Realising a lasting jump in health care performance

1. Realising a lasting jump in health care performance 28 January 2009 Caroline Figuères, managing director WB ICT sector Week

2. 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

3. 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 IICD’s supported ICT projects and programmes 40% projects continue independently 10% failure only

4. 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

5. 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

6. 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

7. 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. C

9. 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

10. 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

11. 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

12. 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

13. 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.

14. 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

15. 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, M&E reporting. Make data aggregation possible, data warehousing and data mining.

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