Integrating digital solutions into national health data systems through public-private collaboration: An early experience of the SPICE platform in Kenya.

Public-private collaborative efforts to address healthcare challenges in low- and middle-income countries have been the focus of digital initiatives to improve both access and quality of health services. We report the early feasibility, experience, and learnings of migrating healthcare data generated from a proprietary, privately owned cloud-based environment into an on-premises National Health Data Center (NHDC) in compliance with Kenya's data management legislation. In 2018, Medtronic LABS entered into a partnership with the Kenya Ministry of Health and other stakeholders to improve access to quality services and data availability for non-communicable diseases (diabetes and hypertension), anchored on the SPICE digital health platform. Data migration from SPICE to the NHDC necessitated the establishment of multi-stakeholder coordination structures, alignment on system configuration requirements, provisioning of on-premises servers, data replication and monitoring. The data replication process showed consistency in format and content with no evidence of data loss. The monitoring of the server uptime and availability, however, exposed overall downtime of 15% of the total time tracked between April and December 2022 caused by Internet Protocol address configuration issues, power outages, firewall rule changes, and unscheduled system maintenance. Monthly tracked downtime however reduced from a high of 28% in April 2022 to 5% in December 2022. Our early experience shows that data migration from proprietary host environments to public "one-stop-shop" national data warehouses are feasible provided investments are made in the requisite infrastructure, software and human resource capacity to ensure long-term sustainability, maintenance, and scale to match cloud-based data hosting. Further, digital health solutions developed in collaboration with non-state actors can be integrated into national data systems, saving Governments the cost and efforts of building similar tools while leveraging private sector capacity.

A comparison of bacterial indicators and methods in rural surface waters.

The United States Environmental Protection Agency (USEPA) recommends the use of Escherichia coli (E. coli) and enterococci as indicators of enteric pathogens in fresh waters; however, fecal coliform analyses will remain important by virtue of the large amount of historic data collected in prior years. In this study, we attempted, in a real-world situation (i.e., a rural inland watershed in the Piedmont of South Carolina) to compare different bacterial indicators and methods to one another. We compared fecal coliforms, enumerated by membrane filtration with E. coli, enumerated by a commercialized enzyme substrate method and observed E. coli/fecal coliform ratios of 1.63 and 1.2 for two separate tests. In the same watershed, we observed an E. coli/fecal coliform ratio of 0.84 when we used the commercialized enzyme substrate method for both enumerations. Given these results, users of such data should exercise care when they make comparisons between historic membrane filtration data and data acquired through the use of the more modern enzymatic methods. Some sampling and side-by-side testing between methods in a specific watershed may be prudent before any conversion factors between old and new datasets are applied.