Title: MEDICAL INFORMATICS IN GHANA
1MEDICAL INFORMATICSIN GHANA
Yaw Ofori-Adjei B.Sc.(Med Sci) University of
Ghana Medical School
28th February 2003
2Outline
- Introduction
- Health System
- ICT Landscape
- Medical Informatics
- Potential Gains
- Barriers
- Conclusion
3LAND MASS OF 238,537 Sq Km
4Political History
- Gained Independence in March of 1957
- Series of Coups after independence
- Last Coup was 1981 by Flt Lt J.J. Rawlings
- Military Rule for 11 years ( J.J. Rawlings)
- J.J. Rawlings elected president in 1992
- J.A. Kuffour, President 2000 - Date
5- Ten (10) Administrative Regions
- 110 Districts
- The district is the unit of planning and
political administration
The Capital City is Accra
6Economic
- Foreign exchange is from export of Timber,
Cocoa, Pineapple, Gold, DiamondsBauxite and
Tourism
- Domestic Economy revolves aroundagriculture
which contribute 36 of GDPand employs 60 of
work force
7World Bank Estimates 2001
Ghana opted for debt relief under the Heavily
Indebted Poor Countries Initiative (HIPC) in 2002
8People
- Total Population is 19.7 Million (2001)
- 36 of Population is Four Urban Areas of Accra,
Kumasi, Sekondi-Takoradi and Temale
- Small ethnic groups which Speak 50
differentlanguages and dialect
- English is the official language
- 60 of population are Christians 16 Islamand
rest, African Traditional Religion
9Trivia
10Outline
- Introduction
- Health System
- ICT Landscape
- Medical Informatics
- Potential Gains
- Barriers
- Conclusion
11Health Care System
- Before a health care system was established by
theBritish in 19th Century, African traditional
medicinewas practiced - Health services was then solely for Europeans
- Services was extended to Ghanaian peoplein the
late 19th Century - In 1923, the Korle-Bu Teaching Hospital
wasbuilt. It has remained the main referral
hospitaland a model for other hospitals in the
country
12Health Care System
Structure
- Current system is a three-tiered system
- National
- Regional
- District
- Focal point of the system is the district level
13National
- MOH Policy formulation, monitoring and
evaluationof progress in achieving targets - GHS Allocation of resources and creation of
partnership with private sector
Regional
- 10 Regional Health Administrations serve as link
betweenthe national and district levels and
allocate resource within theregion
District
- DHMT Concerned with operational planning
andimplementation of service within the
district. - Health facilities Hospital, Health centres,
posts and clinic
14Health Care System
Hospitals
592 Health Centres
15Health Care System
Finance
- After independence medical services were freeand
financed by the government - User fees were introduced in 1978, a cost
sharingsystem nicked named Cash and Carry - Health finance then came from public funds,
hospitalfees and charitable aid. - Current government is instituting a
NationalHealth insurance scheme to replace the
Cash andCarry system
16WHO 2002
17Health Care System
Donor Community
Department for International Development,
DFID Danish Agency for Development Assistance,
DANIDA United States Agency for International
Development, USAID Japan International
Cooperation Agency, JICA United Nations
Childrens Fund, UNICEF The World Health
Organisation, WHO United Nations Population
Fund, UNFPA Nordic Development Fund, NDF
18Outline
- Introduction
- Health System
- ICT Landscape
- Medical Informatics
- Potential Gains
- Barriers
- Conclusion
19ICT Landscape
- Majority of Companies are Hardware Salesand
repair - The Market is rapidly growing
- Market Size is 35 Million
- 3rd Largest US Export Market in Sub-SaharaAfrica
after South Africa and Nigeria - 2001 sales was 4 Million an increase of 46over
2000
20ICT Landscape
Telecommunications
- Service Market estimated 171 Million inannual
revenue(1999) Estimates for 2002are 400
Million - Services offered
- ISDN
- Wireless Internet Access
- VSAT
- Dialup Internet Access
- VPN
- Equipment Market annual revenue 60
MillionEstimates for 2002 are 200 Million
21ICT Landscape
Telephone use
- Total monopoly of fixed lines byGhana Telecom
- Total fixed lines 250,000
- Teledensity of 76/1000 persons
- 5 Mobile Phone Operators offering
- GSM, AMPS, ETACS
- Analogue
- GPS services
- Satellite Telephones
- Total Mobile Lines 300,000
22ICT Landscape
Internet Access
- 46 Licensed ISP, 10 operational
- Dialup subscribers are 8,000
- Average Cost is 25-44/Month
- Cyber Cafés are the growing trend
- 1,400 in Accra
- Each Café has an average of 10 pcs
- Average Cost is 1/hour
- Main use is Free Web based email
23Source WorldBank Development indicator database,
April 2002
24ICT Landscape
Software Development
- Mainly Confined to Financial Sector
- Development is mainly for WINTELplatforms
- Open Source is mainly used by
- ISPs
- Students and
- Hobbyists
- To date there has been only one opensource
project in Ghana and West Africa
25Outline
- Introduction
- Health System
- ICT Landscape
- Medical Informatics
- Potential Gains
- Barriers
- Conclusion
26Medical Informatics
- Medical Research
- Public Health
- Clinical Informatics
27MIMCom.NET
A malaria research network for Africa
- Formed in 1997 at Multilateral Initiative on
Malariaconference in Dakar - African scientist identified lack of
communication asa major barrier to carry out
their work combating themorbidity and mortality
of Malaria - A working group was formed to discuss ways in
whichresearch scientists in Africa may have the
same level of Internet access as colleagues
elsewhere in the world - The National Library of Medicine was charge with
leading the effort to create the necessary
communication network
28MIMCom.NET
A malaria research network for Africa
Features
- Allows researchers an open link to send
andreceive mail - Search Medical literature and databases
- Sharing of files and images
- Permanent, continuous access 24 hours a day7
days a week - Minimal cost to participating users
29MIMCom.NET
A malaria research network for Africa
Design
- NLM designed and operates the network and
coversall necessary costs - Determination of requirements and site survey
- Negotiation with African Telcom authorities
- Assistance with equipment purchase Installation
- Training and support
- Establishment of document delivery system
andinformation portals - Individual sites and funding partners are
responsiblefor equipment costs and cost of
shared bandwidth
30MIMCom.NET
A malaria research network for Africa
Implementation
- Network technical hub located at Redwing
SatelliteSolutions(UK) - Large satellite dish focused on
geo-stationarysatellite 37,000km above the
Atlantic Ocean. - Ground station connected to high speed
internetback bone on the ground. - VSAT were installed at Research sites to
accessNetwork
31MIMCom.NET
MIMCom.Net
A malaria research network for Africa
Implementation
Ghanaian Sites
32MIMCom.NET
A malaria research network for Africa
Evaluation
- NLM and International Centre of Insect
Physiologyand Ecology in Kenya are currently
doing thefirst evaluation of the network. - Evaluation covers
- Network performance
- Efficeint use of bandwidth
- Information use and site growth
- Papers published and
- Collaborations carried out
33HealthNet
- This is the SATELLIFEs Global CommunicationNetwo
rk which links Health workers around theworld by
email - HealthNet utilized SATELLIFE's low-
earth-orbitsatellite to establish e-mail
connectivity in various locations throughout
Africa. - Allowed Health care providers who had been
workingin isolation were finally able to
communicate, share experiences and access
information critical to their work. - Ghanaian researchers use HealthNet to
communicatewith London School of Hygiene and the
Tropical DiseaseResearch Centre in Geneva
34HealthNet
- In what has been described as a major public
healthsuccess story in recent times, African
researchersused the network in the control of
Onchocerciasis - This was as a result of Multinational
collaborationincluding Ghana to track the Black
Fly (Simulium)larvae, the vector of the disease
along the Volta river
35SATELLIFES PDA PROJECT
- A collaborative effort between SATELLIFE and
theAmerican Red Cross Society(ARC) - The project was to demonstrate the Usefulness
andFeasibility of using relatively inexpensive
handheldtechnology in the conditions found in
Africa. - Phase One of the project was carried out in Ghana
during a massive measles immunization
campaignby the ARC in December of 2001
36SATELLIFES PDA PROJECT
- Paper surveys are normally used by the Red Cross
to gather data, which is then manually entered
into a database and analyzed to plan a follow-up
campaign - The process is cumbersome, time consuming,
expensive, and prone to human error. - This surveys were therefore not always conducted
37SATELLIFES PDA PROJECT
- It was hypothesized that this survey
- could be done quickly and accurately
andencompass a large sample. - Results would be in a timely manner that would
facilitate planning for future measles and other
public health efforts. - A short user-satisfaction survey was also loaded
onto the PDAs for the surveyors to fill out
after they returned fromthe field. Questions
included topics such as - problems encountered
- ease of use and
- comparison to a paper-based survey
38SATELLIFES PDA PROJECT
Results
- Individuals who were not familiar with computer
technology were easily trained and deployed to
collect data. They completed 2,425 surveys at 67
locations in the targeted region including 41
urban and 26 rural sites. They averaged 28
surveys per person per day. - The PDAs were utilized in the field with no
disruption from elements such as dust, dirt, and
sunlight nor was loss reported due to security or
breakage.
39SATELLIFES PDA PROJECT
Results(Cont.)
- Data was downloaded from the units rapidly and
with no error enabling rapid analysis and prompt
reporting to the local Ministry of Health. The 30
paper surveys took approximately 30 minutes to
enter into a data base, a rate that would have
taken over 40 hours to enter the PDA surveys by
hand. - The user satisfaction survey yielded positive
results - 70 said PDA was easy to use
- All were able to keep the screen clean
- 87 had no problem reading the screen outdoors
- 10 found it too confusing to follow.
40SATELLIFES PDA PROJECT
Conclusion
- The project was a success.
- The speed and ease of gathering data was
unprecedented - The in country costs was 2000
41SATELLIFES PDA PROJECT
Phase Two
- The Project tests the viability of the handheld
computer for gathering information that is
critical to decision makersand policy makers,
and for disseminating information among health
professionals in Kenya and Uganda. - 80 PDAs were shipped to Two Universities in Kenya
and Uganda where they will be distributed to 6th
year medicalstudents and physicians for clinical
use in a variety of settings.
42SATELLIFES PDA PROJECT
- The PDAs contained the following medical content
- Medical textbooks from Skyscape
- 2002 Griffith's 5-minute Clinical Consult
- Harriet Lane Handbook
- 5-minute Pediatric Consult
- A to Z Drug Facts
- Pocket OB/GYN
- HIV/AIDS, TB, and Malaria guidelines specific to
Kenyaand Uganda - MedCalc, a medical calculator with over 40
formulas includinga pregnancy calculator - World Health Organization(WHO)Essential Drug List
- Essential Drug List specific to Kenya and Uganda
43SATELLIFES PDA PROJECT
- An independent evaluation, conducted in December
2002, will examine the usefulness of both the
technology and thecontent, especially as they
impact the behavior of health professionals and
the quality of care they deliver. - The results of the survey is important to Ghana
especiallysince a lot of health practitioners
are not aware of and do not have access to
HIV/AIDS and other clinical guidelines that are
critical in diagnosis and treatment.
44Clinical Informatics
- Electronic Medical Record
- Non-existent
- Processes is paper based ADT, LAB, Radiology
etc - Access and retrieval of patient information is
timeconsuming and very frustrating - Disjointed and Lack of Coordination in
Patientmanagement
45Activity Diagram of a Physician Order
46Clinical Decision Support
- The Ghana National Drugs Programme and
MOHproduce an evidence based treatment
guideline in 2000 - This Guideline is not being used as expected
because - Its not readily available to does who need it
most - Those who have it, find it inadequate because
itcontains out-dated information and its
genericnature of recommended management - No tools for Alerts or provision of patient
specificrecommendations
47Medical Knowledge
- Medical journals are source of knowledge and
- the most used source of information
- Use of Online versions of these journals are
minimal - Ignorance of the existent of these resources
- Cost of subscription to the journals
- Low level of computer literacy amongst potential
users
48Outline
- Introduction
- Health System
- ICT Landscape
- Medical Informatics
- Potential Gains
- Barriers
- Conclusion
49Potential Gains
- National Health Insurance Scheme
- Telemedicine
- Advise of policy makers
- Disaster Management
50Potential Gains - Health Insurance
- The National health insurance scheme which is to
replace Cash and Carry starts later this
year. - The scheme would be run by local mutual
healthorganisations who are likely to either use
of-the-selfsoftware or have one written for
them - There is the consideration of a unique ID system
that would allow patients to cross district
lines for specialist care. - Medical informatics would help create standards
for electronic exchange of financial and
administrative dataand also standards for unique
identifiers, code sets, security and privacy
51Potential Gains - Telemedicine
- Particularly useful in rural settings that have
no doctors andin regional hospitals that lack
specialists e.g. radiologists - Patient findings can be described in email and
theirinvestigations such as ECGs and xrays may
be sent asattachments for expert consultation. - Cheap(200), easy to use and robust digital
cameras with high resolution images (2.1
megapixels) may be used in teledermatology and
perhaps telepathology and teleultrasound
52Potential Gains Disaster Management
- Appropriate use of information technology can be
ofenormous help to those responsible for
disaster managemente.g perennial outbreaks of
Cerebrospinal Meningitis in Northern Ghana and
Cholera and other diarrhoeal diseasein the rainy
season. - Adequate and timely flow of information would be
use inprevention, advance warning, early
detection, notificationof appropriate
authorities, mobilization of response,
containment of the disease and medical care for
thoseaffected.
53Potential Gains Policy Advise
- Effective sharing of information amongst the
various stakeholders in healthcare delivery
would aid theformulation of better health
policies. - Irrelevant and unnecessary repeatition of
research byorganisations within the Ministry of
health would decrease if there is collaboration
amongst them andknowledge created by these
organisations are readilyavailable and
accessible.
54Outline
- Introduction
- Health System
- ICT Landscape
- Medical Informatics
- Potential Gains
- Barriers
- Conclusion
55Barriers
- Financial
- Poor communication infrastructure
- Irregular power supply
- Lack of trained professionals in
- Medical Informatics
- Telecommunications
56Conclusion
- Ghana stands to benefit from the application
ofinformatics in health care. - There are however several pre-requisites that it
needsto meet before an effective and sustainable
system canbe put in place - Use of existing infrastructure and
appropriatetechnology may reduce the cost of
implementation