How To Use Health Informatics To Improve Health Care In Kenyana

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1 Introduction/background Background Healthcare workers are the most vital asset of any health system. To ensure that they can deliver high quality levels of care, they need to be connected to updated system of learning that will up their knowledge, skills and information without disrupting their daily activities. In Kenya however, rural and neglected urban areas, health workers are mostly disconnected from such learning and educational opportunities and, aside from the treat to quality of care, this leads to lower levels of morale and commitment to their work. In response to these problems, Kenya is looking at continuing medical education (CME), to bridge the gap. This umbrella terms refers to all learning by healthcare providers, after basic training. it encompasses on job training or in service and post graduate learning by all trained health including doctors, nurses, midwives, community health workers,, public health staff etc. it is essentially a way to connect rural and neglected urban areas health workers to education and information thus enhancing their capacities and motivations. Some approaches to CME Over the years, various approaches to CME have been tried, including: Out of country training courses, In country training workshops, CME activities at place of work, CME activities at home and (Information and communication services that circulates information and ideas, making them available electronically, on paper or other forms. However, experiences from Kenya indicate that CME activities are falling behind and cannot keep up with the demand. Moreover, current paper and workshop based approaches are quite inefficient and costly, CME in Kenya are supported by big pharmaceutical companies which is not a sustainable approach 2.The CME are poorly coordinated, supply driven, and that the content of the information and learning provided is frequently not relevant to the diverse needs of today s rural health care workers. Finally, the motivations and incentives of the health workers to participate in CME efforts were queried. 1 P age

2 Health informatics Opportunities Few countries have a system of continuing medical educations. There is very little follow up or updating skills after initial training, there is a need to reclaim this skills for better delivery of services (Koech DK 3 ), recently trained providers usually have little access to experienced providers to call upon for consulting, reviewing cases, solving problems and reinforcing clinical decisions and diagnosis, that why staff reeducation and ongoing clinical training must be strongly emphasized to ensure high quality care and addresses the public health concern. Since year 2006, the government of Kenya through the ministry of communication developed a Kenya national ICT policy ( ) that included the strategic pan clearly outlining the areas of priorities. Based on the policy paper one of the component of this paper was universal communication access, the policy further explicitly underlined the importance of establishing the ICT center in the entire 210 constituency famously dubbed the digital villages. The government is on course of delivering this objective. In the recent past the mobile services have spread widely with 23 million Kenyans connected, while about 8 million have access to the internet. With the arrival of the communication platform, health informatics fellows can begin to examine many new opportunities to deliver CME using the available and sustainable health informatics approaches with consideration of the existing infrastructure. The reasons why the use of the health informatics will be effective and efficient approaches are as follows The Health informatics can make CME more efficient by reducing duplication, by enhancing coordination, and by facilitating collaboration and standardization. Health informatics can make CME more demand responsive by decentralizing content development and delivery and by empowering the health workers themselves to understand and influence efforts in this area. Third, health informatics can make CME more sustainable by reducing costs (of travel for instance), and by helping to scale up CME efforts to reach all health workers. Fourth, by making CME more attractive participants have argued that the incorporation of health informatics itself is a significant motivator for learners. 2 P age

3 Challenges in implementing web based CMEs Amidst all the positive ideas on the potential application of Health informatics to CME, several constraints and limitations are there. Health informatics can only make a difference to CME when certain conditions are met. The following are some of the constraints The core factors that influence the adoption and diffusion of ICTs in education have been Identified in many studies and project reports such as the UNESCO Meta survey on the Use of Technologies in Asia and the Pacific20 and, in the context of East Africa, by IDRC in its thorough analysis of ICT policy making in the region. 4 What emerges from these analyses is that the factors are essentially the same in both developed and developing economies, although they differ in terms of importance depending on which side of the digital divide they are viewed from. What differentiates the rate of adoption and diffusion is not a difference in the factors at play, but rather the degree to which they have been developed or are present in a given country. 3 P age

4 Critical Literature review on the use of Health informatics techniques in delivering the continuing medical education Health informatics can bring learning resources and information to the learners, instead of making the learners travel to the places of learning. This allows health workers to learn in their own workplace while, the facilitator can offer CMEs a t the comfort of their offices, by doing so the health workers will benefit from highly experienced and qualified expertise. Health informatics can also provide opportunities for interactive communication and networking. They also offer opportunities for health information to be generated locally to suit local situations, thus enhancing its relevance. Finally, they offer many opportunities to bring new information and ideas from around the world to the individual workplaces of even the most isolated heath workers. Health informatics has been used widely, in the most developed countries; the approaches have proved to work, in article written by Markova T, Roth LM 6 the department of family medicine at Wayne state university, while conducting the didactic conferences found it to be challenging for many program based on the fact that, residents were located in multiple sites and it was difficult for them to be at centralized point.. In order to overcome this barrier, they implemented distance learning and electronically delivered the conferences to the residents. The result were, E conferencing proved to be an effective method of delivering didactics in our residency program. Its many advantages included ease of use, cost efficiency, and wide availability of equipment. Residents had the advantage of both geographic and temporal independence. Our e conferences were interactive, and in addition to a PowerPoint presentation, faculty provided Web sites and hyperlinks for references. Initial problems included slow speed connection, the requirement for digital materials, and the need for residents and faculty to adjust to a new learning method. In an effort to evaluate learning outcomes in web based CMEs (Curran V, Lockyer J, Sargeant J, Fleet L) 7, noted that there has been a significant growth in use of webbased continuing medical, A number of evaluation and met review studies have examined the effectiveness of Web based CME to varying degrees. One of the main limitations of this literature has been the lack of systematic evaluation across 4 P age

5 different clinical subject matter areas using standardized Web based CME learning formats. One group of pretest posttest designs were used to evaluate knowledge and self reported confidence change across multiple Web based courses using a standardized instructional format but comprising distinct clinical subject matter. Participants also completed a participant satisfaction survey and a self reported retrospective skill/ability change survey. The result were, majority of courses evaluated demonstrated significant pre to post knowledge and confidence effect size change, as well as significant self reported retrospective practice change. In conclusion, a Web based CME instructional format comprising multimedia enhanced learning tutorials supplemented by asynchronous computer mediated conferencing for case based discussions was found to be effective in enhancing knowledge, confidence, and self reported practice change outcomes across a variety of clinical subject matter areas. Scope of the study current situation In a baseline study yet to be published, I conducted earlier last year on the view of health workers on the e learning the finding are as follows, to establish the acceptability of the e learning in central Kenya, it study covered all the health workers I.e. consultants(1%), MO(2%), Co(9%), medical student, pharmacist(4.3%), lab techs(10.3%), community health workers(3%), nutritionist(2.2%), nurses (38%) and so on, it was clearly that the 73.2% of the person had access to the computer. The confidence level on using the computer was noted as 25% High, 38.5% moderate and 14.6% lower. The health workers interviewed confirmed that <2hrs 43.5%, 2 4hrs and >4hrs had the access to computers at the said time points. 78.5% of the client were willing to use e based learning. Based on unpublished work of, (P.M. Ndavi,S. Ogola,P.M. Kizito,K. Johnson) 8, the following was noted. The DHMT survey assessed several components related to training activities of staff: elements of training, continuing medical education (CME), and courses attended in the previous 12 months. About 5 out of 10 districts had a training committee and 4 out of 10 had criteria for selecting staff for CME, skills update courses or seminars. An assessment of the scope of courses attended by district staff as components of CME reflects emphasis on the most pressing public health issues. The top three courses staff had attended in the previous 12 months 5 P age

6 were on prevention of mother to child transmission of HIV (PMTCT), malaria, and family planning, as reported by 90 percent, 77 percent, and 68 percent of the DHMTs respectively. Additional courses attended by staff were on Integrated Management of Childhood Illness (IMCI 54 percent), as well as infection prevention, essential obstetric care, and 18 management skills courses, each reported by 51 percent of DHMTs. Between 40 and 49 percent of DHMTs reported that staff had attended courses in focused antenatal care, post abortion care, and logistics management training. Least reported courses attended by staff in the districts were on decentralization, malaria in pregnancy, and postpartum care, cited by between 21 and 35 percent of the DHMTs. 8 The importance districts attach to continuing medical education (CME) is evidenced by the range of resources for district reproductive health and safe motherhood programs, which were available in close to 60 percent of the districts. The most available resources for CME in RH/SM were guidelines and an in house training team. Next in availability were the modern electronic resources (23 percent) and Evidencebased Practice in Training (EBPT) in about 25 percent of the districts. Space, funding, and resource centers were available in about 26 percent, 16 percent and 12 percent of the districts, respectively, for CME in reproductive health and safe motherhood. Objective of the study The study proposes to achieve the following To increase the uptake of the CME by at least % though Web conference technology Increases the number of CME from to To reach health worker though web conference 6 P age

7 The method of approach (Strategy) For the project to be successfully implemented, the following issues are Key, That CME itself should be recognized as a high priority at all levels, including by government and health workers. The political commitment is critical; the health workers also need to be motivated, this will only be achieved through the listing of CMEs in the annual operation plan for delivery of the services at the district level as well as provincial level The CMEs are be anchored through the mentorship program, which is one of the programs run by the district health management team, where skills are passed to the mentee in a structured manner. 7 P age

8 References 1. A realistic approach to the evaluation of the quality management movement in health care systems: a comparison between European and African contexts based on Mintzberg's organizational models, P. Blaise,G. Kegels The International Journal of Health Planning and Management Volume 19, Issue 4, pages , October/December Financial support of continuing Medical Education, Robert steinbrook, JAMA. 2008: 299(9): The need for rehabilitation of lost skills in health care delivery, Koech DK, Africa journal of Health sciences, 1998 Jul Dec;5(3 4): Etta, F.E. and L. Elder, eds At The Crossroads: ICT Policy Making In East Africa. IDRC. 8/ 5. Farrell, G.M. and C. Wachholz, eds ICT in Education: Meta Survey on the Use of Technologies in Asia and the Pacific. UNESCO. 6. Markova T, Roth LM, conferencing for delivery of residency didactics, Journal of the association of American medical colleges 2002 Jul;77(7): Curran V, Lockyer J, Sargeant J, Fleet L -Evaluation of learning outcomes in Web based continuing medical education, Journal of the association of American medical colleges, 2006 Oct;81(10 Suppl):S Decentralizing Kenya s Health Management System: An Evaluation, P.M. Ndavi1,S. Ogola2,P.M. Kizito2,K. Johnson, jan Wikipedia 10. Report of a Conference held in Moshi, Tanzania 8 10 April 2003 Information and Communication Technologies and Continuing Medical Education in East and Southern Africa 8 P age