Full digital population health management in the heart of Africa
The next time I plan to demonstrate the power of digitization in population health management, it is clear which country should be visited: Rwanda. According to the scope description of our project, our task is to implement a digital system to collect, aggregate healthcare data in order to enable evidence based resource allocation, quality management and policy making. Taking my previous experience in “advanced” health systems, my expectations about what is achievable were very moderate. Spoiler: What we have found in Rwanda is far beyond of what I have ever seen in any country in the world.
But let’s start at the beginning. Taken limitations of the infrastructure, large distances and huge spread of the communities in the countryside, the most important principle of the healthcare provider infrastructure is to be as close to the local communities as possible. It starts at several 100 thousands local volunteers. Continues at healthcare centers, where most of the professional help is provided by well educated nurses.
So how can one decide which is the best way of allocating limited resources in such a highly distributed system? Rwanda’s healthcare expenditures per capita was $215 in 2015 (Germany’s was $5182). Rwanda’s life expectancy at birth is 65 years (improved from only 31 years in 1995!), while Germany’s is 81 years. The government has realized early on that having access to high quality healthcare data is a substantial factor. It has executed at an enormous speed: 1998–2008 excel based data collection; 2008–2011 MS Access based registries; from 2012 a fully web based data collection and analytics system which is available from almost all local facilities. Community volunteers submit relevant data to local Health Center’s per mobile phone.
Apart from long term trend analyses, drill-downs, configurable dashboards, pivot tables, the system supports the effective control of epidemics. Individual cases of infectious diseases are reported immediately in a dedicated subsystem.
Ingredients of this success story: clear system level strategy and execution; continuous training and engagement of all players — each facility has a data manager, specifically devoted to support the data collection; and a powerful open source software enabling all this: DHIS2 (https://www.dhis2.org/). Great acknowledgements should go to the Team from the University of Oslo!
And what about using electronic medical records instead of those huge books and paper records? No worries, this is already on the roadmap of the Ministry of Health and being piloted. Fast internet access and wiring for local area network to the point of care is being set up in all facilities.
It was quite a shocking surprise, but our project has morphed within hours form establishing the very basics of digital health data management to enable sophisticated distributed access to organizations, such as Caritas Rwanda, which operate and manage healthcare facilities and engage local volunteers. These organizations provide data in the first place and also have primary responsibility for proper management and execution, therefore seamless digital access to this gold value data is essential for them.
We knew that Africa is magic world full of surprises, but this experience was beyond any expectations.
