Since 2021, Elephant has worked in partnership with state governments in Nigeria to digitise public sector health facilities with our lightweight EHR, ElephantOS.
In early 2024, we carried out a Proof of Concept Study for a new tool, Elephant Nudge, a clinical co-pilot which uses nudges, incentives and fraud detection to guide clinicians toward higher quality care. Our first study tackled typhoid in Nigeria. After strong results from the POC study, three of our Nigerian state partners asked us to turn Nudge’s attention to malaria case management.
The results shared here demonstrate the huge potential for Nudge to improve quality of care at scale for our government partners:
Introducing Elephant Nudge
Elephant Nudge can be configured to tackle any condition, at any level of the healthcare system and it integrates seamlessly with any frontline clinical tool.
It works in three main ways:
1) Guiding clinical actions - using highly targeted nudges to influence clinical actions at the point of care, adapted to clinician behaviour and patient needs. Design nudges in line with national protocols.
2) Incentivising with pay-for-performance - helping payers to validate and reward clinical actions with pay-for-performance incentives.
3) Supporting education - providing clinicians with personalised feedback and training, based on adaptive, clinical performance data. Nudge can be tailored to support education at every level of the health system.
Common challenges for malaria
Nigeria contributes to 31% of malaria deaths globally1. Common challenges for malaria in Nigeria include inaccurate diagnosis and drug resistance, caused by lack of testing and, over and inappropriate, prescription of drugs.
How Nudge works to address these challenges
This initial version of Nudge was integrated with ElephantOS, our lightweight EHR. It used highly targeted nudges to guide, influence and support clinicians to adhere to clinical guidelines:
- ElephantOS nudged clinicians to test patients with suspected malaria
- Clinicians took photo of test result (sent to Audere’s AI*)
- If the test was negative, clinicians were warned before prescribing ACTs
- Facilities were incentivised through targeted pay-for-performance subsidies for each completed checklist
When prescribing, the tool also indicated which prescriptions were considered best practice. The medications covered were WHO-recommended treatments, guaranteeing patients access to the most critical and effective malaria fever care.
*Improving accuracy of diagnosis with Audere's HealthPulse™ AI
For this intervention, we partnered with Audere to incorporate their HealthPulse™ AI solution, to deliver instantaneous AI-validated rapid diagnostic testing integrated into clinicians workflow. The aim was to improve accuracy of diagnosis and data quality, confirmed through AI-powered interpretations of rapid tests.
The results showed significant improvements in quality of care:
After 5 weeks of the Nudge + Audere AI intervention, we achieved the following impact, indicating a clear improvement in adherence to clinical guidelines for testing and prescribing:
The results are compared with baseline data from the Elephant EHR in the 3 months prior to the study:
1) 48% increase in testing rates
2) 16% decrease in antibiotics prescribed to suspected malaria cases
3) 10% decrease in anti-malarials despite negative test result
4) 10% decrease in patient out-of-pocket expenditure (OOPE) across the full visit
5) By increasing testing, diagnoses and surveillance of other febrile conditions increased
These strong results lay the groundwork for future larger scale deployments.
Where we are going next:
We are now working with our government partners to configure Elephant Nudge to target other high priority conditions in our markets, such as broader fever management and Maternal Newborn Child Nutrition and Health. We are excited at the huge potential for Elephant Nudge to be deployed at scale, both within Elephant OS, our lightweight EHR, as well as within other frontline clinical tools.
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