Developing Health Information Systems in Developing Countries

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Developing Health Information Systems in Developing Countries.
Ibrahim I. Banat1, Bara’ah M. Al-Hrut2, and Yazeed f. Al-Ma’aitah3, 1 Computer science, Al-Hussein Bin Talal, Ma’an-Jordan. 2 Software engineering, Al-Hussein Bin Talal, Ma’an-Jordan. 3 Software engineering, Al-Hussein Bin Talal, Ma’an-Jordan.
The development of appropriate integrated and scalable information systems in the health sector in developing countries has been difficult to achieve, and is likely to remain elusive in the face of continued fragmented funding of health programs, particularly related to the HIV/AIDS epidemic. In this article we summarized some information about developing systems, so that the health sector's systems get standardized to strategy of those complex systems used in modern countries, in order to make them work more efficiently to improve services and information gathering, retrieving, and analyzing discussing challenges and providing some useful strategies. The article provides theoretical concepts to support standardization processes in complex systems, and to suggest an approach to implement health standards in developing country settings that is sensitive to the local context, allows change to occur through small steps, and provides a mechanism for scaling information systems.

Keyword: health information, Developing Health information Systems, Developing Countries.

I. INTRODUCTION: his article addresses the issue of strategies for developing information infrastructure standards in general and for the development of information systems support for the health care sector in developing countries in particular. We identify complexity as the main source of the challenges that such strategies need to address and propose the concept of flexible standards as a key element in a sustainable infrastructure development strategy. The article contributes theoretical concepts to support standardization processes in complex systems, and suggests that the complexity of a standard is determined by its constituting actor network. We describe an approach to development and implementation of health standards in developing country settings that is both sensitive to the local context and scalable across geographic and programmatic areas. Poor health status, rampant diseases such as HIV/AIDS, and inadequate health services are seriously hampering human, social, and economic development in developing countries [4]. Appropriate health information systems (HIS) are seen as crucial in this respect. On the ground,


however, HIS development in developing countries has proved to be difficult due to organizational complexity, fragmented and uncoordinated organizational structures all maintaining their own HIS, unrealistic ambitions, and more generally due to the problem of sustainability[6]. The health care sector in a country consists of a large number of institutions ranging from small and simple health care centers up to large and technologically advanced hospitals. We have summarized proposals to make concrete guidelines for HIS standardization. Will talk about Methodology on how to collect data and get it and how to study by the members of this group on the development of health in Jordan and some developing countries such as South Africa and Thailand. but in the case study will be talking about the data that was collected and the results have been obtained through a questionnaire distributed to the citizens and staff in both the private and public institutions and health centers, hospitals and the development of the health system in South Africa and Thailand.

The discussions will be displayed Targets of this report and we put the difficulties in establishing this report. As in appendix we will develop models of the questionnaire carried out by the group to gather information on health development in Jordan. We will be presenting some results from some countries such as South Africa, and Thailand. 1. Jordan: Questionnaire focused on the health system in Jordan and the questions contained about material respects) the equipment and technological development and the entrance of buildings and site) and moral) relationship with other staff members and their relationship to patients and visitors) to the health system. The questionnaire was divided into two parts department put on a class of beneficiaries of the health system, and the other part put on staff) nurses, doctors .....). The results were negative, where dissatisfaction with the health system in Jordan, especially in the public sector had been preferred to the majority of staff going out to work outside the country and preferred beneficiaries to receive the service in the private sector where services are better in terms of the rules of hygiene and respect.... and other preference to the private sector at the government: A. Analysis of talking back: About 99% see that the economic situations effect on the medical system badly. About 80% prefer receiving medical services in private hospital or clinics. About 80% suffer from lack of medicine availability. About 75% from doctors see that the services in public sector is the best and the salaries good rather than private sector (some of staff in private sector indicated to this points) About 99% see that the private sector very organized more than public sector in medical system and in criterions of cleanliness. About 99% see that the increasing of population effects on the medical system negatively 80% see that the medical centers in Jordan have technology and improve it but slowly 89% indicates to absence of ministry censorship and inspecting 70% the staff and health system not officinal to sudden diseases (the staff in private center

II. METHODOLOGY: We find here in this article some results that were collected by group members in a questionnaire at the level of health in Jordan, to study and evaluate health information systems. The impact of these perspectives on cohesion and participation and approach after the development of health systems in Jordan, this article is to discuss. The objective of this research is the work of bringing forth knowledge through participation in planning, implementation and analysis of the results report the case of other contributions, and will present some results on the development of the health system in South Africa and Thailand. A. Ontological Basis for the Study and Data Collection Methods: Based on this study to collect information and study and analysis of the rates of development in these results through a questionnaire distributed to the citizens and employees who work in the public sector and private institutions and private companies, health centers and hospitals. Either by South Africa and Thailand has made some researchers in studies about the system health in these countries and the sources of health centers, hospitals and the Ministry of Health [3]. III. CASE STUDY: This case study focuses on the development of the health system in Jordan, where the information was collected from a large number of community groups and citizens, staff and doctors were collected to measure the results of health development in Jordan.

said “all of new cases of new diseases export to public hospital and centers) 95% no collaboration between medical centers together, or between medical centers and research centers. a. Reasons of slackening health developing: There are a lot of factors that effect on health developing badly, economical factors, cultural factors and organizational factors. 1. Economic factors: economic situation that country suffers from, such as nationalist revenue not enough to support health developing systems, and there are a lot of projects that wait the material supporting from government, that is about governmental sector. At ad hoc sector the investor enters external enterprises not in the country because of high revenue in other countries, so this sector does not have enough support too. 2. Organizational factors: * Lack of organization and management in the medical centers especially relationship between employees and managers. * The absence of equality and this will cause troubles, and we mean equality in salaries, furlough, recompenses, bonus, departures …..Etc. * Lack of security in medical centers. So this always causes psychological troubles to the staff. * Absence of intendancy on the staff work, systems and resources of center. * Lack of collaboration between medical center and another centers in all medical scopes. 3. Cultural and educational factors: (That is including employees and populations), [Figure 1]. * The graduators of universities abroad come to us with low level in some cases because their universities focus on revenue rather than education. That is clear with the repeated medical mistakes. * lack of workshops that offered for the clinical staff inside the country or abroad which make the staff keep in touch with all innovations in the Medicine field and medical revolution that the world live rapidly, so lack of knowledge of the innovations cause decrease in the level of doctors-nurses. * shortage of healthy awareness among people and lack of care in the general health principles this cause bad effect on the performance of the medical centers , because the more carelessness means more diseases ,and the increase of sickness cases cause the increase of pressure on center which can't assimilate the big amount of the cases come , which cause the disturbance of these centers and it's staff , accordingly that cause medical mistakes that indicates that health systems developing doesn’t go on in a good case . * Absence of code of ethics in some medical centers, so this effects negatively on the services. At last, we must not ignore the psychological case for the medical staff, where the work pressures, long work hours, short breaks and low salaries, all of these elements cause imbalanced psychological case for the staff. So that affects (The employee's work badly.) [Figure 2]. b. Propositions that may help to solve health systems problems: The economic problems are government specialty , but we can help by rationalization in resources using, and attracting investments to country. c. About organizational problems the following propositions may help: 1. The equality in division of labor helps employees to work in calm and satisfying environment. 2. Increment of salaries of employees and giving bonus will encourage staff to work with high morale then the healthy aim will fulfill. 3. Enhancing security in all different medical centers this will make the medical work and environment very secure and intact. 4. Adsorbing intendancy on staff and other resources in health centers. 5. Change old staff with new continuously this is about organizational problems now about cultural and educational problems its can solved by: a. Adsorbing workshops for the staff in medical centers.

b. Altering curricula in the universities and colleges and institutes to convoy developing and changing in health scopes. c.Encourage collaboration between health centers in country, and between health centers and the educational sector. d. Sending medical expeditions out the country to countries which have high tech in health such as Britain. e.Issuing medical encyclicals that help people to have good health culture, and enhancing health awakening among people . 2. South Africa: Created in South Africa after the end of the apartheid regime was attractive (to collect data and a series of programs DHIS and analysis of data) in response to the need for integration and equality. Manager for the first time that access to useful information and present [2]. The success of this and drew a larger number of people and the provinces and health care programs. Investing addition to developing the technical parts of the infrastructure, and large investment in training of health workers in the large-scale health care facilities in 4000 in the nine provinces. This has contributed to the development and acceptance criteria and the creation of attractors. Over time, and how the development and standards (e.g. minimum data sets) can be modified and expanded, with the changing demand [1]. The new set of criteria, with the emergence of the various requirements for the provision of information. During this process increases the complexity of the system of standards and the kind of words in use, and access to infrastructure is changing to improve. To adapt to the system makes it easy to implement, since it depends on the current practice, while the flexibility to accommodate the behavior of the transition. These practices are entirely different practices under the apartheid regime used, which was bureaucratic and centralized, and inflexible. Have the changes in the standards of the recorded data is possible because the individual criteria, flexible and easy to correct. They were in the sense that the minor technical changes that easy to do. Equally important, because each was a simple organizational and limited in scope and functional, as each player free to this extent is not by increasing the standard of their own as the additional data on the hierarchy of the rules allowed. Participated limited conflict. The other criterions were limited to a restricted area and therefore limit the number of players that some changes had to be. Order with a variety of areas related to standards and increased selfexperience and the speed of learning and improving the infrastructure of the increased public information and health care [5]. We believe that the experiences from South Africa, best practices, as an attempt to adopt another. But do all countries, this is not a trivial matter. For example, known, proven, as in the past by many researchers complex social systems and technical standards and generally strong inertia. According to Hughes (1987), the price of the unique circumstances existing only in severe crises or external shocks to change.The change of regime in South Africa such a unique circumstance [2]. 3. Thailand: Thailand (population of 64 million people, divided into 75 provinces, 795 Districts) Thailand uses HIS and uses an extensive ICT infrastructure, Individual patients Data is captured by electronic means in most health amenities, and typical datasets are submitted to the central level, from where feedback of the health services is easily reached by using the web ( The system results was very clear, the system work positively, example: the HIV/AIDS cases decreased from 4% in 1990 to 1.3 % in 2004 in 2001 universal coverage scheme indicates to improve excellence of data to change decentralized distribution of funds system depend on capitation costs for health system promotion and for costs for Patient care. The National Health Insurance Scheme (NHSO) has established (CUPs)) a system of Contracting Units ) in each region consisting of a hospital and their network of clinics , which are then paid for the services they are depiction according to the data submitted , The CUPs are provided with ICT network access and computers as part of their payment. The system identified Two sets of standard national data , one come to cover community services and including immunization, family

planning, disease surveillance, the other is covering hospital services (inpatients, outpatients, patient payment) , sub data sets are specified to be sent to the national level by email health facilities use software applications for the primary capture of report electronically to the CUPs using Internet or USB memory sticks.Feedback from the central level is webbased. Interchange of information between local and central levels is increasingly robust and scaleable, the provinces are free to collect and process the additional information and it's free to use any application of software we need (software applications have been developed). Infrastructure and socio-economic situation be different between provinces, and between cities, while freedoms for local innovation enable higher provinces to develop solutions according to their possibility. The first version of the standard and the infrastructure was built in order to solve one very specific problem – the model for financing the health services, the infrastructure and standards have been extended and modified – it has evolved as a Complex Adaptive System, [3]. IV. DISCUSSIONS: The members of the group offered many suggestions for an evolutionary health system in developing countries and Jordan, but it would be supported development projects in developing countries in terms of providing financial aid to developing countries in order to improve the level of health is either for Jordan computerization of health systems to get rid of the burden faced by staff. Either by what they encountered difficulties in the work of this report is that we did not find only one reference speaks on the subject of development the health information system in developing countries, we have conducted a questionnaire on the level of health in Jordan, where the distribution of papers questionnaire to the citizens and employees in the public and private institutions and centers health and hospitals, then leaves the questionnaire were studied where we got the results have been presented previously in the case study.


Figure 1


Figure 2

Bulletin of the World Health Organisation (83), 2005, pp. 632-639. 6. UN. United Nations Millennium Development Goals Declaration, United Nations General Assembly, New York, September 2000.

1. Braa, J., and Hedberg, C. “The Struggle for District Based Health Information Systems in South Africa,” The Information Society MIS Quarterly (28:3), 2004, pp. 337-362. 2. Day, C., and Gray, A. “Health and Related Indicators,” in South African Health Review 2005, P. Ijumba and P. Barron (eds.), Health Systems Trust, Durban, South Africa, 2005.
3. J.Braa, W. Mohammed, O.Hanseth, V.Shaw, and A.Heywood,”DEVELOPING HEALTH INFORMATION SYSTEMS IN DEVELOPING COUNTRIES.” MIS Quarterly Vol 31 Special Issue/August 2007.

Ibrahim Ismail Banat was born in Zarqa, Jordan, in 1991. He is studying computer science in Al-Hussein Bin Talal University, in Ma’an, Jordan and he lives in Zarqa, Jordan. Bara’ah Mohammad Al-Hrout was born in Madaba, Jordan, in 1987. She is studying software engineering in Al-Hussein Bin Talal University, in Ma’an, Jordan and she lives in Madaba, Jordan. Yazeed Fayez Al-Ma’aitah was born in Zarqa, Jordan, in 1983. He worked in armed force in 2003-now, in 2004 he was studied Information Technology in Technical Prince Faisal Collage, in 2006 graduated from that collage, in 2009 he is studying software engineering in Al-Hussein Bin Talal University in Ma’an, Jordan and he lives in Zarqa, Jordan.

4. Sahay, S., and Walsham, G. “Scaling of Health Information Systems in India: Challenges and Approaches,” in Enhancing Human Resource Development through ICT. Proceedings of the IFIP 9.4 on Enhancing Human Resource Development through ICT, A. O. Bada and A. Okanoye (eds.), Abuja, Nigeria, May 26- 28, 2005, pp. 41-52. 5. Shaw, V. “Health Information System Reform in South Africa: Developing an Essential Data Set,”

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