After a nice albeit brief personal and work visit in the States, I landed back in Africa for a meeting in Nairobi on Standards in Health Information sponsored by WHO and including a number of countries in Africa. I was joined by a number of colleagues from Mozambique, including the Ministry of Health, a public hospital in Maputo that is one of the first to implement an integrated electronic information system, and staff and students from one of the major universities in Mozambique who are working with the Ministry of Health on information systems.
Information systems in health care is an area where I have been increasingly working, first in Malawi, and now in Mozambique, as local governments and implementing organizations try to set up systems where patient information can be better documented thereby improving the quality of care as well as setting up systems to monitor what is happening at the local, regional, and national level (e.g. how many patients are accessing ARV therapy.)
The challenges to doing this--and especially doing this well--in Africa are great. Health care workers are in dire numbers (Malawi had about 1 doctor for every 100,000 persons and Mozambique has equally staggering rates, compared to about 1 doctor for every 300 patients in America.) Much of clinical care rests on health care workers who are less trained, in fewer numbers, and with fewer resources (e.g. anything from dependable electricity and running water to drugs). And many of the typical tools for such systems (sophisticated IT systems, communications infrastructure) are non-existant or non-reliable in Africa. Many computers hit the "computer graveyard" within their first year of deployment, "dying" from lack of virus protection, misuse, and the elements (dust, heat, moisture).
In these crowds, I am always humbled by the expertise and knowledge of those around me.
Though I do not necessarily speak the same language of software, hardware, communications standards, etc, there are clearly many lessons that are learned.
That as much as we can, we should not be trying to reinvent the wheel every time.
That we should continue to find ways to foster collaboration and communication as collaboration results in a better, more applicable, more scalable product (i sat and watched a group of developers try and debug a system for a while, each offering ideas, input, and other constructive criticism on how to make it better).
That sometimes working 80% is good enough to get going and start trying it rather than waiting until things are perfect.
And finally when something is working, trying to standardize and share those products, ideas, etc, can ultimately help us all move forward.
Information systems in health care is an area where I have been increasingly working, first in Malawi, and now in Mozambique, as local governments and implementing organizations try to set up systems where patient information can be better documented thereby improving the quality of care as well as setting up systems to monitor what is happening at the local, regional, and national level (e.g. how many patients are accessing ARV therapy.)
The challenges to doing this--and especially doing this well--in Africa are great. Health care workers are in dire numbers (Malawi had about 1 doctor for every 100,000 persons and Mozambique has equally staggering rates, compared to about 1 doctor for every 300 patients in America.) Much of clinical care rests on health care workers who are less trained, in fewer numbers, and with fewer resources (e.g. anything from dependable electricity and running water to drugs). And many of the typical tools for such systems (sophisticated IT systems, communications infrastructure) are non-existant or non-reliable in Africa. Many computers hit the "computer graveyard" within their first year of deployment, "dying" from lack of virus protection, misuse, and the elements (dust, heat, moisture).
Despite these challenges, there is some amazing work going on to build these systems. Teams across Africa, with support from the US and Europe, are building the foundation of systems. 
Perhaps the most noteworthy piece is the role of collaboration across developers.
Despite these challenges, there is some amazing work going on to build these systems. Teams across Africa, with support from the US and Europe, are building the foundation of systems.
Perhaps the most noteworthy piece is the role of collaboration across developers. Whereas software and systems development is often a competitive process with developers fighting for dollars and recognition, the meetings was full of ideas and learning being shared across individuals and teams, projects and countries. Though the needs remain extraordinary, there are small glimmers of initial success of appropriate and feasible information systems being developed and implemented, all with the aim of improving health information for persons in Africa and other less resourced countries. Most importantly, a community is starting to grow that is actively dialoguing and sharing what's working and what's not is being shared.
Perhaps the most noteworthy piece is the role of collaboration across developers.Despite these challenges, there is some amazing work going on to build these systems. Teams across Africa, with support from the US and Europe, are building the foundation of systems.
Perhaps the most noteworthy piece is the role of collaboration across developers. Whereas software and systems development is often a competitive process with developers fighting for dollars and recognition, the meetings was full of ideas and learning being shared across individuals and teams, projects and countries. Though the needs remain extraordinary, there are small glimmers of initial success of appropriate and feasible information systems being developed and implemented, all with the aim of improving health information for persons in Africa and other less resourced countries. Most importantly, a community is starting to grow that is actively dialoguing and sharing what's working and what's not is being shared.
In these crowds, I am always humbled by the expertise and knowledge of those around me.
Though I do not necessarily speak the same language of software, hardware, communications standards, etc, there are clearly many lessons that are learned.
That as much as we can, we should not be trying to reinvent the wheel every time.
That we should continue to find ways to foster collaboration and communication as collaboration results in a better, more applicable, more scalable product (i sat and watched a group of developers try and debug a system for a while, each offering ideas, input, and other constructive criticism on how to make it better).
That sometimes working 80% is good enough to get going and start trying it rather than waiting until things are perfect.
And finally when something is working, trying to standardize and share those products, ideas, etc, can ultimately help us all move forward.
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