Changing the country’s health landscape


Alias Ndaziona was amazed with the experience that she recently underwent at her usual Antiretroviral Treatment (ART) clinic situated at Mfera Health Centre in Chikwawa.
Instead of going through the manual process of calculating the length of time she has been on ART and when last she had the test to determine whether she qualifies for viral load testing or not, it was done electronically.
She has had her Body Mass Index (BMI) tested, in a few seconds; the health worker swiped the barcode on her health passport with the aid of a computer and told her to go to the next room, which happens for consultation.
“I was surprised to be told that the ‘machine’ has detected that I need to have my viral load checked. Initially, the health workers used to calculate this through my history record in their paper files recalls Ndaziona, sounding amazed.
She happens to be one the first 55 patients on ART to receive treatment using the Electronic Medical Recording Management System at Mfera Health Centre.
“I felt like today was faster than the other days. I was assisted in a few minutes,” Ndaziona says.
Hard copy patient files, hospital records and facility reports among others are a common sight in most hospital cabinets. This is also very common in the ART treatment clinic where a patient’s record also need to be kept, in addition to the health passport record which the patients keep for themselves.
This has however proven to be problematic when it comes to tracing files for research or reference purposes. The information has also been lost in some cases. This has especially happened through fire accidents and other calamities.
Malawi News has also learnt that most of the country’s health facilities have had low data quality, in terms of patient level information for clinical decision making and continuum of care, accuracy of data, and timeliness of reports to the district health officer.
These and many other problems have had a negative impact on the welfare of patients, and have probably put lives at risk. Taking all these issues into consideration, Baobab Health Trust (BHT) with financial assistance from Centre for Disease Control (CDC) has introduced electronic health recording or electronic medical recording system to Malawi’s health sector.
Located over 30 kilometres away from Chikwawa District Hospital, Mfera Health Centre is one of the 36 clinics, whose ART clinic(s) have just been initiated into electronic recording across the country.
In-charge of Mfera Health Centre, Matthews Makoka says the introduction of electronic record management has eased things for health workers at the facility.
“The electronic system is able to detect if a patient has missed appointments before. After their weight is recorded in the system, it is able to detect if the patient is due for viral load testing.”
“This is a ray of hope to us because we will not have to stress over stationery shortages. In addition to that, we will not be strained that much when a patient is not responding to treatment accordingly, as the system is also able to detect if a patient missed their clinic appointments,” he said.
Makoka further elaborated that Malawi being a resource constrained country, the patient to health worker ratio is quite high and that calls for task shifting and avoiding duplication of efforts.
“This system ensures that information once collected by one health worker should be re-used by others on the same visit or future visits in high burden facilities (like ours) to help save resources towards the clinical management of patients,” he said.
CDC website on Global health titled Innovative electronic medical record system expansion in Malawi says this is the systematized collection of electronically-stored health information in a digital format for patients and indeed population. These records can be shared across different health care settings. It says Health workers have to endure using paperwork every day because there has been no alternative.
CDC says keeping track of even one patient undergoing treatment for HIV can be complicated. This is the case because most health facilities in the country use paper filing of patient information.
“The offices of medical assistants and the nurses’ work stations are full of paper work. Most health facilities in Malawi have patients’ files all over the place,” observes CDC.
The presence of so many files around has also led to patients receiving wrong treatment in the past, since their files could either not be found or it would have taken lots of time for the health workers to locate the information. Too much time spent on one patient led to formation of long queues, which eventually resulted in long working hours for the health workers.
Health Management Information System Officer for Zomba District Health Office, Dearie Madeya says health workers have been spending much time recording and processing patient’s information manually.
“The Ministry of Health spends a lot of money to print patient registers so this system will save a lot of money. It has made it easy for health workers to submit reports to the DHO on time. It’s all happening at a touch of a button,” he says.
The electronic system has also been introduced in Laboratories within the country’s central hospitals. In most cases, patients have also spent much of their time waiting for their results to receive appropriate treatment due to the manual system that was used there.
Baobab Health is piloting the use of electronic Laboratory Information Management System, popularly known as LIMS.
Deputy Hospital Director for Zomba Central Hospital, Rose Chayachaya, says since the hospital started using the system in April this year, there has been sanity in the way laboratory orders are processed.
“Results could go missing or get mixed up thereby forcing health personnel to restart the whole process. This development used to work to the disadvantage of the patients,” she recalls.
BHT’s Media and Communication Officer, Matthews Malata says their mission is to improve Information Communication and Technology -ICT usage in the country’s health facilities by building, deploying, and maintaining innovative, robust and sustainable health care information systems, suitable for the developing world.
This is being done in collaboration with government and health care workers.
“Our organisation is installing Electronic Record Management System in health facilities, in line with guidelines through department of HIV and AIDS. The system observes patient’s confidentiality,” he said.
Our visit to some of the facilities which have had the system installed established that the general benefits of the system include the fact that it is customised to specified environments and has proven to be user friendly, regardless of levels of computer knowledge.
It has also been observed that the system uses low power consuming devices and alternative energy such as solar. This means that it will not in any way be affected by the prevalent power outages.
To the patients, the system is beneficial because it will facilitate easy generation of reports, easy transfer of information, minimised errors, easy to maintain, reduced cases of misdiagnosis and treatment, continuity of patient care (built to fit large and small facilities) among other benefits.
To government, this system will help in evidence based decision making, easy reporting and reliable medical records.
Ministry of Health and Population says BHT’s is one of the partners that are helping the ministry to move with the times, in terms of going Digital.
The ministry’s spokesperson, Joshua Malango says the ministry and Lighthouse are the principal partners and other partners are ITEC, Gates Foundation and BHT.
“Priority of the program is given to people living with HIV who are on ARVs. This technology is helping in record keeping. This is unlike the hardcopy system which is prone to loss,” he says.
The use of Electronic Medical Recording Management System is addressed in the new Electronic Transactions Act (ETA). The information collected is personal data within the meaning of the ETA. The ETA says personal data means any information relating to an individual who may be directly identified or if not directly identified, may be identifiable by reference to an identification number or one or several elements related to his physical, physiological, genetic, psychological, cultural, social or economic identity. Among others, the Act stresses the need for the responsibility to protect personal data against accidental or unlawful destruction or accidental loss, alteration, unauthorised disclosure or access, “in particular where the processing involves the transmission of data over a network, and against all other unlawful forms of processing.”
Among the early beneficiaries of the EMRS intervention are patients such as Ndaziona. The system enforces adherence to patient management protocols or guidelines, hence ensuring improved quality of care for patients.
More than 400,000 ART patients in the country are already accessing treatment through this system, according BHT’s.

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