Health Ghana - Summary Report

Introduction

The International Institute for Communication and Development (IICD) organises a series of ICT Roundtables with/in several developing countries around the world. Hitherto Roundtables have been organised in Burkina Faso, Tanzania, Jamaica, Zambia and Ghana. The Roundtable is developed to promote and enhance local reflection on the potential role of Information and Communication Technologies (ICT ) in the respective countries´ development. The aim is to assist in the formulation of input for ICT policies and formulate specific project ideas, suitable for implementation.

In Ghana, IICD started activities in 1998 in cooperation with the Internet Society of Ghana. A National Roundtable conference in ICT, hosted by the Internet Society of Ghana (ISOG) with support from the Minsitry of Communication and IICD, was held in 1998. The National Roundtable resulted in the implementation of 3 projects in the area of Environment, Education and E-commerce in Agriculture .

This report summarises the results of the Sector Roundtable conference with a focus on ICT in Health care provision in Ghana, held October 4 to 8 in Accra. A comprehensive report on the conference and a reference report on the current status of ICT in Health Care Provision in Ghana are available on request.

The workshop was hosted by the Internet Society of Ghana, with support of the Ministry of Health and the International Institute for Communication and Development (IICD). Professionals from Global Business Network (GBN) facilitated the workshop.

At the Roundtable, 40 representatives of various stakeholders gathered to reflect on the role of ICT in Health Care provision in Ghana. The participants represented government institutions, the private sector and academia. (The full list of participants is provided in Annex 1).

1. Objectives

The purpose of the Sector Roundtable in Ghana is to deepen the shared/common understanding of the potential role of ICT in the provision of Health Care in Ghana and to develop a series of annotated project ideas. In terms of outcomes, the Roundtable therefore has two primary objectives:

• Provide ICT-policy recommendations for the health sector
  
• Generate annotated project ideas involving/supporting ICT deployment in the health sector
  
  In order to arrive at these objectives, the Roundtable participants followed a process of scenario building, supported by facilitators of Global Business Network.
  
  2. Recommendations for an ICT policy on health care provision
  
  The ICT policy recommendations were developed with the help of:
  
  
• Creating basic scenarios for the future of health care provision & ICT in Ghana
  
• Identification of priority areas with ICT leverage
  
  A first series of conversations focused on the role of ICT in the development of health care provision in Ghana. As a vehicle, the stakeholders together developed scenarios and a vision on the role of ICT in health care provision activities in Ghana over the next decade. Furthermore, the participants selected a number of priority areas, where ICT is thought to contribute most to such development.
  
  In the discussions, the key elements of the national health and ICT policies have been taken as a starting point. A reference report based on the health sector programme of work and including an overview of the current ICT landscape in the health sector was used . The conversations on scenarios, health care provision activities and priority areas generated a series of ICT policy recommendations, which can be used as input for future ICT policy making in the health sector.
  
  These recommendations can be grouped under a number of key issues and include:
  
  2.1 ICT POLICY FORMULATION
  
  
• The major purpose of an ICT policy in the health sector is to support health policy goals. Consequently, ICT policy is dependent upon the existence of an explicit health sector policy.
  
  
• It is to be based on the assumption that ICT deployment as such offers no solution to all problems. Rather, it is to facilitate the enabling role of ICT in a wide range of health care provision activities, with the ultimate aim to deliver better health care to the people of Ghana.
  
  
• A systemic approach is highly recommended in the development of an ICT policy. Also, there is a need to actively pursue ‘strategic’ conversations in which various worldviews around the role of ICT in the health sector can cross-fertilise each other (away from a culture of ‘guesstimation’).
  
• In the context of the many changes affecting the health sector, it is important to ensure continuity of ICT policy if unintended consequences, such as the proliferation of incompatible systems and technologies or low quality of data, are to be avoided. An organisation structure that reflects the importance of ICT throughout the health sector could be one means to this end.
  
  
• Resistance to change is a reality that should be taken into account with any implementation of ICT. Appropriate guidance and awareness building can help to alleviate fears of e.g. higher dependency on technology, loss of direct contacts between patient and care provider, anticipated shifting power base, job redundancy, etc.
  
  
• Finally, ICT deployment should enhance and not exclude human involvement. As a matter of protecting against the introduction of new errors, therefore, one must be sure to include the necessary checks and balances.
  
  2.2 PLANNING & LEARNING
  
  
• To enable learning and continuous improvement, it is important to have an institutionalised planning process in place in the health sector of which the Information & ICT planning process forms an essential and integral part. Additional means of learning from previous experience in this field are also to be considered.
  
  
• A prerequisite for an effective implementation of ICT policy is the availability of relevant and high quality healthcare data/information which can be used for effective planning and decision making in the health sector (re. the GIGO principle: garbage in, garbage out). This also implies clear definition of corresponding accountabilities.
  
  
• A set of desired concrete outcomes, as well as performance indicators for qualitative and quantitative benefits to be obtained, are to be defined.
  
  
• Through the availability of the above, ICT provides major potential to improve the performance of the health care provision system by supporting management decisions and health policy formulation on the basis of empirical data and scientific information analysis. ICT can also support the generation of such required information / performance indicators.
  
  
• It is advised to use an action learning approach, building on small successes (e.g. pilots). This allows for a gradual evolutionary development, with learning both at the level of adaptive changes and at the level of target setting (so called ‘double loop learning’).
  
  
  2.3 LEVERAGE AREAS FOR ICT DEPLOYMENT
  
  
• The following areas have been identified as having a leveraging effect on the contribution ICT can make to achieving better health care provision in Ghana:
  - ICT policy formulation
  - Patient care
  - Planning and budgeting
  - Sector performance assessment
  - Surveillance/control systems
  
  
• From a systemic perspective, it appears that the focus in these leverage areas is placed on balancing loops (feedback of information supporting containment strategies; e.g. for Malaria) and on information flows (information flows that enhance co-ordination/integration between various health sector actors; leading to increased speed and/or scope of interventions).
  
  
  2.4 STAKEHOLDER INVOLVEMENT
  
  
• In various areas of ICT deployment, it is essential to involve stakeholders in the process, each of which has different perspectives to offer. They also have different requirements to ICT (e.g. health care quality, effective management of health risks, efficient health care provision, information security, increased scope of information, etc.
  
  
• It seems obvious that if the aim is to provide better health care, participation/consultation of patients and/or clients during planning and implementation is necessary. Similarly, in the light of new and changing roles for both the public and the private sector, there is a role for the private sector to be considered.
  
  
• Because of the links/relations to other sectors, inter-sector dialogue is recommended in order to formulate and review ICT policy (basis for inter-sector collaboration).
  
  
  2.5 COMMUNICATION INFRASTRUCTURE & ACCESS COVERAGE
  
  
• Particularly in remote/rural areas, reliable telecom infrastructure is required to provide good access to health care for patients. However, the availability of such infrastructure at low cost is an important issue to be considered.
  
  
• There is a need to define minimal requirements for interoperatability and cross-platform compatibility.
  
  
• On the issue of standardisation, careful thought should be given to what should, and what should not, be standardised. Though it is recognised that there currently is a lack of standardisation, a continued attention for flexibility is also necessary.
  
  
  2.6 OTHER CRITICAL SUCCESS FACTORS
  
  Other critical success factors to be addressed in the ICT policy framework are:
  
  
• A careful analysis of the nature of the information which flows in the health sector, both vertically and laterally, and the actions that should be enabled.
  
• ICT’s contribution to timely, accurate, reliable, complete and relevant information from all activity levels in the health sector.
  
• Careful consideration of the cost and benefits of ICT applications in health care.
  
• Due attention for the sustainability of ICT applications (e.g. maintenance).
  
• The availability of a framework for dealing with data confidentiality and security
  
  
  
  
  
  
  
  3.Project ideas
  
  The scenarios, health care provision activities and priority areas served as a context for the development of annotated pilot project ideas in each of the priority areas. These project ideas will serve as a basis for the development of pilot/demonstration projects in Ghana by the participants, together with local and foreign partner organisations.
  
  Annotated project ideas are developed for application in the priority areas of health care provision as stated in national health policies. Within these priority areas, projects were selected in which ICT is expected to have most leverage.
  
  In the following section a short description is given of the project ideas, including the project objectives, activities and the agents of change. The agents of change are the owners of the project and will carry forward the development and implementation of the projects. To ensure scope for learning and extension to other levels in he health sector, the agents of change do not work in isolation but in close partnership will relevant stakeholders at the different levels of intervention.
  
  
  3.1 ICT POLICY FORMULATION AND AWARENESS STRATEGIES
  
  Problem area
  The development of an ICT policy for the health sector is pre requisite for the implementation of ICT that support the effectiveness and efficiency of health care provision in Ghana. Without a straightforward policy, the introduction of ICT in the heath sector may be insufficient or may be implemented in a scattered, inconsistent, inefficient and ineffective way. Yet, a clear ICT policy for the health sector has not yet been developed. This is first of all the result of limited awareness of the potential role ICT can play to assist heath care provision.
  
  Project objective
  The project’s objective is to develop an ICT policy for the health sector, based on active participation of well-informed stakeholders in the policy formulation process. The project will focus on the decision makers and staff of the Ministry of Health at the central level. Later activities can be set up at regional and district level.
  
  Project activities
  This is to be realised to a range of awareness raising activities including:
  
• Workshops with multiple stakeholder groups addressing issues of knowledge building on the potential contribution of ICT to health care provision, alleviation of fears around ICT, demystification the technologies behind ICT and the introduction ICT as a useful tool in solving complex information and planning problems at the Ministry.
  
• Active use of video shows and on-site visits to demonstrate examples of successful ICT applications in health care and in other sectors will help participants to visualise the role of ICT in health care provision.
  
• An introductory ICT capacity building programme.
  
  Executive agency and partner organisations
  The Ministry of Health at the central level is the executive agency. Partner organisations could include the responsible government departments, learning institutions, research institutions and the parliament
  
  
  3.2 PATIENT RECORD SYSTEM
  
  Problem area
  The manual patient data system currently prevalent in the health sector presents a bottleneck to realising efficient and high quality health care services. The quality of services is affected as a result of the lack or inaccuracy of historical patient data and patient data across health facilities. Further bottleneck is the inefficiency due to lost time and resources spend on information input, retrieval and analysis. Finally, resource allocation and planning is hampered by inaccurate date resulting in practises of ‘guestimation’. An electronic data patient record system is required to address these issues affecting health care quality for patients and clients and affecting work practises of medical staff and managers.
  
  Project objectives
  The development of a patient data record system that is to improve accuracy, speed and consistency of patient/client care. The system will assist in information storage and analysis, supporting activities including more accurate and timeliness diagnosis and continuous treatment, monitoring and evaluation of patients. In addition, the patient records will support the managers in health services and resource planning and budgeting and space reduction. The information can furthermore be used for reporting, prevention, health education and research.
  
  The information will cover both out-patient date and in-patient data. To limit the initial scope of the project, the project will start with record keeping at the moment of hospitalisation. The entering point is thus at hospitalisation. However, the system foresees in out-patient data. After hospitalisation, the patient will be kept on record to built patient history.
  
  The project will focus initially on regional hospitals. For the pilot phase, it is suggest to start a pilot in two regional hospitals will participate and two teaching hospitals. Preferably, smaller hospitals with basic ICT infrastructure will participate to ensure a fast project implementation. The pilot will serve as a action learning, which can be duplicated to larger regional hospitals, district hospitals and basic health care facilities at other levels and in other regions.
  
  Project activities
  
• Careful design of the patient record system and information requirements and standards, taking into account the costs-benefits of the ICT deployed in the system.
  
• The information collected includes qualitative and quantitative data on the patient (personal data, diagnoses,
• Development of a Database that is easily accessible to medical staff and management at hospitals and other levels and support storage, retrieval, analysis and reporting
  
• Development of a confidentiality standard for patient data
  
• Training information officers on information storage, retrieval, analysis and maintenance of the system
  
• Training for medical staff and management on information storage, retrieval and analysis
  
  Agents of change and partner organisations
  The regional hospitals participating in the project are the agents of change and include representatives from general and information management and medical staff. The patients should be directly involved in the design of the system to ensure customer oriented results. Stakeholders at the national level should be involved in the design the project to allow for the highest possible standardisation level required for duplication of the system in other regions and levels in the health sector. Finally, health research institutions: Partnership with research institutions (national or foreign) with experience in this area is important for knowledge transfer on best practises and historic errors made.
  
  
  3.3 DECISION SUPPORT SYSTEM FOR PLANNING AND BUDGETING
  
  Problem area
  Effective and efficient health care provision requires careful planning of activities and related budgets. Yet, there are found considerable problems in both areas and all the more in the consistency between planning of activities and the related budget planning. A limited number of initiatives in this area are addressing planning and budgeting at the national level. Yet, these tools may not be suitable for addressing the needs of management at the district and sub-district level.
  
  In particular, these problems prevail at the district and sub-district levels. Introduction of tools at these levels will ensure a high degree of synergy with health care provision at the lower intervention levels. Furthermore, the limited scope of operations in each district and sub district will enhance feasibility of a pilot project.
  
  Project objective
  The project contributes to a more efficient, effective and integrated planning and budgeting at sub-district and district level. It will support managers in more efficiently and effective allocation of resources to the different health care services. Central and regional authorities and financing agencies will also benefit from a better allocation of resources in the health care delivery system and improved management of health care.
  
  Initially the project will be developed in three sub-districts in three districts. This will allow for testing the system under different conditions. Ultimately, the project can be extended to other districts.
  
  Project activities
  
• Design and development of a basic but modern software application for integrated activity and budget planning and monitoring at district / sub district level. Sufficiently flexible and standardised for allowing replication to other areas
  
• Structured gathering and collation of budget and planning data that supports the monitoring, analysis and reporting on budget and planning
  
• Training for information officers on the maintenance and use of the system
  
• Training of management on the use of the system
  
• Provision of required ICT equipment where lacking
  
  Executive agency and partner organisations
  District and sub-district health authorities (general management, financial and planning officer and information managers) in the pilot areas will be the executive agencies. Central and regional level health authorities will be close partners in the design, monitoring of the pilot and eventual duplication of the pilot to other levels and areas in the health sector. In addition, specialised research institutions can be important partners in this project for technology transfer.
  
  
  
  3.4 DECISION SUPPORT SYSTEM FOR PERFORMANCE ASSESSMENT OF
  VULNERABLE GROUPS
  
  Problem area
  Effective and efficient health care provision requires careful assessment of needs of the population. This requires regular and structured information gathering, processing and analysis of information on the population. Yet, the information collection on the population is not in place or is not providing the information required for health programming. This particular affects the health care provision to vulnerable groups (infants, children, maternal) in rural areas.
  
  Project objective
  The project will develop a decision support system supporting the assessment of vulnerable groups and performance measurement of related health services. The system will provide a tool for a more structured collection and analysis of qualitative and quantitative health related information on the population. To ensure viability of the project and to learn from experience, a pilot phase can be started in a small number of district. Yet, the pilot project is to serve replication to other areas the country.
  
  Project activities
  
• Development of a set of clear and standardised performance indicators for the determination of the most vulnerable group of people and improved quality of the health care services provided to these groups
  
• Development of a database that allows for easy and fast upgrading and access to data
  
• Development of related software tools supporting the analysis of data (trend analysis tools, etc.)
  
• Training of information officers and health managers using the system
  
  Agent of change and partner organisations
  District health management in the pilot areas will be agents of change (DDHS, Rural Health Information Officer, SMO in charge, DA at planning office). Direct co-operation with the communities is a prerequisite for a successful design, development and implementation of the system. National and regional level management and information officers will be partners in the design, monitoring and replication of the pilot project activities to other areas and levels in the country. Partnering with research institutes in Ghana and abroad will allow for learning from best practices.
  
  
  3.5 COMMUNICATION LINKAGES FOR SURVEILLANCE
  
  Problem area
  Access to adequate means of communication is a pre condition to the surveillance of the health risks. However, in parts of the rural areas of Ghana, these communications means are not present. This has caused late (too late) information and reaction by distance health providers in emergent health events. Linking dispersed locations, where surveillance and early warning systems are required, will help to save time, costs and lifes. More in general, the communication linkages are required to facilitate the integration of remote areas in the national health care system.
  
  Project objective
  The project objective is to establish communication linkages at levels where no communication means are available to support surveillance and early warning purposes. If required, this include linkages at district, sub district level and community levels. The communication linkages will support rapid transfer of information, rapid action on information and timely mobilisation for action.
  
  Initially, the project will be implemented in one region only. This will allow for rapid action learning for expansion of the system to other regions. Ultimately, all regions should be linked up
  
  Project activities
  
• Set up communication linkages up to the lowest level of intervention The ICT deployed will depend on the viability and cost/benefits at each level. ICT can include radio, telephone, fax that will at least support voice communication
  
• Training on maintenance of the system
  
• Training on surveillance activities for responsible agents at all levels of the information chain on data collection, reporting and actions to be taken when messages are received
  
  Agents of change and partner organisations
  Regional health management and health information managers are to become agents of change in the project, in close co-operation with all information officers involved in the surveillance information chain. Communities should be involved to ensure effective co-operation in crisis situations. National level information and surveillance management should be involved to ensure proper project design allowing for adequate duplication of the project to other areas of Ghana.
  
  Co-operation with public or private communication providers can avoid duplication of infrastructure and result in important benefits in terms of technology transfer, equipment, implementation and maintenance cost. Yet, the type and extent of co-operation must be considered carefully to avoid a supply push and lock in situation with communication providers.
  
  
  4. Follow-up activities
  
  The Roundtable workshops are subsequently followed by a series of activities, which are to result in realisation of the project ideas within a period of about 12 months
  
  
• Project formulation: The agents of change will develop a draft project proposal. IICD and ISOG will provide assistance to the development of a sustainable project proposal with a 5-year planning period. As much as possible, the projects will seek integration with the health programme of the Ministry of Health.
  
  
• Fundraising: Funding will basically seek through budget allocation in the Ministries’ health programme. The agents of change and IICD will make a joint effort to ensure the required budget allocation.
  
  
• Start-up: IICD will assist in the implementation of the project and in capacity building for the agents of change.
  Annex 1. List of participants national ICT round table
  
  LIST OF PARTICIPANTS
  
  NAME INSTITUTION DESIGNATION ADDRESS/ E-MAIL TELEPHONE
  1. Isaac Adams Ministry of Health
  Head Quarters Head, Information monitoring and Evaluation mah-me@africaonline.com.gh 024318612
  2. Sam Bugri Ministry of Health Head Quarters Representative of the Minister of Health moh-hd@africaonline.com.gh 021-662982
  3. Mrs. Vic Dako Ministry of Health Head Quarters Health Administr. and support Service Division. kofidako@ghana.com 021-771817
  4. Mr. Yaw Brobbey - Mpiani Ministry Of Health Head Quarters Head Health Administration and support Service Division 021-663848
  5. Yohanes Atumo Ministry of Health Head Quarters. Regional Health Information Officer. P.O Box 184, Accra. 021-222490
  6. Prince Boni Ministry of Health Head Quarters. Health Planner Health Resource Division P.O Box MB 44, Accra. 021-661354
  7. Dr. S.A. de Youngster Minitry of Health Head Quarters Head, Center for Health Management. moh@ghana.com 021-667962
  8. Daniel Darko Health Information Management. P.O Box 2848, Accra. ab@africaonline.com.gh
  9. Abel Bolchtmay Health Information Management Center for Health Information Management, Hospital Korle-Bu P.O Box 2848, Accra. chim@africaonline.com.gh 021-668152
  10. Patience A. Brown Health information Management. Center for Health Management. chim@africaonline.com.gh 021-668152
  11. Nicholitta Attioghe Health Information Management. Information officer P.O Box 2848, Accra. 021-668152
  12. William N.A. Roberts Health Information Management. Information officer P.O Box GP-2848, Accra. 021-66152
  13. Dr. Eddie Addai Ministry of Health R 024369067
  14. M Yaw Owusu-Ansah Ministry of Health
  Regional Office ,Wa Head of Information Unit P.O Box 288, Wa. wusuya@yahoo.com 075622727
  15. Ken A Gbeve Ministry of Health Regionl Office
  Tamale Regional Health Information Officer. P.O Box 99, Tamale. a_abbey@africaonline.com.gh 071- 22710/22545
  16. Harry Opata Ministry of Health Regioal Office
  Koforidua R.H.A, koforidua 08123351
  
  17. Ivan T. Essegbey Ministry of Health Regional Office
  Kunasi P.O Box 1908, Kumasi. 051- 22089/23651
  
  18. A.K Gyan Ministry of Health Regional Office
  Kofuridua Regional Health Information Officer. P.O Box 75, Koforidua. 23361
  19. Isaac Lartey Ministry of Health Statistics
  Regional Office
  Secondi Regional Health Information Officer P.O Box 202, Secondi moh-wr@africaonline.com.gh 031- 46640/46018
  20. Nicholas Opoku Frimpong Komfu Anokye Teaching Hospital.
  Kumasi Head of Department. Statistics and Records Komfu Anokye teaching hospital. P.O Box 1934, Kumasi. 225301 Ext:299
  21. Dr. K.N Tamakloe Nyaho Clinic Private Practitioner P.O Box 5224, Accra. 775341
  22. S.Ofosu Amaah University of Ghana
  School for Public Health Director gsph@ghana.com 021-500388
  23. John Gyapong HRU Deputy Director P.O Box 184, Accra. gyapong@ighmail.com 021-230220
  24. Dr. W.K Bosu Regional Health Administration Cape Coast SMO (PH) wbosu@ighmail.com
  25. Clement Ofori C.I.G.A.D.S P.O Box AN-6341, Accra. 042-32281
  26. Awuah Barimah R.H.A Sunyani Regional Health Information. P.O Box 145, Sunyani. 0617079
  27. Ekow Wiah Private Practitioner P.O Box 325, Legon. 024359999
  28. Tony Williams Health consultant Consultant
  29. Stanley Atiapah Street Girls Aid Health Officer P. O Box 14292, Accra 021-226688
  30. Fiifi Ghartey Regional Health Administration, Cape Coast Ministry of Health Regional Office P.O Box 63, Cape Coast 042-32282/042-34309
  31. Issah Yahaya Ministry of Communication Research, Statistics and Information Manager P.O Box M 41 issayy@yahoo.com 021-242608/235800
  32. Seth D. Acquah HRD-Ministry of Information Fellowships HRD acquahseth@hotmail.com 021-661354
  
  33. C.C.Chinery ENR Hospital, Sekondi. Ministry of Health P.O. Box 229, Sekondi 031-3151
  34. Nani Tengey Regional Health Administration Rgional Biostatics Officer P.O Box 72, Ho 091-8214
  35. James Addo Ministry of Health Health Information Officer P.O Box kb 493 Korle Bu 021-763613
  36. Prof. R.R. Britwum Ghana Medical School Lecturer P.O Box 4236, Accra 021-667705
  37. A. Asiedu Ofei Komfu Anokye Teaching Hospital District Admnistrator P.O Box 1934, Accra 051-24621
  
  
  
  
  NON-PARTICIPATING AUDITORS
  
  NAME INSTITUTION DESIGNATION ADDRESS/ E-MAIL TELEPHONE
  38. Mr. Heldering Royal Netherlands Embassy Embassador Sankara Circle
  Heldering@acc.minbuza.nl 231991 / 2
  39. Luana Reale European Union Ministry of Finance
  Health
  40. DFID (UK)
  41. Dr. K.A.Banson HSSO, DANIDA SNR. Health Adviser PMB, TUC P.O, Accra. Vbaimpoe@africaonline.com.gh O24-321386
  
  
  
  CONFERENCE HOST & STAFF
  
  NAME INSTITUTION DESIGNATION ADDRESS/ E-MAIL TELEPHONE
  41. Dr. Nii Quaynor ISOG President Quaynor@ghana.com
  42. Mr. Mohammed Saani Abdulai ISOG Vice President Abdulaim@ghana.com 024 371571
  43. Dr. Stijn van der krogt IICD Programme Manager Juffrouw Idastraat 11
  PO Box 11586
  2502 AN The Hague
  The Netherlands
  Krogt@iicd.org
  www.iicd.org Tel +31703117311
  Fax +31703117322
  44. Alain Wouters
  Global Business Network Facitator wouters@well.com
  
  45. Philippe Vandenbroeck Global Business Network Facilitator philipp@ping.be
  46. Abdul - Wahab Issah Center for Information and Communications Technology. Instructor awissah@yahoo.com
  47. Musah Haruna Balle Baz Center for Information and Communications Technology. Instructor mharuna@yahoo.com
  48. Philip Vandyck Internet Society of Ghana Chapter. Administrator Pvandyck@hotmail.com 021-763613
  49. Eric Osiakwan Internet Society Of Ghana. Organising Secretary P.O Box MP1186 eosiakwan@yahoo.com 027-589115