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Health information systems in developing countries: Star Wars or reality?

Patricio V. Marquez's picture

(Doctor at the GP office working with prescriptions. Kirov, Russia. Credit: Dmitry Kirillov/World Bank)

In the late 1990s, an international consultant told me that a proposed electronic health information system in the Dominican Republic was “like Star Wars and will not work in this country.”

 

Our objective was to improve service delivery by virtually connecting health providers to share medical records with one another as patients moved from health centers to hospitals. We learned that this was much more than an overnight task, requiring a sustained medium-term effort by the government to get the system fully up and running.

 

In recent years, I’ve seen similar efforts realized in the Russian Federation, Georgia, Azerbaijan and Botswana. In two Russian regions, Chuvash Republic and Voronezh Oblast, for example, electronic records are helping coordinate the flow of clinical and financial information across the health systems as facilities, departments within hospitals, and health insurance agencies have been “virtually” connected through broadband networks. The electronic records are supporting clinical decision-making, facilitating performance measurement and pay-for-performance initiatives, and ultimately the continuity of care as patients move across the health system. Inter- and intra-regional medical consultations and distance learning activities are also being supported by telemedicine networks that connect specialized hospitals with general facilities.

Laboratory accreditation: Critical to quality care

Miriam Schneidman's picture

The quest for an accurate, timely and affordable medical diagnosis remains elusive in many developing countries.  In East Africa, laboratories are often poorly staffed; ill-equipped; and lack quality systems. Obsolete equipment clogs up limited space. Clinicians often resort to presumptive diagnoses rather than requesting lab confirmations. Individuals suffering from infectious diseases, such as tuberculosis, run the risk of going undetected and transmitting the disease to others, or being misdiagnosed, which in turn leads to compromised care and higher health care costs. 

 

Many laboratories are not adequately prepared to respond during public health emergencies, yet their services are critical to detecting new pathogens and containing disease outbreaks. 

 

World Laboratory Accreditation Day, observed recently, offers a good opportunity to draw attention to the critical role of laboratories in health, and the importance of accreditation in promoting quality.  Accurate and reliable laboratory services are critical for conducting clinical diagnosis, guiding treatment, and responding to disease outbreaks.  There’s a growing recognition of the importance of laboratory services, and several important initiatives have been launched, including the WHO-AFRO Stepwise Laboratory Improvement Process towards Accreditation (SLIPTA).

Pour un accès plus équitable à la planification familiale en Asie du Sud

Julie McLaughlin's picture

Le 11 juillet, lors de la Journée mondiale de la population, des acteurs mondiaux de premier plan dans le domaine de la santé se réunissent à Londres pour tenter de mettre la priorité sur l’enjeu de la planification familiale. Cet enjeu est au cœur des travaux du personnel de la Banque mondiale chargé des questions de santé en Asie du Sud, qui s’emploie à trouver les moyens qui lui permettront d’aider plus efficacement les femmes et les familles à espacer les naissances et à éviter les grossesses non désirées.

 

Même si les pays d’Asie du Sud ont progressé dans l’élargissement de l’accès à la contraception moderne et dans le recul global de la natalité, la région accuse la deuxième plus forte mortalité maternelle du monde. Dans ces pays, les ménages pauvres, marginalisés et non instruits n’ont pas accès aux services de santé génésique dont ils ont besoin, et notamment à la planification familiale.

 

En Inde, au Népal et au Pakistan en particulier, les taux de fécondité et d’utilisation de contraceptifs diffèrent considérablement d’une catégorie socioéconomique à l’autre : en Inde, alors que le taux de fécondité n’est que de 1,8 chez les femmes les plus aisées, il se maintient à 3,9 parmi les plus démunies. Au Népal, les femmes instruites ont, en moyenne, 1,9 enfant, contre 3,7 pour les femmes non instruites. Au Pakistan, la prévalence de la contraception atteint aujourd’hui 32 % chez les couples riches et seulement 12 % chez les couples pauvres. En Inde, dans l’État du Meghalaya, 36 % des couples désireux de recourir à la planification familiale n’ont pas accès à une contraception efficace.

Planificación familiar en Asia meridional: Mejorar la igualdad de acceso

Julie McLaughlin's picture

 

El 11 de julio, Día Mundial de la Población, mientras los líderes mundiales de la salud se reúnen en Londres para debatir sobre el otorgamiento de una mayor prioridad a la planificación familiar, el personal del Banco Mundial que trabaja en el sector de salud en Asia meridional estará pensando en cómo respaldar más eficazmente a las mujeres y las familias de esta región para espaciar los nacimientos y evitar los embarazos no deseados.

 

Aunque los países de Asia meridional lograron aumentar el acceso a la planificación familiar moderna y reducir los índices totales de fecundidad, la región sigue teniendo la segunda tasa más elevada de mortalidad materna. Los hogares pobres, marginados y sin educación no cuentan con los servicios de salud reproductiva que necesitan, incluida la planificación familiar.

 

En India, Nepal y Pakistán, en particular, las diferencias en la fertilidad y el uso de anticonceptivos entre los grupos socioeconómicos son sorprendentes: en India, la tasa de fecundidad en la parte más rica de la población es de 1,8, mientras que sigue siendo de 3,9 entre los más pobres; en Nepal, las mujeres con educación tienen en promedio 1,9 hijos, mientras que las menos educadas tienen un promedio de 3,7; en Pakistán, la prevalencia de anticonceptivos es del 32% en las parejas más ricas y de apenas el 12% entre las parejas pobres, y en el estado indio de Meghalaya, el 36% de las parejas que quiere practicar la planificación familiar carece de acceso a métodos anticonceptivos eficaces.

Maya’s second birthday: Celebrating strong health systems

Cristian Baeza's picture

We’ve got something to smile about this week at the World Bank: Our baby Maya, who has shown us the importance of having a strong health system and access to quality maternal and child health care, has reached her second birthday!

 

To mark this special occasion, we’re launching a new video about the things that helped Maya achieve this milestone, including access to family planning and proper nutrition. These are two key services provided by well-functioning health systems that create healthy futures for mothers and their children—along with other affordable services, trained health workers, clean water, vaccines, well-equipped clinics, and many other moving parts.

 

The video—the second in a series that began with Maya’s birth—comes as the global health community holds a summit on family planning this week in London. I hope Maya’s story underscores what a difference access to effective family planning can make. By giving women the means to space the births of their children by three years, for example, deaths of children under-five would decrease by 35%.

Family planning in South Asia: Improving equity of access

Julie McLaughlin's picture

On July 11, World Population Day, while global health leaders  meet in London to discuss giving greater priority to family planning, World Bank health staff in South Asia will be thinking about how to more effectively support women and families in this region to space births and avoid unwanted pregnancies. 

 

While the countries of South Asia have made progress in increasing access to modern family planning, and reducing total fertility rates, the region still accounts for the second highest burden of maternal deaths. Poor, marginalized and uneducated households do not have access to the reproductive health services they need, including family planning.

 

In India, Nepal and Pakistan in particular, the differences in fertility and use of contraception across socioeconomic groups are striking: In India, the fertility rate among the wealthiest part of the population is only 1.8, while it remains 3.9 among the poorest. In Nepal, educated women have on average 1.9 children while the least educated have an average of 3.7.In Pakistan, contraceptive prevalence is 32% among wealthier couples and yet only 12% among poor couples. In the Indian state of Meghalaya, 36% of couples who want to practice family planning lack access to effective contraception.

U.S. health reform – The cartoon version

Owen Smith's picture

Health Care Reform, by Jonathan GruberIn a landmark decision, the U.S. Supreme Court today upheld the main provisions of President Obama’s Affordable Care Act, including the individual mandate (i.e., everyone must buy health insurance). It represents a major step towards universal coverage for health care in the U.S., something that many countries around the world are striving to achieve.

For those interested in gaining a better understanding of this complex legislation, you can do no better than to start with a graphic novel about the law written by Jonathan Gruber, a professor at MIT and one of the main architects of the Affordable Care Act (and, for that matter, of the Massachusetts health reform that it closely resembles). It’s a great introduction to the policy issues surrounding market failure in health insurance, without having to wade through a dry textbook or World Bank report.

South Asia's nutrition marketplace

Julie McLaughlin's picture

Malnutrition in South Asia is the worst in the world (yes, worse than that of sub-Saharan Africa). It undermines the efforts of countries to reduce poverty, increase educational attainment and productivity, expand innovation and entrepreneurship, and reduce maternal and child mortality. It’s also why, for the past two years, 21 organizations from India, Nepal, Afghanistan, Pakistan, Sri Lanka and Bangladesh have implemented community-based innovations for improving infant and young child nutrition, financed by a unique World Bank small grants initiative known as the Development Marketplace.

Intersectoral work for health: Mirage or oasis?

Patricio V. Marquez's picture

It is common to hear officials from countries and international agencies talk about the multiple challenges that impede intersectoral work for health. The concern is valid: while ministries of health and related institutions are organized and funded to improve the “health” of the population, other ministries do not have such a mandate. In most cases, this has led to a certain paralysis characterized by lofty aspirations in the health sector about the potential benefits of intersectoral action, but with little collaboration and action involving other sectors.

Survie de l’enfant: Un impératif des systèmes de santé

Cristian Baeza's picture


La semaine dernière, l’Inde, l’Éthiopie et les États-Unis organisés un Sommet pour des actions concrètes en faveur de la survie de l’enfant, avec la participation de représentants venus du monde entier. Cet événement est à la fois opportun et fondamental : l’enjeu est de renforcer davantage les engagements pris sur le plan national et international ainsi que la responsabilité des pays dans la réalisation du quatrième objectif du Millénaire pour le développement (OMD), qui vise à réduire la mortalité infantile. Si de nombreux progrès ont été accomplis dans ce domaine, il est des pays qui risquent de ne pas remplir cet objectif à l'horizon 2015 et qui ont le plus besoin de notre soutien et de notre coopération.

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