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Computer science applications to improve health delivery in low-income countries. Neal Lesh. My Story.
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Computer science applications to improve health delivery in low-income countries. Neal Lesh
My Story Mid-thirties computer researcher seeks more fulfilling career. Goes back to school then off to Africa. Discovers things are more simple and more complex than he originally imagined. Can't imagine doing anything else...
Thesis It is increasingly possible to apply computer innovation to improve health care delivery in low-income countries.
Who are you? It is increasingly possible to apply computer innovation to improve health care delivery in low-income countries.
What’s in this for you? • Taste of global health • Confidence that information can help • Two examples Patient record systems for AIDS treatment Medical algorithms on handhelds • Cautionary cartoon
Global Health Puzzle Is Mexico healthier than Canada?
Risk Factor Poverty as a for surviving the Titanic. % survived
Simple Story $$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$ Life expectancy: 78 years Infant mortality: 5 per 1,000 births Maternal mortality: 8 per 100K births Life expectancy: 45 years $ Infant mortality: 95 per 1,000 births Maternal mortality: 500-1000 per 100K
Simple Story $$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$ $$$$$$$$$$$$$ $$$$
Simple Story “We are the first generation that can end poverty.” -Eveline Herfkens, UN Millennium Campaign
Complexity • Corruption, careerism, tax write-offs • 5-star poverty alleviation meetings • Unintended consequences, e.g., paying volunteers • Imperialism & foreign experts “If you want to build a ship, don't drum up people to collect wood and don't assign them tasks and work, but rather teach them to long for the endless immensity of the sea.” • Antoine de Saint-Exupery
Information as Care • Study: rigorous application of standard treatment protocols reduced in-hospital mortality in children’s malaria cases by 50% • Clinician’s complaint: where are my lab results?! • Patient Knowledge Example: five danger signs for seeking care during and after labor.
Roadmap • Taste of global health • Confidence that information can help • Two examples Patient record systems for AIDS treatment Medical algorithms on handhelds • Cautionary cartoon
AIDS Treatment in Rural Rwanda One year later
Improving Health Systems One year later
Infrastructure One year later
Electronic Medical Record (EMR) Clinicians & Patients EMR Staff Paper forms Patient Monitoring Reports Re-allocate resources Funder & government reports Program Monitoring Reports Managers $
OpenMRS • Open source framework for medical record systems • www.openmrs.org
Data Quality • Mistyped IDs • Missing & conflicting data • Backlog Potential solution: point-of-care systems
Roadmap • Taste of global health • Confidence that information can help • Two examples Patient record systems for AIDS treatment Medical algorithms on handhelds • Cautionary cartoon
Tanzania: underfive mortality was 13% lower in the two IMCI districts Significant impact on stunting Full IMCI in HF 13% difference 95% CI: -7%, 30% End of study Source: Schellenberg J et al
Deploying IMCI • IMCI • Shown to reduce mortality and morbidity • Adopted by ~100 countries • But uptake not as good as hoped • Training expensive • Correct use tapers off over time • Supervision challenging
Why Automate IMCI? • Improve adherence • Improve supervision • Easier to update • More sophisticated protocols • Reduced training
Field Work Results to be published in CHI’08
What are we going to do today, Brain? The same thing we do every day, Pinky…. Make a plan to TAKE OVER THE WORLD!!!!!
Thank you! neal@equalarea.com