There’s a rush to bring big, advanced health innovations to the developing world. But they’re often hampered by a lack of buy-in and a lack of technical support. Often times, a simple solution is best.

A simple way of looking at the health systems in developing economies’ health systems is a series of levels between the center and the periphery. Workers at the periphery are usually the point of contact between the health system and the population to whom the healthcare is delivered. The closer one gets to the periphery–what we call frontline health–the clearer the limits to the availability of professional technical staff and equipment are obvious.

New frontline health service models are introducing a cascade of innovative technologies from mobile payment platforms to telemedicine and enterprise level health record systems to the various levels of the health system.  Yet, what is overlooked, particularly in low-resource-settings is that introducing “state of the art” innovation, and operationalising it are not the same things.  We often leap into the “how” before we have achieved competency in “what” we are trying to do.

In health, inefficiency and poor management can mean a loss of life, not just market-share, and as African health systems face an evolving set of challenges such as noncommunicable diseases and implementing universal health coverage, management and operations are critical to getting more out of limited resources. Sometimes all you need is to improve what you do; and increasing the efficiency of low-tech is the breakthrough.  A prime example is with health data: It doesn’t have to be electronic, but it does need to be accessible and organised–and you don’t need enterprise level technology for that.

Data, Organisation, and Information

A main challenge to providing ongoing care and treatment to hospital patients in Ghana is the difficulty of retrieving, or sometimes even just locating, patient records in a timely and systematic manner. When the patient is first treated or admitted to the healthcare facility, they get a health record. On subsequent visits, patients can wait for as long as three hours for records to be located–if they are lucky. In cases where the records cannot be located, the clinic creates completely new records for the patient. The patient ends up with many records, their medical history scattered in different files and at different locations. In bigger facilities, the different departments each create their own records, making clinical decisions and communication among the different clinicians extremely difficult, if not impossible. In certain situations, the health facilities are even compelled to allow the patients to take their records home.

The result of this poorly designed system are long waiting times for patients at the records department due to the missing and misfiled records. Storage space also becomes a major problem and it is common to see improvised records centers scattered all over a health facility. This leads to wasted human and financial resources, and a loss of revenue.

To solve the problem, many facilities have decided to go “paperless” and digitise their medical records system. Over the years, huge sums of money has been invested in digitisation. But despite the investment, there is very little evidence of improved service delivery. The long lines are still present, and patient waiting times have not been significantly reduced. The computer systems seem more to be hindering than helping the smooth delivery of services: It is now common to see patients waiting because the system is “down.”

Health facilities are learning the hard way that developing computer-based hospital information systems is not a trivial task. Managing the technology itself is a complex task and demands its own expensive specialists, who are very often not readily available. Apart from the problem of the lack of accompanying infrastructure–irregular supply of power, poor reliability and cost of Wi-Fi  and internet connectivity, and need for the maintenance–the introduction of the technology puts a premium on new ways of doing things, which the facilities are usually not prepared for.

Too often, the existing manual system is being digitised without sufficient thought to the objective. The design and implementation of the organisational changes that are required are often ignored or not properly managed. Installing electronic systems on top of a collapsed paper-based system just creates more chaos, since this only perpetuates the existing deficiencies. Technically sound systems end up organisationally disastrous.

But a less flashy solution works much better: An electronic records management system (ERMS) designed to manage the manual health records from the creation to final disposal has proven to be very successful and has been in use in some hospitals in Ghana since 2011. This was done by reorganising the filing system, considering the backgrounds and capacity of the staff, and then designing a system as close as possible to what the staff was using. There are still physical records, but the ERMS uses bar codes to monitor and tracks their movement, so staff always know where to find them. This reduced the average time of file retrieval from three hours to less than 10 minutes.

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