Investigating the interface between health system reform and HIV/AIDS in sub-Saharan Africa: an approach for improving the fight against the epidemic

One country's journey to interoperability: Tanzania's experience developing and implementing a national health information exchange

BACKGROUND

Robust, flexible, and integrated health information (HIS) systems are essential to achieving national and international goals in health and development. Such systems are still uncommon in most low and middle income countries. This article describes a first-phase activity in Tanzania to integrate the country's vertical health management information system with the help of an interoperability layer that enables cross-program data exchange.

METHODS

From 2014 to 2019, the Tanzanian government and partners implemented a five-step procedure based on the "Mind the GAPS" (governance, architecture, program management, and standards) framework and using both proprietary and open-source tools. In collaboration with multiple stakeholders, the team developed the system to address major data challenges via four fully documented "use case scenarios" addressing data exchange among hospitals, between services and the supply chain, across digital data systems, and within the supply chain reporting system. This work included developing the architecture for health system data exchange, putting a middleware interoperability layer in place to facilitate the exchange, and training to support use of the system and the data it generates.

RESULTS

Tanzania successfully completed the five-step procedure for all four use cases. Data exchange is currently enabled among 15 separate information systems, and has resulted in improved data availability and significant time savings. The government has adopted the health information exchange within the national strategy for health care information, and the system is being operated and managed by Tanzanian officials.

CONCLUSION

Developing an integrated HIS requires a significant time investment; but ultimately benefit both programs and patients. Tanzania's experience may interest countries that are developing their HIS programs.

The burden of HIV-related illness on outpatient health services in KwaZulu-Natal, South Africa

Health services in sub-Saharan Africa will be faced with increasing numbers of AIDS patients for many years to come. Where there is good availability of drugs and other resources, the costs of treating HIV/AIDS is likely to be higher than those of treating other types of illness. This will put services under strain and potentially jeopardise health system reform, depending on the vulnerability of the system. Whereas previous research has focussed on inpatients, this paper looks at the impact of HIV/AIDS on outpatient services in a district of South Africa. Through facility visits at various levels of care, data concerning HIV status and the costs of care was collected for all patients presenting over a set period of time. The proportion of patients presenting for HIV-related care ranged from 20.2 to 24.5%. The average costs of treating HIV-positive patients were significantly higher than those for non HIV patients at hospitals, with clinics not experiencing this difference due to the limited service provided. District hospitals spent the greatest proportion of direct patient care resources on treating HIV-related illness. In terms of outpatient care, this data suggests that district hospitals may require the most support in dealing with a rising number of AIDS patients.