered into the system, dashboard, reports and landing page allow easily monitoring of mortality, morbidity, reproductive health, diseases surveillance, Epi and nutritional indicators.

The landing page, that is publicly available,  displays indicator values at country and camp levels. The picture below shows pie charts (Fig.2) about the top five causes of morbidity in 6 Rwandese Refugee camps, grouped by disease type ( Acute Health Conditions, Chronic Diseases, Injuries, Mental Health Disease)

Fig. 2: Total consultations, Rwanda-June 2018

The following image instead shows the breakdown of ‘Skilled Birth Attendance’ indicator in Rwandese camps (Fig.3)

Fig. 3: Skilled Birth attendance breakdown, Rwanda-June 2018

The dashboard is also a key element of the iRHIS system. Displayed data is based on users’ permissions and Figure 4 shows some dashboard indicators (population, morbidity and mortality) related to Kiziba Refugee camp in Rwanda.

Fig. 4: Dashboard for Kiziba camp- week 30 2018

A great advantage of the system is that not only camp, country or regional supervisors but also clinicians at health center level can view updated indicators directly on their dashboard on their tablets. This helps them to always have a clear picture of the current status of the Health Facility or Camp where they work in. Furthermore, they can see their data collection efforts being used to generate valuable information.

Also reports are automatically generated weekly. They provide a comprehensive overview of public health and wash indicators at refugee camp level. Figure 5 and 6 show some examples of iRHIS reports.

Fig. 5: Example of HIS Indicator Report for Nyarugusu Camp (Tanzania, June 2018)

Fig. 6: Example of Disease Surveillance Report for Mugombwa Camp (Rwanda, week 30)

In the coming months, the system will be constantly monitored to improve its performance and facilitate the roll out in other countries. In August, Sudan will be added to the list of implementing countries. Particularly, next week health staff from 7 camps in Easter Sudan will be trained on the use of the new system.

We’ll continue keeping you posted on future updates of the project! Stay tuned!

In collaboration with UNHCR​, Gnucoop has been troubleshooting, bug-fixing and maintaining the Twine web platform, that allows UNHCR and partners’ staff to collect and explore public health, water-sanitation and nutritional data, from health facility level in about 40 countries worldwide up to HQ level.
After this phase, Gnucoop was granted the commission to re-design the current Twine application to make it more suitable to current and future needs, overcoming the limitations of the original application.

This application allows to collect data and compile entry forms in a user-friendly way, visualize data, analyse and generate reports at different levels.

Through the web app you can analyse and generate reports, analyse public health, wash and nutrition indicators.

It’s possible to navigate through a dashboard and repository

Back Excerises

section at multiple geographical level:  from refugee camps worldwide to country offices up to regional and HQ level. 

It’s possible to navigate through a dashboard and repository section at multiple geographical level:  from refugee camps worldwide to country offices up to regional and HQ level. 

From 20th to 24th of February we have been in Kakuma Refugees Camp.
This mission is part of the project we’re developing in support of UNHCR.
During the first day we’ve visited the General Hospital of the Refugees Camp, managed by IRC (International Rescue Committe)
First visit to IRC General Hospital

Together with the partners we discussed the program of the following days, which aim was to submit the new data collection system to the clinic staff and test it.
 

Testing at the IRC Main Hospital (OPD, IPD, RH, EPI Sectors) 

From our point of view, getting the chance to be on the field personally was of great utility. In addition to that, the presence of two persons with different competencies and capabilities – namely one developer and one project manager – was essential to understand and face the issues rised.

The workers have been explained and shown by the developer how to use the application in the very real field conditions and how to deal with some problems. We had to acknowledge that those mechanisms and passages often considered “trivial” by technicians are not regarded as such also by the users, therefore we took this as a lesson learned for the next field testing.
The deep knowledge of forms has been very helpful for feedback gathering and the related reviewing processes.
Furthermore, we could count for some urgent issues on our staff in Italy, who was reacting almost in real time to any request. 
Two categories of users participated in the test:

• Nurses / Midwives for forms related to Reproductive Health;
• Refugees employed in the clinics, for all the other forms.

Generally, the feedback we received was content-related, while almost nothing about the new collection system, that is the transition from the use of paper to electronic devices, was mentioned.
Only in the Expanding Program in Immunization (EPI) sector of the Main Hospital, the clinicians have expressed strong doubts, and declared to prefer the current paper forms.

It was the first testing so we focussed on the first feedback from the users, how they reacted to the use of the new system.  As already explained, they did not make any comments on the application but simply suggested some changes on the content of the form. 
In terms of timing, probably, after few days, they will get used to the system and get faster.
We suggest to spend more time to explain better to the users how it will change the entire process of data collecting and reviewing, thanks to the new system and make them aware about its potentials.

Since a couple of months Gnucoop is engaged in a big project is support of UNHCR. Twine is a web-based platform currently used by UNHCR in refugee operations for data collection and reporting. We first approached this system in order to analyse its weaknesses and to come up with suggestions for the development of a new high performing and user-friendly application.
The so-called “NewTwine” – it is our purpose to give it as well a brand-new name – is being designed from scratch, including a total review of the current system architecture and the development of a mobile application for a unique data collection tool that represents the biggest news of the project.
This application allows to collect data and compile entry forms in a user-friendly way, visualize data, analyse and generate reports at different levels: from refugee camps worldwide to country offices up to regional and HQ level. The type of information concerns healthcare, water and sanitation, nutrition and food security sectors, where the Health Information System (HIS) functionalities entail the biggest component.
Twine is something that user can easily learn to utilize and this is huge beneficial for UNHCR at all levels because it allows the standardization and the speedup of several operations: it has just one interface for data entry; it offers the possibility of working offline and synchronizing when connection is available; it allows selected users to create and modify forms for data collection.
The project´s implementation started in April 2016 and is going to be completed until June 2017. We are currently testing the collecting section. During the analysis phase we have been piloting a new data collection modality using Twine in the WASH sector. Scope of it was the identification of strengths and challenges before extending the new system to other intervention sectors.
A five-week-feature testing between August and September 2016 took place in four Countries, such as Kenya, Jordan, Rwanda and Tanzania. First the Out-Patient Data (OPD) collection forms were tested on 80 tablets, but the application will be responsive and therefore data could be also entered by PC, Laptop, and smartphones.
Different persons, with individual expectations and experiences brought many useful and necessary feedback to modify and give us a better direction for the future development of the application.
During the testing 49 versions of the application have been released and more than 150 issues fixed. Based on the feedbacks, we were able to pinpoint some weaker points in development including the   enhancement of the offline-sync function and also thinking about harmonizing across the different Twine platforms (web and mobile).  The need to focus more on the aesthetic/user interface aspects of the app has been also pointed out.
The data elaboration and reporting section is being developed  now. This tool will allow the user to create new reports and customize her/his own dashboard.
Up to now a very collaborative working atmosphere between Gnucoop staff and UNHCR is being contributing to the first positive results. We are very satisfied with that and share the opinion of Eugene Paik – Public Health Data Analyst at UNHCR – when saying that “the development is heading in the right direction”.

Anche in Italia nasce un’applicazione in supporto ai migranti, per soddisfare la necessità sempre più evidente di facilitare il loro accesso alla burocrazia italiana ma anche alle istituzioni italiane che in questo modo sono più vicine a 5 milioni di persone di diverse nazionalità che intendono vivere in Italia.

L’App InfoStranieri nasce nel 2014 da un’idea di Bashkim Sejdiu, trentunenne kosovaro arrivato in Italia ventun’anni fa e che da oltre dieci anni offre servizi di assistenza burocratica agli altri stranieri che vivono in Italia.

Lo scopo dell’App è quello di rispondere alle esigenze:

•  di tutti gli stranieri regolari costretti a vivere l’incubo di dover adempiere a tutta una serie di requisiti burocratici particolarmente complessi, dispendiosi in termini di tempo e per di più in un Paese del quale stanno ancora imparando la lingua;

• dello Stato Italiano in quanto il Paese necessita di personale straniero regolare e pertanto trarrebbe molto giovamento dalla semplificazione degli adempimenti di cui sopra, con particolare riferimento alle procedure di regolarizzazione.

Guarda l’intervista a Bashkim Sejdiu