Technology

INTERVIEW: A Health Management Information System is the Ultimate Solution for Uganda’s Poorly Managed Public Hospitals – Dr. Kiyimba

Through their research conducted between 2010 and 2012, the Integrate Intelligent Computer System (IICS) found out that the government was losing a lot of funds in managing health facilities.

From procuring drugs and distributing them, accompanied by poor management of health facilities, the IICS suggested that building a Health Management Information System (HMIS) was the only solution for most of the problems that were being faced by the government in the health sector.

Being an initiative of the government which had been sanctioned to work under the Uganda National Council of Science and Technology (UNCST), the government adopted IICS’s recommendations and funded the project, which facilitated the engineering of HMIS.

Today, the HMIS is installed in seven hospitals across the country and these include Naguru Hospital in Kampala, Entebbe Hospital, Masaka Regional Referral Hospital, Mbarara Regional Referral Hospital, Gulu Regional Referral Hospital, Nebbi Regional Referral Hospital and Moroto Regional Referral Hospital.

ChimpReports’ Busein Samilu spoke to Dr. Silver Kiyimba, the Principal Investigator of the project about the progress of the system at IICS headquarters in Kampala and below are excerpts from his responses.

It is been ten years since you initiated the IICS project, started as a research project and later turned into a solution based initiative. Has the journey been worth it?

It’s true this project started as a research in 2010 funded by government under Uganda National Council of Science and Technology (UNCST). The reason why we started was to find solutions to deal with certain problems found in service delivery in the public sector.

Our major aim was to help government to find ways of how it could use computers to deal with certain problems especially in service delivery.

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We started with the health sector. We carried out a research in the health sector between 2010 and 2012, and we established some areas which would benefit from computer-based system and the major one was management of medical supplies in health facilities.

At the time, government was injecting in a lot of money to procure medicines and distribute them in health facilities. But patients were still complaining that there were no drugs in hospitals.

We concluded that a computer system could solve that problem. So, we engineered a computer system that manages the chain from the time of procurement to the time a patient takes the medicine.

We found out that this would help a number of issues like; poor accountability of medicines, it would help government to get reports of the actual usage and demand of the medicine in the health sector.

As you may be aware, a local television last year carried out an investigation and established that some health officials were stealing and selling government drugs. Did you include a feature that would tackle such an issue in this system?

See, we are not policemen. We went to find the problem and we did so with an open mind. When drugs get to facilities and patients don’t get them or they expire, there must be an underlying problem.

The major problem then, was mismanagement and that is why drugs were not well accounted for. There is something that had to be done differently concerning the acquisition of medicine if theft is to be ironed out.

Has this system been useful to the hospitals as per your goal and projection?

Absolutely! The system we engineered to manage medicine does a simple job; it helps the hospital to plan for the medicine they require, how?

Our system runs in patterns at hospital level. It will run from a disease burden of the hospital, the previous dispensing log, and it has the capacity of knowing how much medicine will be needed in the following year.

If you have that information, you are most likely to have accurate predictions of your needs in future. When you go to a hospital and find that they are running out of medicine, that means they asked for less medicine than they needed or it may be that the disease burden has gone up, but no body documents this so the system can help them in recording this statistics.

The systems user homepage

What happens to drugs that expire? Does the system reflect these numbers and a possible reason as to why?

There are reasons why drugs expire. One, it could be that these drugs were not needed by the hospital they over ordered this item.

Poor store management procedures where you may end up ordering for drugs forgetting that you already have it. The system will help in addressing that for example when you are ordering the drug which you already have, it will tell that you already have it.

The system knows all the disease burden and their treatment so when you diagnose a patient, it will look into records and tell you the number of that disease burden and its available medicine in store.

It will use this data over the year to evaluate the burden fluctuation. Therefore, the fluctuation on the disease burden affects the fluctuation of the medicine. That’s how it can be solution.

You spoke about the management of drugs but there is a problem of overdosing or under dosing. How does your system help with diagnosis and prescription of drugs by health workers?

The system manages the clinical/doctor’s room. When you go to see the doctor, currently, you need to have an exercise book where the doctor writes the diagnosis which you go with to the dispensing room where you receive the medicine.

When you lose that book and go back, you are most likely to get the same medicine.

Our system is designed in the way that instead of you going with an exercise book, the doctor will attend to you on his computer and the system will recommend which drug to give you and it will keep a copy of your medical history.

In that case, when you go to another hospital, l they just need your thumb and they will attend to you when they have your previous medical reports. Our system is patient centered.

Doctor, basing on what you said above, it appears as if the system makes health workers less important, especially when drug prescription is a click away.

There is nothing that can replace a human being.

A system is a system for example when you are a farmer and use a tractor, you remain a farmer, you are not going to tell the tractor to go and dig.

There is a problem with doctors when it comes to prescription of medicines for example if he gives you six different drugs, there is a problem with interaction of medicines. One drug can stop another from working or cause an effect on you so the system is helping them on that issue.

It will not allow him to prescribe two drugs that will affect the patient. So, for us we are giving tools to health workers to help them work smartly.

The government for years has faced a problem of absenteeism of health workers and doing shoddy work while treating patients. How does IICS address this?

Actually, it is one of the major issues that we found out during our research. Health workers come at any time they want, absent themselves and even work in more than one hospital. One week she works for a government hospital and another week in private sector.

The effect in that is that a health worker is earning money from a tax payer so he is your Boss and so, the other function of the system is to make sure that health workers are present in a health facility during hours that the hospital works.

The system is the one that allocates a patient a doctor whom he/she is supposed to see so it has knowledge on all doctors who are supposed to be on duty and whether they are all available.

The system takes the biometric details when they arrive and manages them like it makes sure that doctors see patients and also monitors the number of patients waiting against the available doctors the system is patient centered (the heart of our system is on patient).

It shows how many doctors were available, the number of patients attended to, types of examination, prescriptions so that when you visit another health facility, they are able to know where to start from.

Some of the IICS staff

According to the list of hospitals where the system is currently installed which include; it appears you are concentrating on Regional Referrals mainly, why is that?

Actually, in two months’ time we are planning to have it installed in all Regional Referral Hospitals. We chose to start with Regional Referrals because it’s the second last level of referral.

According to the design of Uganda’s health sector, at the village you have VHTs, at the Parish we have Health Center (II), at the Sub County we have (III), at the County we have Health Center at the County you have Health Centre (IV), at the District we have the Hospital and one Regional Hospital for the regional districts.

All referrals from Health Centre (III) and (IV) are referred to Regional Hospitals so they consume a lot of drugs and other resources. By the end of elections, we want to cover all Regional Referrals and by April next year, we want to start on district hospitals then turn to health centers and finally VHTs.

What are some of the challenges you face as innovators here?

The challenge we have as innovators, when you come up with something new, you may not please everyone for example what you are doing may be interrupting with someone’s interest or income.

If I used to work in six hospitals and there is this thing which makes me work in one place, will I like it? May be for some reasons I used to take medicine and sell it outside and now I no longer do that will I be happy with it?

And again, for example let’s say you do something which is antagonizing my daughter in Kiruhura and I am the Minister, will I support you?

Corruption and lack of good will has also affected our activities. We are not properly supported by those responsible. We would be very far by now, the entire Uganda would be covered and by now we would be able to know which accident happened where, its magnitude as I said we need patriotic people to achieve all this.

Before you go, Doctor, our audience would want to who Dr. Kiyemba is.

I am a computer scientist, the brain behind this innovation. Prior to this, I was working at the University of Sunderland in United Kingdom as a Computer Scientist. I came back in 2009 and initiated this project which later started in 2010.

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