A Breakthrough in Sankuru: How We Cracked the Accountability Puzzle with AI

Using artificial intelligence, cell phones, and a lot of help from the Holy Spirit, we’ve made a breakthrough that could have a major impact on our ability to grow, reach more children, and transform health care delivery in Sankuru — and perhaps even beyond.

Accountability Is the Foundation

Accountability is at the very foundation of good health care. You don’t need a degree in medical informatics — which, incidentally, I do have — to know that. Good care requires knowing which child received what service, when it was given, and what still needs to happen next. That sounds simple until you try to do it consistently across remote communities with paper registers, limited connectivity, difficult transportation, and very limited resources. Any physician in the United States who has struggled to keep medical records up to date — even with sophisticated electronic systems — can appreciate how complicated this becomes.

The Bottleneck That Limited Our Growth

In Sankuru, severe poverty and difficult transportation and communication infrastructure make the challenge even greater. Until recently, someone had to review and manually enter nearly every data point. It was slow, expensive, and required a great deal of supervision. Frankly, our growth was sometimes hobbled by our absolute insistence on clean, accurate data. But we have never been willing to sacrifice accountability for speed. If we cannot demonstrate that children actually received the care we say they received, then we have not built the kind of program our donors, our health workers, or the children of Sankuru deserve. Now that bottleneck is beginning to break.

Informatics in the field with twins: double the trouble — and double the value.

A Different Way

Using cell phones, workers in the field can record services where they happen. The system is designed for places where internet access is unreliable, so information can be collected offline and synchronized when connectivity becomes available. Built-in checks help reduce common errors, and the information can be reconciled against official reports and health-center records. Artificial intelligence then helps us digest large amounts of information, identify inconsistencies, summarize performance, and turn raw data into reports that people can actually use. AI is not replacing accountability. It is helping us make accountability possible at a scale that would have been extraordinarily difficult just a few years ago.

From Data to Fair Payment

The same verified information also helps us compensate health workers transparently for the work they actually complete. Workers can see how their payment was calculated and receive a simple electronic pay statement. That matters. A nurse, vaccinator, data-entry worker, or community health worker can see the connection between the work performed, the information recorded, and the compensation received. Supervisors can review the same information, and we can trace program spending back to real services delivered to real children. We already know that health workers in other parts of Sankuru are eager to participate in a system that recognizes and fairly compensates good work. That should make it easier for us to expand while preserving the standards that matter most.

What Better Information Means for Prevention and Care

Prevention Begins in the Community — Esther Prevention brings vaccines and other preventive services closer to children and families where they live.

Reliable information is not just about better reports. It helps us see which children have received preventive services, where gaps remain, and where health workers need to return. That makes data a practical tool for reaching children rather than simply counting them afterward.

Care at the Bedside — Esther Soins connects compassionate clinical care with the information needed for follow-up, accountability, and learning.

The same principle applies to care for sick children. When information is captured where care happens, we can better understand what services are being delivered, follow the work of the health centers, and make sure our support is tied to real care for real children.

Why This Matters Beyond Esther

Health systems in many low-resource settings struggle to obtain timely, accurate medical data. Without reliable information, it is hard to deliver the right care to the right people — especially children — at the right time. Traditional paper-based systems can be slow and vulnerable to delayed reporting, transcription errors, and incomplete information. Our approach combines offline field data collection, verification, rapid analysis, and transparent activity-based payment in a way that is affordable enough to use at the grassroots level. I do not know if we are the first people anywhere to assemble these tools in this way, and being first is not really the point. What matters is that the system is working here, under some of the most difficult conditions imaginable, and it may give us a practical path to grow without abandoning accountability.

What This Means for Donors

For those who support the Esther Fund, this creates something especially important: confidence. When you give, we want to be able to show that your gift translated into actual services for children — vaccinations delivered, preventive services completed, sick children treated, and health workers compensated for verified work. Good intentions are not enough. Compassion must be joined with accountability.

The Right Tool at the Right Time

When I came to Sankuru, I knew that accurate medical information would be essential to saving children. I had no idea how we could generate that information reliably and affordably across such difficult conditions. I am deeply grateful that, in God’s wisdom, He decided to send a computer-savvy physician here at exactly the moment when tools like artificial intelligence became practical enough to help. Sometimes the right tool appears at exactly the right time. And I believe we are only beginning to understand what God may allow us to do with it.

Paul Law, MD, MPH

Executive Director, Esther Fund