1.0 Tell us the core business for Baobab Health?
Baobab Health Trust is a Malawian NGO that uses information technological innovation to improve health crises in Malawi and other developing countries.- started small and has achieved a lot- now in almost 123 health facilities managing OPD and ART data
2.0 What is the motivation behind your work? in other ways what problem are you trying to solve?
Improvement of the quality of patient care through provision of data for decision making by program managers and health service providers working in real time.
3.0 Key Projects
National ART system in 121 facilities
Birth registration system in 31 facilities and District Councils
Electronic Village register in 83 villages
Laboratory information system – 6 facilities
Chronic care system under deployment – 4 facilities
4.0 We understand you do or you have just mentioned of electronic birth
registration and electronic death registration how are you able to do this?
We work closely with NRB and Ministry of health to understand theier
birth and death registration business process and use them to develop the birth and death
registration systems which are fully automated and have improved the turnaround time in terms of data flow and printing of certificate The systems capture same information as is done on paper. The capturing workstations are placed at the hospitals and DCs office and processing is done at DCs and NRB Headquarters
5. Relationship with NRB and MoH
They are our key partners and at the same time our customers. BHT only develop systems that will fill a gap that is identified by them within their information systems. This is very much in line with the government policies
The Government of Malawi has a 2013 ICT policy which clearly states that the government shall work with various stakeholders to increase the use of ICTs in service delivery and the health sector is one of them. We are developing systems which are helping the government of Malawi generate data which informs policy direction.
In the case of NRB we have developed the electronic birth and death registration systems being used to capture births and deaths at district hospitals and councils.
We are also piloting electronic village registers in 83 villages under Traditional Authority Mtema where village headmen and their clerks are using touchscreen computers to register new births electronically. So be it at the hospital or the village all the data is pushed to the DC for that particular district for vetting before it is pushed to NRB HQ for approvals so as to have the birth certificate printed. However let me state that the electronic death registration is on trial phase and the outcome with determine whether it can scale or not
6.0 Who develops these systems because others say it is local staff while others think you hire people from elsewhere to do the job for you ?
BHT Always Builds Local Capacity: Expatriates are expensive, often temperamental, and almost always temporary. So for any project to have real staying power, it needs to be designed for handover to local staff from the beginning. We value local talent we will always stand by that because that’s not sustainable. If we identify a technical gap we reach out to our technical partners notably University of Pittsburgh who are specialists in Medical/Health informatics
7.0 Have you started implementing your systems outside Malawi?
Not yet, but we getting a lot of international inquiries from African countries and beyond which is good as best practices are being exported to other nations. We are ciurrentky developing a concept note on how best to export our services to other nations without compromising or services back home.
8.0 In some cases people complain of downtown of your systems, how are you addressing this issue ?
I am glad you raised this issue.
Even in Lilongwe, the capital city, electrical power is intermittent. Yet, if you are using an electronic patient records system, you have to commit to 100% uptime during clinic hours. Technology solution needs to be very energy-efficient so it can be run off backup power as needed. Baobab has introduced a 48VDC approach taken from the telecommunications industry to provide multi-day power backup using locally available solar batteries. The The computer literacy levels in Malawi are also not that high compared to other countries in the region and in the west so that does create challenges due to techno phobia.
Mostly downtime issues come in due to prolonged power outages as you know that’s one of the challenges we are yet to fully address as a country. In some cases we have issues of capacity of the ground staff at the facility level or simply lack of urgency to report when system is down. At times it has been due to delays in deploying support staff but we
have improved generally. Connectivity is also linked to the power issues but the growth of our systems has also led to delays as they are being loaded with data everyday. This is being resolved by adopting an enterprise approach where we are procuring industry equipment which will support present capacity and maybe for the next decade or so. We have customised power backup systems which can run up to 72 hours in times of blackouts , in some facilities we have solar and we continue to find other innovative ways of improving what we already have.
So one may ask what happens to the data collected when the system is down? First, we encourage facility staff to do back data entry which is transferring the paper based data recorded when the system is down into the system when its up again.
9.0 We have also established that some health workers shun the system and
prefer to use manual operations are you aware of this? if so what have you
done about it?
This is normal with adoption of any technology. It is a mixed bag although most health facilities have embraced the use of EMRs and we commend them for that.
For non use of the EMRs, we are in constant touch with the MoH through the DHOs mindful of the fact some of the challenges are beyond BHT like shortage of staff and the implications such challenges have on data quality. I appeal to the users and DHOs to always make sure staff are using the systems. It’s an open secret that most facilities have issues to do with human resource challenges. The recent circular on austerity measures has made mention of recruitment freeze and that too does have an impact on health service delivery. BHT believes that with proper planning, the situation can be easily managed without creating gaps. After all the systems has so many benefits to the patients especially on continuity of care. For the health care service providers, they are now able at a click of a button to view different reports which is incredible, a situation that was very tedious before.
10. Now to what extent are your systems integrated or talk to each other……say if i register at Queens and i am given what you call a patient ID, can i use the same ID to be identified at another health facility elsewhere or is that your ultimate goal?
Exactly, that’s our ultimate goal and we have been working on the Demographic Data Exchange DDE software which is currently being tested and when that is finalised and passes the quality test we will take a phased approach to implement it . Knowing a patient’s past medical history is critical to continuity of care, particularly for patients with chronic illness and that is what DDE aims to achieve.
11. What are the challenges you are facing?
Power as already highlighted, most of the hardware is imported and it expensive and times it takes time to clear and tendency by some facility staff not to use the system . Technophobia is also a challenge but our capacity building team are specialists in this area and are doing a good Job.
12.How are your efforts contributing the country’s HSSP?
We are contributing to objective number 6 objective number 6 which talks
about establishing a strong base of high quality, routinely available data for use in decision
making by technicians and policy makers in the health sector. It also talks about empowering the Central Monitoring and Evaluation Department (CMED) which manages all health information systems. So as BHT we are already working with CMED, we have set up infrastructure and the
Ministry is using the systems to generate data, currently over 60% of patients receiving life
prolonging drugs are registered in our system and it has been easy to manage them, make follow
ups and improve on care. The information is out there you are at liberty to talk to the users and people to see how much we have done. So already we are doing our part but we can do more and do it better with enhanced coordination and sound partnerships.
13. How big is your coverage
Well as for the ART and OPD systems we are in over 121 health facilities including referral and district hospitals while for the birth registration system we are in all the 3 central hospitals , 28 districts hospitals and District Councils including Likoma. Different modules have been deployed in different facilities as highlighted earlier on.
14. How sustainable are the initiatives you are doing?
Sustainability is a common denominator is all our processes starting from project initiation
discussions, design stage to implementation. We have developed solutions that should are not parallel with the MOH processes, the system use cheap hardware but very durable as far as our environment is concerned and we continuously engage policy makers at district and national level to support the adoption of technology in our health system. It also important to highlight that sustainability requires commitment of decision makers and right now the indicators are
We remain thankful to the US Government through the Centers for Diseases Control and
Prevention CDC , the Bill and Melinda Gates, WDF and other partners. We are also happy that CDC is supporting the scale up of the systems to 150 more health facilities just in 12 months. This is progress for the country and we are happy to be part of this transformative journey