Uganda’s Paper Cloud
Tackling Uganda’s paper-based health care data management through digitization
A visit to some of Uganda’s health facilities is like a step back in time. Health care workers rely heavily on paper-based patient data management, requiring hours of manual data entry and placing significant strain on an already overstretched system.
The result is often data gaps and inaccuracies. The volume of records produced requires significant financial resources to manage, including maintenance, storage, and human resources.
And then there are the critters. Some health facilities, especially in rural areas, have accumulated cobweb-infested record rooms marked by accumulated paper records and files. Some files have withered and turned brown from years of storage, while rodents and cockroaches have chipped away at the papers, obliterating information.
At Nagongera health facility in eastern Uganda, data clerks used to painstakingly sieve through stacks of files and books weekly to extract data for reporting and analysis. This tedious process often spanned hours to days for a single report, which would inevitably be marred by data errors and inconsistencies.
“It is so time-consuming [manual data entry] — having to tally manually and make sure you capture all the data in all these files,” said Lucy Asio, a data clerk at Nagongera health center. “Something that would take you like a few minutes, you find yourself taking half a day or at most [a] whole day.”
To tackle this challenge, the Ministry of Health in partnership with the U.S. President’s Emergency Plan for AIDS Relief, through the USAID Strategic Information Technical Support (SITES) Activity and health development partners, rolled out an Electronic Medical Records (Uganda EMR) system in 2017. The system — which runs primarily offline but also has cloud access integration — is targeted for rollout in all the 825 USAID-supported health facilities (including high-volume sites and referral hospitals) in Uganda by December 2023, and is designed to improve health data collection, access, and use.
The EMR system allows facilities to upload and store patient data, and enables real-time capture of quality data to inform programming. The system also supports timely and accurate reporting of data into the national electronic Health Management Information System. USAID provided equipment including computers and solar facilities, and trained facility data clerks in the use of the EMR system.
By the end of 2021, the system had been installed in 500 of the 825 targeted health facilities. Following facility and end-user feedback, the EMR underwent several upgrades to improve functionality and user ability. The latest version allows for use at the Point of Care (POC) data capture in a health facility.
That means rather than having a single EMR station (computer) at each health facility, the POC EMR adds the ability to capture data of patients at all points of service in a health facility through additional computer stations — including in triage areas, reception stations, and outpatient clinics.
That, in turn, has resulted in better patient monitoring and processing turnaround times. It has cut wait times for patients and clients from hours to minutes. This is also critical to mitigating the COVID-19 pandemic, where crowding at health facilities increases COVID transmission, and also reduces the time burden of accessing health care for patients. It has also enhanced real-time data collection, potentially reducing the reliance on the manual paper-based system.
“The EMR system is saving us a lot of money because most of our facilities are supported by the government with meager resources, but… we were spending a big portion of that money on the record system which has been manual,” said Dr. Moses Mugonyi, the city health officer in Mbale city, in Eastern Uganda. “We are now also able to work with the little [storage] space that we have because a lot of the data can be stored in software form.”
About the Author
Charles Kavuma is the Management Information Systems Team Lead for the Strategic Information Technical Support Activity at USAID’s Mission in Uganda.
