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For many years, healthcare centers throughout The Gambia have used paper records to document antenatal, delivery, postnatal, vaccination, and child health information. The handwritten logs,often partial, uneven, or hard to read, formed the foundation of the nation’s Health Management Information System (HMIS). This manual system had significantlimitationsfor example, incomplete records, repeated entries, late reporting, and the inability to connect information between mothers and their children.

The outcomes were significant. Incomplete or unreliable data hindered healthcare professionals in monitoring patient records, contacting mothers and newborns, or identifying disease outbreaks promptly. On a national scale, decision-makers faced challenges in distributing resources properly, while donors and program designers did not have the necessary information to create effective responses.

As a reaction, a subtle transformation is taking place at Bundung Maternal and Child Hospital (BMCH) in Serekunda, the biggest city in The Gambia. The implementation ofSmart Paper Technology (SPT)A combined system that connects traditional paper-based processes with digital data automation has changed how the country handles health information. Introduced in 2017, the SPT project was a joint effort between The Gambia’s Ministry of Health, the Medical Research Council of The Gambia (MRCG) affiliated with the London School of Hygiene & Tropical Medicine, the Shifo Foundation, the United States Centers for Disease Control and Prevention (US CDC), and Bundung Hospital.

The Smart Paper Technology

Initially tested at Bundung and Fajikunda health facilities, the system aimed to enhance immunisation and primary healthcare services. It is now being extended to encompass all aspects of maternal and child health services, such as antenatal, delivery, and postnatal care. The technology functions by assigning unique patient identification numbers, barcodes, and QR codes to each mother and child. Healthcare workers complete structured paper forms during patient care, as they have traditionally done, but rather than copying them into large ledgers and manually tallying the data, the forms are scanned, converted into digital format, and synchronized with District Health Information Software 2 (DHIS2), an open-source data platform utilized worldwide for health reporting. This advancement maintains the simplicity of paper-based record-keeping while removing its inefficiencies.

Smart Paper Technology has enhanced our data input, gathering, and archiving,noted Fatoumatta Saidykhan, Medical Records Supervisor at Bundung Hospital. “We utilize significantly fewer registers today, and data is simpler to access.She additionally mentioned that with the SPT solution, patients get SMS notifications two days prior to their planned hospital visits, informing them about their vaccination appointments, antenatal or postnatal check-ups, and appointments for themselves and their infants. Regarding data security, the system has not only minimized paper usage but also improved data accuracy and protection.Access to certain data within the system is limited according to staff roles, allowing only approved individuals to view it, she added.

As stated by Joseph S. Mendy, an Immunisation and Public Health Officer at the Bundung Maternal and Child Hospital, paper records were common, but the Smart Paper Technology approach is more dependable, saves time, and avoids data loss, as encountered with the manual system. He further mentioned that,It provides real-time vaccine inventory, which is very helpful for stock management, and the nurses like it. Printing paper records is no longer a problem, and we can monitor the number of patients treated each day. For example, today we have seen 200 patients, Mendy revealed.

For Famara Fofana, a cashier at the registration desk of the Bundung Maternal and Child Hospital, the SPT solution proves highly effective in emergency situations, allowing nurses to quickly access patient medical histories by entering their phone numbers into the system.“The system maintains all important information from patients’ medical backgrounds, such as medication records, outpatient notes, and maternal and infant documentation. We have the ability to share these records with nurses without needing to leave our workstations,” he stated.

Improvements in data accuracy and speed have minimized reporting delays, shifting from months to days. This has provided health authorities with almost real-time insight into maternal and child health metrics, marking a significant advancement for monitoring and strategic planning. Facility records indicate changes during the same period as the SPT implementation. In Bundung’s area of responsibility, facility-based deliveries increased from 82.5% in 2022 to 83.9% in 2023, while immunization rates for initial doses were notable. Oral Polio Vaccine (OPV) reached 91.7%, Hepatitis B at 92.3%, and Bacillus Calmette-Guérin (BCG) at 76.4%. Concurrently, institutional mortality rates dropped from 2.1% in 2022 to 1.4% in 2023.The level of data quality, promptness, and integration obtained via SPT allows us to now track health results with greater precision and react more quickly,mentioned a senior official from the Ministry of Health who wished to remain unnamed.

Implementation challenges and trade-offs

Although it has achieved success, the implementation of SPT has faced several difficulties. Consistent power supply, sufficient scanning devices, and stable internet access continue to be major obstacles, particularly in remote regions. Moreover, medical personnel require ongoing education not just in patient care, but also in proper form filling, scanning procedures, and data handling.

To fill these gaps, the Shifo Foundation hired Dipika Roy, an international public health consultant, to manage the digital solution and assist with the transition. Roy referred to the initial phase as challenging yet impactful. “Bangunan Hospital was selected for its technologically proficient staff and the capacity to implement such solutions efficiently, Roy explained.

Roy highlighted that the system goes beyond a simple digital enhancement; it signifies a major change in how the healthcare system is held responsible and operates efficiently.By connecting maternal and child records, SPT ensures seamless care. It also promotes comprehensive health coverage by enhancing data accuracy, fairness, effectiveness, and openness, she said.

More than record-keeping

The achievement of the Bundung pilot has captured the interest of national stakeholders who are keen to duplicate its effects in other areas, resulting in the launch of the Expanded Programme on Immunisation (EPI) throughout the country. Reviewers observed that the system enables health planners to track essential indicators almost instantly, facilitating quicker reactions to vaccine safety issues, enhanced supply chain operations, improved monitoring of mothers or infants who miss appointments, and more accurate distribution of resources.

As the system grows, Bundung Hospital and its collaborators are venturing into new areas, such as digital inventory management (monitoring medicines, vaccines, and supplies) to avoid shortages and excess.The effective SPT approach in immunization and primary care has motivated the project to extend to inventory management across all facilities, said RoyIt will enable us to efficiently track, regulate, and handle medical supplies throughout the nation.

In addition to improving efficiency, SPT relieves healthcare professionals from the significant administrative workload of paperwork, enabling them to concentrate more on providing patient care, as stated by Fatoumatta Saidykhan, the Medical Records Supervisor.

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