Global health e-infrastructures: integration and use of information

The Verdikt project focus on research on development and implementation of DHIS2, an open source platform for health management in use in more than 40 countries in Africa, Asia, and Latin America. DHIS2 is used both as a data warehouse for statistical data, and for patient-based information supporting antenatal care and immunization. The project has since the start been part of this development, and conducted research on strategies, standards for interoperability with other systems, and design and implementation of DHIS2 in local contexts. A central theme has been how local innovations can be included in the global source code, to be shared among all implementing countries. The last year the project has succeeded in this for two innovations currently spreading across Africa: 1) Use of “cloud” infrastructure and mobile Internet, 2) development of regional data warehouses. 1) In 2011 DHIS2 was implemented as a national health information system in Kenya based on “cloud” infrastructure, as the first country in Africa. This was possible because the bandwidth had increased through new cable projects to Africa combined with national development of 2/3G mobile network. Innovative use of the new HTML5 standard, with storage capacity in the browser, made it possible to enter data temporarily in DHIS2 in offline mode when network connection is unavailable. Laptops and modems could thus cover the whole country. By building on the experiences from Kenya, countries such as Rwanda, Uganda, Burkina Faso, Liberia, Nigeria and Ghana have all implemented DHIS2 as an online system. In Nigeria a few states are still not covered this way. 2) The Verdikt project has from the beginning been engaged in West Africa, first through implementation av DHIS2 in Sierra Leone, Ghana, and other countries, then through a collaboration with West African Health Organization (WAHO), which is the health department of ECOWAS. Together with WAHO we have developed a regional policy for health information systems, and initiated development of a regional data warehouse for all 15 member countries. This will be an important surveillance system for epidemics in the region. Challenges are related to the complexity of 15 different countries, some of which have internal conflicts. Nevertheless, based on a prototype and overall design, the East Africa Community (EAC) has decided to implement a similar data warehouse. Given that EAC only has 5 member countries, 4 of which are already using DHIS2, the development will probably progress faster here than in West Africa. Another important result is that the two regional bodies have started collabora tion on the development of their data warehouses. Based on this positive development, DHIS2 and the Verdikt project were awarded the University of Oslo’s Innovation Prize for 2013.

The research project Global Health eInfrastructures (GHeI) is proposed through a cross-disciplinary international consortium comprising of researchers, users (of health information) organizations, and groups representing providers of infrastructure. GHeI addresses key challenges to society by contributing towards improved health services provision in developing countries - but with relevance to Norway - through enhanced access and use of health information. The currently fragmented (un-integrated) and unc oordinated health information systems, however, represent major obstacles to adequate health services. The key analytic aims addressed in SIGH are grounded in VERDIKT's overall interdisciplinary call on "communicating organisations" and "seamless infrast ructures"; to facilitate interaction across levels, geography, services and professions in health care through developing and using interoperable infrastructures, thereby enabling increased organisational communication and integration of health services p rovision. The principal aim of SIGH is that of conceptualising - and subsequently intervening - in the fragmented (i.e. non-integrated) information systems in health care, typified by large scale fragmented, technical and institutional, systems. The broad er aim is to maximize the societal impact of such ICTs in health care by intervening in key health problem areas such as maternal and child health. Building on an ongoing, long-term project (called HISP) operating in many African and Asian countries, GHe I aims at extending HISP by establishing laboratories for heterogeneous health information infrastructures and open source software at WHO, Geneva, and in Norway, as well as pilot sites in Norway, India and Tanzania. Methodologically, our research approa ch is action-oriented and interpretative.