Improving Maternal Child Health (MCH) services delivery: The role of the Zambian SmartCare eHealth system

Presenter: George Muyunda Jhpiego Zambia Country Office 1st FIGO Africa Regional Conference of Gynecology and Obstetrics, Addis Ababa, Ethiopia, October 2013

What is SmartCare?
The National Standard Electronic Health Record (EHR) System of Zambia Provides Continuity of Care for clients Collects micro data that can be aggregated at any level for decision making/support

Vision
Each person in Zambia has a complete electronic health record Assurance for continuity of access to high quality confidential care Provision of up-to-date information to caregivers at point of service delivery Provision of timely information to health policy makers

Mission

To enable the provision of quality health care for Everyone, Everywhere, Every time, by improving health information systems

History & Milestones

2004: Consensus building, Continuity of Care (COC) concept formation, and resource identification 2005: Ante-natal Care (ANC) pilot in Kafue District with 98 percent patient return rate with Smart Card 2006: Integration with Anti-retroviral Therapy (ART) Patient Tracking System (PTS) to create a Continuity of Care Patient Tracking System (CCPTS), later renamed SmartCare

History & Milestones contd

2007: Role-Based Security; National and provincial level training begins; SmartCare competency required for ARV dispensing accreditation 2009: SmartCare Certification program instituted 2011: Under 5, Family Planning, OPD modules, etc. included 2013: over 750 sites deployed to. SmartCare also deployed to 14 PSE health training institutions

Collaboration/Partnerships

Role of Jhpiego in SmartCare implementation

Pre-Service
Support the creation of Computer Labs Support Deployment and maintenance of SmartCare & SmartCare Computers Capacity building to Tutors and Lecturers Technical Support and Supervision Incorporating SmartCare in PSE Curriculum

In-Service
Support Deployment and maintenance of Smartcare, Computers and other SmartCare Equipment Capacity building:

Service providers, District and Provincial Managers and supervisors SmartCare Support Staff

Technical support and Supervision Support Data Migration Promote SmartCare Institutionalization
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The agony of paper records

Maternal Child Health (MCH) Modules in SmartCare

Antenatal Care (ANC) including Prevention of Mother-To-Child Transmission (PMTCT) Delivery Post Natal Care (PNC) Under Five (U5) Family Planning

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SmartCare: Data Collection

Registers Forms Tally sheets Direct Data Entry Etc.,..

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At the Clinic/Hospital
Clients/Patients registered on first clinic visit All clinical interactions recorded/entered Clients/Patients given Smart Card, which contains a copy of all their records

Client/patient is registered and their details are entered in a facilitys database; even if they forget to bring their Smart Card to each visit, their record is available!

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SmartCare is designed for portability

Records also copied onto an encrypted Smart Card

Smart Card carried by the client/patient from facility to facility

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Continuity of Care: The Smart Card

Stores all healthcare service

records for a client/patient It provides continuity of care for the Client/Patient wherever they go
Provides durable, portable

and confidential storage for data

Replaces paper records

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A Maternal Child Health Provider at work

Records also saved onto an encrypted Smart Card A MoH MCH Care giver providing health service to a mother while entering service data into SmartCare. The mother goes home with an updated Smart Card.

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Sample reports: CD4 Monitoring

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Sample reports: Medication History

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What Providers said during routine support visits

SmartCare promotes quality of health service delivery as it provides medication and laboratory test results history for both mother & child resulting in continuity of care

It has helped to standardize the approach to health care, improved record keeping, report generation and the quality of care

SmartCare is good and beneficial as it facilitates easy data entry, continuity of care, prevents loss of records, easy reporting and follow ups

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Challenges
High Staff turnover Lack of electricity Power outages Data entry/use & roll up to the center

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Conclusion
The observations are encouraging that SmartCare enhances the quality of health service delivery in Zambia However, a detailed study needs to be conducted in the future to confirm these observations

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Hillary Clinton and SmartCare

The former US Secretary of State, Hillary Clinton, holds up a Zambia SmartCare Care Card and said she had worked 10 years in the US to promote electronic health records and said she might need to send people to Zambia to see how it was done. This was during her visit to Zambia in June 2011.

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Thank you

Amasegenalo

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