Using Technology to Strengthen Public Sector Healthcare Service Delivery

A Kenyan doctor posted at a public health facility spends 4.2 minutes on an average to treat a patient, according to a 2017 study by the Development Economics Research Group of the World Bank. This is vastly inadequate compared to the 15 minutes recommended by the British Medical Association and 21 minutes that an American patient gets with her family physician. The primary reason for this is the limited number of doctors treating large volumes of patients. The problems of staff shortage and dismal infrastructure are compounded further with inefficient work processes.
This is the challenge their initiative seeks to address. The problem is all pervasive, from the bottom most unit—termed a ‘dispensary’ staffed by nurses who handle the needs of the most vulnerable rural communities — to higher centres staffed by clinical officers, general practitioners and specialists. None have the management tools that can help them streamline their work nor does a lower level have a pragmatic way to supplement their scarce medical skills with help from higher levels. Inordinate time is spent on routine tasks of maintaining registers and records further limiting the time available for delivering care. Keeping paper records also makes them error-prone, retrieval difficult and undermines inventory management. Performance reports to the higher levels are also filled and sent manually making analysis difficult, especially since they are normally delayed. Since medical skills are deployed in a pyramidal structure within the county, cases that could have been handled at lower levels with a little higher level support end up in reality at the higher levels. This leads to overcrowding and improvident use of scarce resources.

The project brings, with the active support of the county’s ministry of health, higher efficiencies to the resources already invested in the public sector. This necessitates duly aligning and re-adjusting the ICT solutions currently being used in the private sector to the needs, compulsions and habits of the public sector. Once in place, the model addresses the needs of the poorest communities close to their residence and serve as a conduit for referring them to the higher levels.
The project focus on four main attributes of integrated ICT-based solutions:
1. Decision support tools to nurses at rural government health facilities and doctors and clinicians at higher centres, which will provide standardized care efficiently and use tele-consultation features to supplement local skills.
2. Electronic medical records integrated with ICD-10 diagnostic support for referrals and continuum of care.
3. Dashboard of real-time metrics to supervisors auto-analyzed to facilitate quick remedial measures
4. Inventory management, using a bottom-up utilization model.
The entire system is designed to work in low resource settings, and can function even if only 2G connectivity is available. (Better bandwidth improves quality of transmission and images.) The core application for the rural clinics, loaded on a laptop or a tablet, provides algorithms that improve the efficiency and quality of service delivery. Similar tools, more sophisticated in medical terms, are available to doctors and clinical officers available at higher levels. The ICT system accepts a range of off-the-shelf devices on a plug and play basis, which also allows for future additions when more devices become available.

This project provides decision support and tele-consultation tools to providers across the structure, so that lower levels will use ICT tools to provide standardized quality service on their own, or in teleconsultation with medical resources at higher centres. Electronic medical records stored in the internet cloud, a diagnostic and decision support system with updates of ICD-10 lists, inventory management on a utilization basis and metrics for supervisors is an integral part of the suite of solutions. The ICT solutions integrate the utilization of resources over time and space, so an integrated service delivery system is forged, within existing resources using triaging principles. Besides provision of care, the system provides metrics to decision makers for course corrections, and triggers alerts about outbreaks on the basis of pre-determined levels. The teleconsultations functionality improves access to affordable and quality care to the remote and rural areas, by delivering cost-effective health care through live (synchronous) and store-and-forward (asynchronous) teleconsultations. Health management team members will also benefit under the project through easily available data on stock utilization and essential health and morbidity data.