Developing HIS on the Silk Road Lessons learned from Armenia, Azerbaijan, Georgia

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Developing HIS on the Silk RoadLessons learned
from Armenia, Azerbaijan, Georgia
Eva Slawecki, Project Manager Canadian Society
for International Health
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(No Transcript)
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South Caucasus
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Health systems in transition

• Deteriorating health infrastructure
• Low salaries for health personnel
• Out-of pocket payments for services
• Decreased access and use of health services
• Poor distribution of health human resources and
  concerns re quality of care
• No management culture
• Corruption

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Health Information Issues

• Unreliable official statistics
• Gaps and under-reporting
• Over-reporting for financial gain
• Misrepresentation for political/cultural reasons
• Excessive data collection with little value
• No feedback to points-of-care and providers
• Poor quality data no standards
• Too many forms to fill out
• No incentives for HIS development and
  implementation
• No perceived need for information
• No trust in health information
• Lack of willingness vs. lack of capacity

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South Caucasus Health Information ProjectPhase 2
(September 2001 2005)

• Goal To strengthen health reform in the South
  Caucasus countries, through the appropriate
  application of health information technology and
  information management strategies.

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Project partners
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Resources

• CIDA contribution 3.4 m (79)
• In-kind contribution 888,500 (21)

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Approach to capacity-building for HIS to support
health reform

• Training and Education
• short long-term focus
• Decentralization of capacity
• Data processing and communications infrastructure
  based on appropriate technology
• Relevance to National and International
  priorities and agendas

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Global Context

• Millennium Development Goals
• Poverty Reduction Strategies
• Poverty Health
• CIS-7 Initiative
• Good governance
• Donor harmonization

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1. HIS Policy-related activities

• To address overarching priorities and agendas
• Regional conferences to address common issues
• Linkages between HIS and PRSPs, MDGs, good
  governance, etc.
• Coordination with other donors stakeholders
  (WHO, WB, DFID, USAID, UNFPA)

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2. HI and Medical Education

• Developed Health Informatics curriculum
• computer basics
• EBM ( biostatistics, literature searching,
  critical appraisal),
• Application of HIS (hospital-based systems,
  databases, information management)

• Set-up of computer labs
• New resources (e.g., HINARI, textbooks)
• Training of instructors

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3. HIS Certificate Course

• 150 hrs instruction train-the-trainer study
  tours
• Participants from MOH, districts, academic
  institutions, other programs
• 60 people trained to develop, maintain, use
  health information systems

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4. HIS Demonstration Project

• Technology to be used for health data collection
  and analysis.
• By example, the information could be used to
  choose meaningful indicators.
• Instructional development path (methods and
  lessons learned).
• Case study for HIS Certificate Course.

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4. HIS Demonstration Projects

• Replicable HIS models operational in central
  district level sites (Artashat, Ganja, Gori)
• Based on electronic health record (EHR)
• Modern information concepts and technology
  replacing manual methods
• Multi-server, multi-facility database
• Local language interface
• Supports multiple data sets

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Total number of trainees
Indirect beneficiaries of HI Curriculum
training 1245
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Capacity-Building Results

• Individual
• HIS specialists, users, and health professionals
  (current and future) have increased capacity for
  understanding and using data
• Study tours to Canada have broadened the
  stakeholders vision of HIS potential and
  contributed to behaviour change
• Organizational
• Demonstration projects in each country
  contributed to improving the quality of data
  processes and tools
• Educational institutions have increased capacity
  in HIS
• Systemic (enabling environments)
• Coordination with other donors, policy advice,
  activities addressed at managers and
  decision-makers

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Challenges Met

• Geopolitical
• Regional cooperation
• Country-specific health reform issues
• Society, culture, language
• Partnerships
• Coordination with other (larger) donors
• Understanding local needs
• Relationship between executing agency and funder
• Project Management
• Administrative structure
• Project implementation timelines
• Appropriate technical assistance

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Lessons Learned Project Context

• Must learn as much as possible about political
  environment ASAP
• Recognize that decisions by partners may be based
  on donors expectations
• Cannot pre-empt a countrys own policy
  development initiatives
• Decision-making officials will change posts
• be prepared to establish new relationships and
  rebuild understanding of the project

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Lessons Learned Partners Expectations

• Executing agency must be seen as an equal partner
  not as a project consultant to CIDA, carrying out
  tasks on demand.
• The agreed upon goals must always remain the
  focus as the project is implemented
• Partners may find use of management language
  confusing and unnecessary
• this may lead to incorrect assumptions re
  agreement on principles

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Lessons Learned Project Implementation

• Selected participants may not necessarily be the
  most appropriate to achieve project objectives
• Must assess benefits and constraints of using
  local language
• Project planning must consider domestic
  professional responsibilities of participants
• Gender issues - questioning differences in data
  could lead to investigation and action in a
  manner that is culturally relevant

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Lessons Learned Project Implementation

• Study tours prove Seeing is Believing
• Doing is understanding role of demonstration
  project and train-the-trainer
• The achievement of visible results inspires
  confidence, motivation and cooperation
• Planning for sustainability is crucial this may
  influence choice of personnel, training,
  software, hardware, etc.

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Sustainability factors

• Competent informed human resources
• educated current and future users and
  decision-makers
• Infrastructure and financial resources
• Optimize use of existing resources
• Ability to leverage
• Political will
• Local champions

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Conclusions

• Built capacity (individual institutional) in
  each country
• Introduced new resources technology
• Supported HIS and health reform agendas
• Lessons learned contribute to knowledge bank of
  CSIH other stakeholders
• Still need for 'culture of information'
• Successful project solid foundation to build on