Common health problems of refugees and displaced population groups in the Sahel region are infectious diseases, particularly respiratory infections, acute diarrheal diseases, malaria and malnutrition, as well as general mental illnesses such as post-traumatic stress disorder, depression, psychosis and suicide attempts. The project "Digital System for Better Health Care Management of Refugees" (SysRef) aims to improve the quality of health for refugees and displaced people in Chad living in refugee camps.
Measures to improve health care management include the development and implementation of digital tools. Specifically, the project pursues the following goals: (i) improving the diagnosis and treatment of infections and other health problems, such as mental illness among refugees and displaced people; (ii) a follow-up of specific target groups, such as pregnant women; (iii) registration of vaccinations and monitoring of vaccination status; and (iv) automatic collection and assessment of epidemiological data. The developed digital tools will be tested and validated. Their transferability to regions with comparable humanitarian crises will be assessed.
The project is implemented from 2019 to 2022 and is divided into four phases: analysis of the situation, development of digital/IT systems, implementation and use of tools, and dissemination of results and analysis of the replicability of the tools. The project is directed by the Swiss Tropical and Public Health Institute (Swiss TPH) in close collaboration with the ‘Centre de Support en Santé Internationale’ (CSSI), the UNHCR and other partners in Chad.
Update from April 2021:
The project team analysed the medical conditions, services offered and technical competence, and the state of infrastructure and information technology in three selected health centres in the health district of Goré in southern Chad covering four refugee camps with a population of 38’000. A team of international and Chadian clinicians developed clinical algorithms for identified common diseases (including mental health conditions) of adults, and children and adolescents aged 2 months to 15 years. The algorithms were approved by a Chadian committee of medical experts and thereafter digitized by the ICT technicians. A pilot test was conducted in the health centers in September 2020 in partnership with the UNHCR and the Chadian NGO “Centre de Support en Santé Internationale”.
The findings from the pilot test guided the next steps, particularly how the clinical decision support system (CDSS) can be integrated into the local process of medical care, and what measures are needed to maximize the use of the tools. Challenges include the complexity of the technological solution taking into account the poor internet connectivity, power supply, and the SARS-CoV-2 pandemic and related travel restrictions. Trainers were trained by the project clinicians in N’Djamena in March 2021 and involved 11 cadre health professionals from the health facility and district level. An end-user training for the release of the first package involving 35 state nurses and midwives and 42 nurse assistants was conducted in June 2021. Another end user training of the same participants for the release of the second package is planned for early October, along with a final round of testing of the CDSS by the clinicians and ICT technicians.
The CDSS builds on the choice of symptoms and the scope of application covers a whole life span. The project team adopted a parallel development and implementation approach: the launch of a basic version (first package) is followed by the release of two additional extensions (packages 2 and 3) that are gradually introduced. Since the local project team bears much implementation responsibility, a close collaboration with the international project team was established, mainly through virtual exchanges but also physical participation of the Basel-based experts at critical events such as the pilot test and training.