‘We have succeeded in putting in place an efficient and high-quality health monitoring system’

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Five questions to Etienne Mugisho
Expert of the ‘Support project to Burundi’s national health information system’

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What does the programme you work for exactly consist of?

The programme, which started in 2012, had two main objectives. On the one hand, putting in place a digital health data collection and processing system for Burundi’s healthcare entities in order to have reliable and relevant data on the health situation in the country. On the other hand, digitising healthcare processes in hospitals.

Before, medical information was recorded manually in registers, if it was registered at all. And so there were errors and gaps. Also there were budget-related issues because the healthcare entities had to invest in these registers with their own means. Every month a report had to be forwarded to the capital, where health information was further processed manually. By computerising and automating these processes the data have become more reliable and more readily available.
How many entities have been involved in this? 

Health care in Burundi uses a two-line system. In the first line you have the health centres, which is where patients should in principle go when they have a health problem. Depending on the diagnosis the health centre may refer a patient to the hospital it falls under. Currently, there are approximately 60 hospitals and 960 health centres throughout the country. All of these have tablets and computers.

But there is more: In Burundi, like in many other sub-Saharan countries, electricity distribution is subject to rolling blackouts and outages. For the system to be efficient, a solution had to be found to supply electricity non-stop. Rather than investing in generators, we chose for solar panels. All healthcare entities now have a source of energy; the ones we have digitised dispose of solar panel kits providing electricity for a server and a set of computers and tablets.
"Now, Burundi’s health authorities dispose of real-time comprehensive and reliable data about the nation’s health situation."
Quite a logistical challenge?

Indeed, be we could rely on external service delivery to install all of this. Actually, I believe that the hardest part was not delivering the needed equipment but rather making sure that the new system would get adopted. Changing habits is always a challenge. Also, because at the same time this approach helped digitise a set of core processes.

I must admit that I expected strong resistance of doctors against the new system because such resistance had been noticed in other countries where the same was done. But in Burundi this was rarely so. On the contrary, many doctors were thrilled. With these new tools they can consult the complete digital medical file of each patient, instead of having to search through scattered documents. It greatly facilitates their work and so they mostly were among the strongest advocates of change.
This year is the year of project completion. What results have been obtained?

Now, Burundi’s health authorities dispose of real-time comprehensive and reliable data about the nation’s health situation. It is a precious means and helps coordinate the organisation of health care in the country. On the one hand, needs can be assessed more accurately since we dispose of data on diseases treated. On the other hand, we can also compare data of different entities and identify areas where the population is more reluctant to visit a health centre, for instance. It can help find underlying reasons for such gaps and remedy these. 

Furthermore, the Burundi authorities can more effectively fight epidemics. The health information system does indeed allow for permanent monitoring of some potentially epidemic diseases, such as cholera, yellow fever and Ebola.

If a patient visits a health centre or a hospital and shows symptoms of one of these diseases, the health authorities are notified almost in real time so they can take timely and appropriate measures to stem a potential outbreak. Finally, the system is also valuable for prevention: We dispose of accurate statistics on children in Burundi below 5 in a vaccination programmes or of pregnant women attending antenatal care and/or delivering with medical assistance.
How can you make the system sustainable?

We have asked this question from the onset of the programme. One of the answers is ‘self-financing’. We noticed that digitisation allows healthcare entities to improve their cost tracking and billing practices. So, we convinced managers to put aside a part of the extra revenue generated and constitute a provision for maintaining and replacing equipment. But that is not enough yet.

Fortunately, the European Union has launched a call for projects under a 3-year programme promoting resilience of the Burundi population by strengthening good practices such as this digitisation project. Enabel has responded to that call and has been selected. So we can further consolidate this initiative.

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