CDC’s MMWR [*] posted a link to the Community Preventive Services Task Force 2016 publication:  Diabetes Prevention: Interventions engaging Community Health Workers :  https://www.thecommunityguide.org/sites/default/files/assets/Diabetes-Prevention-Community-Health-Workers.pdf

Jean Sack

HIFA profile: Jean C Sack is a Public Health Informationist at Jhpiego – an affiliate of Johns Hopkins University, Baltimore, MD, USA.      Jean.sack AT jhpiego.org

[*Note from HIFA moderator (Neil PW):

CDC = Centers for Disease Control (US)

MMWR = Morbidity and Mortality Weekly Report]

This week’s print issue of The Lancet (28 January) contains a 73-page Lancet Commission on Essential medicines for universal health coverage. It also contains five Comments on this  subject.

Lancet Commission: Essential medicines for universal health coverage

Veronika J Wirtz et al.

The Lancet 2017; Volume 389, No. 10067, p403–476, 28 January 2017

DOI: http://dx.doi.org/10.1016/S0140-6736(16)31599-9

‘Appropriate use of medicines depends on behaviours of many stakeholders

• – Patients must take the medicines that are clinically appropriate for their illnesses, in the right doses and dosage forms, at the right time, and for the recommended duration. Patients and their caregivers require: knowledge about symptoms and information to decide when and where to seek care; convenient access to quality medicines at affordable costs; and knowledge, motivation, and skills to use the recommended medicines as directed.
• – Prescribers must prescribe clinically appropriate, cost-effective products. They require: diagnostic and therapeutic decision-making skills; up-to-date, evidence-based treatment guidelines that are consistent with medicines available and reimbursed in their systems; reliable, valid diagnostic tools in facilities; professionalism, training, time, and appropriate incentives to act in the interests of patients and caregivers…
• – Consumer organisations and pharmaceutical manufacturers provide information to health professionals, and in some settings directly to the public. They require: regulatory oversight to provide unbiased, evidence-based information.’

We know from WHO that ‘Globally, most prescribers receive most of their prescribing information from the pharmaceutical industry and in many countries this is the only information they receive.’ World Medicines Report, WHO, 2011. “Appropriate use of antibiotics [and other medicines] is only possible if healthcare workers and the public have access to reliable, unbiased information on medicines. Universal access to reliable information on medicines is readily achievable and should be a cornerstone of efforts to promote rational prescribing. There is an urgent need for concerted action.” WHO: http://www.who.int/rhem/didyouknow/essential_medicines/rational_antibiotic_use/en/

The causes of incoreect use of medicines are multifaceted and WHO advocates 12 key interventions accordingly:

• 1. Establishment of a multidisciplinary national body to coordinate policies on medicine use
• 2. Use of clinical guidelines
• 3. Development and use of national essential medicines list
• 4. Establishment of drug and therapeutics committees in districts and hospitals
• 5. Inclusion of problem-based pharmacotherapy training in undergraduate curricula
• 6. Continuing in-service medical education as a licensure requirement
• 7. Supervision, audit and feedback
• 8. Use of independent information on medicines
• 8. Public education about medicines
• 9. Avoidance of perverse financial incentives
• 10. Use of appropriate and enforced regulation
• 11. Sufficient government expenditure to ensure availability of medicines and staff.

http://www.who.int/medicines/areas/rational_use/en/

The Lancet Commission adds to our understanding but its recommendations are off-target. ‘The Commission proposes three recommendations to governments and the main public or private payers to operationalise this focus while implementing health system reforms toward UHC:

• 1. Governments and the main public or private payers should establish independent pharmaceutical analytics units (or equivalent)…
• 2. Pharmaceutical analytics units must collaborate with multiple stakeholders…
• 3. Engaged stakeholder groups, led by data produced by the pharmaceutical analytics unit, should identify and prioritise local medicines use problems, identify contributing factors across the system, and develop and implement sustainable, long-term, multifaceted interventions…

Arguably, the above can provide further data on the local and national causes of poor quality prescribing.

But let’s not forget the basics. Prescribers and users of medicines need access to reliable unbiased information, not only on individual, commonly used medicines but also on diagnostics and on appropriate selection of medicines (as given in formularies such as the BNF). ‘Globally, most prescribers receive most of their prescribing information from the pharmaceutical industry and in many countries this is the only information they receive.’ As for patients, we know that they are often given no information at all, or the information is in a language they do not understand.

The HIFA Project on Access to Information for Prescribers and Users of Medicines is currently exploring these issues, including a global literature review on the information needs of prescribers in LMICs. http://www.hifa.org/projects/prescribers-and-users-medicines  We invite you to contribute.

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa.org  

This week’s print issue of The Lancet (28 January 2017) carries an important article by Richard Horton, Editor-in-Chief. He has just returned from Berlin where he attended the Academic Publishing in Europe conference.

He writes: ‘We talked about important issues, to be sure: our collectively poor reputation, improving peer review, gender discrimination. But we didn’t talk about how we might address emerging epidemics, climate change, or conflict and war. Academic publishing has lost touch with the concerns of the very society it is supposed to serve. It has become so wrapped up in its own technical preoccupations and internecine struggles that the global predicaments that publishers should be addressing have been forgotten or ignored…’

‘In 2003, the Berlin Declaration on Open Access to Knowledge in the Sciences and Humanities was published. It was a self-declared milestone in the open access movement. 2017 demands another Berlin Declaration, one directed to the crises we face today. The Declaration I offer is a proposal only, but I hope you might consider signing up to it. It says, for example: “We, the undersigned, are concerned that the potential contributions made by academic publishing to human prosperity and advance, as well as to the protection of our planet’s rich but vulnerable ecological and cultural resources, have not been fully realised. In accordance with the spirit of the Sustainable Development Goals, launched on January 1, 2016, and with a target date for completion of December 31, 2030, we wish to commit ourselves to using the publishing resources at our disposal to accelerate progress towards the fulfilment of these internationally agreed goals.” Academic publishers: let’s do something important. Together.’

The full text of Richard’s article is freely available here: http://thelancet.com/journals/lancet/article/PIIS0140-6736(17)30183-6/fulltext

And the Declaration is here: http://www.thelancet.com/BerlinDeclaration2017

I have read and signed it and invite you to do so also. The text includes the words ‘We, scholarly publishers in and across Europe…’ because this reflects the first signatories at the Berlin meeting. However, the Declaration can I think be signed by anyone who agrees with it, whether you describe yourself as an academic publisher or not, and wherever you happen to be based.

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa.org  

Below are extracts from a new item on the AllAfrica website (with thanks to Tropical Health Update). You can read the full article here:

http://allafrica.com/stories/201701270636.html?aa_source=nwsltr-ebola-en

London — Three years on from the start of the West African Ebola epidemic, lessons are still being learned. And the most surprising are not coming from the scientists, but from the affected communities themselves; about how, with hardly any help, they tackled the virus and won.

One of the curious aspects of the epidemic, which shook Guinea, Liberia, and Sierra Leone, was the way in which the number of cases started dropping before the main international response was in place. In one area after another, the infection arrived, spread rapidly, and then – apparently spontaneously – began to decline.

Ebola first crossed over from Guinea into Liberia’s Lofa County in March 2014. A rapidly erected treatment centre at Foya, on the border, was soon full to overflowing. In September, it was treating more than 70 patients at a time. But by late October, the centre was empty.

Paul Richards, a veteran British anthropologist, now teaching at Njala University in Sierra Leone, has been worrying away at this phenomenon. He is convinced the main driver of the reduction was what he calls “People’s Science”; the fact that people in the affected areas used their experience and common sense to figure out what was happening, and began to change their behaviour accordingly.

He told a recent meeting at London’s Chatham House: “One of the pieces of evidence which makes me think that local response was significant is that the decline first occurred where the epidemic began, so that the longer the experience you had of the disease, the more likely you are to see tumbling numbers. So, someone was learning… People ask me, ‘How long does it take to learn?’ And we don’t know, but on the basis of this case study, it’s about six weeks.”

A lot of national and international effort was put into public health education, and the messages broadcast on radio were very widely heard. But initially they were not very helpful, with a lot of emphasis on the origin of the disease, and warnings not to handle dead animals or eat bushmeat…

American anthropologists, who interviewed people in urban areas of Liberia during the outbreak, found a sense of frustration that the information campaigns told them about the origin of Ebola, how it was spread, but didn’t give them practical advice on how to care for sick relatives, how to transport them safely to hospital, and what to do with corpses when the burial teams didn’t arrive…

—

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa.org  

The Trump administration is preparing executive orders that would clear the way to drastically reduce the United States’ role in the United Nations and other international organizations, as well as begin a process to review and potentially abrogate certain forms of multilateral treaties. The first of the two draft orders, titled “Auditing and Reducing U.S. Funding of International Organizations” and obtained by The New York Times, calls for terminating funding for any United Nations agency or other international body that meets any one of several criteria.

Those criteria include organizations that give full membership to the Palestinian Authority or Palestine Liberation Organization, or support programs that fund abortion or any activity that circumvents sanctions against Iran or North Korea. The draft order also calls for terminating funding for any organization that “is controlled or substantially influenced by any state that sponsors terrorism” or is blamed for the persecution of marginalized groups or any other systematic violation of human rights.

The order calls for then enacting “at least a 40 percent overall decrease” in remaining United States funding toward international organizations. The order establishes a committee to recommend where those funding cuts should be made. It asks the committee to look specifically at United States funding for peacekeeping operations; the International Criminal Court; development aid to countries that “oppose important United States policies”; and the United Nations Population Fund, which oversees maternal and reproductive health programs.

If President Trump signs the order and its provisions are carried out, the cuts could severely curtail the work of United Nations agencies, which rely on billions of dollars in annual United States contributions for missions that include caring for refugees.

As a general observation in considering this issue, it is worth remembering what proportion of the WHO budget comes from the USA.

WHO’s total approved budget for 2016-2017 was $4,385 million. This comes from two sources: 1) assessed contributions from the member countries (including the USA), which totalled $929 million (or 21.2% of the total) and voluntary contributions from a wide variety of donors, which amounted to $3456 million (or 78.8% of the total). So the overwhelming majority of WHO’s funding comes from voluntary, not government, sources.

The bills before Congress and other US executive decisions can only affect the assessed contributions – the government contribution. In 2016/17, the US is due to provide 21.18% ($227 million) of WHO’s assessed contributions. This is only about 5.2% of WHO’s overall budget.

A President can stop the flow of US government money to the UN system, but probably not – at least not without extreme measures –  other US money. To take the largest example, in 2015 the US-based Gates Foundation contributed more to the WHO budget than the entire US government.

I should stress that this is purely a financial argument. The loss of US government support to WHO (and the rest of the UN system) would be devastating politically and technically. Many government institutions – such as the National Library of Medicine (NLM) and the Centers for Disease Control and Prevention (CDC) – provide crucial technical support to many of WHO’s programmes.Presumably these institutions could be compelled to withdraw their technical support.

So cutting US government contributions to WHO would not be a financial killer. But if the US were to pull out completely, it would still be a disaster for global health.

To get an impression of what Trump can do to national agencies he doesn’t like take a look at https://www.nytimes.com/2017/01/25/us/politics/some-agencies-told-to-halt-communications-as-trump-administration-moves-in.html?emc=edit_th_20170126&nl=todaysheadlines&nlid=64410890&referer=&_r=0

If he applies such strictures to US government organizations like the NLM or CDC, it would seriously impact global health. If he reins in USAID, PEPFAR, and the like, African health would be set back decades…

Cheers, Chris Zielinski

chris@chriszielinski.com

Blogs: http://ziggytheblue.wordpress.com and http://ziggytheblue.tumblr.com

Research publications: http://www.researchgate.net

‘Due to ongoing health information deficiencies, resulting in fear and frustration, social media was at times an impediment and not a vehicle to support health information needs.’ This is the conclusion of a new paper in BioRxiv (an open access biology journal).

CITATION: Health Information Needs and Health Seeking Behavior during the 2014-2016 Ebola Outbreak: A Twitter Content Analysis

Michelle Odlum, Sunmoo Yoon

doi: https://doi.org/10.1101/103515

ABSTRACT

Introduction. For effective public communication during major disease outbreaks like the 2014-2016 Ebola epidemic, health information needs of the population must be adequately assessed. Through content analysis of social media data, like tweets, public health information needs can be effectively assessed and in turn provide appropriate health information to effectively address such needs. The aim of the current study was to assess health information needs about Ebola, at distinct epidemic time points, through longitudinal tracking.

Methods. Natural language processing was applied to explore public response to Ebola over time from the beginning of the outbreak (July 2014) to six month post outbreak (March 2015). A total 155,647 tweets (unique 68,736, retweet 86,911) mentioning Ebola were analyzed and visualized with infographics.

Results. Public fear, frustration, and health information seeking regarding Ebola-related global priorities were observed across time. Our longitudinal content analysis revealed that due to ongoing health information deficiencies, resulting in fear and frustration, social media was at times an impediment and not a vehicle to support health information needs.

Discussion. Content analysis of tweets effectively assessed Ebola information needs. Our study also demonstrates the use of Twitter as a method for capturing real-time data to assess ongoing information needs, fear, and frustration over time.

—

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa.org  

CITATION: Establishing the Africa Centres for Disease Control and Prevention: responding to Africa’s health threats

John N Nkengasong, Olawale Maiyegun, Matshidiso Moeti

Lancet Global Health, Published: 17 January 2017

DOI: http://dx.doi.org/10.1016/S2214-109X(17)30025-6

‘On Jan 31, 2017, heads of states and governments of the African Union and the leadership of the African Union Commission will officially launch the Africa Centres for Disease Control and Prevention (Africa CDC) in Addis Ababa, Ethiopia…’

The new website is available here: https://www.au.int/en/africacdc

Comment (Neil PW): I am still not clear about the logic of creating a second regional body ‘safeguarding Africa’s health’ as compared with strengthening what is universally recognised as an underfunded WHO Regional Office for Africa. It’s also not clear how the Africa CDC will be financially supported, in the short and long term, especially with the new Trump Administration in the US. Can anyone advise?

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa.org  

Just to bring everyone up to date on the WHO DG selection process, today (24 January), the WHO Executive Board will select five of the six candidates for interviews on Wednesday, 25 January. The three candidates that will stand in the May election will then be announced on Wednesday evening. The decision will be made by WHO’s Executive Board, made up of representatives of 34 member states, and will be followed in May by a final vote by WHO’s 194 member states.

According to Science Magazine (http://www.sciencemag.org/news/2017/01/wanted-leader-toughest-job-global-health) “Six countries have fielded candidates to succeed Margaret Chan, the former Hong Kong, China, health official who is stepping down after 10 years at the helm. Among the top contenders, many say, is former Ethiopian Health Minister Tedros Adhanom Ghebreyesus. The African Union has declared its support for him and some observers have suggested it’s time for WHO’s first director-general from the African continent. Another candidate widely seen as having good chances is David Nabarro, a physician nominated by the United Kingdom who has worked at WHO in various positions and was appointed the United Nations’ senior coordinator on Ebola in 2014. The other candidates are Pakistani cardiologist Sania Nishtar; former French Health Minister Philippe Douste-Blazy; Hungary’s former minister of health, Miklós Szócska; and WHO’s assistant director-general for family, women’s and children’s health, Flavia Bustreo from Italy.

…………

The WHO Executive Board selected by vote the following 3 candidates to be presented to World Health Assembly as nominees for the post of Director-General of WHO.

Five candidates were interviewed by Member States today prior to the vote. The names of the 3 nominees were announced at a public meeting on Wednesday evening, 25 January 2017.

Dr Tedros Adhanom Ghebreyesus

Dr David Nabarro

Dr Sania Nishtar

Further details of the selection process and result and biographies of the candidates are available on the WHO website at http://who.int/mediacentre/news/notes/2017/director-general-nominees/en/

Chris

Chris Zielinski

chris@chriszielinski.com

Blogs: http://ziggytheblue.wordpress.com and http://ziggytheblue.tumblr.com

Research publications: http://www.researchgate.net

The WHO Watch Team is watching the 140th Executive Board Meeting of the World Health Organisation.

Follow the link below to get updated with the statements and daily briefs of the sessions.

http://www.ghwatch.org/node/45513

—

With regards,

Tara Ballav Adhikari

Global Country Representative Coordinator at Healthcare Information For All

Charles A Uzondu, Henry V Doctor, Sally E Findley, Godwin Y Afenyadu, and Alastair Ager.

Glob Health Sci Pract. 2015 Mar; 3(1): 97–108.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356278/

ABSTRACT

Introduction: Nigeria has one of the highest maternal mortality ratios in the world. Poor health outcomes are linked to weak health infrastructure, barriers to service access, and consequent low rates of service utilization. In the northern state of Jigawa, a pilot study was conducted to explore the feasibility of deploying resident female Community Health Extension Workers (CHEWs) to rural areas to provide essential maternal, newborn, and child health services.

Methods: Between February and August 2011, a quasi-experimental design compared service utilization in the pilot community of Kadawawa, which deployed female resident CHEWs to provide health post services, 24/7 emergency access, and home visits, with the control community of Kafin Baka. In addition, we analyzed data from the preceding year in Kadawawa, and also compared service utilization data in Kadawawa from 2008–2010 (before introduction of the pilot) with data from 2011–2013 (during and after the pilot) to gauge sustainability of the model.

Results: Following deployment of female CHEWs to Kadawawa in 2011, there was more than a 500% increase in rates of health post visits compared with 2010, from about 1.5 monthly visits per 100 population to about 8 monthly visits per 100. Health post visit rates were between 1.4 and 5.5 times higher in the intervention community than in the control community. Monthly antenatal care coverage in Kadawawa during the pilot period ranged from 11.9% to 21.3%, up from 0.9% to 5.8% in the preceding year. Coverage in Kafin Baka ranged from 0% to 3%. Facility-based deliveries by a skilled birth attendant more than doubled in Kadawawa compared with the preceding year (105 vs. 43 deliveries total, respectively). There was evidence of sustainability of these changes over the 2 subsequent years.

Conclusion: Community-based service delivery through a resident female community health worker can increase health service utilization in rural, hard-to-reach areas.

Those who care about the future of the UN and its specialized agencies (including WHO) should be concerned about a bill introduced quietly to the US Congress in early January that calls for the United States to pull out of the United Nations and WHO.

The bill, H.R. 193 — known as the American Sovereignty Restoration Act — is on the US Congress website (https://www.congress.gov/bill/115th-congress/house-bill/193).

It was introduced to the House on January 3 and referred to the Committee on Foreign Affairs. The official summary of the bill is as follows:

“This bill repeals the United Nations Participation Act of 1945 and other specified related laws. The bill requires: (1) the President to terminate U.S. membership in the United Nations (U.N.), including any organ, specialized agency, commission, or other formally affiliated body; and (2) closure of the U.S. Mission to the United Nations. The bill

prohibits: (1) the authorization of funds for the U.S. assessed or voluntary contribution to the U.N., (2) the authorization of funds for any U.S. contribution to any U.N. military or peacekeeping operation, (3) the expenditure of funds to support the participation of U.S. Armed Forces as part of any U.N. military or peacekeeping operation, (4) U.S.

Armed Forces from serving under U.N. command, and (5) diplomatic immunity for U.N. officers or employees.”

According an Inter-Press Service News Agency article by Baher Kamal entitled “Trump to Pull Out of the UN, Expel It from the US?” (http://www.ipsnews.net/2017/01/trump-to-pull-out-of-the-un-expel-it-from-the-us/), “While its official title says it seeks to end membership in the U.N., there are several other key components of the bill which include: ending the 1947 agreement that the U.N. headquarters will be housed in the U.S., ending peacekeeping operations, removing diplomatic immunity, and ending participation in the World Health Organization. Should the bill pass, the Act and its amendments will go into effect two years after it has been signed.”

Chris Zielinski

chris@chriszielinski.com

Blogs: http://ziggytheblue.wordpress.com and

http://ziggytheblue.tumblr.com

Research publications: http://www.researchgate.net

HIFA profile: Chris Zielinski: As a Visiting Fellow in the Centre for Global Health, Chris leads the Partnerships in Health Information (Phi) programme at the University of Winchester.

When it comes to dietary sodium, less is certainly best, yet Americans today consume 50% more than the recommended daily quantities of sodium. Diets high in sodium increase blood pressure levels. High blood pressure damages the kidneys over time, and is a leading cause of kidney failure. To help Americans reduce salt intake to the ideal one teaspoon per day, the National Kidney Foundation offers 10 tips to reduce sodium in your diet. To help Americans reduce salt intake to the ideal one teaspoon per day, the National Kidney Foundation and Council of Renal Nutrition member Linda Ulrich offer 10 tips to reduce sodium in your diet….more

Does your infant have a regular fussy period each day when it seems you can do nothing to comfort her? This is quite common, particularly between 6:00 p.m. and midnight—just when you, too, are feeling tired from the day’s trials and tribulations. These periods of crankiness may feel like torture, especially if you have other demanding children or work to do, but fortunately they don’t last long. The length of this fussing usually peaks at about three hours a day by six weeks and then declines to one or two hours a day by three to four months. As long as the baby calms within a few hours and is relatively peaceful the rest of the day, there’s no reason for alarm….more

Barack H. Obama, J.D.

N Engl J Med 2017; 376:297-299January 26, 2017DOI: 10.1056/NEJMp1616577

Health care policy often shifts when the country’s leadership changes. That was true when I took office, and it will likely be true with President-elect Donald Trump. I am proud that my administration’s work, through the Affordable Care Act (ACA) and other policies, helped millions more Americans know the security of health care in a system that is more effective and efficient. At the same time, there is more work to do to ensure that all Americans have access to high-quality, affordable health care. What the past 8 years have taught us is that health care reform requires an evidence-based, careful approach, driven by what is best for the American people. That is why Republicans’ plan to repeal the ACA with no plan to replace and improve it is so reckless. Rather than jeopardize financial security and access to care for tens of millions of Americans, policymakers should develop a plan to build on what works before they unravel what is in place.

Thanks to the ACA, a larger share of Americans have health insurance than ever before.1 Increased coverage is translating into improved access to medical care — as well as greater financial security and better health. Meanwhile, the vast majority of Americans still get their health care through sources that predate the law, such as a job or Medicare, and are benefiting from improved consumer protections, such as free preventive services…..more

Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high. Blood glucose is your main source of energy and comes from the food you eat. Insulin, a hormone made by the pancreas, helps glucose from food get into your cells to be used for energy. Sometimes your body doesn’t make enough—or any—insulin or doesn’t use insulin well. Glucose then stays in your blood and doesn’t reach your cells.

Abstract

Background: Primary health care (PHC) outreach teams are part of a policy of PHC re-engineering in South Africa. It attempts to move the deployment of community health workers (CHWs) from vertical programmes into an integrated generalised team-based approach to care for defined populations in municipal wards. There has little evaluation of PHC outreach teams. Managers’ insights are anecdotal.

Methods: This is descriptive qualitative study with focus group discussions with health district managers of Johannesburg, the largest city in South Africa. This was conducted in a sequence of three meetings with questions around implementation, human resources, and integrated PHC teamwork. There was a thematic content analysis of validated transcripts using the framework method.

Results: There were two major themes: leadership-management challenges and human resource challenges. Whilst there was some positive sentiment, leadership-management challenges loomed large: poor leadership and planning with an under-resourced centralised approach, poor communications both within the service and with community, concerns with its impact on current services and resistance to change, and poor integration, both with other streams of PHC re-engineering and current district programmes. Discussion by managers on human resources was mostly on the plight of CHWs and calls for formalisation of CHWs functioning and training and nurse challenges with inappropriate planning and deployment of the team structure, with brief mention of the extended team.

Conclusions: Whilst there is positive sentiment towards intent of the PHC outreach team, programme managers in Johannesburg were critical of management of the programme in their health district. Whilst the objective of PHC reform is people-centred health care, its implementation struggles with a centralising tendency amongst managers in the health service in South Africa. Managers in Johannesburg advocated for decentralisation. The implementation of PHC outreach teams is also limited by difficulties with formalisation and training of CHWs and appropriate task shifting to nurses. Change management is required to create true integrate PHC teamwork. Policy review requires addressing these issues.

Keywords: Primary health care, Community healthcare workers, Outreach teams, Africa, Human resources, Policy

Insights of health district managers on the implementation of primary health care outreach teams in Johannesburg, South Africa: a descriptive study with focus group …

S Moosa, A Derese, W Peersman – Human Resources for Health, 2017

Executive summary

Information and communication technologies (ICTs) have great potential to improve health in both developed and developing countries by enhancing access to health information and making health services more efficient; they can also contribute to improving the quality of services and reducing their cost. Patient information systems, for example, have the ability to track individual health problems and treatment over time, giving insight into optimal diagnosis and treatment of the individual as well as improving the delivery of services. This is particularly useful for chronic diseases, such as diabetes and cardiovascular diseases, and for maternal and child health services where a record of health and treatment over a period of time is required. Analysis of data in patient information systems can lead to new insight and understanding of health and disease, both chronic and acute.

Over the past decades, there have been great advances in ICTs for health, and the World Health Organization (WHO) has responded by establishing the Global Observatory for eHealth (GOe) to assess the adoption of eHealth in Member States as well as the benefits that ICTs can bring to health care and patients’ well-being. To that end, the second global survey on eHealth was launched in late 2009, designed to explore eight eHealth areas in detail.

This, the final report in the Global Observatory for eHealth Series, assesses the results of the survey module that dealt with the patient information. It examines the adoption and use of patient information systems in Member States and reviews data standards and legal protection for patient data. The survey results – provided by WHO region, World Bank income group, and globally – showed that electronic information systems are being increasingly adopted within health settings; while this is seen primarily in higher-income countries, emerging economies such as Brazil, China and India, for instance, are also beginning to introduce electronic medical records (EMRs) into their health systems.

Low-income countries, however, have struggled to initiate large-scale electronic medical record systems. While some low-income countries have been able to attract technical and financial resources to install patient information systems at some sites, these require significant investments for their successful implementation. In fact, these systems require abundant resources including skilled labour, technological, and financial means, all of which can be difficult to procure in low-income settings. Further, patient information systems designed for high-income country health systems may not be appropriate in low-income countries In particular, internationally-harmonized clinical models and concepts are needed for data interoperability and standardized international case-reporting, which could mitigate discrepancies between systems. The International Organization for Standardization’s Technical Committee on health informatics ISO TC 215, or example, has developed an eHealth architecture that incorporates levels of maturity into the components of a health system to address these differences in requirements and capacity.

Of course, these issues are only relevant to electronic patient information systems. While use of such systems is increasing, many Member States still rely on paper-based systems for health data collection. The survey data analysed by WHO region showed that all regions have a high use of paper-based systems, particularly the African Region and South-East Asia Region. Countries within the Regions of the Americas, Eastern Mediterranean, and the Western Pacific reported a higher use of electronic transmission of health records than computer use to collect health data. This may be due to the use of fax or scanned image technology where the communication is electronic but the origin and destination are paper.

The use of electronic systems is higher for aggregated (summary) data than individual patient data. This could be because there is an institutional need for the aggregate data at management levels which in turn stimulates the creation of an electronic system. There may be a perception that individual patient data in electronic format may not be of as much value for administration, particularly given the difficulty of implementing patient information systems in general. However, the value of individual patient data for improved patient care is very much a case of ‘connect the dots’: given that many patients receive services from separate facilities and care providers, some form of electronic record system could compile these data and make them accessible to other health care professionals, leading, for example, to early detection of an influenza outbreak.

Electronic health systems must be built in a way to facilitate the exchange of data; disparate systems using separate disease definitions, for example, are of little value. Standards must be applied to the data and the systems themselves to allow for and facilitate the exchange of data between various sources. The adoption of standards is progressing well across most Member States including standards for eHealth architecture, data, interoperability, vocabulary, and messaging. These are important foundation blocks for the implementation of patient information systems because they facilitate clear communication. In addition, most countries have taken steps to establish legal frameworks for the protection of patient data.

The report concludes with an overview of steps Member States can take to facilitate the implementation of patient information systems. These include adoption of open source, standards-based software platforms and data exchange standards to make efficient use of existing resources. In addition, there needs to be clear legislation governing patient privacy and protecting the security of health information for records in electronic format. Finally, the development of well-trained health informatics professionals should be a priority.

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