Health Systems strengthening in the RCC health network through use of ICTs to promote access to equitable, quality and efficient health Services
Uganda Catholic Medical Bureau (UCMB) with support of Cordaid & IICD under the Connect for Change (C4C) consortium has been implementing a three year project focusing on health systems strengthening with interventions targeting access to relevant timely information and sharing of knowledge and skills through continuing education. The project was designed to provide infrastructure such as Local Area network, computers, modems, audio devices, tools for patient data management and reporting, in addition to capacity development through training and continuous technical support. All these are geared to bridge information and communication gaps that exist within the RCC health network. This will translate into accessible, equitable, quality and efficient health services specially targeting the rural under-privileged. The UCMB network comprise of 32 hospitals with 12 training schools, 1 laboratory training school and 252 Lower Lever Units (LLU), with over 8,225 health workers.
The project has three components 1) Teleconferencing services for Sustainable communication and capacity building, 2) Electronic Patient Records Management System (EPRMS) for effective and efficient patient data management, 3) Web-enabled HMIS to strengthen data capture and reporting systems
The project ended with June 2015 and registered successes but also challenges and lessons.
Basing on basing on lessons from past years, there were issues that needed to be addressed and others needed to be strengthened to ensure the results of the project are sustainable past the project life.
Equipment and Infrastructure development in Health facilities:
In all, 14 hospitals out of 32 (43.7%) have established local area networks and equipped with computers for continuous training and have Electronic Patient Record Management System (EPRMS). During 2015, 9 out of 14 had serious power problems and this was addressed by equipping them with inverter systems.
Currently 213 Lower Level Units out of 251 (84.9%) have computers connected to internet in the UCMB network and they are able to use word, excel and internet based communication –emails, skype. Of the 213 mentioned above, 185 (74%) were directly supported by C4C project.
From the year 2011, about 2,121 health workers (about 25% of all health workers in facilities accredited to UCMB) have been trained in ICTs especially basics of computer –Operations, word, Excel, Power point, internet and emails. Of these 708 (33% of all trained) were trained in the between January and June 2015.
These training were targeting strengthening capacity of health workers and systems at the facilities: HMIS & tools, Computer basics, EPRMS-Care2x, Systems Administration, Learning/change management workshop for Hospital Managers, Teleconferencing, Patient Satisfaction Survey (Akvoflow, tablet use, data collectors for Patient satisfaction survey, Project Management for managers.
Positive change in the attitude by health workers has been observed and this is attributed to continuous training and equipping of Health Units with ICTs. UCMB received positive remarks from Health workers about access to information, knowing what is happening in rest of the world, access to medical information. It is hoped that this will translate into staying longer in rural Health Units – higher retention rate.
However small, all hospitals now have a component of ICTs included in their plans. This is important for sustainability of the ICTs. Also more facilities have requested UCMB to support them with automation of their records management system.
- Sustaining the after project activities (support, system maintenance-corrective and adaptive) means additional costs to UCMB but also sustaining computer based systems by the facilities whose budgets are already constrained is a challenge however, some facilities have improvised cost cutting measures .
- Security for equipment: some equipment’s have been reported stolen or vandalized and the project budget could not cover replacements. This disrupted services in some instances for example not collecting survey data on patient satisfaction because tablet was stolen. The solution to such challenge is to include costs of insurance for certain equipment in the project budget.
- Staff attrition by health workers previously trained still remains challenge for now and the future
- Low computer skill levels among the Health workers
- Resistance to change: Unsupportive hospital staff towards implementation of EPRMS and use of computers and other ICTs
Major lessons learned:
ICTs are enablers and they do not directly translate into medicines or staff salaries but can have serious impact on performance. Thus they need to be embraced by managers as way to bring about efficiency.
Acceptance and use of computers for routine work and other ICTs is a gradual process and require more time and patience in a rural setting. More men are willing to participate and even spare time in the evenings to learn more as compared to women. It’s important that more women are encouraged and convenient training time is set that does not conflict with peak time for domestic work such as evening time.
To implement software based systems, adequate support is essential for success. UCMB used central trainings but later initiated facility based mentorships and trainer of trainer approach. Staffs that were mentored offered first level support and carried basic trouble shooting since most of them are not professional IT staff. UCMB uses remote support through telephone, email and remote desktop for trouble shooting. This enabled few staff at UCMB to support many facilities at low cost.
Open source software is low cost only if you have in-house capacity to manage and sustain it
For sustainability of ICTs, emphasis on buy in by managers is paramount. Managers are able to source for funds to repair, maintain and ensure safety of the equipment.
For the Case of medical workers who tend to resist change to computerised system, it has only been possible where managers were convinced and used hard measure to ensure they use such systems.