The story of digital health records in Africa; let's clap for Zambia, Ghana and Kenya

Unreliable power and skills shortages have been blamed for the failure of many e-health projects. But it could be more: hospitals just don't need them

GUINEA, Liberia and Sierra Leone begin 2015 still carrying the burden of Ebola, with total cases  nearly touching 20,000 by the end of 2014, and over 7,600 deaths.

The dilapidated health care systems in these countries, plus denial and turf wars among the various health agencies in the region have been blamed for the lethargic response.

Other African countries without a legacy of war – or that have recovered from conflict – might begin the new year comforting themselves that their healthcare systems may not be in such shambles, and if they were faced with a similar crisis, they might handle it better.

But they shouldn’t pop the champagne yet – even though primary health care may be reasonably satisfactory in some countries, disease surveillance and the ability to collect healthcare data can be dreadfully weak.

For example, one healthcare worker in Tanzania, speaking on condition of anonymity, told Mail & Guardian Africa that it is common practice for some public hospitals – even major ones in big cities – not to keep patients’ files within the hospital premises.

Instead, the patient’s file is in the form of an exercise book that the doctor fills out and the patient takes home, and is expected to bring on the next visit. Patient records are only retained in the hospital in case of an admission.

The rationale is to free up room in the hospital that would be used to store patient records, and to speed up time taken during a hospital visit that would otherwise be taken trying to trace a file.

But it also means that hospitals have no way of picking up emerging trends among its outpatients.

In 2005, a legally binding regulation for the preventing and controlling the international spread of diseases called the International Health Regulations (IHR) came into force.

It requires governments to establish a system to detect, assess, notify and report public health risks and emergencies of international concern, and collaborate in controlling the movement of people through airports, ports and ground crossings – as is needed for a disease like Ebola.

Digital question—-again

But a report from the World Health Organisation (WHO) in 2013 indicated that compared to other regions, Africa’s performance was below average for most of the IHR core capabilities.

Digitising health records is one popular option for governments to capture, analyse and report healthcare trends.  One 2012 study indicated that several African countries, including Kenya, Uganda, South Africa, Tanzania, Ghana, Nigeria, Cameroon and DR Congo are in the process of rolling out electronic medical records, although many are still concentrated at the local and pilot stage.

Adopting digital records in one project in Kenya  shortened patient visits by 22%, doctor time per patient was reduced by 58%, and patients spent 38% less time waiting in the clinic.

Ghana is one of the few African countries to  attempt to roll out electronic records broadly in the public sector, with a national policy on e-health published in 2012.

Zambia, too, is leading the way in digital records, with more than 550 clinics and hospitals around the country now using a pocket-sized chip card that carries an encrypted copy of a patient’s medical history.

But one survey showed that the majority of digital records projects in Africa are concentrated in HIV-related centres, as the shift to digital seems to be driven by donors’ need to report trends and outcomes of their projects.

As they are sustained by funding from international partnerships, it raises questions about the sustainability of these systems by the local healthcare infrastructure.

But even more crucially, sometimes the structure of a local healthcare system is the real factor in determining whether an electronic system is broadly adopted, or not.

Records…or no salary

In Kenya, for example, the Ministry of Health requires all public health centres, even the smallest local dispensary, to file reports to the Ministry of Health on the trends of certain diseases, including malaria, polio, measles, and others that are required to be under surveillance.

Filing these reports on time determines whether the healthcare staff gets will get their salary or not – meaning that the country’s medical data is quite robust, as it is a mandatory requirement to file these reports, or you don’t get paid.

With paper based systems, even a small clinic could take two or three days to compile the data in all its intricate requirements, which would often require the clinic to literally close their doors for a couple of days as staff do the reports, attending only to serious emergencies.

One healthcare technology enterprise is rolling out a system that drastically cuts reporting time.

Vecna Cares’ Clinipak is a server and wireless local network, powered by direct AC, solar panel or car battery. Connected by WiFi to handheld tablets, the system captures patient data and generates the mandatory reports in just minutes.

“I’ve been in the m-health field in Kenya for over a year not, and until now, had not really identified a system that allows accurate, secure capture of information, efficient and effective way of reporting,” says Jackline Cheruiyot, Vecna’s Kenya project manager, adding that uptake has been very fast particularly when healthcare workers hear that they don’t have to spend days compiling data.

Unreliable power and skills shortages have been blamed for the failure of many e-health projects. But it could be more: If a country’s healthcare system does not require this reporting – or even doesn’t require keeping records within the hospital – then digital solutions might see much less uptake.

Vecna’s technology is currently deployed in Kenya, Zanzibar and Nigeria, with a slightly modified system being tested in Sierra Leone.

Ebola drives tech 

The Monrovia version features a robot with a two-way communication system — basically an iPad on wheels – with a display screen and camera that allows a doctor to assess suspected Ebola patients as they come into the hospital without coming into physical contact with them, potentially cutting down transmission of the disease between patients and staff.

Healthcare staff are among the highest risk of contracting the disease spread by contact with body fluids.  As of December 21, 2014 a total of 666 healthcare workers were known to have contracted the virus, and 366 of them had died, according to WHO.

It takes 20 minutes for a health worker to get into the Ebola protective suits and another 20 to get out of them, but the robot cuts down assessment time and greatly reduces the risk of infection, and crucially, helps capture and report patient data.

It will also help with actually figuring out what works in treating Ebola, which is  mostly just hydration and maintaining blood pressure and oxygen levels.

At the moment, most doctors are relying on their own experiences and what’s reported to be successful in the past to determine how to treat a person, says this article by Time.

But there’s no single database doctors can go to get the most up-to-date data on what’s working in the current outbreak.

The new system could make it easier for doctors to get directions on how much medication they should provide, for instance, or what to do when someone has a seizure.


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