Computerization of Public Hospitals in Burundi: Processes and Results

Abstract

Background
In Burundi, the Ministry of Public Health and Fight against AIDS initiated in 2012 with the support of the Belgian Technical Cooperation, a pilot project for implementing an electronic hospital information management solution in a number of public health facilities. The aim was to improve the overall hospital management and hence the quality of patient care.

Approach
Four hospitals representing the three levels of the health system (district, province and central) were involved as early as March 2015 in a pilot phase of the project.
From the start, four preliminary activities were identified and dealt with in the four hospitals: (i) the setting up of a steering committee, (ii) assurance of reliable electrical energy; (iii) assurance of a reliable internet connection and (iv) contracting of a computer expert.
An assessment was made of each hospital in order to collect the business needs and define the scope of the project, as perceived by the health facility staff.
As a result from this assessment and after consulting the steering committees, a consensus was reached on the functionalities to be developed and a preference was expressed for open source software.
An external provider was then selected to implement an open source hospital information management system (OpenClinic GA) and provide maintenance for 3 years.

Lessons learned
A ramp-up in the use of the application with a significant increase in registration performance in the 4 hospitals has been noted, in addition to:
- A gradual abolition of paper registers;
- A full invoice recovery rate for out-patient consultations and 95% recovery for in-patient admissions over the study period;
- A registration of ICD-10 diagnoses for 31% of the outpatient encounters but only for 5% of the hospital admissions.
But also:
- An overall average cost of € 1,300,000 for this pilot phase (excluding the cost of BTC's ongoing technical assistance);
- Continuing user requests for the development of additional functionalities;
- A weak ownership by the hospitals of the project management aspects.

Discussion
Nearly two years after going live, the results of the computerization pilot phase in Burundi show:
- A satisfactory use of the application;
- Regular updating of the application;
- A high level of user satisfaction;
- Increased production of health services and greater control over revenue;
- Remaining significant electrical energy and human resources challenges;
- A high initial investment cost but which has dropped by almost 50% in the extension phase that was achieved in a later stage.
The most important challenges encountered were the weak setup of the project management, problematic ICT-staff retention and inadequate coverage of increased energy needs.