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Supported by the European Commission under Horizon 2020, mHealth4Afrika is co-designing and validating a modular, multilingual, state-of-the-art health information system addressing primary healthcare requirements in resource constrained environments. mHealth4Afrika has co-designed a comprehensive range of functionality and medical programs in partnership with Ministries of Health, district health officers, clinic managers and primary healthcare workers from urban, rural and deep rural health facilities in Ethiopia, Kenya, Malawi and South Africa. This paper provides insights into how mHealth4Afrika is leveraging HL7 FHIR to support standards-based data exchange and interoperability between Electronic Medical Records and DHIS2. This work is currently being validated in the field.

Supported by the European Commission under Horizon 2020, mHealth4Afrika is co-designing and validating a modular, multilingual, state-of-the-art primary healthcare platform for use in resource constrained environments. Based on active consultation and collaboration with Ministries of Health (MoH), district health officers, clinic managers and primary healthcare workers from urban, rural and deep rural health centres in Ethiopia, Kenya, Malawi and South Africa, mHealth4Afrika has co-designed a comprehensive range of health programs and associated functionality. This paper provides insights into how mHealth4Afrika is supporting a holistic, patient-centric, standards-based "cradle to grave" approach to replacing paper-based registries and program-specific (or siloed) electronic solutions installed in many cases by donors targeting specific diseases. mHealth4Afrika is a HL7 FHIR-based platform integrating Electronic Medical Record (EMR) and Electronic Health Record (EHR) functionality, leveraging medical sensors and decision support at the point of care, saving time associated with monthly aggregate data reporting and encouraging attendance through SMS communications with clients and community health workers.

mHealth4Afrika has introduced the use of CE approved medical sensors at the point of care in primary healthcare facilities in Africa as part of an integrated platform supporting primary health care services. This paper shares insights into the standards-based architecture and HL7 FHIR service developed to support data transfer from sensors with proprietary standards to populate the mHealth4Afrika electronic patient record via custom Android and Windows applications. The current iteration is being validated in healthcare facilities in Ethiopia, Kenya, Malawi and South Africa.

Context: Previous studies have identified positive relationships between geographic proximity to family planning services and contraceptive use, but have not accounted for the effect of contraceptive supply reliability or the diminishing influence of facility access with increasing distance., Methods: Kernel density estimation was used to geographically link Malawi women's use of injectable contraceptives and demand for birth spacing or limiting, as drawn from the 2010 Demographic and Health Survey, with contraceptive logistics data from family planning service delivery points. Linear probability models were run to identify associations between access to injectable services-measured by distance alone and by distance combined with supply reliability-and injectable use and family planning demand among rural and urban populations., Results: Access to services was an important predictor of injectable use. The probability of injectable use among rural women with the most access by both measures was 7‒8 percentage points higher than among rural dwellers with the least access. The probability of wanting to space or limit births among urban women who had access to the most reliable supplies was 18 percentage points higher than among their counterparts with the least access., Conclusions: Product availability in the local service environment plays a critical role in women's demand for and use of contraceptive methods. Use of kernel density estimation in creating facility service environments provides a refined approach to linking women with services and accounts for both distance to facilities and supply reliability. Urban and rural differences should be considered when seeking to improve contraceptive access.