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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Having worked in various IT (Information Technology) departments and roles over the years, I’ve become accustomed to the point of view that IT workers are “just” overhead. In many organizations, they are considered a cost of doing business. Often the attitude is summed up in a statement like this: “We’ve got to have email, but I’ll be darned if I know what those people do all day!”
Sometimes, it is even worse and the IT department is just seen as an obstacle to work around. As the Wall Street Journal writes: “often it’s just easier to accomplish certain tasks using consumer technology than using the sometimes clunky office technology our company gives us”.
Then there are the poorly supported in-house applications that the IT department tends to throw together. If the organization is large enough, they’ll have a dedicated support team, but, again, this is seen as a cost of doing business instead of something that adds value.
I think part of this can be understood because much of what a savvy technology worker does is completely behind the scenes. If it is done well, the end-user sees the product of the work, but not the hours put into it. The end-user has no means of understanding the work performed.
I encountered just this sort of thinking in a conversation with my brother the other night. In May, he’ll take his boards and become a certified pharmacist. In the past, he’s worked as a lab tech at the Genome Sequencing Center at Washington University in St Louis, so he is no stranger to the value that a good IT department can add to any organization, but he was still under the impression that IT had a “neutral” economic effect.
In an attempt to illustrate just what kind of difference IT has made in the past and can make in the future, I used an example almost any American our age is familiar with: Pa Ingall’s house.
Enamored with the idea of owning his own land (and being somewhat of a loner), Pa headed west and worked and struggled to build a farm and house for his family. He worked long hours, but, at the end of the day, the best house he could build for his family still lacked some amenities like indoor plumbing and electricity that even the poorest modern day American home-owner would consider necessities today. The technology was simply not available (e.g. electricity) or was completely infeasible (e.g. indoor plumbing for prairie homes). Obviously, the creation and spread of technology has helped create a healthier and more efficient home for the modern American.
The Open Source efforts that IntraHealth’s Informatics team are pursuing could offer the same scale of benefits for health care in developing countries. As you can see from the photo to the right, many of these countries still use nineteenth century methods for organizing information about their health care workers. When there is a regional epidemic, the official in charge will have to rely on his memory or go sort through stacks of paper-based records to find the right people to send to the area.
The paper-based system lacks good reporting tools, as well. Manually compiling a list of areas with worker shortages is going to be a time-consuming, error-prone task. iHRIS puts good reporting tools at your fingertips. Reports can be created in seconds, rather than hours or days.
If iHRIS is successful to any degree, we will have a real chance of dramatically improving the health care in these countries by helping the health care workers get better access to training and by ensuring that they are deployed where they are most needed.
This, from something as mundane as providing better access to personnel records.
For someone who has been involved in IT for a few years, the chance to have this kind of impact can be intoxicating!
Posted by
Mark Hershberger on 10/29/2007 • Tags: Africa, Data Collection, Decision-Making, Digital Divide, HRIS, Information Systems, Open Source
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Well, the best answer is “not much.” As I work on an HRIS implementation in Kigali, Rwanda, this week, I have been giving the need for accurate, continuously maintained data a lot of thought. Many developing countries have embraced decentralization—the shift of decision-making authority from the central level to the regional or local level. While decentralization has many good points, it presents challenges for collecting country-wide data. Imagine a situation where every region and district used a different method for collecting and sharing data on health workers! While separate methods of data collection might work well locally, lack of consistency across the country makes collection of data for use at the government level challenging at best.
We all know databases rely on consistency of information to generate reports. To get consistent data, regional and local health managers must have a way of submitting standardized data to the central level that does not add an excessive additional burden. More importantly, local health leaders must see the benefit of providing data to the central government—access to country-wide aggregate information, increased services from the Ministry of Health or easier maintenance of their own health worker records.
Ensuring a local level commitment to share data is only half the challenge. Western culture is data oriented—we love charts, graphs and numbers. Because current data is often lacking, many health leaders in developing countries have, by necessity, learned to rely on intuitive decision making. Add this to an increasingly rapid shift from paper based systems to databases and the process can be overwhelming.
For me, this is where Pam McQuide’s stakeholder leadership group model becomes so important. Stakeholders united in a common purpose and pursuing a shared benefit can agree on appropriate, effective ways to evolve well-entrenched methods of data collection. Having seen the success of the stakeholder model time and time again, even I find myself here in Rwanda still fighting the siren song of the perfect system to focus on what is most important— local stakeholder leadership and the data itself.
Posted by
Vanessa Spann on 10/24/2007 • Tags: Data Collection, Data Quality, Decision-Making, ICT4d, Information Systems, Leadership
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