Baobab Health Trust (BHT) is a non-governmental organisation in the development of Information Communication Technology (ICT) innovations aimed at improving healthcare services in the country’s hospitals. The organisation has developed electronic birth and death registration system as a way of strengthening the Civil Registration and Vital Statistics (CRVS) programme in Malawi. Our contributor MATHEWS MALATA digs more into the innovations in this interview with BHT’s executive director MARTHA KWATAINE. Excerpts:
What is the focus of Baobab Health Trust?
Baobab Health develops, deploys and supports the implementation of real-time customised information and communications technology solutions for the improvement of healthcare in low resourced environments. We have 18 years of developing Electronic Medical Record Systems [EMRS] and Civil Registration and Vital Statistics [CRVS] applications. Primarily we work with the Ministry of Health and Population and we have implemented solutions with funding from different donors such as the Centers for Disease Control and Prevention [CDC], World Health Organisation [WHO], the Global Fund, World Diabetes Foundation [WDF], Bill and Melinda Gates Foundation [BMGF], National Aids Commission [NAC] and The Vital Strategies, among others.
What problems are the solutions trying to address?
For some time, our focus has been on HIV and Aids but now we are slowly venturing into other areas such as non- communicable diseases, Civil Registration, and Vital Statistics [CRVS]. The systems improve the quality of patient care through clinical decision support based on the latest Ministry of Health and Population treatment guidelines. Additionally, the EMRs have been key in standardising care across facilities. Most importantly data is gold and the EMRs deliver granular epidemiological data which has been informing programme disease interventions. You may also wish to know that we have installed gadgets at the airports to detect suspected cases of Ebola. We also support mobile applications for community disease surveillance.
What are these innovations we are talking about?
We have many, but our flagship innovation is the National, Antiretroviral Treatment (Nart) system which helps in the management, treatment, monitoring, and prevention of HIV and Aids. It also contributes towards the achievement of the UNAids 90-90-90 goals for eradicating the HIV epidemic.
Others systems include the Out-Patient Department [OPD] , Antenatal Care System [ANC], HIV Testing Services [HTS], Laboratory Information Management [LIMS] , Electronic Birth Registration [e-BRS], Electronic Death Registration [e-DRS] and the TB Electronic Health Record [HER].
Who benefits from these innovations?
Patients, health workers, local and international researchers and the nation at large. Let me say a few things; an ART quarterly report which could take two weeks to process manually now only requires a single click of a button. We have big facilities like Bwaila Hospital [in Lilongwe] with over 23 000 HIV clients. Tell me how such a busy facility with limited staff can provide care to all clients without the help of computers? It will be chaos and chances are we could lose most of the gains we have registered in the fight against HIV and Aids.
The other advantages are that patients spend less time in the queue, their medical history is always available guaranteeing continuum of care and the system prevents health workers from doing shortcuts when doing certain procedures. We generate a lot of data which researchers use for various studies to generate new information. These are just a few examples.
Are these solutions in all the hospitals?
No. We have proved to everybody that EMRs can work in Malawi and no one can dispute that. Moving on, this must be a well planned national programme driven by the government of Malawi and not just the donor community. Pull all resources together, learn from the mistakes and build on the successes before scaling up the programme.
Currently, we are in over 205 health facilities excluding 28 National Registration Bureau [NRB] sites at the district level and other community programmes. You may wish to know that the Nart system alone currently manages over 524 000 of the 828 000 plus nationally registered HIV clients on ART representing nearly 65 percent. Resources available we would love to see all hospitals using the systems.
On CRVs, how far have we gone with the birth and death registration systems?
NRB uses the electronic birth and death registration systems which are fully automated and have improved the turnaround time in terms of data flow and certificate printing. The systems capture the same information as is done on paper. The capturing workstations are placed at the hospitals and district commissioners [DCs] offices. District NRB staff pushes the information to NRB headquarters in Lilongwe for certificate printing. Validations are done at different stages. We have just concluded a massive upgrade of the system in all the 28 districts and we are happy to have facilitated the decentralised printing of birth certificates currently being done at the District Registration Office [DRO] as opposed to the ministry headquarters. This is a big milestone.
Any surprises, so far?
Well, we are always in the design room. However, let me say we have rolled out the Demographic Data Exchange in Zomba and Blantyre. This innovation facilitates inter-facility sharing of patient demographics. This means patient demographics can be accessed at any facility within the two districts just at the scan of a barcode that is usually placed on the health passport. The moment you scan everything pops up on the screen and this means you don’t have to be asked all those basic questions they ask before presenting complaints.
Secondly, we finalised the new architecture which now pulls together the various systems we have been developing over time to use the same database. This means a doctor in one section i.e OPD can access a patient clinical record from other sections i.e laboratory, antenatal care, ART, and others. Eventually, we should be showcasing a hospital-wide system that caters for all departments at a facility and takes care of billing issues which our clients have been requesting.
How sustainable are the solutions being implemented?
The systems are developed by Malawians from the designing stages to deployment in the facilities. Our health workers are usually trained and all systems are developed following the Ministry of Health guidelines, so we don’t see that area as a big challenge. Nevertheless, there is a need to build the capacity of government IT staff so they can be able to support the systems on their own. We have been doing that but I think we have issues to iron out.