‘Information empowers people on the local level’

Interview with Nic Moens on an innovative solution within the Health sector

As it concerns matters of life and death, healthcare is universally held to be important. The conditions typical of developing countries make the Health sector there particularly complex. IICD’s Country Manager for Tanzania, Nic Moens, sheds light on the main challenges facing the Health sector and describes the far-reaching benefits of applying health management information systems within that sector.

The greatest challenges to healthcare in developing countries are no doubt the tremendous lack of resources and the severe ‘brain drain’ of health workers who, having been trained in the West, are enticed to remain there where salaries are high and medical personnel is in short supply. Moens sees the highly segmented society in countries like Tanzania as forming yet another challenge: “The very wealthy elite is more apt to suffer from more ‘modern’ problems like heart disease and is willing to pay for the different kinds of treatment those require. Then, somewhere in the middle, you have a larger urban group with health problems related to life in the cities. And finally there’s the huge mass of especially rural poor. That makes it all very unbalanced.”

Management issues also tend to be more complex in the health institutions of developing countries than for example in schools or businesses. Moens explains: “Since all health institutions are essentially a kind of public good (even when they are run as businesses), the various management formulas applied are inevitably at least somewhat politically driven and therefore likely to change over time. Creating a stable health policy is therefore a big challenge for developing countries.”

ICT can be an essential part of the solution to many of these challenges, especially because it can drive a number of additional solutions. Moens describes the benefits of using health management information systems, which are one of the main engines in any health-reform agenda. “For one thing, those systems help you to structure the processes at a health facility by enabling you to review patient flows, to computerise it and then to start managing on the basis of real data rather than on your impressions of what might be the case. This can lead to a better use of capacity, a higher level of satisfaction among patients, and a significant increase in revenues. Those information systems can also help to highlight key data in connection with the allocation of resources, for example when you need to decide whether to put your money in prevention or in a curative approach. And with that kind of management data, you can start thinking about the business model. It also holds on a higher level: once you can show, as a nation, on the basis of real data, the specific kinds of diseases you have to deal with, how things are operating, and that you are in control of what is going on, then you can start developing effective policies , monitoring them.”

On all levels, the ICT-based health management information systems therefore strengthen the position of those who use them. Moens: “With the standard top-down system – the ‘we-know-best’ system – local health facilities themselves never get any real feedback on the information they submit. But by switching to a bottom-up system, in which people at the health-facility level can make use of their own information, that information gets practical value. It helps them structure their activities and it becomes a source of learning for them. They see the numbers of patients going down, they make better use of their capacity, their income goes up, they start to make sense of what is going on – and all that information gives them the ability to act. In that sense, the information actually empowers people on the local level. ICT is a very strong driver for making those changes happen.”

“Not surprisingly,” Moens continues, “having access to that kind of information motivates people to structure their system better. Rather running around putting out seemingly random fires, people are given an overview of the situation. And that makes them start to think differently. When they have better results, local health workers will be more apt to share their data with people at higher levels, but they will also be more apt to expect a response. While most health workers are by nature rather conscientious people, they still need information and feedback in order to stay motivated. Once different local health facilities start to visit each other and build networks, they are more apt to demand more say on the district level.”

Using ICT can help the Health sector respond even to its most fundamental challenges. Since donations to the Western, faith-based organisations that run mission hospitals have fallen sharply in recent years, those hospitals suffering and tend to go bankrupt. Their lack of resources directly hurts the rural poor, since those facilities tend to be located more in remote areas. While governments often step in to help, they are slow in doing so. ICT makes it easier to set priorities, enabling substantially reductions in waste and inefficiency while increasing accountability. And that will be better access to better quality healthcare for those who need it most. Moens: “With the lack of financial resources and shortage of staff in the Health sector in African countries, I think there’s no question that ICT will have a very prominent role there, although it will vary per segment. IICD’s role will be to offer support in the overall process and to pay more attention to what you can do with this kind of technology to help the rural poor in particular.”

Once the ICT-based solutions become part of an integrated medical system and start generating savings, they are bound to become sustainable. They will very soon end up being indispensable management tools. In that sense, ICT has a high added value in that context. Moens is optimistic and foresees important advances resulting from subsequent generations of health management information systems: “We are now looking at the possibility of mapping out certain disease patterns and comparing those with other factors like health expenditures, water and sanitation situations so that people can make links and revise their decision-making.” That can vastly increase the impact and lead to improvements in the lives of many more people. In that sense, those up-scaled ICT solutions form a parallel to IICD’s shift towards sector-level ICT4D programmes.

Return to main text >>