A key challenge in many resource constrained environments is lack of access to sufficiently qualified and experienced healthcare professionals. In Africa, there are no doctors in primary healthcare facilities – making the knowledge of nurses critically important. The World Health Organisation highlighted in 2016 that Electronic Health Records (EHR) enhance patient diagnosis and treatment through access to accurate, timely patient data.
The social need mHealth4Afrika focused on was to replace traditional paper-based registries with a comprehensive, scalable, adaptable and multi-lingual patient-centric technology platform that integrates Electronic Medical Record and Electronic Health Record functionality with the use of medical sensors at the point of care, strengthening the quality and accuracy of aggregate reporting to inform resource allocation and policy formulation, and strengthening healthcare delivery, staff capacity and greater intensity of community engagement.
It was clear from the needs assessment and baseline study carried out in Q1 and Q2 2016, that none of the intervention primary healthcare facilities in deprived semi-urban, rural and deep rural environments in Ethiopia, Kenya, Malawi and South Africa, previously had access to use of medical sensors or a complete electronic patient record system at the point of care.
The agreed starting point for the co-design of this platform with all key stakeholder groups (Ministries of Health, District Health Offices, Clinic Managers and primary healthcare professionals) was to start with maternal and newborn healthcare, which have unacceptably high morbidity and mortality rates.
The level of detail captured in paper-based registries is constrained by their physical nature and they often reflect older medical knowledge. It can be challenging to create a comprehensive medical history for patients who have engaged with multiple services or attended different health facilities, and data duplication across different program registries. This can impact on quality and continuity of care.
mHealth4Afrika is a HL7 FHIR-compliant patient-centric health platform built on DHIS2, focused on supporting UN SDG 3. Co-funded by the European Commission under Horizon 2020 (ICT-39-2015) and co-designed and validated with Ministries of Health, District Health Officers, Clinic Managers and Health Workers in Ethiopia, Kenya, Malawi and South Africa, it strengthens healthcare delivery in resource constrained environments by integrating electronic medical record (EMR) and electronic health record (EHR) functionality with the use of medical sensors, and analytical, visualisation and decision support tools to facilitate monitoring and interpretation of patient results. It saves time through automatic generation of aggregate data, lab integration and presenting easy-to-digest client histories and supports greater client retention through SMS appointment reminders.
mHealth4Afrika is designed to support the efficiency and effectiveness of both management and healthcare staff, particularly in primary healthcare facilities. It does this by increasing:
• Quality and impact of care through timely capturing of patient information, systematic storage of important data points in patient records and improved frequency of follow up
• Frequency of contact with a focus on healthcare prevention through use of state-of-the-art technologies at the point of care and SMS reminders
• Accuracy and quality of monthly aggregate program indicators used for decision making
• Access to educational materials for clinic staff and patients to improve skills
