3. My Story
Mid-thirties computer researcher seeks
more fulfilling career. Goes back to
school then off to Africa. Discovers
things are more simple and more complex
than he originally imagined. Can't
imagine doing anything else...
4. Outline
• Background
The simplicity and complexity of global inequity
• Two examples
Patient record systems for AIDS treatment
Medical algorithms on handhelds
• Conclusion
5. Risk Factor
for surviving the Titanic.
0
10
20
30
40
50
60
70
1st 2nd 3rd
class of service
%survived
Poverty as a
10. Simple Story
“We are the first generation
that can end poverty.”
-Eveline Herfkens, UN Millennium Campaign
11. Complexity
• Corruption, careerism, tax write-offs
• 5-star poverty alleviation meetings
• Unintended consequences, e.g., paying
volunteers
• Imperialism & foreign experts
“If you want to build a ship, don't drum up people to
collect wood and don't assign them tasks and work, but
rather teach them to long for the endless immensity of
the sea.”
– Antoine de Saint-Exupery
12. Information as Care
• Study: rigorous application of standard
treatment protocols reduced in-hospital
mortality in children’s malaria cases by 50%
• Clinician’s complaint: where are my lab
results?!
• Patient Knowledge Example: five danger signs
for seeking care during and after labor.
13. Outline
• Background
The simplicity and complexity of global inequity
• Two examples
Patient record systems for AIDS treatment
Medical algorithms on handhelds
• Conclusion
17. Electronic Medical Record (EMR)
Patient Monitoring
Reports
Clinicians & Patients
Managers
EMR Staff
Paper forms
Program
Monitoring
Reports
Funder &
government
reports
$
Re-allocate
resources
22. Data Quality
• Mistyped IDs
• Missing &
conflicting data
• Backlog
Potential solution: point-of-care systems
23. Challenges & Opportunities
• Keep up with demand
• Increased impact on decision making
– Inform to Improve (I2I) teams
• Integration of lab and pharmacy components
• Detecting important trends in data
24. Outline
• Background
The simplicity and complexity of global inequity
• Two examples
Patient record systems for AIDS treatment
Medical algorithms on handhelds
• Conclusion
29. 10
15
20
25
30
35
1999-00 2001-02
Annualmortalityrate
Morogoro (IMCI) Rufiji (IMCI)
Ulanga Kilombero
Tanzania: underfive mortality was 13% lower
in the two IMCI districts
Source: Schellenberg J et al
Full
IMCI
in HF
End of
study
13% difference
95% CI: -7%, 30%
Significant
impact on
stunting
30. Deploying IMCI
• IMCI
– Shown to reduce mortality and morbidity
– Adopted by ~100 countries
• But uptake not as good as hoped
– Training expensive
– Correct use tapers off over time
– Supervision challenging
35. Exploratory Study
• Pretesting & rapid iteration
• Structured interviews
• Observed trials w/
additional clinician to:
– Ensure safety
– Record adherence to IMCI
– Record time
37. Key Findings
• Must be
– Fast
– Flexible
– Improve adherence to IMCI
• Must address intentional deviation from IMCI
– Temperature, respiratory rate
– Advice
42. House Hold Visit (Task Queue)
000:04:56
Register Birth
Investigate Diarrhea of Sick Child
Review malaria bed nets
Topic of month: nutrition during
pregnancy
END VISIT
43. Day Planning
MKWERA : TB Referral (2 wks)
MKEA: Severe diarrhea (3 days)
CHUMA: late HH visit (3 months)
KAIGILE: routine HH visit
MGANDA: routine HH visit
EXIT
44. Outline
• Background
The simplicity and complexity of global inequity
• Two examples
Patient record systems for AIDS treatment
Medical algorithms on handhelds
• Conclusion
45. Conclusion
• Key points
– Must understand context
– Much potential, many challenges
– Keep it simple
• Challenges
– Evaluation, local ownership, I2I, duplication of
effort, …
I’m going to start with what somehow seems like a fun example, which is that if you bought a more expensive ticket on the titanic, not only do you get nicer food, but you’ve got a higher chance of surviving the trip, as shown in this graph. these numbers are real, though it would be a little more fair to show men, women, and children separately ... since this is one of the few cases of where being a woman or child is protective. but moving onto some statistics which I think is the most disturbing of the talk...
Okay, so on to the world. And one thing about this talk and public health in general, in that it’s pretty focused on people and their basic needs. not so much the animals. not even so much the environment, though that’s certainly important for our health. but we can start with how many of us there are. and there’s about 6.1 billion people, and counting... and population growth is certainly a factor for public health
Okay, so on to the world. And one thing about this talk and public health in general, in that it’s pretty focused on people and their basic needs. not so much the animals. not even so much the environment, though that’s certainly important for our health. but we can start with how many of us there are. and there’s about 6.1 billion people, and counting... and population growth is certainly a factor for public health
Okay, so on to the world. And one thing about this talk and public health in general, in that it’s pretty focused on people and their basic needs. not so much the animals. not even so much the environment, though that’s certainly important for our health. but we can start with how many of us there are. and there’s about 6.1 billion people, and counting... and population growth is certainly a factor for public health
Okay, so on to the world. And one thing about this talk and public health in general, in that it’s pretty focused on people and their basic needs. not so much the animals. not even so much the environment, though that’s certainly important for our health. but we can start with how many of us there are. and there’s about 6.1 billion people, and counting... and population growth is certainly a factor for public health
Okay, so on to the world. And one thing about this talk and public health in general, in that it’s pretty focused on people and their basic needs. not so much the animals. not even so much the environment, though that’s certainly important for our health. but we can start with how many of us there are. and there’s about 6.1 billion people, and counting... and population growth is certainly a factor for public health
Paying volunteers, discussing work-for-food programs over fancy dinner during famine,
In Tanzania: under-5 mortality was 13% lower in the two IMCI districts compared to non-IMCI districts and there was a significant impact on stunting
