The Challenge of Non-Communicable Diseases and Road Traffic ...

66 The Challenge of Non-communicable Diseases and Road Traffic Injuries in Sub-Saharan Africa
unreliable or limited internet connectivity. A positive
sign is that although few African countries have
national policies or governance relating to e-health
or telemedicine, a growing number have institutions
involved in telemedicine development. There
is already, for example, a well-established collaboration
between high- and low-income countries in
the RAFT Project (Réseau en Afrique Francophone
pour la Télémédicine) coordinated by the Geneva
University Hospital, Switzerland, and university
hospitals in 18 largely francophone countries in Africa,
which focuses on telemedicine and distance
education of health care professionals working in
remote sites [465].
5.6. Addressing Information and
Research Gaps
Information
Health information is needed for assessing health
needs, developing evidence-based policy-making,
performance management, and monitoring and
evaluating interventions [39]. Countries with the
greatest health challenges also tend to have weak information
systems [466]. On top of this, monitoring
and reporting requirements related to grants, global
declarations, and health and disease programs can
add considerable burdens – a potential risk that
NCD efforts need to avoid.
Several countries (for example, Botswana, Namibia)
are making significant efforts in integrating
their multiple, disparate, disease-focused, standalone
health information systems. In Botswana, the MOH
completed the Health Information Management System
Strategic Plan in April 2012, that provides an ICT
road map in line with the MOH-adopted e-health
strategy, to integrate the current standalone systems
into the existing Integrated Patient Management System
(IPMS). IPMS is a centralized, electronic medical
record system focused on patient care and treatment
in clinic, and hospital settings. It stores data on various
health services, including ART, prevention of
mother-to child transmission, laboratory, and pharmacy,
and in the near future will support the clinical
case-management of Safe Male Circumcision and the
National Cervical Cancer Prevention Programs. It is
being implemented in 11 hospitals covering close to
75 percent of total MOH hospital beds, their labs, and
satellite clinics and have plans to expand to at least
30 hospitals across Botswana. In Namibia, the Ministry
of Health and Social Services is in the process
of integrating 61 disease-oriented, donor-supported,
standalone applications into a single Web-based,
Web-enabled platform. The Integrated Health Care
Information Management System is a patient-centered
record management system, that is HL7 9 compliant,
which covers all aspects of hospital clinical
case management and ancillary services in day to
day operations. The system is being pilot tested in the
Windhoek Central Hospital and it is expected to be
operational in the other three largest hospitals in the
country by the end of 2013, including the Katutura
Hospital, which operates as the national trauma referral
center. It is expected that once full connectivity is
in place, the system will allow the sharing of complete
patient records across Namibian health institutions.
In the implementation of electronic health records
(EHR) and ICT platforms, important challenges
need to be addressed in order to overcome, in addition
to existing technological barriers (such as
lack of uninterrupted power supply, connectivity,
and bandwidth): (a) the transitioning of hybrid approaches
where traditional paper-based processes
are maintained in parallel in direct competition
with the EHR and supporting ICT platform; (b)
the adoption of common health and information
exchange standards (for example, ICD-10; HL7);
(c) change-management strategies aiming to implement
organizational change processes deemed
critical in the delivery of health services, incorporating
the clinical workflows and decision-making
processes supported by the new technology; and (d)
the required, qualified IT operational and maintenance
support and financial backing needed for the
sustainability of the systems.
Limited civil registration and unreliable vital
statistics relating to fertility, mortality and causes
of death in Africa are recognized problems: for example,
only four African countries report cause of
9 HL7 standards provide a framework for the integration, sharing,
and retrieval of electronic health information. These standards
define how information is packaged and communicated from one
party to another, setting the language, structure, and data types
required for seamless integration between systems.