Sustainable Health Information System (HIS) in Developing Countries
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Remember the game Diner Dash? The game has different sections that should run smoothly and quickly to serve their customers and prevent them from leaving. It is a simple game but deals on a system that if perfectly carried out will lead to happy customers. Like a business, the success of any system or program depends on different internal factors that should run smoothly and be evaluated on a daily basis. But unlike a business, Health Information System (HIS) in developing countries usually starts from an external sources (e.g United Nation or World Health Organization) which supply technological and financial support, which later devolve to a local counterpart to continue its implementation. A successful HIS is not equivalent to a sustainable HIS. Success may be short term and thus, does not mean sustainable. Here, the author enumerates factors that if addressed properly, will contribute to a long-term sustainable success of HIS. These include human resources, system design, infrastructure, consumers/demand, donor or funding, and flowchart or standard operation procedure (SOP). In this article, the author will also discuss problems possibly being faced by developing countries regarding the abovementioned factors and give possible solutions to achieve sustainability.
As I mentioned in the previous blog, human resource (or the lack of it) is the main problem in health informatics or any health information system. But aside from having a scarcity of human resources, there is also no system with regards to training of the human resources. Kimaro et al (2007) mentioned that HIS in developing countries is usually described as “top down approach” where the donors and high-level players are the decision makers excluding the users during the system design, who will eventually implement the system. A system with top down approach is doomed to fail because the system is not fully understood by the users or stakeholders at the grassroot level.
Here, I propose 4 level human resources, which include health informatics innovators, managers, users and supporters. Health Informatics Innovators or Health Information warriors are the ones who design the system, from start to the end. Innovators also coordinate with the other human resources (managers and users) regarding the training and familiarization of the system. Training the users on how to implement the system is a very important task an innovator should do. They also update the system as the need arises. The Manager is someone who directs and delegates orders to the users. In more remote areas, where resources are scare, a health informatics warrior may also serve as a manager. The main role of a manager is to make sure that the users properly and smoothly implement the system. He also identifies problems and troubleshoots them as they arise. The third player is the User. The users are the ones who implement the system at the grassroot level. They are the frontliners to the consumer, thus they are the first ones who pick up problems in the system. The fourth player is the supporter. Supporters include the government and the media. They have no direct hands-on relationship with the consumers but they support the implementation of the system making it sustainable in the long run. The government works on the ethical and legal frameworks of the HIS and the media acts as information diffuser.
For a system to be efficient and sustainable, a well defined, structured human resources, who know their roles and stick to them are important.
Problem: Complicated and Rigid system design
A health information system is the tool the users use to efficiently collect data from the consumers. For a HIS to be sustainable, the system should be user-friendly, useful, flexible, reality-driven and has interoperable standards. The system should be simple enough for the users to easily understand the technology and implement it properly. It should cater the need of the users and consumers as well as easy to adjust as the need arises. The lack of interoperable standards leads to redundancy and complexity of the system. If the system is interoperable, it would be efficiently and easily reproducible in different parts of the system.
Problem: Unreliable and expensive Internet access and electricity and complicated software and hardware
Because of unreliable and expensive Internet access in the developing countries like the Philippines, Luna et al (2014) opened the possibility of using wireless networks and mobile phones in health information system. The government plays a vital role in the expansion of Internet accessibility in the country. It needs a better legislation regarding Internet connectivity in the country. Like the system itself, the hardware and software should be user-friendly, flexible and simple and if possible, in the local language so that the users can easily understand the technology.
The problem with health information system, especially upon introduction to the masses, is its acceptability. People do not easily accept its use, thus the demand is very low. Like in business, if the demand is low, the business will not be sustained and will soon collapse.
The media, as an information diffuser plays an important role of informing the consumers the benefits of HIS. If HIS is properly implemented, healthcare system will be efficient and the consumers will notice the benefits of HIS and soon will accept its use. Aside from information dissemination, all human resources should work hard to properly implement a simple and user-friendly HIS towards an efficient healthcare system. I remember the announcement of the Present President Duterte that government agencies should be able to facilitate documents of their consumers within 72 hours (which originally takes 2 weeks). This news excites the masses and the people demanded for a faster processing of papers. This will not be possible if the government offices do not acquire and implement information system that efficiently handles consumers’ data.
Problem: Short-term or lack of funding
As I mentioned, in HIS, the usual initiators of the system are from the fundings from international organizations. But usually, it is short-term. The government / Department of Health should have the initiative to take over as soon as the external forces leave the system to the locals. The government should continue what the international societies started and funded. Another source of funding would be Private-Public partnership.
Problem: Lack or inefficient SOP
A standard operational procedure is the backbone of any program or system. This dictates the flow of processes within the system. If the SOP or flow is erratic, the system will fail and the output will also be erroneous. Part of the SOP is a feedback mechanism to constantly identify problems and correct the problems immediately.
- Heeks R. Health information systems: Failure, success and improvisation. Int J Med Informatics 2006;75:125-137.http://www.uio.no/studier/emner/matnat/ifi/INF5761/v12/undervisningsmateriale/Heeks%20-%202006%20-%20Health%20information%20systems%20Failure,%20success%20and%20i.pdf
- Kimaro HC & Nhampossa JL. The challenges of sustainability of health information systems in developing countries: comparative case studies of Mozambique and Tanzania. J Health Informatics in Developing Countries 2007;1(1):1-10http://www.jhidc.org/index.php/jhidc/article/viewFile/6/34
- QA Qureshi, B Shah et al. Infrastructural Barriers to e-Health Implementation in Developing Countries: European Journal of Sustainable Development (2013), 2, 1, 163-170 ISSN: 2239-5938
- G Kouematchoua. Sustainable Development of Medical Informatics in Africa: Need for a Health Informatics Curriculum https://static.aminer.org/pdf/PDF/000/246/678/telemedicine_in_sub_saharan_africa_a_proposed_delphi_study.pdf.
- D Luna, A Almerares et al. Health Informatics in Developing Countries: Going beyond Pilot Practices to Sustainable Implementations: A Review of the Current Challenges. Healthcare Informatics Research. 2014 January;20(1):3-10. http://dx.doi.org/10.4258/hir.2014.20.1.3 pISSN 2093-3681