CALAT ICT CO.LTD

Laos profile , as still affected by legacy of war, “Vietnam war”

Overview of HMIS in Lao PDR and its challenges

GNU health in Lao PDR, its evolving throughout;

GNU health functionality ,and its core module approaches;

GNU health project main tasks performed, and to be done within timeframe;

Main challenges;

Lesson learnt;

GNU Health prospective in Lao PDR.

Land area: 236,800 sq km

Population:6971202/ Y.2016

Provinces: 18

Districts: 148; poor: 72;

Villages: 8,438.

Male life expectancy: 60.5Female life expectancy: 64.4

B-52 F-aircrafts did 580,000 sorties; Many types of

Bombs -two million tons dropped over 2/3 of Laos

territory; 30% of them remain unexploded (UXOs) >

WW.II’s bombing.

42/47 poorest districts seriously affected.

Bombing destroyed many villages and displaced

hundred thousand of Lao civilians during 9 year period.

Each year there are now just under 50 new casualties,

down from 310 in 2008.Close to 60% of accidents result

in death, and 40% of victims are children…..

Over 25 years on, less than 1% of these munition have been destroyed.

Overview of Health Information Systems in Lao PDR - 2016

5

5 Copyright 2015 FUJITSU LIMITED

DHIS2

Level 3

Health

Serv

ices

OPD, IPD HMIS/DHIS2

HMISLevel 1

DHC

MCH M&C HandbookDigitalization

Form/Data entry report TallyTally Tally

Publishing

Indicator figures

Already connected

Planned to be connected

DHHP,MCH Center

Health InformationForm/Data entry

DPIC

Individual data CentralHealth facility District/Province

Form/Data entry

UNDPA

Report

UNDPA

Health Financing National Health Accountant SystemDOF

Healt

h

Hu

man

R

esou

rces

Deployment

Retention

Training CourseInformation System (TCIS)

Health Personnel Information Management System (HPIMS) DHP

Facility, equipment

Meds

Level 0

m-Supply Level 2

DHC, DFD, MPSCM

ed

s,

tech

nolo

gy,

facilit

y

Level 1

Level 1N/A

N/A

N/A

Fin

an

ce

Health insurances

Health Equity Fund, Free Maternal ServicesDOF

3 infectiousdiseases

Malaria Information System Level 2

Tb Information System Level 2

HIV/AIDS National Monitoring and Evaluation Reporting System (MERS) Level 2

ProductionHealth training institute Students information

DTR

EPI Information System

Early Warning and Responding Network(ERWAN)

Model Healthy Village

Early warming

Health promotion

DCDCLab & Epi Center

DHHP

DCDCHIV/AIDS Center

DCDCTb Center

DCDCMalaria Center

DHHP,MCH Center

EPI

N/A

N/A

N/A

DTR

Info. Exchange

Overview of HIS in Lao PDR

• Fragmentations of Health information system driven by vertical programs and diseases funded by different funding agencies

• Since 2013 to present , MOH applying Open source web base system using DHIS2 for data collection, reporting , analyzing and dissemination of Health information.

• Only 3 mains data sets are incorporated to DHIS2 (OPD, IPD and Maternal and Child Health information) aggregate at health facilities level

• MOH are now working with relevant Ministry of Health Departments concern and Diseases center to merge into a single platform using DHIS2

• Ongoing development of merging Malaria , TB, and HIV.AIDS into DHIS2 are now on progress.

• Remaining Human Resource, Health Financing, Surveillance system, etc ..

Overall Achievement

Health Information System (HIS) is the 5th prioritised

area of the Health Sector Reform (HSR) strategy of

Ministry of Health

Integrated health information platform has been

established on DHIS2 – an online, web-based system:

HMIS, MNCH, summary HR, populations and soon, HIV,

TB, Malaria to join the platform (Dec. 2016)

DHIS2/HMIS covers all MOH health facilities with 96%

reporting complete rate

Challenges

Use of information limits to reporting leads to:

Data quality assurance is limited

Many managers are unaware of the system

Staff enter data but get little feedback

Concept of specific assignment and shifting roles of data

managers is new in the DHIS2 system

Recognition of DHIS2/HMIS not for overall health sector , yet

Access to internet and computers

Current capacity and training doesn’t meet demands for the

extension of the system.

GNU health was firstly introduced at CMR in Laos by CALATICT

on Jan.2014,and completed by Nov.14.it has been customized

and translated to Lao language. Now well functioning.

Early Jan 2016, started implementing GNU Health at Mahosot, a

public hospital.

With Main functionalities: EMR,HIS and HeIS(Health information

system),and

Core module approach: Individual & community management,

patient management, hospital information management.

In Lao PDR, the hospitals are about forming in

terms of the public health services, similarly to

many other developing countries.

Mahosot, is an old & complex public hospital with

more than 600 beds, some buildings were built

since French colony, for more than 6o years ago;

Some equipment are too old such as: TCS,

mammo… cannot be incorporated easily (file

attached needed)

Identified location where the networking is being set-up thru

optical fibers and UTP cables

Set up seven point of optical fiber, and 350 drop point of UTP

Set up the main server and work-stations

Collect and consolidate the users’view points to customize to

Mahosot context and situation;

Completed the system translation into Lao language, and

manual operating for various departments;

Completed data entry of drugs, staffs, and health care

service thru overall the hospital;

Adapted GNU Health system to be closely to the real context

&situation to become specific to Mahosot hospital ( large

infrastructure with old physical facilities)

Revise and reset the network due to irrelevant system

designed with Cissco experts collaboration;

Completed data entry of drugs, staffs, and health care service

thru overall the hospital;

Customize GNU Health system to be very closed to the real

situation to become specific to Mahosot hospital ( large

infrastructure with old buildings)

Training sessions for GNU health operation ( IT Team, MD,

nurses….)

Medical care service( reception, registration, card issuing,

syndrome , categorize the patient and their needs)

Set-up GNU health into the remaining departments such as

:ER,ICU, OB, IPD and OPD..

Set-up GNU health into every medical care support likewise

Analysis, Xrays, ultra-sound,mammo..;

Some other tasks out of plan, to make the analysis system

more efficient.(additional project cost to be agreed upon)

Dr Luis Falcon’s instructions for setting-up LIMS,

Medical service processes

Medical service processes cont.

1. Review and revise the networking systems that are

found not suitable to the project team and the health

professionals, that leads to some delay;

2.Equipment and support materials of the GNU health

system (Switches; size and specifications to be relevant

for bigger data, concern for future extension )

3.Service medical care process to cope with changes

toward to new and modern systems.

4.Linkage electronic data of Laboratory and Xray units ,

incorporate with LIMS.

5. Paradigm shift from old habits & culture of the staffs to online

system as required (eager, reluctant, resistant)

6. Conceived TOT did not work well as expected ; CALAT’s Team

are committed to help them operate the new system.

7. Data entry for all patient from overall country (8,438 villages,

drugs purchase & sell price, health care service price, etc..)

8. Budget constraints versus needs & requirement from such a big

hospital in terms equipment& devices.

Standards and accreditations not yet set-up.

Full support of high authorities as MoH &CEO is a must, that is the case. They are

eager to see HIS feature from GNU Health , and its outcome (apart from its

advantages over non free license software)

Mastering English language is part of need for end users , despite Lao language

translation.

IT staffs of the hospital cannot act as good trainers without the assistance of

CALAT’s teams.

Should budget allocation be relevant to project costing, to ensure smooth

implementation ,particularly for such a big & complex hospital.

Well planned and designed project implemented by well trained health

professionals, along with budget allocation, is a must, to ensure high quality of

system with high level of sustainability;

In addition to being free software, the system focuses on holistic approach to

patient, health promotion, disease prevention.

Centre of Medical Rehabilitation (CMR) as a small size center, is using HIS since late 2015, as Good example.

Project completion of GNU health at Mahosot hospital will be a good model for other public health centers overall country;

Calat ICT team‘s presentation to Military Hospital (103 H),and Savannakhet province hospital . Leaders from both hospitals are very interested.

Extension of GNU health overall country seems to be envisaged.

FEDERATION;

MOBILE APPS;

SYNCHRONIZATION WITH OTHER HOSPITALS;

LIMS, PACS MORE FRIENDLY USED/TEACH;

LAOS IN NEED OF HELP FROM OUR COMMUNITY TO STEP FORWARD ONTO OVERALL HSR,ESPECIALL HeIS.

Monalisa