Transforming Health Services Through ICT - The Case of Rwanda’s TRACnet Program

Jean Philbert NsengimanaCountry Director

Voxiva Rwandajphilbert@voxiva.com

+250-78-830-8998

outline

• E-Health Defined• Vision for e-Health in Rwanda• Benefits• What’s TRACnet• TRACnet: addressing crucial HMIS

challenges • TRACnet: Overview of Technology• Key lessons learned

Rwanda and ICT : the regional context

• Rwanda still lagging behind in penetration indicators

• Ambition is to be the regional ICT hub

• 2020 vision: Transform the country from a predominantly agriculture-based to a knowledge-based economy by 2020

• NICI Plans– Education and HR dvpt,

Infrastructure, Socio-economic dvpt, e-Gov, Private Sector dvpt, Rural and Community Access, Legal and Regulatory, National Security Law and Order

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eHealth Defined

• Ministry of Health Rwanda: The Use of Information and Communications Technologies to Provide and Support Healthcare service delivery.– Efficient delivery of healthcare services– Transformed health sector decision-making

culture– A clearly defined architecture and standards

for integrated and interoperable e-Health systems

Foundational components Developing policies for e-health

Equipping hospitals with networks and computers Connectivity of healthcare facilities

System security Subscription to evidence based medical literature

Minimum set of indicators NID integration

Development of Integrated e-Health architecture and standards Providing remote IT support to healthcare facilities

e-Health Center of Excellence

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Major Benefits to the health sector Improved accessibility to healthcare services Evidence based practice, improved quality Informed clinical and public health planning

Better efficiency, productivity, cost effectiveness

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Rwanda eHealth Building Blocks

Benefits

Public & Patients

• Improved Health Outcomes

• Improved, specialized care more available and accessible (remote consultation, patient monitoring, imaging, etc.)

• Health information follows patient

• Reduced travel costs• Access to education

and prevention resources ($1 on prevention saves $8 on treatment)

Health Care Providers

• Better access to clinical information

• Less duplication of diagnosis tests

• Better coordination of interventions

• Greater practice efficiency

• Improved financial and administrative efficiency

• Ability to reach many without travel risks and costs involved

Health System

• Better population health and protection (e.g. Integrated Disease Surveillance and Response)

• More effective health planning and decision making

• Cost effective and sustainable health system

• Improved Health education and Research

TRACnet

• Dynamic, innovative, adaptable, IT system that collects, stores, retrieves, and disseminates critical program, patient and drug information related to HIV/AIDS care and treatment.

• Developed by Voxiva under a grant funded by the CDC under the aegis of PEFPAR.

Background: HIV situation in Rwanda

• Persons on ARV as of December 2008•57,514 adults•5,635 children

• HIV prevalence sex ratio (F/M): 3.6/2.3

• Access to ART services• 2004: 12 facilities offering

ART• Jan 2010: 266 out of 513

country wide• 2012: Universal Access: all

facilities offering ART, VCT/PMTCT

HMIS – Challenges and opportunities

MOHTB Malaria HIV/AIDS MCH EPI Disease

Surv.

Nat’l AIDSCommission

Global Fund

PEPFAR

Other Donors

DistrictHealth Authority

ProvincialHealth Authority

Labs

Warehouse/Distribution Center

NGO NGO NGO NGO NGO

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How does TRACnet work?

CellPhone

PCs/Internet

PDA/Smartphone

SAMPLE DATA

TRACnet allows users to:•Collect real-time

information from the field via web, phone, mobile application, paper...

•View, analyze and map the data in real-time to make more informed decisions.

•Communicate and send alerts and information back out to the field in a timely and systematic way.

LocalApplications

Phone

Technology

TRACnet system

TRACnet

Functional Modules

Program Indicators (ART, PMTCT, VCT)

Patient Registry (Registry, Care & Treatment Record)

Inventory (Shortage Reports, ART Inventory)

Laboratory (Results, Inventory Supplies)

Integrated Disease Surveillance & Response

Outbreak Alerting

Communications Modules

Interactive Voice Response

Cell Phone Client

PC Client

SMS

Systems Modules

Facility Registry

User registry

Access Control and Permissions

Dashboards and Analytics

Configuration

Communications

Notifications

Under Construction

TRACnet in use

• Hosts National Facility Registry (513 facilities)

• Used by all 266 ART facilities

• 90% of facilities using phone to report

• 1,159 registered users• Close to 1,000,000 user

sessions so far

Key lessons learned

• Stakeholder engagement and ownership• Flexibility and scalability• System documentation• Data quality from the source (garbage in,

garbage out)• Integration, interoperability with other

systems• Governance structures and mechanisms• Capacity building crucial for sustainability

“We don't want to lose anyone.”

ICT development framework - what should investment be focused on?

• Awareness• Content • Applications

• Policy• Legal,

Regulatory

•Skills to use•Affordability

•Infrastructure•Energy•Connectivity

Access

Ability

VALUEEnvironment

Is it time to shift the focus from infrastructure to content and applications?(Since the individual market for access will be saturated soon).