Bringing health care in Africa into the electronic age

But what’s health care got to do with software design?

Lots, explains Seebregts, a senior manager at the South African Medical Research Council, Executive Director of Jembi Health Systems, and a key player in a cluster of IDRC-funded projects on “e-health” in Africa.

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More coherent health systems

Recently, there’s been a growing, worldwide realization that greater benefit could be wrung from poor countries’ limited health budgets by “shifting the focus away from isolated projects and toward strengthening health systems in general,” he says, addressing a workshop in Ottawa.

Computer specialists have a key role to play in achieving that. To improve the efficiency of health systems, managers and planners need sophisticated yet easy-to-use software programs allowing them to track both the demands on and the capacities of the health system, so they’ll be able to apply scarce resources where they’ll do the most good.

That’s where the IDRC-funded Open Architectures Standards and Information Systems (OASIS) project enters the picture. Operating in South Africa, Zimbabwe, Mozambique, and Rwanda, OASIS has provided support for African software designers to adapt open-source software to local conditions, to help those countries’ health authorities create and implement effective health policies.

The researchers — based at local universities — have faced several challenges. One is that the software must have maximum “interoperability”—meaning that it allows for communication between different aspects of the national health system and, ideally, across national borders. It must also be simple enough that local clinic staff feel comfortable using it.

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Successes within challenging environments

Now entering its second phase, OASIS has already met with success.

The Mozambican arm of the project — dubbed M-OASIS — has been working closely with the national ministry of health. Recently M-OASIS entered into a longer-term working relationship to help incorporate e-health software into the ministry’s new five-year plan. In that country, M-OASIS has provided the government with reliable year-to-year statistics on deaths from HIV/AIDS, enabling the ministry to evaluate the effectiveness of its efforts to manage and treat the epidemic.

Another mark of success is that international funding agencies like the Rockefeller Foundation and the US Centre for Disease Control are now funding aspects of OASIS’ four-country program. Originally, IDRC was OASIS’ sole funder.

Comments Seebregts: “IDRC had a real catalytic role in this enterprise. It identified a new area of research, took the risks, and nursed it through the first phase until others saw the value of the work.”

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How new technologies can help

As Africa embraces new information technologies supported by a rapidly growing robust fibre optic network across the continent, health systems — and the patients who rely on them — stand to benefit in various ways.

Medical records that are as mobile as patients, for example, can help clinic staff arrive at more accurate diagnoses. Meanwhile, electronic databases can help managers move the right drugs and supplies, in the right quantities, to the places they are needed.

Other e-health innovations bring multiple benefits. Cellphone users connected to computer servers can not only receive reminders about medication schedules or information about symptoms. They can also send word of sudden illnesses to authorities, giving officials an early warning that new epidemics may be brewing.

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Cheaper, better patient care

Seebregts says even simple interventions can lead to enormous reductions in cost and improvements in treatment.

He cites the case of an HIV/AIDS patient whose antiretroviral drug regime appears to have stopped working. Though a clinician would normally opt to move the patient to second-line drug treatment, detailed electronic medical records and the use of laboratory tests and a clinical decision support tool” can indicate when the switch is not truly necessary.

“The moment you move to the second-line drugs, you’ve shortened a patient’s life expectancy by limiting drug options,” explains Seebregts. The second-line drugs are also several times more expensive than the standard treatment.

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The Canadian connection

The e-health initiative has sparked collaboration across continents. For example, a new “living laboratory “ under construction at the University of KwaZulu-Natal in Durban, South Africa, will use software and models developed by Canada Health Infoway. But the benefits flow in two directions: lessons from the lab in Durban, in turn, will come back across the ocean to help Canada Health Infoway refine e-health models intended for use in Canada.

“We are in the midst of a wonderful process of mutual learning and growth,” comments IDRC program officer Chaitali Sinha.

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Keeping it local

While international collaboration is important, Seebregts also insists that having the local capacity to keep systems up and running is key to making e-health work in Africa. That’s why he was happy when the team in Mozambique recently declined his offer to help them with a presentation.

“The greatest accolade for us,” he recalls, “was hearing ‘we don’t need you anymore–we’re a completely self-supporting unit.’”

Stephen Dale is an Ottawa-based writer.