LIN has learned that digital systems alone are not the solution to problems that may exist at the health system level. It is a long collaborative process insystem strengthening working across sectors.
The trajectory of Luke International (LIN)’s work in Malawi closely follows the development of the Electronic Medical Records Systems (EMRS) in the country. The EMRS manage digital versions of a patient’s medical record. For more than 13 years, LIN’s technical and operational staff have been involved in the design, installation and maintenance of these systems.
Since 2019, LIN has been working with the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) to implement and support point of care (POC) EMRS and electronic registers in central and northern Malawi. Jointly, the organizations support the systems in more than 700 health facilities across the country. EGPAF is the prime recipient for the Health Information System (HIS) project funded by the United States Centers for Disease Control (US CDC). In the five-year period, major investments will be made in replacing and upgrading hardware, power backup and connectivity at high-burden health facilities.
LIN brings to the table combined expertise in medical informatics and public health. Many of LIN’s health information system officers have joined with prior experience working in HIV clinics and health facilities. LIN’s Malawi Country Representative, Rebecca Mtegha, was the first Malawian employee to join when the organization started its work in 2008. She started her career working with the Taiwan Medical Mission that supported operations of Rainbow Clinic, the antiretroviral therapy (ART) clinic at Mzuzu Central Hospital. With the growing number of patients requiring life-time follow up, the team saw the need to move from paper records to a computer system. TESMART, a touch-screen enabled system, was subsequently born.
Joseph Wu, LIN’s first Country Representative in Malawi from 2008, recalls the days when they first sat down together with the clinic staff to go through processes and clinical workflows. One of the reasons why the system was well accepted was that it was developed together with the users. With full support from the hospital director, the system was implemented and adopted within less than a year. With funding from the US CDC, LIN was able to deploy the system in additional health facilities in Mzuzu, Rumphi and Nkhatabay.
At the time, qualified computer engineers were scarce, especially in the northern part of Malawi. The system was coded mostly by programmers from Taiwan. This proved challenging once the programmers were no longer in country. A few data clerks with IT training were identified and trained to maintain and provide user support. Duke Ceasar, Temwanani Chinula and Francis Mafupa, were the first technical staff to come on board. Over the years, they continued to build expertise and technical skills, including completing further education in computer science, leading to adequate local capacity to customize and develop home-grown systems.
In 2010, LIN joined hand with Baobab Health Trust (BHT) and migrated the system to the now nationally implemented platform. As an organization, it was not an easy decision. However, LIN saw the bigger need for system harmonization and integration. As the National Electronic Medical Records System (NEMRS) began to take shape, the organizations were able to build on the foundation and explore different use cases. Notably, after the Ebola outbreak in West Africa, LIN and BHT assisted the Malawi government to build an electronic integrated disease surveillance and response (eIDSR) system. The eIDSR system was able to monitor disease diagnosis made from the EMRS and create alerts for notifiable diseases such as cholera.
With technical support from the Pingtung Christian Hospital (PTCH) and funding from TaiwanICDF, LIN introduced the Picture Archiving and Communications System (PACS) in Mzuzu Central Hospital and Rumphi District Hospital. This system is integrated with the NEMRS and enables digital X-Rays to be recorded, transmitted and viewed. The hospitals became the first in the country to completely migrate from the analogue to digital system. (Find out more from the interview with Mzuzu Central Hospital Radiographer Mr. John Manda).
What LIN has learned is that digital systems alone are not the solution to problems that may exist at the health system level. The digital interventions must accompany a long collaborative process in system strengthening working across sectors (including clinical, public health, ICT, logistics). LIN strongly believes that the ultimate goal of the EMRS is not to collect data or to make reports. The goal is to assist health services to deliver quality care to patients. Looking into the future, LIN envisions an EMRS that more closely mirrors the needs of healthcare providers that brings added benefits and incentives for the users.