This week I start working on a project to help gather medical information in villages throughout Rwanda, so the project I’ve been working on for the past couple of months is officially over. I’ve written my postmortem and had a chance to recuperate from the travel (including the airline losing my baggage in London and a screaming three year old on an eight hour flight — horror stories best only hinted at).
But this last project looks as if it was about as successful as I could hope for, so indulge me a few moments while I tell you what we did.
While medical information is gathered throughout Uganda, reports are regularly written, and analysis is frequently done, sharing information between health care workers and officials is problematic. Until now, there was only one small central library at the Ministry of Health which held only a single stand-alone PC for accessing and reading electronic documents.
To make matters worse, the proprietary software for storing and accessing the electronic documents only accepted PDFs, so anything a doctor wrote in, say, Microsoft Word had to be converted before it could be used in the system.
With the help of the Knowledge Management (KM) team at IntraHealth, a few of us on the Informatics team put together a Joomla+KnowledgeTree combination that would allow health care workers and officials to upload any Office document, collaborate around them, and easily access them from any networked computer.
My work centered on the integration and initial set up of the software — putting it all together in a way that made the KM people happy. And, frankly, much of that work isn’t any different than what I could be doing in almost any Tech Shop or corporate environment. And for a while, it was like any software project, full of frustrations and delays. While KnowledgeTree was an obviously mature piece of software, I found some of its idiosyncrasies irritating and some of its capabilities anemic.
The real difference — the real satisfaction — came when I was finally able to sit down with the librarian at the Ministry of Health in Uganda and I heard him say “This is great, it is so much better and easier to than our current system! And we don’t have convert all our files to PDF first!”
It was a relief to hear those words. Until then, doubt still lingered. But after that meeting, while there was still a lot of work to be done and a lot of work that I wouldn’t be able to complete, now I knew that we had a successful, even worthwhile, product.
Even better, the technical people I worked with and trained as well as the Ministry workers all understood the usefulness and had the same goal in mind: fostering adoption of the new “electronic library” throughout Uganda.
Now, back to the work. Hopefully I’ll have another success story in a few months.
Posted by
Mark Hershberger on 8/14/2008 • Tags: Africa, Capacity Building, FOSS, Information Systems, Tools
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I wanted to share some resources I’ve recently discovered that promote the use of free and open source software (FOSS) in Africa. Some of these applications are for health, some are for other purposes. But the more open source software becomes familiar to users in the developing world, and the more they use and trust free software, the more likely they will be to adopt an open source information system like iHRIS. We are all working toward the same goals: providing low-cost, sustainable software that helps these countries improve their systems.
- The Free Software and Open Source Foundation for Africa is promoting the use of FOSS and the FOSS model in African development, and the organization supports the integration of FOSS in national policies.
- Open Source Africa provides a migration guide and a connection to the FOSS community in southern Africa.
- The Google Africa Blog is sharing news, stories and thoughts about using Google tools in sub-Saharan Africa.
- OpenMRS is an exciting project to develop an open source electronic medical record system framework specifically for the developing world.
Posted by
Shannon Turlington on 7/30/2008 • Tags: Africa, FOSS, Free Software Community, Open Source, Software
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As a public healthcare management professional and a former intern with IntraHealth, I have had the opportunity to work with human resources information systems (HRIS). I believe an HRIS is a robust, simple and easy-to-manage tool that Tanzania can utilize for efficient healthcare workforce management.
Tanzania has a healthcare workforce deficit compared to its workforce influx, attrition, and population growth. At the same time, HIV prevalence is projected to further increase the workforce demand. With the deficit in the healthcare workforce and high burden of diseases, the country’s policy and decision makers need to clearly understand the current healthcare workforce situation in order to plan for optimization and strategize interventions to improve the situation.
The Capacity Project’s free and integrated Open Source human resources information system (HRIS) software is capable of capturing healthcare workforce information throughout training and employment. It can be used by healthcare authorities such as the Public Health Association, the Medical Association, the Ministry of Health and Social Welfare and healthcare service providers, to maintain current and accurate healthcare workforce information required for correct and efficient response to healthcare delivery challenges.
The loosely manual and scattered electronic information currently maintained by the healthcare authorities can be linked and integrated through an electronic HRIS with verified accuracy and regular updates, thus saving much needed resources that would otherwise be required to conventionally maintain the current system. Similarly, career-related information like relocations, promotions, training and remuneration can be smoothly tracked by the system, analyzed and used for planning and reporting.
An increase in training infrastructure is seen as an option toward bridging the country workforce gap. The HRIS will be useful in determining exact requirement and devising of plan to address the same. Given that training is a long-term solution, based on reliable data, short-term training programs could be devised to improve the situation. HRIS-guided decisions would extend government’s health care policy reforms including private sector participation in health education provision.
Lack of linked information has resulted in significant differences in the number of health workers per capita in different areas of the country with urban areas having better staffing ratios than rural ones. This has resulted into staff ratios determination by existing infrastructure rather than actual needs thus limiting interventions through usual human resource policy means. The data-based HRIS will be a useful tool for balanced workforce deployment to meet health care needs.
- - Bakari Bakari
Bakari A. Bakari (MBA), has served as the Information Systems Manager with the Medical Stores Department, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania, since 1999. He is currently a Hubert Humphrey Fellow 2007/08, at the School of Public Health, University of North Carolina, Chapel Hill. He spent six weeks as an intern with IntraHealth International Inc., Chapel Hill working with HRIS, Open Source Technologies and PDA usage in data collection.
Posted by
Carol Bales on 4/9/2008 • Tags: Africa, HRIS, iHRIS
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I’ve been in Rwanda for a little over a week now. Its my first time here and so far I really do love this country. Its quite beautiful, much more lush and green than I had imagined. The people are quite friendly and always offer up a smile. I am here to start a new project that will involve using hand-helds to collect health data (more on this in a later post). To that end I’ve been working closely with the folks at the Twubakane project. Its great to be here and see some of these bigger projects working outside of the context of my comfortable office at home. There is a lot of great work going on here.
After meeting with the folks I will be working with at Twubakane, I was taken to the Ikigo health center in Kicukiro. Its a small facility that seems to be handling a great number of folks in a densely populated area. We had a surreal experience riding out to the center as we were bumping along the pothole-filled dirt road only to run into a film crew in the middle of a shoot - camera on rails, mic booms, the works. I’m still left confused by it. Nonetheless we met with some of the community health workers who go door to door in their villages to collect data. I learned that they are elected by their peers in the villages to do the job - there is a great deal of trust there. Twubakane should be praised for these kinda of approaches as it brings a sense of honor to these important tasks. We talked at length (with much translation) about what has worked and what has been difficult with the paper-based system we hope to replace or enhance. There are some very important steps in the paper system we’ve got to think on. The current system allows all of the workers and the program supervisors to review the data together as they compile it. This lets them figure out if changes in the numbers are due to a growing health problem, or mistakes in collection. If we have the data in our system doing the compilation for them we might skip this step and that would be bad for the communities. We must keep this in the program itself.
Meeting with the health workers was worth the trip for me on its on, but of course I’ve done more than that while here. We hope to be able to hire a local developer to join the team, but only have a couple days left to get that done. It is possible though. I’m excited about this project and being here in Rwanda has brought home to me the importance of certain aspects of our approach at IntraHealth. The use of open source hit me in the head as I was asked very pointedly about it (unprompted, I promise!) It seems the idea of having to fly someone in to work on a couple of extra proprietary systems has grown old. But more than that, the true ownership of these projects in terms of Stakeholder Leadership Groups, or the elected health workers, or hiring local talent seems to be the right approach for this kind of work.
Posted by
David Mason on 3/3/2008 • Tags: Africa, Cellphones, Data Collection, Digital Divide, Mobile Technology, Open Source, Public Health, Technology, Volunteers
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The facilitators of the pilot Data Driven Decision Making (DDDM) workshop held in Uganda last summer felt it was a success and received positive feedback from participants. Fourteen attendees filled out evaluation forms at the close of the workshop and all agreed that that the workshop met its objectives and DDDM was relevant to their work. Also, while only one person felt ‘very comfortable’ with the topic prior to the workshop, eleven did afterwards. Still, efforts must be made to support and sustain this type of work amongst decision makers in Uganda.
Ummuro Adano, Senior HR Systems Advisor for the Capacity Project, has said DDDM is a “mental shift that can take place over time” and cannot be fully accomplished through just one workshop. One participant agreed, and explained, “We learned that data use in decision making needs to be developed. It’s about ‘how can I prove this and what is the rationale?’ It’s having the inquiring process in the thinking and decisions that we make.“ He added that by attending the workshop, participants began to realize it was a lot more risky to make decisions without the use of data, “We also learned that data can be deliberately ignored to achieve certain objectives.”
When asked how attendees will use what they learned at the workshop in the future, one participant said they will train themselves to look for evidence in all decisions that they make. “We should be able to make a reference to a source of data so that people can confirm and be certain we are using data that is authentic,” he said. He also mentioned that it is important to share current records from the various sources, “We need a system in place to maintain the databases that we are creating and maintain up to date (information) because data that is out of date, as we learned, is not very useful in decision making.”
The workshop produced several outcomes that will help participants utilize DDDM in their future work and encourage other decision makers in Uganda. One activity produced a finalized list of HR policy and management questions for the Ugandan health sector. Another result was a list of next steps and actions that included strengthening the MOH Resource Center so that it can function as the effective HRH data storage facility that collects, integrates, and provides access to the various sources of data. The Resource Center will also promote using data for decision making.
Some participants offered other suggestions for how to sustain this work. One participant said, “We need to create demand for data among policy makers and managers. We need to motivate each other in terms of further workshops to engage policy planners at the level higher than we had so in the future they may demand a certain level of quality.” Another participant agreed and added, “These kinds of trainings need to be replicated, followed up, because we are getting to a stage where we are now, that we want now to use information more.” He said they need to follow up with trainings, etc. with as many of the decision makers as possible.
A follow up to the Ugandan DDDM workshop is scheduled for this summer. Other DDDM workshops are planned for Swaziland and Rwanda this spring, where information is now becoming available from their HR Information Systems and ready to be evaluated.
Posted by
Carol Bales on 1/8/2008 • Tags: Africa, Decision-Making, HRIS, ICT4d, Information Systems, Public Health
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The DDDM workshop in Uganda this summer provided the first opportunity for many of the participants to review and discuss reports from the iHRIS Qualify system in the Nurses and Midwives Council. Dr. Pamela McQuide, HRIS leader, said she was extremely excited about participants’ reactions to seeing the reports. “When participants had actual Ugandan data, they erupted in discussion,” she said. She explained that the reports spurred lots of questions and they talked for three or more hours, showing that “they are very hungry for their own data and supporting it.”
One participant said the workshop gave meaning to the data they had been generating and built up credibility and interest in the HR information systems being established in Uganda. “It was the first attempt we had at integrating information from the various sub-systems in HRH and seeing how all these sort of fit together in order to have meaningful information.” He went on to say that the most surprising thing he realized was the amount of data already available. “It was just amazing to know there was so much data already available from different subsystems. I found that overwhelming, it was just phenomenal.” As he stated, a strong HRIS is a phenomenal tool for integrating data, where the sum becomes much more important than the parts.
Another participant said that after viewing the data he realized they already had routine information that they should start taking advantage of. He described how different the situation in Uganda was before HRIS strengthening was initiated, “We were looking at a format that was inaccessible, it was paper-based and in containers, but now that it’s in a database it’s easy to analyze.” He went on to say that the reports presented at the workshop were “able to tell us what was really happening on the ground.”
The HRIS team is in the process of implementing similar systems at the other three Uganda medical licensing bodies (the Pharmacy Council, Medical and Dental Council, and Allied Health Professional Councils). As an outcome of the workshop this summer, bi-annual HR data reports will be produced. The reports will incorporate data from all four councils and other sources, such as data from the EU and will influence annual reporting, budgeting, and strategic planning.
Once data can be integrated from various sources and reports can be generated, it is important that the information is presented in a variety of ways so that decision makers can understand and use it. Dykki Settle, HRIS leader, led a session on data quality and presentation that covered useful techniques to enable decision makers to use data. He emphasized that reports should be timely, tied to policy questions and available to the right people. Colorful reports will not be effective unless, as Ummuro Adano has stated, they are “combined with active leadership, change management, and effective professional development for key decision makers.”
Posted by
Carol Bales on 11/30/2007 • Tags: Africa, Capacity Building, Decision-Making, FOSS, FOSS4G, HRIS, ICT4d, Information Systems, Open Source, Public Health, Sustainability
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