18 December 2012

Zambia: Smart-Care to Improve Health Record Keeping

LONG queues and missing medical files at health centres have for a long time hindered continuity of health -care for under-five children and pregnant women.

However, the recent training of health staff in Smart-Care by Alliance for Community Action on HIV and AIDS in Zambia is set to reduce time spent by those seeking attention at health centres and also improve storage of patients' medical information.

The four-day intensive training held in Lusaka for the nine participants from Mungule and Chaisa health centres was intended to build capacity in Smart-Care in the two facilities.

Smart-Care is an electronic health record system which stores client (patient) information on a computer, as well as a smart card, and easily produces reports at facility, district, provincial or national levels.

Because clients keep a copy of their own records on a smart card, complete medical information is always with them, allowing continuity of care even when they travel to different parts of Zambia.

The card allows doctors to see the type of treatment being offered or that was offered in the past, without necessarily relying on the patient's verbal information.

The training conducted by facilitators from the Ministry of Health who also provided computers, started with a test to investigate the participants' knowledge on the system and was followed by in-depth training from the basics of how to turn on the computer and access Smart-Care, upto how to enter client's information and most importantly, storage of the content.

For the duration of the training, each participant had access to their own Smart-Care training computer to allow them have hands-on experience while the teaching progressed.

Although during the first two days, some of the participants struggled to manoeuvre their way in the system, by day four, each was able to operate the computer and get into Smart-Care with minimal guidance.

In order to have the patient's complete medical history, Smart-Care has been installed with specific questions, depending on the service being provided, be it on Family Planning, HIV and AIDS, Prevention of Mother to Child Transmission (PMCT), Ante-natal, Under-five etc.

The system has strict security, what you can do in the Smart-Care depends on your job, and your level of privileges. For example, a registration clerk will only be able to register clients, while a doctor, nurse or clinical officer will be able to enter a client's medical information. A pharmacist will be able to enter drug dispensations.

Alliance Zambia executive director Jillian Johanssen who joined the participants for a session, admired Smart-Care's sophistication and accuracy in ensuring that every bit of the patients medical information was put on record.

And Shupe Makashinyi, the organisation's programme manager said," We applaud Government's efforts in their development of a national health electronic record system, which will go a long way in serving lives. The efficiency that the Smart-Care will bring cannot be emphasised."

She said Alliance Zambia was grateful for its partnership with the Ministry of Health and that of Mungule and Chaisa health centres and also thanked the donors, Save the Children Sweden for their commitment to helping Alliance Zambia achieve effective service delivery in communities and facilities.

To the participants, Mrs Makashinyi had these words, "You will be partners that will be playing multiple roles. You are up here, learning new skills and you will go back and effect them. You will also be our champions to help us advocate Smart-Care.

"Part of Alliance Zambia's work is to do advocacy, to speak for the voiceless. We expect you to speak with us on behalf of the people, to create demand. Our role as well as yours is to comfort people, to assure them that things are changing at our facilities, that things are better. The baby and that child are our focus. Assure them that they don't have to wait in the queue for a long time anymore."she said.

Alliance Zambia with support from Save the Children Sweden is running A Concern for All: Maternal and Child Health Interventions Towards 2015.

The project located in rural areas of Chibombo and highly populated peri-urban Mandevu area in Central and Lusaka provinces, respectively, and is accelerating Millennium Development Goals 4 and 5; to reduce mortality and morbidity rates for children under-five years old in Zambia by 2014 by two thirds, and to promote safe motherhood, improve maternal health in Zambia by 2014 and reduce maternal mortality by three quarters.

For the participants, who are part of a small workforce at the two health centres, once put into place, Smart-Care will reduce on time spent searching for a patient's file among thousands in the registry.

As one participant explained, "Our record keeping at the clinic is quiet tiring and cumbersome. We issue cards to clients after recording the information in a book. We file the book, while the client goes with the card. When the client comes for the next visit, they line-up and issue us with their cards. We have to go to the registry, and look for the books.

"But our registry is filled with so many books to an extent that sometimes we fail to find the books. In that case, we advise the client to buy another book, unfortunately when this happens, the client's information is lost and there is no continuity of services. With this new system, books will no longer be used. Probably our registry can be used for other things and our clients will be attended to more quickly because we shall spend less time looking for books."

She explained that sometimes patients, who include pregnant women and mothers with under-five children, spend the entire day at health institutions, waiting to be attended to because nurses at the centre have to attend to people in the Out Patient Department (OPD) first.

For others, Smart-Care will also ease time spent writing monthly reports.

"The programme itself is a nice tool to help us run reports as when required. Current situation is that reports are done on paper and it consumes a lot of time considering we are understaffed and have patients waiting, while we do the reports with Smart-Care, its instant command," noted another participant.

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