How Uganda’s health care problems can end with a phone

By Rosebell Kagumire

In December 2008, 15 km from the Ugandan border a British doctor saved the life of a teenage boy in Rutshuru in eastern Democratic Republic of Congo, by amputating his shoulder.

Dr. David Nott had succeeded in carrying out a life saving operation using his mobile phone where he text a colleague in Britain for procedures and instruction. He had never performed such an operation before.

The boy had lost his left arm in the war torn country during in fighting between government and rebels in eastern DRC. By the time he was taken to a hospital in Rutshuru his wound had been infected and doctors feared he would die within days if the operation was not done hence a forequarter amputation – which involves removing a collar bone and the shoulder blade was performed successfully.

This was just one of the many examples of the rapidly growing application of clinical medicine using information and communication technology. It is this field that has come to be called Telemedicine that is having many African countries look to experts to help put in place ehealth systems that would help overcome problems of limited health care skills and growing disease burden.

And the Ugandan government if all goes according to plan could tap into this rapidly growing medical field where medical information is often transferred via telephone, the Internet or other networks for the purpose of consulting, examination and at times medical procedures.  Through project called ICT4MPOWER, the ministry of health will use Isingiro district for pilot studies to try and figure out how Uganda can use ICT to improve the information flow from patients and communities to the regional referral get better health out comes.

The project which will cost about Ush 4 billion will put in place an electronic patient referral and feedback mechanism.

Dr. Edward Mukooyo, a commissioner in the ministry of health in charge of the project said the ICT4MPOWER will increase the effectiveness of the Ugandan health system and empower community health workers in the Isingiro district and Mbarara region for better health outcomes of the rural population.

During the three years, the experts will develop an electronic health record and referral system, unique client ID system as well as strategic delivery of eLearning and tele-consultation.  The projects are expected to serve about 400,000 population.”

He said they will use unique patient identifier to strengthen the referral chain from the districts to the regional hospitals.

“When you visit health centres at all levels today across the country, it is mainly patients who carry their own records of when they last visited the doctor and what they were diagnosed with,” said Mukooyo, “Centres don’t have these records so it makes it difficult to make referrals.”

As a result many people have died of treatable diseases while others spend enormous amount of money to be re-examined due to lack of proper referral mechanisms from the health center.

How it will work

In this project, a mobile phone camera will be used to take photos and GPS positioning records of members of every household in the village. This information will be fed into a central server where Health center II, III and IV will gain access to the persons biodata and medical information will be stored.

Every time a person visits the health centre, his/her data is updated at all the levels including the referral hospital which in this case will be Mbarara university teaching hospital.

To carryout this initial recording effectively, there will be need to train village health teams in using these mobile phones and the final plans are underway for the project to start.

Also health centres will be supplied with computers Network systems will be put in place to ensure the timely update of the individual data.

Health policy experts hope will improve substantially not only the handling of referral but also disease epidemiology in the country.

“The lack of national IDs has hindered tracking of data about disease history or changes and this has led to mishandling of patients. This will improve our heath system greatly,” Dr. Mukooyo told a recent meeting on ICT-Africa funded by the European Commission.

Many health centres cannot easily track patients or care givers to avail relevant information after they have left the centres and it is common for many children for instance missing immunisation schedules and many pregnant mothers not getting enough antenatal checks due to lack of a followup mechanism.

Through village health teams, which are comprised of people who know the village well will be responsible for such primary follow-up.

It is this computerization and the reliance on broadband connectivity that is expected to make the project a success.

“This will be a three year project and we should see results in the first year,” said Dr Mukooyo, “After the 12 months we will gauge if the project is viable and after three years we will roll it out to the whole country.”

It is also expected that the project will improve service delivery by trying to overcome the problem of few numbers of medical practitioners willing to work in rural areas.

“ICT can be utilized to improve current workflow processes in community health units and bring needed healthcare services to the point of need,” said a statement from SPIEDER , a Swedish agency for ICT in developing regions which will provide 50 percent of the project funds.

The Ministry of ICT, Uganda Communications Commission (UCC) through the Rural Communications Development Fund will provide the infrastructure for the implementation of the ICT4MPOWER project.

Also the project will rely heavily on Makerere University Faculty of Computing and IT (CIT) with inputs ranging from software development, to development of e-content and solution documentation.

“The (CIT) faculty will also provide staff to man and run the new system while the medical school will ensure there are health workers when it is ready to roll throughout the country,” said, Dr. Ian Munabi from Makerere University Department of Anatomy, “the fact that we have all well trained manpower we ensure a smooth continuity of better health care in the country.”

Most of the technical expertise however will be from Sweden’s   Biomedical Engineering Department at Karolinska University Hospital and the Royal Institute of Technology, as well as Ericsson AB.

Besides aiding referrals and patient follow ups, the project will ensure transfer of skills and knowledge to many health workers especially those working in rural settings like Isingiro who have had nor access to the use of ICTs.

Health workers while using more modern ways of examining patients and consultations as well using the access to internet to share information on cases.

Many say this project if successfully implemented will increase confidence in the way health care is delivered in the country.

The experts spearheading the project say keeping electronic health records and effective administration of patients in hospitals and clinics; Diagnostics, treatment and follow-up of patients on distance through remote monitoring and tele-conferencing solutions will just be priority areas in the implementation but with time and enough funds such improved information flow can help revamp Uganda’s health care.

For instance it is believed Uganda loses lots of money in drugs which are stocked and expire due to poor stock management. Such a project the ministry of health says would prevent such incidents. Indeed in 2006, I established that many Anteritoral Viral drugs had expired from the National Medical stores which led to the firing of the management. Many drugs expire in health centres due to negligence and poor record keeping.

Just like in many African countries, such efforts by Ugandan government to promote telemedicine will not come easy.

The main challenge as Dr. Mukooyo put it is as “technophobia” and said many health workers in Uganda are not used to using these technologies which means they will require a lot of training and sensitisation.

He also cited the problem of power as most districts have no reliable power. There are plans to tap into solar power under this project.

Prof. Venansius Baryamureeba, Dean Faculty of ICT told The Independent that lack of skills must be addressed.

“Of course things like taking a picture and sending it and feeding the right information to the system require imparting skills Many people in Uganda have never used a computer and therefore don’t much skills. And those who have access to computers have a problem of mindset,” said Baryamureeba. “Some people even with access to ICTs still want to do things manually.”

But he said ultimately the success of such a project will depends so much on how much is put into infrastructure.

“Telemedicine is not only phones, you need databases and local area networks, internet connections and all these also rely on a good power supply.”

But some are worried about the challenge of acceptability. Most Ugandans are used to getting face to face discussion with medical practitioners, one health worker told The Independent, they want the doctor in the white coat and when they find a nurse even if they know enough to take care of the problem because of the ease with which they will be able to get information after such a project is in place- most patients will not easily take that.

People still have doubts and they will still want a doctor.

Other challenges pointed out was the difficulty in attracting qualified health practitioners to work in the rural areas and this would be a big factor for any ehealth project to succeed.

However the roll out of these ehealth initiatives in the country is not being done in isolation. The government is eyeing the near launch of submarine fibre optic cables at the eastern African coast which is expected to highly boost internet accessibility and lower costs in the region.

Although the pilot project in Isingiro will still rely on satellite connections for internet and telephone calls, by the end of the three years when the plan is supposed to be rolled out to all districts, the country will be already reaping from connections from Seacom optic fibre cable that will be operational by June this year and the East African Marine Cable System (EASSy) that will connect eastern African countries including Uganda via high bandwidth fibre optic cable system to the rest of the world by mid next year.

With the ICT4MPOWER project in place Ugandans will be waiting to see if the advancement of ehealth can make a real much needed change in Uganda’s ailing health system.