The Rwanda Ministry of Health is investing in mobile health (mHealth) technology. In August 2009, the Ministry launched an mHealth (M-Ubuzima) initiative to support community health workers in maternal and child health interventions by utilizing mobile technology. 432 community health workers, who are responsible for maternal health in the Musanze district, were given mobile phones equipped with Rapid SMS tools. These mobiles allow health workers to report difficult cases, complications or emergencies to the nearest clinic or hospital, and improve maternal health information tracking by capturing data about pre-natal health, delivery, and birth outcomes. The pilot project has produced hopeful results, and the goal is to give mobiles to all maternal health workers across the country and eventually to all community health workers.
The World Bank’s Board of Executive Directors has approved US$63.66 million to create a unique regional network of 25 public health laboratories across Kenya, Tanzania, Uganda, and Rwanda. This network will operate across country borders, improving access to diagnostic services to vulnerable populations in cross border areas and making optimal use of internet and mobile communications to improve public health.
Laboratories are currently the weakest link in the region’s public health defenses, seriously hindering each country’s ability to confirm and respond in a coordinated manner to disease outbreaks. By bolstering diagnostic and surveillance capacities, the new multi-country laboratory network will help to identify potentially devastating disease outbreaks at an early stage, enabling countries to act quickly to prevent the rapid spread of diseases across borders. Communicating outbreak-related information across national borders in real time is more important than ever before, as labor mobility is likely to increase shortly with the establishment of the East African Community common market and with growing global travel.
The network will also support the roll-out of new technology for drug resistance monitoring and more efficient tuberculosis diagnosis, most notably for people living with HIV/AIDS. Greater access to diagnostic services is expected to significantly contribute to improved health outcomes, and ultimately to attaining the Millennium Development Goals.
The Centers for Disease Control and Prevention, on behalf of the Tanzanian Ministry of Health and Social Welfare (MOHSW), is currently tendering for a major revamp of the country’s information systems handling the response to HIV and AIDS. The purpose of this program is to provide technical assistance to strengthen Health Management Information System (HMIS) capacity within all levels and units of the ministry in order to:
- Build on lessons learned and investments in the HIV/AIDS sub-sector to support national planning and harmonization of health sector information systems to achieve the goal of one data collection and dissemination system that meets the needs of all government, cooperating partner, non-governmental, and civil society institutions operating in the Tanzanian health sector.
- Improve the capacity of the ministry to collect, manage, and analyze aggregate program monitoring and evaluation data to meet government, international, and cooperating partner reporting requirements.
- Support the ministry in systems analysis, process design, vendor selection, and deployment of operational or transaction processing management systems supportive of standard operating procedures across the MOHSW.
- Support the creation of a data warehouse, or analytical processing system, which brings together information from aggregate data collection systems, surveillance and evaluation studies, transactional systems and National Bureau of Statistics data.
- Support application of data analysis in dissemination papers, abstracts, and report cards.
- Support the use of policy analysis, projections, and modeling techniques to build evidence-based policy formulation, programmatic resource allocation, and decision making across the health sector and at all levels.
A pilot malaria drugs supply management project called “SMS for Life” has Tanzanian authorities excited over its potential. The project, which brings together IBM, Novartis, Vodafone and the Roll Back Malaria Partnership, taps into a combination of smart technologies to track and manage the supply of anti-malarial drugs.
The initiative uses a combination of mobile phones, SMS technologies and intuitive websites to track and manage the supply of Artemisinin-based Combination Therapy drugs and quinine injectables, both of which are key to reducing the number of deaths from malaria. Vodafone, together with its technology partner MatsSoft, developed a system in which healthcare staff at each facility receive automated SMS messages, that prompt them to check the remaining stock of anti-malarial drugs each week. Using toll-free numbers, staff reply with an SMS to a central database system hosted in the United Kingdom, providing details of stock levels, and deliveries can be made before supplies run out at local health centres.
East African Community ministers responsible for social development met in Bujumbura in October and urged the fast-tracking of an integrated e-health regional information network to identify, confirm and respond rapidly to outbreaks of diseases with international ramifications.
That’s the good news.
The not so good news is that this project was due to be piloted in 2007.
The Fogarty International Center, part of the US National Institutes of Health, today announced it will award more than $9.23 million to eight global health informatics programs over the next five years – two of them from Africa.
The University of KwaZulu-Natal in South Africa will use its new award to develop research and training capacity in informatics through a Pan-African collaborative initiative involving institutions in Uganda, South Africa and Zimbabwe. The funds will allow the UKZN to continue to offer postgraduate programs in informatics while assisting other universities in Africa to establish their own medical informatics training programs.
And a grant will support the development of an East African Center of Excellence in Health Informatics. The center will be a major resource for improving local human capacity for health informatics and clinical research in sub-Saharan Africa, building upon an almost two-decade collaboration between Indiana University and Moi University in Eldoret, Kenya.
Opinion by ITWeb (excerpts only)via
Speaking at this year’s GovTech Conference, the CIO of the Department of Health, Dr Shaheen Khotu, gave a bewildering presentation. His subject was the National Health Information System of South Africa, and in particular, the provision of an electronic health record. The aim of such a record is to keep all medical data for South Africans where they can be accessed by health services anywhere.
The notion is a good one. Reality, however, is not only far removed from the ideal, but will never get there.
Down Referral is a mechanism to increase access to care for large numbers of patients requiring Anti-RetroViral (ARV) therapy. Down referral to primary health care sites often ensures that patients receive treatment within walking distance of their homes, reducing the financial burden associated with transport and loss of income for clinic visits. In South Africa PEPFAR-funded NGO Right to Care has worked with US biotech company TherapyEdge to develop a module for TherapyEdge’s suite of HIV treatment products.
The system maintains patient record continuity between the initiation site and the primary health care down referral site. The higher level prescribes the drugs. The lower level records the details of each patient visit: if the the patient is stable the drugs are issued, if not the patinet is referred up again.
One minor problem wth the system: how many primary health care facilities have computers with internet connectivity?
Sub-Saharan Africa could soon have medical records of people living with HIV and AIDS patients run electronically, thanks to The DREAM Project which now operates within the framework of the national health systems of several African countries. DREAM has now spread to 10 African countries: Mozambique, Malawi, Tanzania, Kenya, the Republic of Guinea, Guinea Bissau, Cameroon, Congo RDC, Angola and Nigeria and is being used by thousands of professionals in 31 centres and 18 molecular biology laboratories that are already operational and by now has reached its fourth version.
The Dream Project aims to introduce the essential components of an integrated strategy for the prevention and treatment of HIV/AIDS and will provide efficient management of the clinical data regarding the treatment of the patients and epidemiological analyses. The project is intended to serve as a model for a wide-ranging scale-up in the response to the epidemic in a unified manner of gathering data by different centres in different countries, monitoring of centres and for the refining of therapies.
DREAM was launched in Mozambique in March 2002, following two years of groundwork. However, the idea for the project was born in 1998 when the Community of Sant’Egidio– a Christian movement founded in Rome in the late 1960s that has a strong base in Africa – decided to fight the devastating impact of HIV/AIDS.
The medical files of over 73,000 assisted patients are managed by this software and the data collected with it have become essential for the epidemiological research that is carried out to improve the effectiveness of the therapy.
Specific software for the management of the patients’ EMR has been created within the DREAM programme in order to deal with the challenges deriving from the context in which DREAM operates. Setting up a computer infrastructure in health centres, providing a power supply, as well as managing the data and the project resources efficiently and reliably, are some of the challenges the project aims to solve.
As for Internet connections, especially regarding bandwidths that are not always adequate, the matter is tackled in different ways. Careful enquiries made to local Internet service providers (ISP) have allowed many centres to have good quality Internet access at an accessible price. In cases where this was not an option, the problem has been resolved by using satellite connections, usually installed in our laboratories.
For all the rural centres that are not connected to the Internet, it has been possible to transfer requests for tests via flash disk from the centre to the laboratory. The same applies to the transfer of backup of the centres. Once the backup reaches the laboratory, the software makes it possible to send all the backup of the satellite centres to a centralised server. Another important point: the size of files sent is reduced, to make them as robust as possible, so as not to be vulnerable to possible loss of data. An incremental backup system with especially strong redundancy was designed in order to achieve this.
Testifying to the quality of the networks (electrical as well as computer) of DREAM centres, VoIP communication systems have been introduced (at times supplied by the operators), which have allowed for the reduction in intercontinental teleconsultation costs. DREAM has chosen to invest in intensive short-term personnel training, followed by more prolonged in-service training with the support of expert personnel at the workplace.
Community intervention models have also been developed, such as outpatient care, community and home-based care. These do not require extensive resources and can be set up quickly. As a backup, a small number of high technology centres capable of supporting large areas (e.g. molecular biology laboratories) have been set up. In every DREAM treatment centre, a computer with the DREAM Software is available for all staff members; everyone follows the patient as per his/her specific competence and tasks and while doing so, has all the updated data of the said patient at his/her disposal.
Not only does this make procedures more efficient and the work of the centre more streamlined, it has also served to guarantee the quality of data, with each staff member able to verify the said data from his/her own station.
Centres are lcoated within a 150 km radius of cities and have been equipped so that they can offer the same qualitative level of treatment and monitoring as those closer to the cities. Apart from supplying equipment, the transport of blood samples and periodic supervision by DREAM staff are also organized.
The attention paid to the requests of the end users, covering every aspect of care and treatment, the possibility of having homogenous data from different countries, are only some of the significant features which have made this computer system an indispensable tool for the management of treatment and for epidemiological research.