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ZAMBIA HEALTH INFORMATICS
LANDSCAPE
DR. CHARLES CHENGO, MD, MSc.
PRESENTATION OUTLINE
Introduction
Issues in Zambia
1)IT/ICT infrastructure
2)Healthcare Funding
3)Information Governance:
Legal
Healthcare policy
4)Current Health Informatics Projects
ICT POLICY
Zambia’s first draft Information and
communication Technology (ICT) policy was
launched in December, 2003 (IICD, 2004).
Section 2.9 concerns use of ICT in health
HEALTH INFORMATICS BENEFITS
Health experts, policy makers, payers and consumers consider health information technology key to improving efficiency and quality of health care (Chaudry et al, 2006).
Broad and constant utilisation of health information technology will: Improve health care quality (electronic medical records (EMRs) help
practice evidence based medicine (EBM))
Prevent medical errors (EMRs, computerised prescribers order entry systems (CPOES))
Reduce health care costs (e.g. national radiology repositories)
Increase administrative efficiencies
Decrease paperwork, and
Expand access to affordable care
Enhance research (makes data mining easy)
CLINICAL DECISION SUPPORT SYSTEMS (CDSS),
ARTIFICIAL INTELLIGENCE
In the USA medical errors cost the country $17-$29billion
annually (Grimes DJ, et al, 2005)
Clinical Decision Support (CDS) is defined broadly as a
clinical system, application or process that helps health
professionals make clinical decisions to enhance patient
care (HiMSS).
CDSS enables EBM to be practised
Reduced medical errors
Improved prescribing habits
Less adverse drug reactions
.
In a study done in Melbourne, Australia (Thursky
KA, et al, 2006), there was a reduction of broad
spectrum antibiotic use with the introduction of a
computerised decision support system in ICU
10.5% reduction in total antibiotic utilisation
Increase in switch to narrower spectrum
antibiotics
RENALLY CLEARED DRUGS
Lack of dose adjustment for renaly cleared drugs is a
common problem in hospitals
In Daw Park, South Australia CDSS resulted in improvement
in dose conformity ( Roberts GW, et al, 2010):
Enoxaparin 68%-86%
Gentamicin 63%-87%
Vancomycin 47%-77%
THE ZAMBIAN CASE - INFRASTRUCTURE :
MOBILE PHONE GROWTH TREND IN ZAMBIA
Year Country
population
Subscribers Per 100
inhabitants
Mobile
internet
Growth
rate %
2000 9,885,591 49,957 0.505 - 31.47
2001 10,089,492 97,900 0.97 - 95.97
2002 10,409,440 139,258 1.338 - 42.25
2003 10,774,382 204,150 1.895 - 46.60
2004 11,089,691 413,120 3.725 - 102.36
2005 11,441,469 949,558 8.299 - 129.85
2006 11,574,190 1,663,051 14.369 - 75.14
2007 11,708,450 2,639,026 22.539 215, 472 58.68
2008 11,900,000 3,207,679[1] 26.955 791, 464 21.54
INTERNET AND ISP CONNECTIVITY DATA
Year Country
population
Total
subscribers
Per 100
inhabitants
Type of
internet
connectivity
Growth
rate %
Dial up Broadband
2001 10,089,492 8,248 0.082 7,627 621
2002 10,409,440 11,647 0.112 10,826 821 41
2003 10,774,382 12,000 0.111 10,857 1,143 3
2004 11,089,691 16,288 0.147 15, 334 954 36
2005 11,441,469 10,882 0.095 10,179 703 -33
2006 11,574,190 11,996 0.104 10,067 1,929 10
2007 11, 708, 450 17,946 0.153 12,578 5,368 49.6
2008 11, 900, 000 18,078[2] 0.152 12,484 5,671 0.73
OTHER INTERNET DEVELOPMENTS
A fibre-optic network has been laid,
connecting the country to the Atlantic ocean
thru Namibia and it is expected this will lead
to a boom in broadband
3G mobile broadband launched in April 2012
HEALTHCARE FUNDING:
COUNTRY PROFILE FOR ZAMBIA
Zambia Country Profile – WHO Statistics,
2009
Parameter
Population 11.7 million
GNI / Capita in US dollars per annum $1,220.00
(Uk $38,000,
E.Guinea $14,550)
Percent urbanization 35%
Percentage people living In cities greater than
100,000 inhabitants
29%
Population below the poverty line (National
Standard) (1988 Data)
73%
Population below the poverty line (International
Standard) (Less than US One Dollar / Day)
73%
Infant mortality rate (age less than 5 years)
(2006)
182/1,000 live births (UK 5, Sing 2)
Maternal mortality 561/100,000(Moz 1100, UK7)
Life expectancy at birth (2006) 43 years
ZAMBIA VS. UK
Zambia UK
Population 11.7 million 61million
Absolute funding to health sector $344million $200 billion
Percentage funding to health sector 8.6% 17%
Health funding per capita $29.00 $3278.00
Health funding % of GDP 2.1% 7%
UNDERFUNDED HEALTH SECTOR
In Zambian the health sector is grossly under-funded.With a shoe-string budget coupled with many health challenges, can health Informatics, whose benefits are subtle be seen as a priority?
INFORMATION GOVERNANCE
In the UK the main legislation driving the information governance agenda is: Data protection act of 1998
Common law of confidentiality
Human rights act
Freedom of information act
In the USA, The Health Insurance Portability and Accountability Act of 1996 (HIPAA) protects the privacy of individually identifiable health information;
In Zambia there is no legislation that safeguards data for clients (patients included) information
Health workers are bound by the Health and Allied Professions code of ethics which is not a legal provision per se
INFORMATION GOVERNANCE CONT’D
Concern is only about government
information
The State security act (1969) Chapter 111 of
the Laws of Zambia: An Act to make better
provision relating to State security; to deal
with espionage, sabotage and other activities
prejudicial to the interests of the State; and to
provide for purposes incidental to or
connected therewith.
..
The Public Interest Disclosure (Protection of
Whistle Blowers) Act, No. 4 of 2010.
Therefore it appears it’s not a criminal offence to
abuse information belonging to ordinary citizens
and the only information that is valued is state
information
HEALTH INFORMATICS PROJECT IN ZAMBIA
Sporadic HI projects
EHRS for HIV/AIDS patients initiated and funded by donors (presidential emergency Plan for AIDS relief (PEPFAR), United States Aid for International Development (USAID), etc)
However, these are mainly used for data collection as clinicians do not use them and they are only used by Data Entry Clerks for booking patients, entering laboratory results, generating reports, etc. As a result, many potential benefits have not been passed on to patients and clinicians
TELEMEDICINE PROJECTS
The University Teaching
Hospital in Lusaka has been
engaged in some
telemedicine with super
specialised hospitals (SSHs)
in India
Pan African e-Network
initiative (India an AU)
. UTH
UTH
www.televital.com
WORK FLOW-OFFLINE
www.televital.com
WORK FLOW-ONLINE
CIDRZ
Cervical cancer screening
centres are using digital
images generated via digital
cameras for nurses in clinics
to consult doctors. Images are
posted to a website. Since
2006 over 78,000 women
have been screened
CIDRZ
MOBILE HEALTH
SMS technology for appointment reminders for
HIV/AIDS patients initiated and funded by donors
SMS technology for immunisation campaigns
spearheaded by donors (UNICEF)
CONCLUSION
Health informatics have numerous benefits
It appears IT/ICT infrastructure in Zambia is adequate but there are issues with information governance
Should Zambia invest in Health Informatics in spite of or because of many health challenges?
.
PULA!
REFERENCES
1. Women’s Information for Development Network (WIDNet), 2010.
http://www.widnet.org.zm/news.php?id=23
2. Ministry of Communication and Transport (MCT)
http://www.mct.gov.zm/index.php?option=com_docman&task=cat_view
&gid=51&Itemid=202
3. Breton A., Sheehan J., 2007. Means and Methods. Surgeonsnews.
[online] available at:
http://www.surgeonsnews.info/content/content.aspx?ID=153
4. Chaudry B., Wang J., Wu S., Magllone M.,Majica W., Roth E., Morton
S.C., Shekelle G., 2006. “Systematic Review: Impact of Health
Information Technology on Quality, Efficiency, and Costs of Medical
Care”. Annals of Internal Medicine; 2006; 144;742-752. [online].
Available at: http://www.annals.org/content/144/10/742.full.pdf Viewed
on 6th October, 2010.
REFERENCES
5. Medical News Today, 2009. “Workshop on Telemedicine in Africa”. [online]. Available at. http://www.medicalnewstoday.com/articles/37047.php Accessed on 9th September, 2009.
6. European Space Agency, 2007. Telemedicine Initiative for Sub-Saharan Africa: Pilot Projects Proposed. [online] Scientific Daily. Available at http://www.sciencedaily.com/releases/2007/03/070319175628.htm Retrieved on 9th September, 2009.
7. WHO, 2009. “Country Profile of Environmental Burden of Disease”. [online] available at: http://www.who.int/quantifying_ehimpacts/national/countryprofile/zambia.pdf Accessed 9th October, 2010.
8. UKpublicspending.co.uk, 2009. http://www.ukpublicspending.co.uk/uk_health_care_spending_10.html
9 U.S. Department of Health and Human Services, 2012. Health Information Privacy [online], available at: http://www.hhs.gov/ocr/privacy/, viewed 8th June, 2012.
10. Mulikita S., ([email protected]), 8th January, 2009. “Zambia ICT Infrastructure”. Email to Chengo C. ([email protected]
