In preparation for my health sector presentation next week, I decided to examine how ICTs can be used to improve health in a developing country. But since I have already done a blog post on the Cariopad in Cameroon, a front office technology, I will focus on the back office application of ICTs to improve health system management in Tanzania. “Back office applications,” says Richard Heeks, “help better planning, decision-making, and management” (Heeks ICT Manifesto 2005). After writing my national ICT policy analysis, I learned that healthcare affordability for the patient alone doesn’t improve the overall level of health of a country. The affordability and efficiency of health systems for doctors and hospitals to treat more people at higher quality improves the overall development of the health sector in the long term. For this reason, I will focus on health management information systems in Tanzania.
There have been many ICT health-focused initiatives in Tanzania since the Ministry of Health and Social Welfare (MoHSW) proposed a strengthening of the country’s health information systems (HMIS) in 2000. Two such initiatives, Telemedicine, and eRCH4BC, are examples of how technology can be used to increase communication between doctors and community health workers to treat patients with severe cases who reside in places far from specialists or high quality health care.
Telemedicine in Tanzania enables doctors in remote areas to consult specialized doctors with healthcare expertise and resources in the cities for better diagnoses. “People who can afford it come to cities for their health care in huge numbers and at enormous cost. Telemedicine is beneficial for patients, because they can get specialist consultations and treatment in their own hospital.” Doctors are able to exchange medical data, still images, x-rays, live video and audio over the Internet to a panel of expert doctors in cities. Within a short period of time, they come up with the results and tell the rural doctors what to do. Dr. John Materu of Kibosho Hospital says, “Referral is easier when you can tell the patient the advice that you have got from a specialist-doctor on the right treatment” (IICD video). In terms of efficiency and cost-effectiveness, Telemedicine has the power to transform health development by cutting costs for patients and extending the knowledge of specialists. It seems to be financially sustainable since the Internet-based software is free and training manuals are easily adopted online or through visits from Telemed training institutions. My concerns about the project are the privacy and safety of patients’ information since it is discussed online by a panel of doctors. Also, if the Internet is down for an extended period while someone is in critical condition, there should be a back-up method of communication that doesn’t rely on Internet. Since the project has been able to push funding past their two-year pilot into Phase 2, hospitals are asked to provide funding from their own resources, which also could be a hindrance. Overall though, I am optimistic that Telemedicine is the key to improving HMIS and patient health care in remote areas.
Since I provided a comprehensive review of Telemedicine, I will go into less detail with the second health-focused ICT initiative. “eRCH for better care” was a joint pilot project between Spider and ITIDO from 2011 from 2012 with the objective of improving reproductive and child healthcare systems through ICT intervention in the Rufiji district of Tanzania. Amongst other RCH challenges, e-RCH4B aimed to solve the lack of antenatal check ups and lack of support for community health care workers (CHWs) in rural areas. To solve the former, an electronic record keeping system with both mother and child’s health data made check-ups easier and enabled data transfer data between facilities upon referrals. For the latter, eRCH4BC provided CHWs in with “Tele-maternal,” like to telemedicine but only for mothers, to identify danger signs of women and children “so CHWs can advise them to go to nearby health facilities for more professional care.” It is significant that civil society recognized the lack of formal education that CHWs have to provide new and expecting mothers accurate diagnoses. I hope the Tanzanian government will catch on too. Although Spider has not yet released the project’s evaluation, I am glad to see initiatives addressing fatalities that could be prevented with ICTs.