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Improving Care by Building Information-based Decisionmaking

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Monitoring and evaluation officers at healthcare facilities in Uganda get trained in a software program that increases their capacity for information-based decisionmaking.

Healthcare professionals in Uganda are witnessing the difference good data makes in patient care. Lawrence Sekimpi, the monitoring and evaluation officer for Nsambya Home Based Care in Kampala, is confident that the new wing his employer's hospital is building is an efficient use of its resources. "Now we know our monthly enrollment numbers and the patient load so we can forecast how many additional counseling rooms we need," said Lawrence. Meanwhile, Fred Kahwa, the monitoring and evaluation officer for the Workers' Treatment Center, another Kampala healthcare facility, is using patients' follow-up information to implement a flexible appointment system. Patients' visits are prearranged to ensure they receive appropriate services based on their clinical history.

These are two examples from AIDSRelief, a project that is delivering antiretroviral therapy as part of the President's Emergency Plan for AIDS Relief. Facilities participating in the project are using information to make clinical decisions and improve programs. But this did not happen overnight. When these facilities joined the project, they started implementing a paper-based medical records system to track patient information. AIDSRelief introduced CAREWare, a database originally developed for HIV/AIDS programs in the United States, but modified to fit the needs of resource-poor settings abroad. The implementation of this version of CAREWare included training monitoring and evaluation personnel like Lawrence Sekimpi.

CAREWare is a comprehensive health management information system, which allows users to enter, manage, and analyze HIV patients' clinical and demographic data. While it is essential to meet the reporting requirements of donors and governments accurately and on time, the primary goal of the training sessions is to build the local capacity to manage data to improve the outcome and quality of HIV/AIDS programs. CAREWare training sessions have taught people how to use the database and also increased their understanding of the role of monitoring and evaluation and how to use this information to manage their programs.

The data management systems at these sites prior to CAREWare were not comprehensive. The compilation of reports was often done by hand and required several days. "There was a lot of underreporting, because the data management was a manual process," according to Lawrence Sekimpi.

For the healthcare professionals using CAREWare, it has become a crucial part of their success in being able to scale up their care and treatment programs. Physicians are now able to practice adaptive patient management based on up-to-date clinical information. They can provide patients with appropriate services and treatment based on individual patient history. Doctors can also monitor trends among patients by tracking information on such factors as opportunistic infections and drug side-effects.

Annette Kyagaba, a data management clerk at Nsambya, has witnessed the benefits of the new database: "Once we were asked what was the most common infection at our hospital. Before we had CAREWare, we had to rely on the doctor to come up with the best guess. With CAREWare I can find this information right away from my desktop."

The introduction of CAREWare in Uganda, and the emphasis on using data to support patient care and decisionmaking, has changed the way healthcare facilities operate. By using the software, the staff is improving its clinical and program management.