The World Health Report 2008, from WHO, entitled “Primary Health Care Now More Than Ever” acknowledges the need to improve health systems for all through a Primary Health Care (PHC) reform. The report cites Brazil among other countries as good example of successful implementation of PHC policies and emphasizes the role of integrated health information systems as instrumental to achieving this reform.

It is impossible to deliver high quality health services to hundreds of thousands or millions of people without robust processes. That doesn’t mean taking away the human nature of health care. It means that it is possible to put methods in place that can, with the strong support of technology, organize health care delivery, support promotion and prevention, improve services quality and extend its reach. That IS eHealth.

In general, eHealth only makes sense if it supports a Health System. An example I’ve been closely involved with is SIGA SAUDE system in Sao Paulo city. SIGA SAUDE is São Paulo city’s integrated health information system. It is in operation since 2003, and today is present in all 700 health care facilities, with 14 million people in its database, processing 45 thousand scheduling requests a day. SIGA SAUDE implements all the business rules of the Brazilian National Health System, from family and community care, to surveillance and patient flow management.  The system reflects our country’s experience of using a national health system heavily focused on PHC and its long tradition of developing health information systems, now in the move to an integrated architecture.  Thirty years ago, we started developing several health information systems to deal with specific health issues, leading to 200 different systems that did not talk to each other. From 1999 on, we made the decision to move to an integrated health system to support the nation health system comprehensively. The basic premise is that information should be collected only once at the point whre it is generated and from that shared in the network.

SIGA’s impact has been impressive. Recently, a pregnant teenager was rushed to the hospital presenting eclampsia, a life-threatening complication of pregnancy, and was saved as well as her baby. It happens she had not been to the scheduled prenatal visits and the family care team decided to visit her at home, finding her in this life-threatening condition!   SIGa Saude is now being formally evaluated by WHO/HMN with the support of Rockefeller Foundation (RF) and it has also been cited in the report HIS in Developing Countries: A Landscape Analysis, authored by Vital Wave Consulting with the support of the Bill & Melinda Gates Foundation.

Making the eHealth Connection Bellagio Conference, a conference organized by Rockefeller  Foundation in July 2008, underlined  the need to move away from silos to integrated eHealh systems, with strong support from all developing countries stakeholders. From Sylos to Systems – became a Bellagios mantra, from the first to the fourth week of the conference. The call to action that came from Bellagio was clear:  it is necessary to support, design and fund eHealth systems that are person-centered, to promote health care delivery, disease prevention, promotion and optimal resource allocation.

There was strong consensus that the major barrier to further adoption of eHealth in the global south is human capacity. Technology and infrastructure are the easiest part. What is missing is the understanding by governments, vendors and donors of the complexity of conceiving, developing and deploying eHealth applications in complex and diverse environments, for large masses of people. Since there are still a few siloed systems in Africa, there is a window of opportunity to leapfrog directly to interoperable integrated  eHealth systems. For example, many African countries moved directly to wireless communications instead of using wired solutions.

As we speak probably another siloed database is being created in Africa. The moment to act is now. Every country in the world is looking for solutions to the increasing health costs and the need to cover all citizens. The economic crisis makes it even more urgent to optimize resources and move fast.

At the moment there are  at least two related initiatives addressing the issues raised by the Bellagio call to action: an ISO TC 215 Health Informatics –  technical reference document, lead by WHO and Brazil,  that will address the issue of an eHealth Architecture for emerging and developing countries and  the project  eHealth Enterprise Architecture Framework and Strategy Development for the Global South under a RF grant. The project has started and is being coordinated by a South African organization – Jembi Health Systems, a not-for-profit company based in Cape Town, South Africa, whose mission is to improve health systems through health information systems development.

There is a lot of work ahead of us and I would like to count with the contribution of this network to in having the work done.  ( I guess I wrote too much for my first contribution –  I can be very passionate about by work – !!  Hope you don’t mind!)

Related posts:

1. Blog Roundup: Health IT, Urgency, practicality, and costs of health care reform
2. It is Time for Thoughtful Development and Deployment of Health Information Technology

This entry was posted on Sunday, December 13th, 2009 at 1:04 pm and is filed under HIT/Health Gaming, Innovation, Technology. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.