Groundwork Toolkit: The benefits of point-of-care technology in low resource settings

What are the key issues, costs and benefits of point-of-care electronic data systems in low resource settings?
A case study using the example Baobab Health’s technology for ART clinics in Malawi

Reflecting on the value of data in health care delivery, Ellen Tompsett, one of four MIT Sloan students working in Malawi in 2009 on a Global Health Delivery Lab project, observes:

The staff average roughly 4 hours at a clinic with approximately 1500 patients.  If you can imagine a clinic with over 10,000 patients, the task seems quite daunting and much more time intensive.  It is easy to see how data irregularities can occur.  We were told by an MOH official that one 2006 audit (we were unable to locate a copy of it) showed a 10% difference between the numbers found by the MOH and those reported by the clinics.  In other words, there was a 10% difference in the numbers compiled by the clinic staff in preparation for supervision visits, and the numbers compiled by the supervision team.  In a country like Malawi that purchases $15M of ARVs per year, 10% amounts to a discrepancy of $1.5M.

The Global Health Delivery Lab is a graduate-level class at MIT that pairs teams of graduate students with partner enterprises delivering health care in resource-limited settings in Sub-Saharan Africa and elsewhere. Part of MIT Sloan’s flagship Action Learning program, the course puts students to work on practical challenges that limit access of health care, addressing specific business and organizational needs.

The following study, conducted by the four student team from MIT Sloan, analyzes the application of point‐of‐care (POC) healthcare technology in the developing world by comparing the point‐of‐care concept with both manual (non‐EDS systems) and back‐entry EDS. Point‐of‐care electronic data systems promise to improve the delivery of anti‐retroviral therapy in Malawi in many ways that back‐entry systems and paper processes cannot. The report examines the key issues point‐of‐care EDS addresses, and the costs and benefits of the technology using Baobab Health anti‐retroviral therapy system (BART) as an example. It begins with an overview of Malawi’s healthcare situation and proceeds to analyze the costs and benefits, deployment success factors, and other considerations associated with deployment point‐of‐care technologies.

The study highlights a number of issues that can be addressed by a point‐of‐care EDS:

  • Patient Management – Clinics face a burgeoning volume of paperwork associated with managing thousands of patient records, which are often missing or incomplete.
  • Quality of Care – Nurses make several complex calculations and decisions during each roughly four‐minute ART visit. These include staging, adherence, dosage, and body mass index determination.
  • Data Collection – The Malawi MOH conducts quarterly supervision visits to each ART clinic in the country. Data is collected manually, subjecting it to errors and inaccuracies.
  • Logistics and Planning – The MOH purchases $15 million worth of ARVs each year. There is a high human cost to understocking of drugs, and also measurable costs associated with overstocking, including transportation costs of redistributing drugs and disposal costs.

Download the full Case Study on PointofCare Electronic Data Systems for ART Clinics in Malawi (pdf).

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