The project is awaiting the removal of administrative obstacles for the unification of records
GUINGUINÉO (SENEGAL), 20 (From Europa Press envoy, Borja Aranda)
The Guinguinéo health center has become in recent months one of the examples of the process of digitalization of medical services in Senegal, a program that, however, is still waiting for the administrative ‘green light’ to go live. unification of records, amid concerns about patient data management.
Abdoulaye Dia, chief doctor for approximately two years, stands out in a meeting with journalists during a visit to the facilities, the object of an EU cooperation project – with the collaboration of Belgium and France -, which “only sees benefits” to the implementation of this system in the place, one of the two health centers in the town, located in a department where more than 170,000 people live.
Thus, he says that the center is “a reference” in digitalization in the Kaolack region (center) and explains that before his arrival, “a situation analysis” was carried out that led to the sending of computers and the training of the personnel on the use of the computer program intended to bring together patient information and their medical history.
Dia states that the center sees about 50 patients a day on average, between day, evening and emergency shifts, for a total of more than 10,000 unique appointments over the last 17 months. “The number of patients is enormous,” he acknowledges, before emphasizing that there are others who go to the second center.
The model is based on giving the patient a ticket – which functions as a “personal identification number” – when they arrive at the center, where they pay the fee corresponding to the services they seek – 500 Central African francs (about 0.75 euros) to be seen by a nurse and 1,500 (about 2.25 euros) for an appointment with the doctor, costs that increase after 4:00 p.m.
“This identity allows access to all services,” highlights Dia, who affirms that the system also has a positive impact when it comes to preparing monthly reports and maintaining control over the supply of medicines. “The person goes to the pharmacy to pick up the medication with the same ticket, everything is done at the entrance counter,” he points out.
In this sense, he emphasizes that, in his case, this system allows him to “open the computer, write the (identification) number and obtain his data, age, surname, first name.” Additionally, you can enter symptoms and automatically check for parallels with the International Statistical Classification of Diseases.
Dia acknowledges, however, that at first there were some problems, partly because the population “did not understand how it worked.” “Every beginning is difficult,” he maintains, while pointing out that digitalization has slowed down the process of selling medicines. “We are in the process of solving it. Maybe it is also a human resources problem,” he argues.
In addition, he points out that there are also discrepancies yet to be resolved regarding the “interoperability” of the data and the “duplication” of the registry, given that he currently has to continue maintaining the documents on paper, in addition to updating the database. as required by the authorities until unification occurs.
“The records are made at the end of the month,” he specifies, showing one of the paper documents that must be filled out with the patient’s data, symptoms and pathology. “Every month, the director of health centers travels to obtain the records for the report,” he says, before acknowledging that it is a “somewhat archaic” system that “will be solved with digitalization.”
Dia also regrets that she cannot care for patients from other places or access the file if she is not in the center because data protection systems prevent this from being done by people who do not have permissions, until now only granted to computer scientists dedicated to network maintenance tasks, although work is being done to extend these authorizations.
ADMINISTRATIVE WORK
Woré Fall, representative of the Belgian Development Agency (Enabel) – one of the main promoters of this project – maintains that the work and technical verifications on the validity of the system have already been carried out, although he notes that ” What does not yet exist is the institutional validation” so that all the data collected is imported into the central database.
“Right now, they are forced to do this double work. The Ministry (of Health) demands that we maintain this double work until they ensure that they have the same information in the system and in the records,” he remarks, before delving into that the authorities “do not want to skip this stage.
In this way, it emphasizes that a note has already been sent to the ministry “to demand that institutional validation be given” once the different administrative levels that must approve this step are overcome. “We are waiting. All the work that had to be done has been carried out,” he defends.
In any case, Dia highlights that “the health center must be considered as a pilot” and praises that the Senegalese authorities have opted for “comprehensive digitalization.” “To achieve this, there need to be pilots,” he says, although he regrets that this duplication of work can be a burden at times when “there are many sick people” waiting to be treated.
“What we wanted to propose to the State of Senegal was a model capable of being reproduced,” argues Fall, before indicating that it had to be built “from the base”, since the computer network itself “was totally obsolete.” “There was a very, very unstable connection, so you couldn’t work with the Internet in that state,” he points out.
“It was necessary to launch a local intranet and local servers. There are two servers, one for production and one for backup so that they can work seven days a week, 24 hours a day,” he says, while also pointing to the ” instability” of the electrical grid, which has been resolved through an “autonomous” system of photovoltaic panels that feed the center.
SUSPICATION ABOUT THE DELIVERY OF DATA
Dia emphasizes that, likewise, one of the problems that the model has faced is that part of the population is reluctant to share their data, which leads them to go to the other existing center in the city, which still has not started the digitization process.
Thus, he highlights that there is a “strike” over the delivery of data, a fact confirmed by the representative of Enabel, who emphasizes that some people are “skeptical” about this step. “There is a cultural context, a political context that makes launching this type of project a real challenge,” he says.
In this sense, the chief doctor explains that the health system in Senegal works through health development committees. “Health personnel manage health at the level of their structure. It is necessary to get the population and the community to adhere,” he maintains.
To achieve this support, the community elects people to represent them, which in the case of the town of Guinguinéo is that of a teacher from the local institute. These representatives function as a “mediator” between health workers and the population, according to Dia.
The project, part of the DIRECCT (Digital Response Connecting Citizens) program – active in the regions of Fatick, Kaffrine and Kaolack – had an initial budget of 2.9 million euros, although Enabel provided another 500,000 euros to reinforce it. through their bilateral collaboration, according to Fall, something that has allowed the creation of “a good tool” to improve the delivery of health services, in Dia’s words.