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Developing a national e-health strategy for DR Congo: a preliminary analysis of business needs, existing information systems and solutions
Abstract and Figures
Background and purpose: In order to reclaim its leadership and to better align existing and future ICT implementations in the health domain with the strategic options defined by the National Plan for Health Development, the Ministry of Health (MoH) of the DRC initiated early 2014 the development of a national e-health enterprise architecture. During the preliminary phase of the architecture development cycle, an initial analysis of human resources, business processes, hardware, software, communication and networking infrastructure related to health information management, had to be established. Methods: A first part of the study consisted of a detailed analysis of regulatory documents and strategic plans related to the Congolese health system and health informatics development. In a second part, field visits and semi-structured interviews were organized with a representative sample of relevant health structures throughout the country Results: The study demonstrates the large number of business needs that must be addressed by e-health initiatives. It also documents the donor driven unequal distribution of hardware equipment over health administration components and health facilities. Internet connectivity remains problematic and few health oriented business applications found their way to the Congolese health system. Paper based instruments remain predominant in DRC's health administration. The study also identified a series of problems introduced by the uncoordinated development of health ICT in DRC such as the lack of standardization, data security risks, poor data quality, inadequate ICT infrastructures, an unregulated e-health sector and insufficient human capacity. Conclusions: The results confirm the precarious situation of the Congolese health information system but they also expose a number of bright spots that provide hope for the future: a political will to reclaim MoH leadership in the health information management domain, the readiness to develop e-health education and training programs and the opportunity to capitalize the experiences from early successes with DHIS2 and a number of hospital information management systems.
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... E-Health frameworks in DRC are in their early phases, but the potential for expansion is considerable. According to Steeven & Parick (2021), effective e-health solutions should be tailored to local contexts and success stories. Contextual factors are crucial for successful adoption and sustainability. ...
... Since DRC's independence and transition to democracy, the government has struggled to provide quality healthcare services to its citizens. Some of the key challenges the DRC government is facing in the healthcare industry include a limited budget, geographical isolation of populations, and a shortage of skilled healthcare practitioners (Verbeke et al., 2014). Despite the potential of e-health to address critical healthcare challenges in the DRC, its implementation remains limited. ...
... E-Health implementation in DRC is in its early phases, but the potential for expansion is considerable. According to Steeven & Parick (2021), effective e-health solutions should be tailored to local contexts and success stories. Contextual factors are crucial for successful adoption and sustainability. ...
E-health holds significant potential to address healthcare challenges in the Democratic Republic of Congo (DRC), a nation grappling with limited resources, vast geographical distances, and a fragile health system. This paper examines the current state of e-health implementation in the DRC, exploring existing initiatives, key achievements, and persistent obstacles. While nascent, e-health adoption is gaining momentum, driven by factors like increasing mobile phone penetration and government recognition of its potential. Successful projects include mHealth programs for disease surveillance, maternal health, and HIV/AIDS management, demonstrating positive impacts on data collection, patient follow-up, and health outcomes. However, significant challenges remain. These include inadequate infrastructure, particularly reliable internet access and electricity, limited funding, a shortage of skilled human resources in ICT and health informatics, and issues of interoperability between different systems. Furthermore, regulatory frameworks and national e-health strategies are still under development, hindering coordinated and sustainable implementation. This paper concludes by highlighting the need for strategic investments in infrastructure, capacity building, and policy development to unlock the full potential of e-health and improve healthcare delivery in the DRC.
... For more than a decade, Burundi and the Democratic Republic of the Congo (DRC) have employed TOGAF frameworks to implement integrated HIS and facilitate transition from paper-based instruments. 33,34 Existing resources and processes in the two countries were assessed by reviewing regulatory documents and conducting field visits and interviews with key informants across a range of facilities. In Burundi, the assessment indicated that man- agement was not coordinated with distribution hardware and processes, internet access was often unstable, and, although ICT was used at the district level, paper-based instruments were used by many hospitals and health centers. ...
... The assessment in DRC revealed similar themes and the need for better business operations management, computer hardware and networks, and instruments for routine and facility-based data collection. 34 The assessments suggest that implementing the TOGAF framework, training programs, DHIS2, and an information management system will enable both countries to move forward. ...
... 8 In Burundi and DRC, policy documents and input from key informants captured informa- tion on system strengths and weaknesses to transition effectively from paper-based and piecemeal data collection to a comprehensive business-technology-health system. 33,34 This articulation of the central system elements is demonstrated in Indonesia's efforts to streamline hospital administrative procedures for registration, medical records, billing, and patient tracking, 27 Malaysia's application of critical success factors in expanding EA across public sector HIS. 6 ...
... It should also be noted that the results evidenced the existence of a true coordination problem in the management of information as reported in Botswana in 2015 [8] and in the study by Lippeveld T et al. [9]. There are also problems due to the lack of equipment, financial resources and qualified personnel as reported by Verberk et al in 2004 [10]. Of the 14 hospitals, Bogodogo District Hospital and Tengandogo District Hospital have the highest scores with 62% and 69% respectively. ...
... Health data sciences and mobile health (mhealth), will be an important contribution to the management of massive data produced in hospitals [10,11,13]. ...
An assessment of the quality of the information system was conducted in the 14 hospitals of Burkina Faso in 2017 using the HMN tool (Health Metrics Network). This evaluation was part of the process of developing a master plan for implementing a HIS for the hospitals in the country, and was aimed at analyzing the sub-components of the existing information system. The results are presented as scores, one per component, evaluated in % and converted into quartiles, ranging from the 1st quartile "Not adequate at all" to the 4th quartile "Highly adequate". The scores are as follows: Resources = Q1 (29%); indicator = Q2 (46%); data sources = Q1 (28%); information production = Q1 (21%); data management = Q2 (47%); dissemination and use = Q3 (55%). In conclusion, overall the system is not adequate (mean score 39%), particularly at the level of information production (score 21%).
... It is with this background that Heeks [5] challenged Information Systems researchers to look at various available technologies to reach people so that they may obtain access to health care. This sluggish development is more especially evidenced in the advancement of Technology where most African countries face infrastructural, resource and capacity challenges, as shown in the research done by Verberte et al [6] , looking at business considerations for implementation of her in DR Congo and Twane et al [7] investigating the maternal landscape in a community area in South Africa in order to set the stage for information systems. According to Lee in Baskerville [8], Information Systems (IS), requires an awareness of the fact that the discipline of IS is a study that not only regards technological system and social systems as individual or in parallel but includes the investigation of the phenomena of the interactions between people and Information Technology systems. ...
... The objectives of the IMIA Education Task force was to "establish course, course tracks and programs" that assist health professionals – both health practitioners and non-health practitioners – to "acquire knowledge in information processing and information communication technology". IMIA developed 6 key education principals that followed on the acronym HEALTH, standing for the following: 6] Are there common learning outcomes as per the IMIA recommendations? ...
... Par conséquent, la quasi-totalité des professionnels de la santé commencent à exercer leur métier sans apprendre cette base informatique nécessaire pour le déploiement des systèmes d'information informatisés. Si les professionnels de santé africains se familiarisent rapidement avec les technologies de l'Internet, ils n'ont pas été formés à leurs méthodes porteuses de rigueur, d'organisation, de suivi des processus et des procédures (Verbeke et al., 2014) . ...
Introduction : Le dossier d'un patient représente la mémoire intégrale et écrite de son passage dans un établissement hospitalier (OMS, 2021). Ce travail avait pour objectif, de contribuer à l'amélioration de la gestion des dossiers médicaux des patients par le personnel de santé et les gestionnaires des institutions de santé au travers les différents logiciels de gestion de l'information médicale des patients, dans la ville de Lubumbashi. Méthodologie : Nous avons réalisé une étude descriptive transversale, par interview directe ayant inclus 120 professionnels de santé. L'analyse des données a été réalisée à l'aide du logiciel Epi-Info 7.2.5.0, Excel 2013 et le logiciel Zotero a servi pour les références bibliographies. Résultats : Nous avons trouvé que 41,67% des participants à étaient des infirmiers, 18,33% étaient des gestionnaires des données (Data Manager); 71,67% avaient un niveau d'étude supérieur (licencié). En outre, 84,17% des sujets interviewés avaient une connaissance en informatique de gestion médicale ; 69,17% avaient parlé de la gestion sur papier, 65,83% avaient parlé de version électronique ; 100% des enquêtés avaient parlé du logiciel dhis2 ; 69,17% des enquêtés avaient parlé de Tiernet. Conclusion : Le dossier médical informatisé, est consacré à l'interrogation de la base de données sur toutes les informations accumulées au fil du temps. Il permet de faire le compte-rendu d'hospitalisation. C'est une sorte de résumé de tous les actes diagnostiques et thérapeutiques dont le patient a bénéficié durant son séjour. Il est généré automatiquement mais reste modifiable par le médecin, l'infirmier ou la personne chargée de l'opération de facturation. Au niveau de l'observation il permet de faire le suivi médical. C'est un élément capital dans la prise en charge d'un patient. La présence de sa trace sur le dossier médical est un déterminant de la qualité de ce dossier. Chaque jour pendant le séjour du patient et chaque consultation externe après sa sortie, une observation médicale de suivi doit être inscrite sur le dossier. Les observations de suivi sont classées par ordre chronologique. Ainsi cette étude laisse une ouverture à d'autres recherches pour les aspects non exploités et atteint par ce travail.
... The DRC began to roll out its electronic health information system (HIS) in 2014 using the DHIS-2 platform to house and display collected data (Verbeke et al., 2015). Countrywide scale-up was completed by 2017 (MEASURE Evaluation, 2019). ...
Background:
In response to the DRC's 10th Ebola Virus Disease (EVD) outbreak, the government subsidized routine health services in select health zones with the goal of maintaining routine service volumes. We assess the impact of the initial and revised Free Care Policies (FCP) on total clinic visits, uncomplicated malaria, simple pneumonia, fourth antenatal care clinic visits, and measles vaccinations, testing the hypothesis that routine services would not significantly decrease during the FCP.
Methods and findings:
We used data from the DRC's national health information system spanning January 2017 to November 2020. Intervention facilities were those that were initially and secondarily enrolled in the FCP, which occurred in August 2018 and November 2018, respectively. Comparison facilities were limited to the North Kivu Province and were from health zones that recorded at least one case of Ebola. A controlled interrupted time series analysis was conducted. The FCP appeared to have a positive effect in increasing overall clinic attendance rates, uncomplicated malaria case rates, and simple pneumonia case rates in those health zones where the policy was enacted relative to comparison sites. The longer-term effects of the FCP were mostly non-significant or, if significant, relatively modest in nature. Rates for measles vaccinations and fourth ANC clinic visits appeared to be unaffected or minimally affected, respectively, by the implementation of the FCP and relative to comparison sites. We did not observe the decrease in measles vaccinations that has been observed elsewhere. The study is limited in that we were unable to account for health facility bypassing and service volumes at private health facilities.
Conclusions:
Our findings provide evidence that FCPs can be used to maintain routine service provision during outbreaks. Additionally, the study design demonstrates that routinely reported health information from the DRC are sensitive enough to detect changes in health policy.
... In Africa, digital health is considered a potential solution to address some of the previously described challenges, and is increasingly implemented. However, when designing, developing, implementing, and maintaining digital health solutions, the insufficient availability of skilled human resources is consistently described as a major limiting factor [26][27][28]. ...
Digital health, which is the use of digital, mobile and wireless technologies for health, is increasingly recognized for its potential to strengthen overall health system performance as digital health can increase access to health services, and improve quality and efficiency of care through de-isolation of healthcare professionals in remote locations. One of the most pressing issues in challenged health systems is a global shortage and uneven distribution of health workers, which will likely increase due to rising incidence of non-communicable diseases (NCDs) and a globally aging population, which will generate additional healthcare demand. Digital health can be a catalyst to address this shortage and other urgent issues in challenged health systems. When designing, developing, implementing, and maintaining digital health solutions, the insufficient availability of skilled human resources is consistently described as a major limiting factor. However, several programs, aimed at building digital health capacity at different levels in Africa address this gap. Independent of geography, digital health is a field of science at the intersection of other domains, which is interdisciplinary by definition and which will require more inter-professionalism. There is no single digital solution that fits all. For digital health to develop its full potential in Africa, solutions and applications have to be developed and deployed in cooperation with local human capacity, based on real needs, fostering innovative ideas and combinations of existing and new technologies.
This research explores to what extent Information and Communication Technology (ICT)-based information management methods can help to improve efficiency and effectiveness of health services in sub-Saharan hospitals and how clinical information can be made available for secondary use enabling non-redundant reporting of health- and care performance indicators. In the course of a 6 years research effort between 2006 and 2012, it was demonstrated that patient identification, financial management and structured reporting improved dramatically after implementation of well adapted ICT-tools in a set of 19 African health facilities. Real-time financial management metrics helped hospitals to quickly identify fraudulent practices and defective invoicing procedures. Out-patient case load significantly increased compared to the national average, average length of stay has been shortened in 15 of 19 health facilities and global hospital mortality decreased. Hospital workforce-evaluated impact of hospital information system implementation on local working conditions and quality of care was very positive. It was demonstrated that local sub-Saharan health professionals strongly believe in the importance of health information systems.
To review the key issues related to the design and implementation of an electronic health record (EHR) system in urban primary health care (PHC) practice in Cameroon.
The goal of the project was to assess EHR as a tool to improve providers' performance, quality and continuity of care, and the availability of data in PHC practice in Cameroon. A locally designed EHR system called MEDCAB was developed. The system was based on the International Classification for Primary Care (ICPC) and was designed taking into consideration the PHC practice environment in Cameroon. An original cohort of 14 users was involved in the experiment.
Users generally showed good acceptance of the system. Monitoring the use of the system at the early stages of implementation was important to ensure immediate response to users' comments and requests. Some of the key issues identified during the development and implementation of the system were: user involvement, the choice of an appropriate terminology, pre-existing data collection culture and leadership issues. Some positive achievements brought about by the system included promotion of good medical practice and routine availability of consultation data.
Strengthening the medical record in general, and the EHR in particular, could contribute to its position as a valuable source of information for healthcare delivery, public health and policy making in Cameroon. Challenges to adoption are huge and successful implementation for any specific setting will require a comprehensive modelling of the local medical practice, the choice of an appropriate terminology and a co-ordinated approach involving all stakeholders.
National Plan for Health Informatics Development in DRC (PNDIS)
- F Verbeke
- P Shamashanga
- C Amisi
- G Karara
Verbeke F, Shamashanga P, Amisi C, Karara G, National Plan for Health Informatics Development in DRC
(PNDIS), Technical report, CEDESURK, Kinshasa, DR Congo, October 2014, ISBN 978-99951-69-03-7
Health Information Systems in Africa: Resources, Indicators, Data Management, Dissemination and Use. Technical papers. Algiers: Centre for Health and Social Development (HeSo)
- S-E Kruse
Kruse S-E. Health Information Systems in Africa: Resources, Indicators, Data Management, Dissemination
and Use. Technical papers. Algiers: Centre for Health and Social Development (HeSo); 2008. Available
from: http://www.tropika.net/specials/algiers2008/technical-reviews/paper-8-en.pdf
Eb@lé-Santé: introducing electronic health records in RDC
- M Nyssen
- F Verbeke
- O Bakasanda
- M Rémon
Nyssen M, Verbeke F, Bakasanda O, Rémon M. Eb@lé-Santé: introducing electronic health records in RDC.
ICIA 2011 Conference Papers. Canaan Land, Nigeria: ICIA; 2011. Available from: http://www.fichierpdf.fr/2011/07/15/introducing-electronic-health-records-in-democratic-republic-of-congo/introducingelectronic-health-records-in-democratic-republic-of-congo.pdf