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MEDICAL INFORMATICS IN GHANA

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Title: MEDICAL INFORMATICS IN GHANA


1
MEDICAL INFORMATICSIN GHANA
Yaw Ofori-Adjei B.Sc.(Med Sci) University of
Ghana Medical School
28th February 2003
2
Outline
  • Introduction
  • Health System
  • ICT Landscape
  • Medical Informatics
  • Potential Gains
  • Barriers
  • Conclusion

3
LAND MASS OF 238,537 Sq Km
4
Political 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
6
Economic
  • 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

7
World Bank Estimates 2001
Ghana opted for debt relief under the Heavily
Indebted Poor Countries Initiative (HIPC) in 2002
8
People
  • 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

9
Trivia
10
Outline
  • Introduction
  • Health System
  • ICT Landscape
  • Medical Informatics
  • Potential Gains
  • Barriers
  • Conclusion

11
Health 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

12
Health Care System
Structure
  • Current system is a three-tiered system
  • National
  • Regional
  • District
  • Focal point of the system is the district level

13
National
  • 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

14
Health Care System
Hospitals
592 Health Centres
15
Health 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

16
WHO 2002
17
Health 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
18
Outline
  • Introduction
  • Health System
  • ICT Landscape
  • Medical Informatics
  • Potential Gains
  • Barriers
  • Conclusion

19
ICT 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

20
ICT 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

21
ICT 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

22
ICT 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

23
Source WorldBank Development indicator database,
April 2002
24
ICT 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

25
Outline
  • Introduction
  • Health System
  • ICT Landscape
  • Medical Informatics
  • Potential Gains
  • Barriers
  • Conclusion

26
Medical Informatics
  • Medical Research
  • Public Health
  • Clinical Informatics

27
MIMCom.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

28
MIMCom.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

29
MIMCom.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

30
MIMCom.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

31
MIMCom.NET
MIMCom.Net
A malaria research network for Africa
Implementation
Ghanaian Sites
  • Noguchi
  • Navarongo

32
MIMCom.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

33
HealthNet
  • 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

34
HealthNet
  • 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

35
SATELLIFES 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

36
SATELLIFES 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

37
SATELLIFES 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

38
SATELLIFES 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.

39
SATELLIFES 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.

40
SATELLIFES PDA PROJECT
Conclusion
  • The project was a success.
  • The speed and ease of gathering data was
    unprecedented
  • The in country costs was 2000

41
SATELLIFES 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.

42
SATELLIFES 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

43
SATELLIFES 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.

44
Clinical 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

45
Activity Diagram of a Physician Order
46
Clinical 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

47
Medical 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

48
Outline
  • Introduction
  • Health System
  • ICT Landscape
  • Medical Informatics
  • Potential Gains
  • Barriers
  • Conclusion

49
Potential Gains
  • National Health Insurance Scheme
  • Telemedicine
  • Advise of policy makers
  • Disaster Management

50
Potential 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

51
Potential 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

52
Potential 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.

53
Potential 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.

54
Outline
  • Introduction
  • Health System
  • ICT Landscape
  • Medical Informatics
  • Potential Gains
  • Barriers
  • Conclusion

55
Barriers
  • Financial
  • Poor communication infrastructure
  • Irregular power supply
  • Lack of trained professionals in
  • Medical Informatics
  • Telecommunications

56
Conclusion
  • 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
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