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Realising a lasting jumpin

health care performance

28 January 2009

Caroline Figuères,

managing director

WB ICT sector Week

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Livelihoods (entrepreneurs)• Market price information• Access to new markets• Innovative techniques

Education• Improve curriculum • Access to quality education • Dissemination of materials

Governance

• Access to public services

• Exchange of information

Health• Telemedicine (diagnosis)• E-education• Information systems

Focus

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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 independently10% failure only

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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

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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

IICD interventions at different levels

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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

Case: Health Management Information System project, Tanzania

Access to ICT/telecom (per 100) • Mobile phone subscribers: 14.6• Landlines: 0.4• Internet users: 1• Personal computers: 0.9Source: Worldbank - ICT at a glance, 2006

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

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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.

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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

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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

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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

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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

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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.

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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

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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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