Realising a lasting jump in health care performance 28 January 2009 Caroline Figuères, managing director WB ICT sector Week

Livelihoods (entrepreneurs) Market price information Access to new markets Innovative techniques Education Improve curriculum Access to quality education Dissemination of materials Governance Access to public services Exchange of information Health Telemedicine (diagnosis) E-education Information systems Focus

Seven Guiding Principles Demand-responsiveness Local ownership Multi-stakeholder involvement Partnerships Learning by doing Capacity development Gender equality These principles are key for sustainability of IICD’s supported ICT projects and programmes 40% projects continue independently 10% failure only

Projects in the health sector Ghana, Mali, Tanzania, Uganda, Zambia 24 projects Reaching around 55,000 medical workers 67% are women Approx. 830,000 beneficiaries 82% are located in rural areas

Improve access to and quality of health services –Management of health, hospital and patient information Administrative systems, ordering and billing, disease surveillance, management and logistics of health care, patient records –Professional development and Continuous Medical Education e.g. health research, e-learning –Improving the delivery of health care e.g. telemedicine, remote diagnostic support Improve access to information for patients and/or people in the community Advocacy to improve services, interactive communication, media approaches Provide policy makers with reliable and up-to-date health information ICT policy and strategy development for the health sector IICD interventions at different levels

Tanzania Surface Area (sq. km): thousand Population total: 40.4 million Life expectancy: 52 years Literacy rate: 69.4% Source: World Development Indicators, Case: Health Management Information System project, Tanzania Access to ICT/telecom (per 100) Mobile phone subscribers: 14.6 Landlines: 0.4 Internet users: 1 Personal computers: 0.9 Source: Worldbank - ICT at a glance, 2006 Needs in health sector shortage of staff (min 58,000) limited access to training courses insufficient access to medical and public health information inefficient management

Case: HMIS for Evangelical Lutheran Church Tanzania (ELCT) Project owner: Evangelical Lutheran Church (ELCT)* 20 hospitals 5 paramedical institutions Over 160 dispensaries and health centres 1500 health workers, 2160 beds (*) Covering 15% of the national health services in Tanzania Context: The hospitals and health institutions suffer from inefficient management practices due to a shortage of staff, high turnover rates and inadequate health utilization data. Collecting data takes too much staff time. C

Target groups and goals of the project Target groups: Health workers (doctors, nurses, etc) & patients Goals: Enable hospital staff to work more effectively and professionally Provide timely and accurate information leading to better health care planning Improve speed and accuracy of diagnosis Give more people access to health services Improve financial situation

Facts – pilot phase of the project Project duration: May 2006 – end of 2008 Number of participating hospitals: 1-4 Number of users: 160 Number of beneficiaries: 12,000 Total investment: €250,000

Objectives Make customized software available for standard transactions and reporting Install required hardware Train and help motivating staff to use the system Have support services in place Generate continuous feedback (management and end user) Ensure roll-out to 26 health facilities –Manual containing ‘guidelines’, change management, training, ICT support, user satisfaction test

Results (January 2009) Open Source Software Care 2x is functional* –Several modules available for billing, patient administration, stock-taking, reporting, pharmacy, laboratory, general information A generic Tanzanian version of Care2x has been developed and adapted for the current government health registration system HMIS system now installed in 4 hospitals, two more hospitals are busy implementing their HMIS A Change Management Guide is available 45 developers now trained

Impact (2008) Awareness increased from 57% (2007) to 69% Empowerment increased from 44% (2007) to 65% Economic impact increased from 48% (2007) to 57% –Better revenue collection (30% financial improvement) –Better job perspectives for the individual –More efficient management of hospitals –Lower patient fees –Less patient waiting time Sector impact 56% –Improvement in quality of hospital and health care in general, e.g. better record keeping Negative impact 49% –Looking for different jobs, irregular power supply, catering for privileged people.

Some lessons learned Awareness raising and ownership are key. Early adopters are needed to make others follow (bottom-up), and Longer term support (political and technical) is required –to assure trouble shooting –To facilitate embedding in local/regional/national structures –Network of stakeholders to support activities Need to develop a business model approach –Budget the cost of services and cover connection costs for all services in one package –Develop suitable & adapted solutions (no Western standards) Frequent re-training of users is essential due to high staff- turnover Modular approach to answer the needs

Future ( ) Project expanded for 2 more years Further investment: € 500,000 Further roll-out of the project in the next 2 years Gradually develop Care2x into an integrated solution for the health sector: –Include solutions for telemedicine, M&E reporting. Make data aggregation possible, data warehousing and data mining.