The Digital African Health Library:

Relevant Resources for Decision

Support at Point of Care

Bruce Dahlman MD MSHPE

Institute of Family Medicine, Nairobi

Africa Church Health Association Platform

Safari Park, Nairobi, Kenya

25 February 2015

Reflective Question

What medical information resource(s) do

the nurses, clinical officers or doctors

working in your health institutions use to

provide the best care possible for their

patients?

What are the challenges and barriers to

access current medical information

in your country?

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Motivation for Development of the

Digital African Health Library - I

Health workers in Africa shoulder:

• 25% of the global disease burden

• in 11% of the world’s population

• with only 3% of the global health workforce

• and just 1% of the health care resources

Can health information decision support

resources be of at least some potential

assistance to them? WHO (2006) The global shortage of health workers and its impact. Retrieved from

http://www.who.int/mediacentre/factsheets/fs302/en/ index.html

Motivation for Development of the

Digital African Health Library - II

• Family medicine post-graduate training in a rural setting in Kenya

• “Learner-centred” approach of bedside response to patient –prompted questions

• “Information divide” - locally relevant availability *

• “Internal digital divide” - internet access rurally *

* Rhine, L. (2006). The impact of information technology on health

information access in sub-Saharan Africa: The divide within the divide. Information Development, 22: 242.

Motivation for Development of the

Digital African Health Library - III

Kenyan nurse South Sudanese doctors

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Overview of Research on Doctors Info Needs

Kenya Point of Care Health Information Study

2008-9 with 8 Kenya Family Medicine Registrars

Rwanda Point of Care Study

2009 with 64 Rwandan Residents and Faculty

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Study Conclusions

• Post-graduates and faculty in two East Africa

training programs embraced the use of

smartphones as a tool to assist clinical

decision making to provide best care

• Patients significantly benefited because the

smartphone brought answers to clinicians’

questions to the point of care

• Smartphone format can be used to widely

distribute large amounts of evidence-based

information

Goals for Digital Africa Health Library

The Format and Platform:

• Portable – available where you see patients

– Smartphone is the emerging technology

• Single search engine for all resources

– Enter the search term(s) once

• Easy to set up and use

– No lengthy downloads or complicated sync

• Local resources

Digital African Health Library

Video demonstration

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Resources

• Oxford manual- each usually $35-50

– Anaesthesia

– Clinical Medicine

– Clinical Specialities

– Surgery

– Tropical Medicine

• Future

– Family Medicine – South Africa

– AfricaFEM Emergency Medicine 10

Resources - II

• British National Formulary

• Dynamed integrated resource

• CALS Emergency management

• Africa Health continuing education journal

• WHO Handbooks

– Pocketbook of Care of Hospitalized Children

– Pregnancy, Childbirth, Postpartum &

Newborn Care

• Kenya MoH Clinical Guidelines

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Resources - III

• RHealth Advisor – Robertson

• Helps nurses and clinical officers make

better diagnoses

• India – Accuracy increased from

52% to 85%.

• This requires internet access – otherwise,

all other resources can be used offline.

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Features

• Smartphone or tablet

• iPhone or Android

• Single search of all texts

• Relevant resources for Africa

• No internet connection needed after startup

• Resources updateable

• Option to include your Ministry of Health

Guidelines

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Digital African Health Library:

Country Roll-out

• 2015

Kenya, Uganda, Rwanda, Botswana

Ethiopia, South Sudan and Somaliland

• 2016

Other Anglophone countries – Ghana,

Malawi, Nigeria

How can your hospitals help?

• Our goal is to provide it to rural clinicians

• Needs a data transfer where there is no 3G

network

• IT departments can do the transfer to help

the clients get access

• Please speak to us afterwards

• Fill the response form if you are interested

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Why the Digital Library

• To Support primary care nurses, COs and

doctors in their clinical setting, but also

• Supporting COs and doctors in their training.

• Family Medicine is a primary care specialty

that is becoming understood and promoted

by Ministries of Health as the “missing link” in

especially the rural health delivery scheme

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Family Medicine:

Who is a Family Physician? Kenya Ministry of Health Family Medicine Policy (2007):

“A family physician is a medical doctor

– providing competent and comprehensive clinical care

– over a wide range of patient conditions

– considering the person’s physiologic, psychological, socio-economic, cultural and spiritual dimensions

– within the context of their family and community and

– not limited by the person’s age, gender, organ system or disease entity.”

African Family Doctor

Distinctives

• Is in a consultant role to other primary

care providers: medical officers, nurses,

clinical officers;

• Coordinates to community and Level 2

and Level 3 facilities

• Significant surgical capabilities where

there is no general surgeon available

• M.Med. trained – has speciality degree

The African Family Doctor: A summary

• 4 year M. Medicine speciality training

• Clinical specialist as “consultant to the

primary care team”

• Competent emergency surgeon

• “Bridge” to the community providers

• Equipped to stay & “build” the hospital; not

wanting to become another specialist that

takes them away from the rural facility

Why Family Medicine?:

World Health Organisation “Given the need to provide primary care services to

the entire population, as well as the family doctor’s ability to manage most medical problems,

it makes sense that a majority of physicians should be trained to practice as family doctors. This may be even more important in developing countries, where it may be prudent to limit the utilization of costly hospital-based technology” (WHO, 1994).

Acknowledgements

• Our faithful supporters through AIM Int’l

• Generous resource partners: DynaMed,

Oxford U Publishers, CALS, WHO

• Technical partner – Medhand Int’l

• Research subjects from Moi U., Rwanda

National University, South Sudan doctors

• INFA-MED development team:

Lead Consultant - COO, IT programmer,

Partner Service Officer

Comments and questions?

Correspondence to:

Dr. Bruce Dahlman, Director

Director@DigitalHealthLibrary.net

Mr. Musya Mutua, Lead Consultant

Consultant@DigitalHealthLibrary.net

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