Modular Strategic Implementation of ICT in Health Care Facilities - Tanzania

If Information and Communications Technologies (ICTs) are implemented haphazardly and in a technical manner, they can become a burden rather than an aiding tool. In this project, named ‘Modular Strategic Implementation of ICT in Health Care Facilities’, a modular approach to the use of ICT is implemented in the district hospitals of Magu and Sengerema in Tanzania. A specified strategic model enables the hospitals to choose any module to meet their urgent requirements. A modular approach also ensures that ICT can be implemented in a phased manner so the changes for the local staff and management structure come gradually.

It is widely accepted that Information and Communication Technologies can assist various functions of health care facilities. However, the mere presence of ICT in a health care facility does not necessitate their usefulness in improving the quality and efficiency of delivering health care. In fact, if implemented too fast or in an unplanned manner, they actually have a higher potential to be an additional burden in terms of maintenance and operational expenses.

Therefore a clear strategic model is needed that will take into consideration the various characteristics and requirements of each health care facility. This strategy must be modular in that a health facility can choose any module to best meet their urgent requirements.

A modular approach also ensures that ICT can be implemented in a phased manner so the changes for the local staff and management structure come gradually and are not overwhelming. In this way the meaning of ICT in hospitals gets de-mystified by breaking it down into smaller modules that are easier to understand, to compare and to evaluate. It is part of the project to share the staff’s experiences with the modular approach are shared in a community of practice, which set-up is included in this project.

In this project ICT is implemented in two district hospitals using the phased implementation philosophy. Magu District Hospital uses the Connectivity and the Health Management Information Systems (HMIS) modules. An HMIS is a database system in

which ‘raw data’ are stored and transformed into information. The functionality of an HMIS may differ from organisation to organisation. In general one sees that HMIS collect and generate data and information on patients, costs, performance of personnel and reporting.

The Sengerema Designated District Hospital is implementing the Connectivity, Continuous Professional Development and Public Internet Facility modules.

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Magu Hospital:

In Magu training is ongoing and collaboration with vertical programmes helps to strengthen the HMIS system. A lesson is that project implementation in the public sector does take time. A point of attention is finding approaches that shorten this time. However, the embedding in the overall administration is good. The district council included a most amount for expansion and maintenance of the computers in the hospital. The council also recruited a new IT officer.

The project is now well installed and runnning. More computers are needed for training.  A low costs solution might be n-computing. Also a new dispensary will added to the project. Spill over effects occur: A neigbouring district came to study teh HMIS system and also budgetted for the implementation of HMIS in 2009/2010.

Sengerema Hospital, Nursing school, School of Clinical Officers and Eye Clinic:

In Sengerema the project advances well and a substantial in-house training programme has started. The position for an ICT officer for the hospital and medical schools has been rejected by the Ministry, but will now be financed by the hospital and schools’ own financial means. This is a point of attention for the ICT policy. A business plan is developed for Sengerema to integrate ICT in such a way that it is financially sustainable, well maintained and replaced in time, and still to expand to cover for the increasing ICT needs and new applications to be developed. Novel in Tanzania is that Sengerema school of nursing has now included ICT in the curriculum, including Afya Pro software for HMIS. Sengerema also practices telemedicine and all institutions together developed and implemented a sustainability plan that includes a gradual expansion.

The overall objective is to develop practical knowledge on ICT implementations and to disseminate it within the sector. Knowledge will be drawn from experts and through peer reviews of practitioners. This will result in a publication of lessons learned.

Because the modular approach in both hospitals is quite different, there are also specific objectives for each hospital.

The objectives for Magu District Hospital are:

• Implementation of HMIS - This will increase operational efficiency, enable better management of the facility and provide valuable health data for collection and analysis at the district level.
• Training of HMIS users - This includes training in computer skills, HMIS usage training and on-the-job implementation assistance.
• Change Management - Training personnel to deal with changing organisational procedures and information flow resulting from ICT use.
• Increase internet connectivity

The objectives for Sengerema Hospital are:

• Implementation of the internet access module in the hospital
• Provision of training in ICT for the hospital school of nursing, school for medical officers and inclusion of ICT in the respective curricula.
• To showcase methods of improving and maintaining a high quality of health workers using ICT

Health facilities will be able to get the maximum benefit of ICT if implemented in this strategic modular fashion. If successful, this strategy can be replicated with other projects in a manner that continuously builds on the past experiences and skills gained from previous projects.

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A guide with lessons learned in this project is in preparation and will be disseminated through Afya Mtandao (Swahili for Health Network).