Evaluating the impact of a digital hospital information management system on the operational and financial performance of health facilities in Kenya

Background: In Sub-Saharan Africa, hospital information management systems (HIMS) are predominantly paper based. Countries like Kenya are adopting digital HIMS. However, there is limited evidence about their impact. This study aimed to evaluate the impact of a digital HIMS on the operational and financial performance of Kenyan health facilities. Methods: A retrospective analysis was done using longitudinal data collected at 21 health facilities in Kenya that had actively used the outpatient and/or billing modules of the Elephant HIMS (EHIMS) for at least 9 months. Trends of operational and financial performance indicators across months 3,6,9 after EHIMS adoption were compared to pre-adoption baseline values. The Wilcoxon test was performed to determine the statistical significance of the difference between baseline and 9 months post-adoption. Results: The EHIMS had positive impact on operational performance evidenced by statistically significant reduction, between baseline and 9 months after adoption, in monthly waiting (43.55 vs 35.79 minutes) and journey times (59.90 vs 60.34 minutes). Positive impact was also observed on financial performance as shown by an increase in recorded monthly revenue (100000 vs 210000 KES) and improved tracking of unpaid revenue (0.57 vs 1.19). The above changes were associated with and not directly caused by the EHIMS. Conclusion: The EHIMS was found to have a positive impact on the performance of health facilities at the time points analysed in this study. To demonstrate the full impact of digital HIMS and for clearer attribution, further research should be done to analyse the confounding factors that affect health facility performance

The feasibility of novel point-of-care diagnostics for febrile illnesses at health centres in Southeast Asia: a mixed-methods study

Background The decline of malaria in Southeast Asia means other causes of fever are increasingly relevant, but often undiagnosed. The objective of this study was to assess the feasibility of point-of-care tests to diagnose acute febrile illnesses in primary care settings. Methods A mixed-methods study was conducted at nine rural health centres in western Cambodia. Workshops introduced health workers to the STANDARD(TM) Q Dengue Duo, STANDARD(TM) Q Malaria/CRP Duo and a multiplex biosensor detecting antibodies and/or antigens of eight pathogens. Sixteen structured observation checklists assessed users’ performances and nine focus group discussions explored their opinions. Results All three point-of-care tests were performed well under assessment, but sample collection was difficult for the dengue test. Respondents expressed that the diagnostics were useful and could be integrated into routine clinical care, but were not as convenient to perform as standard malaria rapid tests. Health workers recommended that the most valued point-of-care tests would directly inform clinical management (e.g. a decision to refer a patient or to provide/withhold antibiotics). Conclusions Deployment of new point-of-care tests to health centres could be feasible and acceptable if they are user-friendly, selected for locally circulating pathogens and are accompanied by disease-specific education and simple management algorithms