Mohammad Al-Ubaydli’s blog

Cellular technology for health records in the African countries

Posted in Technology by Dr Mohammad Al-Ubaydli on April 12, 2006

On Saturday in London I met Drs Peter Drury, Simon Fraser and Adesina Iluyemi to discuss using new cellular technology to serve electronic medical records to handheld computers in African countries. It was a useful discussion and my three colleagues were highly experienced in deploying projects in the developing world. Peter, who had originally called the meeting, has been helped formulate policy at the UK’s Department of Health, and is tailoring its Map of Medicine for Kenya.

Soon afterwards Adesina moved the discussion to the excellent HIF-net mailing list. And then Holly Ladd, Executive Director of the pioneering SATELLIFE team, weighed in with her experience. The original posting is archived, but I will quote it in full here because it is so informative:

A previous posting from a colleague in Uganda made passing reference to our project. I would like to take the opportunity to explain and update the list on the work currently underway and the plans for this year.

The Uganda Health Information Network project (UHIN), which currently does use the WideRay ‘jack’ to create a store and forward network, is now entering its third year. The network consists of a handheld computer at each participating health center, an access point located at several sites within each participating district, a centrally located router and desktop computer at the District Health Office. Users enter data onto their handhelds, travel to an access point and upload their data while downloading updates, news and continuing medical education material. Overnight the access point (which has a Linux computer onboard, as well as a data cache a sim card and a battery) makes a call over the cellular network to the centrally located router to exchange data. Data transmitted from each health center is sent by email attachment to the District office the following morning where a conduit automatically moves each file into the appropriate database (disease surveillance, HMIS, etc). Districts then complete the required aggregated reports to the MOH.

A cost benefit study after the first year showed that with only two of the fourteen forms that health centers use to the handheld computer and transmitted over the gsm access points there was a savings of 25% as compared to the paper based HMIS and disease surveillance reporting process. (We have not calculated the cost benefit of being able to provide access to CME through the network.) At this point the UHIN project has been deployed to 160 rural health centers in three districts. The WideRay
‘jack’ is now operating on the gprs network. The monthly cellular cost per health center to transmit routine data AND to receive continuing provider education material, daily Ugandan newspapers and notices from the District Health Directors is approximately $5.35 US – or, stated another way, the per handheld communication cost is $2.45US per month. We expect that a new cost benefit analysis, to be completed this year, will show continued increases in savings. In addition to the reduced costs of using gprs, the training and user support functions to support the network have been absorbed by each district thus reducing overall operating costs. This is possible because the districts have seen real savings by using the network.

But, in response to acquisition cost concerns and a desire to further enhance capability SATELLIFE and our partners in Uganda and South Africa have built a new access point that we expect to start deploying in the next six months. The new ‘Africa Access Point’ will continue to use the gprs/gsm network to transmit data in both directions. It will additionally provide rural health workers with individual email access and will use both infrared and wifi to facilitate exchange with the handhelds that are in use in the three districts. These access points will be about 1/3 the acquisition cost of the WideRay ‘jacks’ currently deployed and
will use all open source software.

The central feature of the store and forward network is that non-urgent information from multiple health centers can be consolidated into a shared access point and that data from each can be consolidated into one phone call /transaction reducing costs and effectively relaying information to and from district health offices to hard to reach (as in a two hour climb on all fours up a mountain!) health centers. We can rely upon existing cellular infrastructure and avoid the costs of building towers, etc. Our goal this year is to expand the number of access points available in the three districts to ensure that these are placed at a reasonably accessible location for health workers. Also, given the current power shortages, we will further expand access to solar chargers for all the equipment.

SATELLIFE and Uganda Chartered HealthNet are working with the Ministry of Health on a plan to expand the network nation-wide in order to support continuing provider development – distance learning for all health workers. We are also about to deploy this kind of network in another country in collaboration with the country’s Ministry of Health. Finally, UCH will be receiving an award for this project for Public Sector Excellence from WITSA to be presented at the World Congress on IT
meeting in May.

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