Realising a lasting jump

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• Realising a lasting jump
• in
• health care performance

28 January 2009 Caroline Figuères, managing
director WB ICT sector Week
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Focus

• Education
• Improve curriculum
• Access to quality education
• Dissemination of materials

• Livelihoods (entrepreneurs)
• Market price information
• Access to new markets
• Innovative techniques

• Health
• Telemedicine (diagnosis)
• E-education
• Information systems

• Governance
• Access to public services
• Exchange of information

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Seven Guiding Principles

• Demand-responsiveness
• Local ownership
• Multi-stakeholder involvement
• Partnerships
• Learning by doing
• Capacity development
• Gender equality
• These principles are key for sustainability
• of IICDs supported ICT projects and programmes
• 40 projects continue independently
• 10 failure only

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Projects in the health sector

• Ghana, Mali, Tanzania, Uganda, Zambia
• 24 projects
• Reaching around 55,000 medical workers
• 67 are women
• Approx. 830,000 beneficiaries
• 82 are located in rural areas

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IICD interventions at different levels

• Improve access to and quality of health services
• Management of health, hospital and patient
  information
• Administrative systems, ordering and billing,
  disease surveillance, management and logistics of
  health care, patient records
• Professional development and Continuous Medical
  Education
• e.g. health research, e-learning
• Improving the delivery of health care
• e.g. telemedicine, remote diagnostic support
• Improve access to information for patients and/or
  people in the community
• Advocacy to improve services, interactive
  communication, media approaches
• Provide policy makers with reliable and
  up-to-date health information
• ICT policy and strategy development for the
  health sector

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Case Health Management Information System
project, Tanzania

• Tanzania
• Surface Area (sq. km) 947.3 thousand
• Population total 40.4 million
• Life expectancy 52 years
• Literacy rate 69.4
• Source World Development Indicators, 2007-2008

• Needs in health sector
• shortage of staff (min 58,000)
• limited access to training courses
• insufficient access to medical
• and public health information
• inefficient management

• Access to ICT/telecom (per 100)
• Mobile phone subscribers 14.6
• Landlines 0.4
• Internet users 1
• Personal computers 0.9
• Source Worldbank - ICT at a glance, 2006

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Case HMIS for Evangelical Lutheran Church
Tanzania (ELCT)

• Project owner Evangelical Lutheran Church
  (ELCT)
• 20 hospitals
• 5 paramedical institutions
• Over 160 dispensaries and health centres
• 1500 health workers, 2160 beds
• () Covering 15 of the national health services
  in Tanzania
• Context
• The hospitals and health institutions suffer from
  inefficient management practices due to a
  shortage of staff, high turnover rates and
  inadequate health utilization data. Collecting
  data takes too much staff time.

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Target groups and goals of the project

• Target groups
• Health workers (doctors, nurses, etc) patients
• Goals
• Enable hospital staff to work more effectively
  and professionally
• Provide timely and accurate information leading
  to better health care planning
• Improve speed and accuracy of diagnosis
• Give more people access to health services
• Improve financial situation

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Facts pilot phase of the project
Project duration May 2006 end of 2008 Number
of participating hospitals 1-4 Number of users
160 Number of beneficiaries 12,000 Total
investment 250,000
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Objectives

• Make customized software available for standard
  transactions and reporting
• Install required hardware
• Train and help motivating staff to use the system
• Have support services in place
• Generate continuous feedback (management and
• end user)
• Ensure roll-out to 26 health facilities
• Manual containing guidelines, change
  management, training, ICT support, user
  satisfaction test

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Results (January 2009)

• Open Source Software Care 2x is functional
• Several modules available for billing, patient
  administration, stock-taking, reporting,
  pharmacy, laboratory, general information
• A generic Tanzanian version of Care2x has been
  developed and adapted for the current government
  health registration system
• HMIS system now installed in 4 hospitals, two
  more hospitals are busy implementing their HMIS
• A Change Management Guide is available
• 45 developers now trained

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Impact (2008)

• Awareness increased from 57 (2007) to 69
• Empowerment increased from 44 (2007) to 65
• Economic impact increased from 48 (2007) to 57
• Better revenue collection (30 financial
  improvement)
• Better job perspectives for the individual
• More efficient management of hospitals
• Lower patient fees
• Less patient waiting time
• Sector impact 56
• Improvement in quality of hospital and health
  care in general, e.g. better record keeping
• Negative impact 49
• Looking for different jobs, irregular power
  supply, catering for privileged people.

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Some lessons learned

• Awareness raising and ownership are key. Early
  adopters are needed to make others follow
  (bottom-up), and
• Longer term support (political and technical) is
  required
• to assure trouble shooting
• To facilitate embedding in local/regional/national
  structures
• Network of stakeholders to support activities
• Need to develop a business model approach
• Budget the cost of services and cover connection
  costs for all services in one package
• Develop suitable adapted solutions (no Western
  standards)
• Frequent re-training of users is essential due to
  high staff-turnover
• Modular approach to answer the needs

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Future (2009-2010)

• Project expanded for 2 more years
• Further investment 500,000
• Further roll-out of the project in the next 2
  years
• Gradually develop Care2x into an integrated
  solution for the health sector
• Include solutions for telemedicine, ME
  reporting. Make data aggregation possible, data
  warehousing and data mining.

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