Digital Health Information Fragmentation

Small health centres in remote villages in some regions of Africa can be quite crowded places…
Those crowds are not only made by patients but also by NGOs’ and organizations’ staff who are running their programs by bringing different types of medicines or collaborating with health staff to collect healthcare information.
Each organization brings its own project, maybe a pilot one, with a good amount of requests or activities to be implemented. So, for example, beside already established standard government forms or registers, community Health Workers (CHWs) are asked to fill out additional forms/registers.

Although the final objective should be to facilitate their work and improve the provision of health care to the most needed, unfortunately this often creates an extra burden to the already understaffed facilities, it generates confusion, overload and waste of precious time on bureaucracy, time that should be rather spent on patients’ care. Furthermore, health workers may receive incentives for the extra workload, thus changing work priorities resulting in poor/ late reporting of standard and well established data to the Ministry of Health.

Many of those pilot projects also involve the use of digital information, using digital data instead of paper forms.

A significant example of the fragmentation of digital health programs is illustrated on the measles map of Uganda developed by Sean Blaschke at UNICEF, as mentioned by Dikki Sepfblog5ttle in his post on Pathblog. The map itself explains why in 2012 the ministry of Health in Uganda called a halt to all eHealth and mHealth Initiatives in the country until they got approval from the Director General of Health Services. The objective was to limit the fragmentation of programs and make sure that the data collected up to that point would feed into the national digital Health Information System, rather than creating additional parallel systems.

The widespread of digital information is already a step forward towards the integration of information as ICT can facilitate the information and data exchange especially if data is collected in appropriate and compatible format.

However, we are still quite far away from the final objective…. And, as David McCann wrote in one of his post on ICTworks about the situation in Uganda, reality sounds more like this:
You’ve managed to track drug stock-outs in a sub-county in Moroto using solar chargers and 50 Samsung Galaxies. That’s great, can we share data with a similar project I did using BlackBerries in Gulu? Probably not. You’ve rolled your own drug-stock-tracking application. And yet when members of Big Aid met with the Ministry of Health, to account for the overlapping features of their mHealth applications and whether API integration is possible, one actually responded along the lines of “well, it’s backed by a relational database, so in theory, yes.” While true, this misses the intent of the question by a wide margin’.

Maybe the halt promoted by the Ministry of Health in Uganda is a way towards increasing interoperability and coordination of projects. For sure, it indicates that government has started to look into taking ownership of these projects and technology to serve the population’s needs.

In other countries specific mobile-health groups, such as the mhealth working group in Malawi, are meeting regularly, with the involvement of the Ministry of Health, to face the issue of integration and overlapping of mobile health projects.

Both the use of compatible technologies and the involvement of stakeholders at various levels are two key elements to start overcoming the problem of mhealth projects fragmentations.

By Paola Fava

Photo source: Margherita Dametti for COOPI

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