Challenge

In rural Sub-Saharan Africa, isolated health facilities with minimal staff struggle under pressure to treat diseases while documenting data for ministries and donors using outdated paper ledgers. Health workers spend 2-3 days monthly on cumbersome reporting. Though digital solutions seem obvious, only 9% of rural areas have stable electricity and network coverage, making improved paper-based systems more pragmatic and cost-effective.

Approach

Sonder worked collaboratively with health workers, ministry officials, public health experts, and designers from Côte d'Ivoire, Mozambique, and Nigeria over 19 months to develop the paper-based clinical support and data collection innovation known as PHISICC. The project was structured into 3 phases:

• Set-Up: Formation and training of working groups that would take responsibility for ideation and design.
• Ideation: Concept exploration workshops, low-fidelity prototype development and field testing.

The PHISICC system was produced using design principles and best practices, resulting in elegant decision-making routine health information systems tools that also meet the data needs of health ministries and donor agencies covering a full range of primary care topics ranging from antenatal and postnatal care to vaccination, sick child visits, and outpatient consultations.

Specific system features include:

• Simple visual hierarchy for the sequential tasks that occur during a clinical interaction;
• Clear iconography to guide clinical actions;
• Algorithmic decision pathways to support assessment, diagnosis, treatment, and referrals; and,
• Prompts for follow-up visit/action discussions.

PHISICC ultimately reframed the role of health workers in remote, rural areas from basic service functionaries to active partners in the health of their patients.

The PHISICC system was produced using design principles and best practices, resulting in elegant decision-making routine health information systems tools that also meet the data needs of health ministries and donor agencies covering a full range of primary care topics ranging from antenatal and postnatal care to vaccination, sick child visits, and outpatient consultations.

The team published several papers further detailing their approach, including:

• Does an innovative paper-based health information system (PHISICC) improve data quality and use in primary healthcare? Protocol of a multicountry, cluster randomised controlled trial in sub-Saharan African rural settings (BMJ Global Health)
• How to design decision-support tools for primary healthcare using a human-centred design approach: the processes and experience of PHISICC in three Sub-Saharan countries (BMJ Global Health)
• Researching, co‑creating and testing innovations in paper‑based health information systems (PHISICC) to support health workers’ decision‑making: protocol of a multi‑country, transdisciplinary, mixed‑methods research programme in three sub‑Saharan countries (BioMed Central)