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© 2017 HELINA and JHIA. This is an Open Access article published online by JHIA and distributed under the terms of the Creative Commons
Attribution Non-Commercial License. J Health Inform Afr. 2017;4(1):90-97. DOI: 10.12856/JHIA-2017-v4-i1-178
10th Health Informatics in Africa Conference (HELINA 2017)
Peer-reviewed and selected under the responsibility of the Scientific Programme Committee
Implementing Burundi's national e-health enterprise architecture:
past, present and future
Frank Verbeke a,b,*, Sandrine Kaze a, Larissa Ajeneza d, Lambert Nkurunziza d, Gervais Sindatuma d,
Hassan Asmini d, Stefaan Van Bastelaere c, Etienne Mugisho c
a Burundi Health Informatics Association, Bujumbura, Burundi
b Department of Biostatistics and Medical Informatics, Vrije Universiteit Brussel, Brussels, Belgium
c Belgian Technical Cooperation, Bujumbura, Burundi
d Ministry of Public Health and Fight against Aids, Burundi
Background and purpose: The Ministry of Health (MoH) of Burundi initiated in 2014 the
development of a national e-health enterprise architecture aiming to reclaim its leadership in this field
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 (PNDS). Methods: The Open Group
Architecture Framework (TOGAF) was used as a method for developing Burundi’s e-health
enterprise architecture. A first part of the study consisted of a detailed analysis of regulatory
documents and strategic plans related to the Burundian 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. Thorough analysis of
human resources, business processes, hardware, software, communication and networking
infrastructure provided both a baseline and a target e-health situation. Finally, a strategic document
was developed for planning the way forward for filling the functional and technical gaps that had
been identified.
Results: the preliminary study demonstrated the donor driven unequal distribution of hardware
equipment over health administration components and health facilities. Internet connectivity was
problematic and few health oriented business applications had found their way to the Burundian
health system. Paper based instruments remained predominant in Burundi’s health administration.
The study also identified a series of problems introduced by the uncoordinated development of health
ICT in Burundi such as the lack of standardization, data security risks, varying data quality,
inadequate ICT infrastructures, an unregulated e-health sector and insufficient human capacity. The
later architecture development effort resulted in the production and validation of a national e-health
strategy for Burundi for the period 2015-2019 (PNDIS). This strategy has been put into
implementation by the Ministry of Public Health and Fight against Aids since 2015 with the help of
the country’s development partners.
Conclusions: the results demonstrated the challenging situation of the Burundian health information
system but also revealed a series of important opportunities for the future: a political will to reclaim
MoH leadership in the health information management domain based on the PNDIS, the readiness to
develop e-health education and training programs and the opportunity to capitalize the experiences
with DHIS2 deployment, results based financing monitoring and evaluation with OpenRBF and
hospital information management systems implementation based on OpenClinic GA.
Keywords: e-Health enterprise architecture, TOGAF, Health information systems, Burundi
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© 2017 HELINA and JHIA. This is an Open Access article published online by JHIA and distributed under the terms of the Creative Commons
Attribution Non-Commercial License. J Health Inform Afr. 2017;4(1):90-97. DOI: 10.12856/ JHIA-2017-v4-i1-178
1 Introduction
In 2005, the Ministry of Public Health and Fight against Aids (MoH) of Burundi has developed a
National Health Policy covering the period 2005 to 2015 [3]. This policy was later translated by the MoH
and its technical and financial partners into a series of objectives and resulted in the National Plan for
Health Development 2011-2015 [1]. Amongst the objectives were the reinforcement of the National
Health Information System and the restoration of MoH's leadership in the field of health information
management. Therefore, a number of priority actions have been identified:
• The development of an e-health strategic plan for strengthening the national health information
system
• The development of an integrated and competitive health information management system
• The development of effective tools for planning, monitoring and evaluation
• Increasing the availability of ICT tools (hardware, networks and software) at all levels of the
Burundian health system
• The promotion of data driven research activities in the health sector
Integrating e-health in the national health policy yielded from the beginning enthusiasm from the
donor community and in the course of the past decade, a growing number of ICT tools have found their
way to the Burundian health sector. But most often, these tools have been introduced for supporting
specific projects lead by NGOs and foreign technical and financial development partners. The majority of
the chosen hardware and software solutions almost systematically served very well the individual project
objectives, but inter-project coordination and interfacing remained almost inexistent. Doing so,
sometimes successful e-health tools remained isolated in silo-projects where they only yielded a fraction
of their potential benefits. Without corrective action, the Burundian health sector threatened to evolve
towards a cacophony of divergent health informatics implementations that did not integrate with a
coherent national health information system development strategy.
In order to cope with this threat, in 2014, the MoH initiated the development of a national e-health
enterprise architecture with financial support of the Belgian Technical Cooperation. The Open Group
Architecture Framework (TOGAF) [2] was chosen as the reference methodology for developing this
architecture. During the first phases 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. This paper describes the objectives, methods
and findings of this preliminary analysis, leading to the development of Burundi’s national e-health
strategy [14].
2 Materials and Methods
The main objective of the preliminary analysis was to provide a reliable estimation of the existing human
and material resources and the issues related to health information management in Burundi. This study
was part of a complete e-health enterprise architecture development cycle according to the TOGAF
methodology, and therefore its output had to address a number of expectations defined by TOGAF. In
summary, the analysis focused on providing answers to the following questions:
• What are the MoH's business needs in terms of health information management?
• Which health information management applications have already been implemented in the field
and to what extent do they address specific business needs?
• What data is being collected today by the MoH and what is the quality of it?
• Which technologies (software, hardware, and networking) are used today in the health domain in
Burundi?
• What are the important health information management problems in Burundi today?
A first part of the study consisted of a detailed analysis of a number of regulatory documents and
strategic plans related to the Burundian health system implementation and health informatics
development [1,3,4,5,6].
In a second part, field visits and semi-structured interviews were organized with a representative
sample of relevant structures of the MoH throughout the country. For the sake of completeness and
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© 2017 HELINA and JHIA. This is an Open Access article published online by JHIA and distributed under the terms of the Creative Commons
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standardization, a study-specific interview guide has been developed and was systematically used by the
interviewers. After an introduction on the purpose of the interview, representatives of each structure have
first been questioned about the mission, the mandate and the vision of their organization, the objectives,
the functions and the roles fulfilled and the way their work is organized. After that, a detailed analysis
was made of health information management related human resources, ICT solutions and non-ICT (paper
based) instruments at their disposal and finaly an inventory was made of existing procedures for
exchanging health information with other (MoH or non-MoH) organizations. Finally, an analysis was
performed of health information management problems, expected benefits, potential threats and the
perceived importance of health ICT for each component of the organization.
The preliminary study was then used as a starting point for the development of a national e-health
enterprise architecture for Burundi. Using the TOGAF toolkit, the architecture team developed therefore
the future target (i) business- , (ii) application- , (iii) data- and (iv) technology architectures for the MoH
and consolidated these in a national e-health strategy for the period 2015 to 2019. This document was
submitted to the MoH for final validation in 2015.
3 Results
3.1 Field visits and interviews
The study of regulatory documents and strategic plans took place in October and November 2014. After
that, a series of field visits and interviews have been organized with 39 relevant MoH and -related
structures in the Bujumbura region:
• The permanent secretary and all MoH directorates
• Major health programs (malnutrition, HIV, malaria, vaccinations, tuberculosis)
• Donor agencies and technical partners (Belgian Technical Cooperation, European Union,
German Cooperation, Unicef, Japanese Cooperation, Gavi fund)
• Health facilities (third level reference hospitals, public and private clinics, health centers)
• Educational institutions
In the period from November-December 2014, the e-health architecture development staff also visited
5 other provinces (Muramvya, Gitega, Ruyigi, Kirundo and Ngozi). In total a sample of 5 provincial
health offices (29%), 5 health district administrations (11%) and 12 hospitals (18%) have been analyzed
by the study, representing an overall coverage of more than 15% of all MoH structures.
3.2 Hardware
The study showed that computer hardware has most often been supplied to the MoH within the scope of
donor-driven intervention programs. There was no organization-wide management of computer
equipment and therefore distribution of hardware over the different MoH directorates, provincial or
district administrations and hospitals was very heterogeneous: some structures which were supported by
several donors were very well equipped; others remained without any computer hardware at all. Under
impetus of national and provincial policies, a growing number of health centers in Burundi had also
started buying computer hardware with their own funds, unfortunately without having a clear idea of how
to integrate these new tools into their existing business processes.
Generally speaking, hardware specifications were quite standard: desktop PCs with Windows XP and
Windows 7 operating systems, of which a large number had limited functionality due to computer virus
infections (there is no budget available for keeping antivirus software databases up to date and many of
the PCs have no access to Internet for performing updates anyway). PCs were almost systematically
accompanied by uninterruptible power supplies (UPS), but due to the lack of battery maintenance, the
protection offered by these UPSs was minimal.
Many of the executive staff made use of laptop computers which in about half of the cases were their
personal privately-owned equipment.
Most of the MoH structures owned one or more printers and many of them were individual printers
that were not shared in a network. Toner and ink cartridge supply was often problematic due to
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© 2017 HELINA and JHIA. This is an Open Access article published online by JHIA and distributed under the terms of the Creative Commons
Attribution Non-Commercial License. J Health Inform Afr. 2017;4(1):90-97. DOI: 10.12856/ JHIA-2017-v4-i1-178
unavailability of toner cartridges on the Burundian market or absence of a budget for this kind of
operational costs.
Files and documents were commonly transferred from one computer to another using USB memory
sticks, which constitute an infamous source of virus infections.
3.3 Networks
At the central level (Bujumbura region), most of the MoH structures had a local network (wired or Wi-Fi)
at their disposal. Often, these networks were connected to the Internet thanks to donor funding, which
unfortunately is always limited in time (and sometimes also in data volume). Few large structures (central
MoH site, Military Hospital) had been connected to the national optical fiber network that offered
reasonable Internet connectivity, but for most of the medium-sized and small health facilities prices for
this kind of service remain prohibitive. Internet bandwidth offered by local ISPs in Bujumbura on the
other hand, was poor and unstable although considerable improvement had been seen in the past few
years. Installation of Internet connections was also uncoordinated, resulting in some structures
accumulating several (poorly performing) parallel connections on the same site: 4 different wired Internet
connections have been identified at the national blood transfusion site, without taking into account the
numerous individual 3G-USB modems offered by donor programs. Remarkably, in spite of the generally
poorly performing Internet connectivity, most MoH structures at the central level stated that an Internet
connection had become indispensable for their activities.
Outside Bujumbura and the provincial capitals, the situation was completely different. Wired Internet
connections were almost systematically unavailable and performance of 2G and 3G wireless data
networks was poor. Some donor agencies (such as EU) had equipped MoH structures with VSAT
connections, which have the advantage of providing stable and reliable bandwidth. Unfortunately, they
come at rather high operational costs and therefore their use is subject to data volume limitations, causing
the Internet connection being unavailable part of the time due to inappropriate use (downloading of
movies or audio) which can consume all of the monthly foreseen VSAT credit in only a few days.
3.4 Software
Almost all of the end user computers ran on Microsoft Windows operating systems (XP, version 7 and 8)
accompanied by Microsoft Office applications, with the exception of a number of desktop and server
computers at the directorate of the national health information system, which ran on Linux Mint or
Ubuntu.
Although health specific software implementations remained rare, a clear tendency towards web-based
business applications was noted, often based on Linux/Apache, MySQL databases and PHP or Java
developments:
• In 2014, the MOH started pilot implementations of the DHIS2 data warehouse in Bujumbura,
Ngozi and Muramvya as a replacement for the outdated MS Access based GESIS health data
collection solution. Further extension of DHIS2 to the other provinces were scheduled after a
detailed evaluation of this pilot experience.
• iHRIS human resource information system deployment also started end 2014 with the first
implementation pilots scheduled for early 2015.
• Hospital information system (HIS) implementations remained exceptional (less than 10% of the
hospitals), with all of the health facilities in our study sample running OpenClinic GA [13]. The
majority of the HIS solutions were concentrated in third level reference health facilities.
• OpenRBF has been implemented for monitoring results based financing (RBF) programs at the
central and provincial levels.
• Joomla and Drupal seemed to be the most popular solutions for dynamic website content
development
Additionally, some successful m-Health applications (the RapidSMS based KIRA Mama project [11]
and SIDA-info [12]) also provided promising results.
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© 2017 HELINA and JHIA. This is an Open Access article published online by JHIA and distributed under the terms of the Creative Commons
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Epi-Info and SPSS were the leading statistics software solutions. General and analytical accounting
systems are not uncommon in the health sector structures of Burundi: Asyst and QuickSoft (local
development), SAGE Saari, Popsy, and Banana were used by half of the health facilities while Tompro
had been recently introduced for project-oriented accounting at the central MoH level.
3.5 Paper based instruments
The vast majority of the provincial and health district administrations were using ICT-tools for reporting
health data to the central level (GESIS), but a number of hospitals and almost all health centers still relied
on paper based instruments for routine data collection. Information was written down in registers by
peripheral health center- or hospital staff and sent on a monthly basis to the health district administration
(emergency surveillance information was sometimes reported more quickly using SMS). Health districts
then forwarded compiled health facility data to the provincial level, where eventually provincial reports
were sent to the central level in Bujumbura.
A minimum of 25 registers must be permanently kept up to date by each health center and an amazing
average number of 75 registers are in use in an average district hospital. Additionally, donors and health
intervention programs sometimes claim parallel and redundant reporting from the health facilities and
district administrations they support, which represents an impressive administrative overhead.
Paper based instruments were also predominant for health record keeping in the vast majority (90%) of
the hospitals, which all faced health information quality issues.
3.6 Health information management problems detected
Over the past 10 years, the existing health sector ICT landscape of Burundi has been growing organically,
with the majority of the project-oriented solutions being brought in by donors and health programs. This
happened in an uncoordinated way, leading to:
• Lack of standardization: health information representation is hardly standardized and very few
international classifications or coding systems are taken into account (with the exception of
some of the DHIS2 and OpenClinic GA modules).
• Data availability risks: many databases are hosted in donor countries outside Burundi, with real
data accessibility risks for the MoH. Also, many MoH agents use personal computer equipment
without appropriate backup procedures or anti-virus protection.
• Data protection risks: data access rights are not formally organized according to the role that
individual agents fulfill in the health administration; usually people have full access or no access
at all to the information.
• Varying data quality: multiple reasons explain the poor quality of some data collected in the
field. There is (1) the lack of intrinsic motivation with MoH staff members who don’t produce
data for their own purpose; (2) the important administrative burden caused by redundant health
data collection processes; (3) the fact that many MoH agents don’t have the necessary
qualifications for producing reliable data; (4) the absence of personal consequences linked to the
production of erroneous information; (5) donors focusing on project health data which
compromises the global and systemic collection of data that is not linked to financial benefits
(RBF) and finally (6) the frequent staff turnover at all levels of the health system (on average
key personnel doesn’t stay longer than 1 year in the same position).
• Varying data promptness: the lack of reliable (electronic) communication instruments delays
the transmission of health information between different levels of the health system.
• Lack of data completeness: data is sometimes being considered a factor of power and the lack
of perceived personal interest in information sharing interferes with effective and systematic
communication of data in the health sector of Burundi.
• Defective and insufficient computer equipment: a number of MoH structures have no access
to appropriate ICT hardware and due to the lack of maintenance procedures, many of the
existing equipment has become defective. Computer virus infections also constitute a major
problem for the MoH administration.
• Inadequate ICT infrastructure: today, access to stable electric power is out of reach for many
MoH structures, even in the larger cities. UPSs have been provided with most of the computers,
but their batteries are often defective and don’t provide any protection against power failures
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(sometimes power failures can last for several days, which heavily compromises the reliability of
electronics in every day’s work). Affordable high bandwidth Internet is unavailable for most of
the MoH components. Donor project-funded Internet connectivity is always limited in time and
does rarely bring a sustainable solution.
• Unregulated e-health market: although e-health solutions are considered “medical devices” by
WHO, neither standards nor regulations have been put in place for introducing ICT-tools into
Burundi’s health system. E-Health solutions deployment therefore escapes from any health
authority control.
• Lack of health applications: most of the software solutions deployed in the health sector are
generic office applications, statistical analysis applications or aggregate data reporting
instruments. Too few health specific application implementations such as hospital-, laboratory-,
radiology- or pharmacy information systems have found their way into Burundi’s health system.
• Insufficient human capacity: human resources constitute a major problem for introducing e-
health solutions in Burundi: on one hand, qualified staff who are capable of effectively using
ICT-tools in their work environment are missing in many of the MoH structures. On the other
hand, there is a plethora of unmotivated and underqualified staff occupying positions in the MoH
administration preventing young and better qualified workers from being recruited. Additionally,
health-ICT related training and education opportunities are not aligned to the needs expressed by
the different directorates and health facilities.
• Organizational problems: the organizational structure of the MoH reflects in no way the
important transversal role of ICT in today’s healthcare. The statute of ICT professionals of MoH
is far from attractive, demonstrating the fact that they are considered an administrative burden
rather than a valuable asset of the organization.
• Ineffective dissemination of information: the absence of a reliable communication network
limits the dissemination of regulations, good practice guidelines and policies from the central
MoH level to the peripheral structures.
3.7 Towards a national e-health strategy
The TOGAF methodology, after applying some simplifications, enabled us to quantitatively and
qualitatively estimate the status of health ICT tools deployment in Burundi’s health sector, based on a
representative sample of administrative structures, health facilities, education- and research institutions.
The preliminary study results more or less confirmed the challenging situation of the Burundian health
information system [4,5,7,8], but they also revealed a number of opportunities for the future [9,10]:
• There seemed to be a political will to reclaim MoH leadership in the health information
management domain by enforcing compliance with international consensus and standards for all
future e-health initiatives, with the MoH in a regulator/gatekeeper position.
• The human resources deficit in health informatics was huge and many of the country’s education
institutions should collaborate on national and international levels to provide necessary and
appropriate ICT training, undergraduate and postgraduate health informatics programs. The
readiness to do so seems to exist on the side of the Burundian academic institutions and the
donor community.
• DHIS2 implementation got substantial support from the government and donor agencies.
Extensive training programs have started in December 2014 and a lot of enthusiasm exists to
make the implementation of a flexible national health information data warehouse happen.
• Hospital information management system implementations have been successful in several
hospitals (University Teaching Hospital of Bujumbura, Military Hospital of Kamenge, Prince
Louis Rwagasore Clinic, CMCK, CNAR), This provided clear evidence for the feasibility of HIS
implementation in Burundi.
The challenge remained to capitalize the experiences from the success stories and to integrate them
into a new coordinated, well adapted and appropriately funded e-health strategy for the country in the
next 5 to 10 years. Therefore, the output of the preparatory study was used as a starting point for the
further development of an e-Health Enterprise Architecture for Burundi’s MoH (PNDIS), of which a first
draft was presented in a stakeholder workshop in Bujumbura on December 10th 2014. A first part of the
PNDIS defines a business architecture, an application architecture, a data architecture and a technology
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© 2017 HELINA and JHIA. This is an Open Access article published online by JHIA and distributed under the terms of the Creative Commons
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architecture for Burundi’s future e-health developments in the public sector. A second part identifies
opportunities of capitalizing existing strategic solutions. A third part provides an implementation plan and
a budget. Based on this architecture exercise, a number of high priority recommendations have been
forwarded by the architecture development team to the Burundian stakeholder community:
• The creation of a national MoH datacenter in Bujumbura that centralizes shared databases and
applications and provides a professional infrastructure with stable electricity, access control, data
backup and redundancy. This recommendation was put into practice early 2017 with the
collaboration of Lumitel, a national telecom provider.
• The development of a multi-technology (optical fiber, 3G and VSAT) VPN-based health care
intranet connecting central, provincial and district level structures. Here also, Lumitel has
engaged in provisioning of internet and VPN connectivity to public health administration and
care structures based on a priority list established by the MoH.
• The implementation of a number of shared generic applications for the public health sector:
accounting software, workflow management, a unique central website, a virtual library, a
geographic information system and an MoH owned mail server (preventing the loss of valuable
information when staff using gmail.com of yahoo.fr accounts leave the organization). These
applications have been scheduled for progressive implementation in the MoH datacenter,
starting with a national MoH collaboration server.
• The implementation/strengthening of a series of health specific business applications such as
DHIS2, iHRIS, OpenRBF, OpenClinic GA HIS, LMIS and a series of health resource registries
(including a facility registry). With the help of the Belgian development agency and guided by
the national e-health strategy, the MoH has made substantial progress in this domain. From end
2014 till today, the DHIS2 data warehouse has been progressively deployed to all health
districts, replacing the former GESIS national health information system. Since 2014, Burundi
remains one of the most successful implementation of results based financing and the OpenRBF
information system has played an important role in the management and monitoring of RBF
activities in the country. Finally, in the period from 2014-2016, four new OpenClinic GA
implementations of a standardized national hospital information management system have been
piloted in 4 hospitals in Bujumbura, Ngozi, Muramvya and Kirundo. Since end 2016, after
successful evaluation of the pilot phase, the MoH has started rolling out OpenClinic GA to other
public health facilities in Bujumbura, Bubanza, Mukenke, Karusi, Gitega, Cankuzo and Bururi.
Several private hospitals in Bujumbura, Ruyigi and Kigutu have joined the MoH in this
implementation.
• The implementation of tablet- and smartphone-based patient oriented health data collection tools
in health centers and at the community level (KIRA Mama and SIDA-Info). This
recommendation is yet to be implemented.
• The implementation of an SMS-to-IP gateway enabling health facilities that have only access to
plain GSM and SMS connectivity to participate in the country’s electronic data collection
mechanisms. The first pilot implementations for this solution will be implemented in 2017 and
piloted in 5 health centers.
• The development of 3 health informatics teaching programs to cope with the important human
capacity building needs: (1) a Master in Health Informatics program in collaboration with
neighboring universities from Kigali, Bukavu and Lubumbashi, (2) a specialization program in
applied health informatics for health professionals and (3) the creation of a biomedical
technician bachelor program. These educational plans have been further elaborated in
collaboration with Université Lumière and the National Institute for Public Health in
Bujumbura and the first cohorts of students will be enrolled in 2017.
• The creation of an autonomous health informatics directorate at the MoH with 4 departments in
charge of (1) standardization and regulation, (2) health informatics infrastructure management
(datacenter and intranet), (3) health informatics education and promotion and (4) helpdesk and
support functions. This recommendation shall have to wait to be integrated in a larger
reorganization plan of the MoH, which is a difficult administrative and political exercise.
Meanwhile, the bulk of the proposed functions of this new directorate are filled in by the actual
Directorate of the National Health Information System (DSNIS).
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4 Conclusions
After a first successful application for the development of a national e-health strategy in DRC in 2014
[15], the TOGAF toolkit also confirmed its status of a comprehensive and practical instrument for
capturing and describing status, needs, opportunities and solutions in complex systems such as the e-
health domain in Burundi. A preliminary e-health status assessment demonstrated the challenging
situation of the Burundian health information system but also revealed a series of important opportunities
for the future: a political will to reclaim MoH leadership in the health information management domain
based on the PNDIS, the readiness to develop e-health education and training programs and the
opportunity to capitalize the experiences with DHIS2 deployment, results based financing monitoring and
evaluation with OpenRBF and the fast extension of hospital information management systems
implementation based on OpenClinic GA. Burundi’s national e-health strategic plan has proven to be a
useful enabler for the MoH in coordinating its numerous e-health activities and for making impressive
progress with nationwide deployment of a number of core e-health applications. Beyond initial
expectations, the national e-health strategic choices have also been adopted by a growing number of
private sector stakeholders.
The focus for future PNDIS implementation in Burundi is on improving systems interoperability
(OpenRBF, DHIS2, OpenClinic GA), extending the implementation of the hospital information systems
to new public hospitals, introduction of new applications for diagnostic and therapeutic support (quality
of care improvement) and the introduction of a limited number of new applications such as a national
asset inventory and maintenance management system and electronic health registries for health centers.
5 References
[1] Plan National de Développement Sanitaire II 2011-2015, Ministry of Public Health and Fight
against Aids, Bujumbura, Burundi
[2] The Open Group Architecture Framework (TOGAF), http://www.opengroup.org/togaf/
[3] Politique Nationale de la Santé 2005-2015, September 2004, Ministry of Public Health and Fight
against Aids, Bujumbura, Burundi
[4] Politique Nationale de Développement des Technologies de l’Information et de la Communication
du Burundi 2010-2025, November 2010, Council of Ministers, Bujumbura, Burundi
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and Fight against Aids, Bujumbura, Burundi
[6] Plan Stratégique National de Développement des Ressources Humaines pour la Santé 2010-2014,
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[11] KIRA Mama project, Unicef, 2014, https://unicefstories.files.wordpress.com/2014/05/projet-kira-
mama-pdf-final-1.pdf
[12] SIDA Info, SWAA Burundi, http://www.sida-info-service.org
[13] OpenClinic GA, http://sourceforge.net/projects/open-clinic
[14] Plan National de Développement de l’Informatique de la Santé du MSPLS au Burundi (PNDIS)
2015-2019, https://dl.dropboxusercontent.com/u/80890982/PNDIS.2.0.BURUNDI.VALIDE.pdf
[15] Plan National de Développement de l’Informatique de la Santé de la RDC (PNDIS), Technical
report, August 2014, https://dl.dropboxusercontent.com/u/80890982/PNDIS-RDC.1.0.pdf
