HHS/CDC Grant: Enhancing Health Information Systems for Quality Care in Malawi under PEPFAR

Baobab Health Trust

Baobab Health Trust (BHT) is a Malawian non-governmental organization dedicated to the improvement of health through the use of information technology. BHT has dedicated its efforts to revolutionizing the use of technology in developing world’s health care environments. BHT’s Vision is to lead the improvement of health through Information and Communication Technology in the developing world. BHT’s Mission is to achieve this by building, deploying and maintaining innovative, robust and sustainable health care information systems suitable for the developing world in collaboration with government and health care workers. In order to encourage knowledge sharing and continuous development of the Electronic Medical Records (EMRS), BHT uses and follows Free and Open Source Software standards. Baobab applies the principle of health system strengthening in development and implementation of systems. Strategic entry points such as HIV/AIDS have been used to support strengthening of the health information systems for other service areas.
As of May 2017, CDC/PEPFAR has funded BHT to continue in the implementation of the EMRS, which has now been deployed to 85 facilities. The COP16 projection is 120 facilities by September 2017. The EMRS consists of a suite of HIV-patient data modules (to include, but not limited to ART/OPD, HTS, Pharmacy, Maternity, ANC and Laboratory Information systems). The current work is integral for the new mandates and goals for improved coverage and age/sex disaggregated reporting. Thus, it is imperative that the EMRS scale-up to additional sites continues in COP17 to reach 150 more PEPFAR sites as is the new target being required by PEPFAR. Doing so would also allow focus to be maintained on the 5.5 districts of interest, which account for approximately 70% of people living with HIV/AIDS who are on treatment. There has not been another similar deviation of such request for the same project/recipients previously. Because of the new requirements for reporting, if not approved there will be major cost implications, severe service disruption, and patient management/treatment delivery: 1) Such would result in the responsibility of implementing partners to manually extract thousands of paper patient records to obtain age/sex disaggregated data. This would be costly because additional data clerks would be needed to conduct the tasks, travel and per-diems would be required, and the time necessary to review paper records would not be conducive or comparable to the time it would take for extraction should the records have been available electronically; 2) In regards to service disruption: for example, if a facility only utilizes one ART register and a data clerk must extract data from that register, there would likely be patients waiting and workflow will be impeded due to there not being an electronic system available for such a task; and 3) Not scaling-up the EMRS in 150 additional sites would negatively impact clinical decision-support services as the treatment guidelines enable staff to adhere to the current protocols. If a facility does not have the EMRS, those patients will miss out on the opportunity for this tool to assist in enhancing the level of care needed for HIV/AIDS services.

Prevention of Mother-to-Child Transmission of HIV/AIDS (PMTCT);
HIV Care and Treatment Clinical Services for adults and children;
HIV Pediatric Care and Treatment (PEDs);
Surveillance and Strategic Information (SI); and
Laboratory

The overarching focus of this FOA is to fund activities to prevent or control disease or injury and improve health, or to improve a public health program or service. Recipients may not use funds for research. Certain activities that may require human subjects review due to institutional requirements but that are generally considered not to constitute research (e.g., formative assessments, surveys, disease surveillance, program monitoring and evaluation, field evaluation of diagnostic tests, etc.) may be funded through this mechanism.
The purpose of this program is to strengthen health information systems at the facility level to improve the quality, integration, and effectiveness of service delivery across care points within Malawi in collaboration with USG implementing partners, including the Ministry of Health and relevant non-governmental organizations. Facility level refers to a facility where patients encounter health care workers and information is recorded at the point of care for service delivered. Such facilities would include health posts, dispensaries, maternities, health centers, community and rural hospitals, district hospitals, and central hospitals. This program will build solid foundations of national electronic HIS infrastructure of reliable data sources for both Health Management Information System national reporting as well as support a reliable National Health Data Repository for surveillance and epidemiological activities.
While these systems will focus on HIV, they will be developed using a lifecycle continuum of care approach and cover other acute and chronic illnesses. Support will be provided to build country owned, sustainable and innovative integrated information systems that strengthen data collection, management and use at facility, district and national levels, and decrease the workload of healthcare workers.