Imagine the case of Julio: A young father in a low-income country who has just been told his wife and baby are dead. He hears what the physician is saying but can’t believe it. He had been assured that his wife would be OK. He accompanied her on prenatal visits as he was told to do, so how could this have happened?
When Julio returns home, he’ll only have money for the cheapest funeral. At the cemetery, they ask for his wife’s death certificate, but Julio has none. His brother-in-law was given a paper from a local nurse, which stated, “Cause of death: Unknown.” Now he faces the prospect of raising two children by himself.
As countries across the world move toward universal health coverage, many interventions can be expanded to save lives, but, for many, one critical factor remains elusive: An information network linking providers, patients, the health system, and the identity of each individual. This kind of system helps patients navigate the health care system efficiently and avoid unnecessary complications.
Although patient data are frequently recorded, the greatest challenge is how to leverage modern technologies to use selectively collected data to enhance administrative and vital statistic systems. The good news is that the right technologies are available. Mobile phones and cheaper tablets connected to the Internet seem to hold promise, but why is it that these tools aren’t moving at the speed needed?
Last month, Toomas Hendrik Ilves, President of Estonia, spoke at the World Bank, not on the nitty-gritty or technical aspects of what information systems have been delivering in his country, but on the overall framework within which the puzzle of information works smoothly, particularly as it relates to the health sector.
At the core of Estonia’s digital systems governance lays the concept of avoiding costly centralization of information based on hardware. Instead, public sector authorities are exploring how to create virtual databases by linking existing systems using a unique identifier, which in the case of Estonia was done through a digital signature. The digital information system links all databases, generating a single entry point where the information is accessible to individual citizens, from clinical files to pension accounts. The government of Estonia has created an open-source and fully interoperable system that facilitates communication among the many local and national government institutions with which citizens interact.
This process centers on selective and progressive integration of various pieces of information that are dispersed in many formats and mediums. What’s needed is an approach that does not look at bits and pieces of an e-government policy, or vertical health programs, but one that can yield more comprehensive and longer-lasting results while strengthening country systems.
If, at the moment when Julio’s wife’s information was collected, her sex, age, and health condition or diagnosis could have been entered into a mobile phone or a tablet, her information could have helped health care managers identify the data as part of a set of women with risky pregnancies. Julio’s wife and other mothers could have been monitored and triaged to the nearest hospital, allowing emergency care providers enough time to treat the patient before she arrived at hospital with a full set of complications.
Instead of focusing on the hype that often surrounds new digital technologies, it is helpful to consider e-Health technology as a comprehensive, strategic approach to governance and virtual integration of databases that may deliver better results for the poor. Linking databases of selective information could generate unique identifiers of mothers and unborn or stillborn babies so their health conditions can be monitored, and final outcomes improved. Moreover, digital information can be used for what in health financing is known as “morbidity risk adjustment.” Health managers could allocate resources more equitably, based on capitation and the specific epidemiologic profiles that emerge from these types of databases (more on this in my next blog).
Other benefits of using a more holistic approach to citizens’ information include linking household and individual conditional cash transfers, non-contributory pension benefits and many safety nets programs.
At the World Bank, colleagues in the health and social protection sectors, as well as in IT, are exchanging ideas and exploring options to use these innovative approaches to enhance the value of development assistance and investments in IT. I believe that developing a comprehensive, multisectoral governance and policy approach can be a way to overcome obstacles that have mired fragmented IT projects in the past.
The ultimate goal, of course, is to improve service to our client countries, so that delivery of health and other social programs can be improved through monitoring, and we can make sound decisions based on what happens to families like Julio’s − who are the poor of the world − in real time.
E-Estonia: The Making of an Information Age Society
Global Civil Registration and Vital Statistics Scaling Up Investment Plan
World Bank and Health