1) Were you able to implement this action? Can you share benefits from this action?
Baseline Readiness:
SCORE: HIGH
Common themes:
National strategies developed / ing
National steering committees / working groups
Semantic and other interoperability standards being developed
Infrastructure assessment, improvements and solutions deployed
Building communities of practice / leadership
Development of indexes to measure “readiness”
Multi-stakeholder dialogues (including non-health actors)
India: some baseline assessment done : Digital India Initiatives, Work in progress, Unique
Identifiers exist
Mother, Child Tracking system built on ID system and another unique ID system for targeting
government subsidies and insurance based on government beneficiary schemes, National
connectivity architecture support
GoI standards semantic being developed standards deployed
Timor Leste: Conducted workshop by Ministry of Infrastructure & Health, e-Health strategy,
National connectivity architecture support (3 companies working on this), strategy is still in the
draft phase, software exists, hardware exists
infrastructure is the priority in Timor.
Vietnam MoH: Last December, government announced that in 2 years the health and insurance
companies must be linked. Two companies with very good ICT infrastructure. Need software
though to support this effort.
Sri Lanka: Set up committee to manage ICT w/ government, also has an eHealth strategy.
End of this year will have government data center set up that connects over 300 health facilities.
Has developed and is testing several health information systems. Each department as
information officer, assessment/ evaluation on the ICT requirements of the country.
Bangladesh: Government declaration for Digital Bangladesh by 2021. 5 year program is being
implemented for cross-sectoral digital approach. Initiating a new SDG oriented program in July
2016. A2i pan cabinet initiative to collect stakeholder needs. Trainings are being conducted and
hardware being distributed.
Indonesia: No Baseline data across 140 districts, in 2007 (113) measured indicators and can
compare with 2013 (85) health performance indicators, conducted census with multiple agencies
along with the National Statistics Bureau.
The comparison of data Help policy makers and also financing.National statistics bureau
Maldives - external consultants evaluated, suggested learning systems as they are, bringing data
from primary facilities to central servers
Bhutan; national assessment conducted
Maldives: WHO helped analyze the existing system and develop plan. Currently working on an
integrated system, but not aggregated data. Working on standardizing software to standardize,
integrated hospital information system, privacy acts (policy),
Bhutan: Baseline is known, ICT masterplan for the Ministry of Health. Problem was
infrastructure in the beginning, now planning that all 20 districts will have fiber optic connection,
and then connect health facilities. Have documented the software they will be needing for the
next 5-10 years. Policy/Documentation: Ministry of Communication for ICT, Government
Interoperability Framework, Health INformatics HR capacity building is needed.
Interoperability framework
Philippines: Budget / Planning sector in interoperability discussions. Started identifying other
sectors (research, etc) for identification at the national level. Inter-ministerial communication.
E-gov index used to assess
have educator of computer science.
Thailand: Benchmarking against other regions. Are there any core indicators that can help all
countries benchmark readiness / etc against themselves.
Have a list of scenario ?
suggest an e-Health index and evaluate the functionality of systems
Get Everyone On Board and Bring your Best Team:
Score: HIGH
Common themes:
Include all districts / states in sharing NEEDS for Needs-based approach
Creating national and international networks for experience sharing
“Collapetition” - friendly competition between districts
Crowdsourcing
Thailand: Visit hospital for accreditation; last year also started IT accreditation
9 hospitals to the level one. Using hospital accreditation approach to evaluate the district and
community levels as well.
Indonesia: Need every district to give input on what they want to know, select indicators and
Building community is critical. Has a community interested in health informatics, involves
international community as well. National ICT board - formed under the presidential decree
includes academia (university), ministries and practitioners. Active communities of practice
Big challenge to build health informatics community of practice / association.
Afghanistan: No policy for ICT sector in 2002. Now, more than 95% of all health facilities are
regularly reporting and reporting on time through hmis. Services provided by NGOs, contractual
agencies, government provides guidance and policy.
Steering committee of mixed skills developed
Task force - one group wanted a comprehensive health information system, while the other group
wanted to prioritize a smaller list of indicators. First principle about collecting data that actually
gave information on how to improve service delivery. Second principle Third principle to use a
system that’s already available in the market. Developed a master database in 2003 so that
different organizations could feed into the same database using the unique identifier system.
IT team needed to be close collaborators with health teams.
Sri Lanka: A technical coordinating committee that looks into coordinated approach to
implementing ICT. Formed steering committee that coordinates government, universities,
etc. Working committee implements what the steering committee decides, and gives feedback to
the steering committee.
Working committee: builds implementation plan
Philippines: problem focused-- Identify the data NEEDED for analysis and policy decisions
Indonesia: being people on board through crowd sourcing
Adapt/Adopt/Develop Tools
+
Good community of resources
Regional experiences are helpful to support / convince stakeholders
Robust to re-use systems where basic problems have been addressed
Flexibility or ‘appropriateness’ of existing systems to use case not always enough
Limited sense of ‘ownership’ of open-source tools
Integrating local feedback is difficult
Private sector incentive to use ‘common’ non-proprietary tools is low
Commitment to UHC / Integrated IHC
Very high consensus
Some resistance to integrating ALL systems due to security, flexibility or resource-intensiveness
2) What challenges have you encountered with these actions (common to all)?
Challenges
Last mile connectivity and cost
Getting to interoperability is difficult - resource intensive
New initiatives / policies require re-alignment
Informatics training and HR limited
Coordinating multiple ICT agencies / Networks
Integrating legacy systems from historically fragmented (pre-strategy
systems)
Engaging private sector is challenging / motivation limited
User-engaged design / feedback limited (although necessary for
‘ownership’)
Selecting common indicator sets - reducing forms RELEVANT to decisionmaking
New initiatives requiring re alignment
Informatics human resources lacking
Improvements in connectivity - fiber optic expansion to villages
Competing network/mno
Timor Leste: Getting the ICT community to understand the health team’s requirements
Private sector governance is challenging
Bangladesh: Governance, but the ICT Ministry was developed to help coordinate.
Indonesia : challenging process of prioritising indicators
Last mile connectivity
User driven design and development is generally lacking from many of these systems! Could use
crowdsourcing to improve this process.
need supporting local system.
Legacy fragmentation - systems are developed over the last 20 years and now integration is a
priority and National eHealth policies are being drafted. How do you bring these systems into the
coverage of these integration policies.
practical strategies to support the strategy
3) What support do you need internal/external to move forward?
Tl: Digital and connectivity infrastructure
Shared Interface across implementors (SHR)
Need similar approach / common indicators for the region through a shared instrument
Core indicators for regional benchmarking
Scenarios to be applied across countries with time constraints to “test” system
functionality
E health functionality tools - to assess the architectural
Shared instrument to measure readiness.
Practical strategies to integrate legacy systems
Ways to integrate feedback into user design
4) Agreement with the first 4 ICTen points:
12- Need to balance the pros and cons of integration - it costs more to maintain and
increases the concentration of human resources required to manage it.
3 - Agree there is no need to re-invent the wheel, but that just customizing OpenMRS
does not fully address the needs of community hospitals. When the existing applications
don’t do what is needed, develop your own software. 2) Reduces the local ownership of
the product being used. Makes it more difficult to integrate on the ground feedback in
real time.
By giving them chance to learn through participation in software development,
4 - It’s becoming increasingly costly and complex to integrate, need to sophisticate
integration.
the VCT services,
Indonesia is vertical program that coming from the top