From Real-world Individuals' Data to National Health Indicators: Multiphase Pilot Study in Gabon.

BACKGROUND: Achieving health goals requires informed decision-making supported by transparent, reliable, and relevant health information. This helps decision makers, such as health managers, to better understand the functioning of their health system and improve their ability to respond quickly to health demands. To achieve this, the health system needs to be supported by a digitized decision-making information system. In Sub-Saharan African countries, inadequate digital infrastructure, including limited internet connectivity and insufficient access to appropriate computer software, makes it difficult to collect, process, and analyze data for health statistics. The processing of data is done manually in this case; however, this situation affects the quality of the health statistics produced and compromises the quality of health intervention choices in these countries. OBJECTIVE: This study aimed to describe the conceptual approach of a data production and dissemination platform model proposed and implemented in Gabon. More precisely, it aimed to present the approach applied for the multidimensional analysis of the data production and dissemination process in the existing information system and present the results of an evaluation of the proposed model implemented in a real context. METHODS: The research was carried out in 3 phases. First, a platform was designed and developed based on the examination of the various data production and indicator generation procedures. Then, the platform was implemented in chosen health facilities in Gabon. Finally, a platform evaluation was carried out with actual end users. RESULTS: A total of 14 users with 12 years of average experience in health data management were interviewed. The results show that the use of the proposed model significantly improved the completeness, timeliness, and accuracy of data compared with the traditional system (93% vs 12%, P<.001; 96% vs 18%, P<.001; and 100% vs 18%, P<.001; respectively). CONCLUSIONS: The proposed model contributes significantly to the improvement of health data quality in Gabon.

Health information systems in developing countries: case of African countries.

BACKGROUND: In developing countries, health information system (HIS) is experiencing more and more difficulties to produce quality data. The lack of reliable health related information makes it difficult to develop effective health policies. In order to understand the organization of HIS in African countries, we undertook a literature review. METHODS: Our study was conducted using the PubMed and Scopus bibliographic search engines. The inclusion criteria were: (i) all articles published between 2005 and 2019, (ii) articles including in their title the keywords "health", "information", "systems", "system", "africa", "developing countries", "santé", "pays en développement", "Afrique", (iii) articles that are written in English or French, (iv) which deals with organizational and technical issues about HIS in African countries. RESULTS: Fourteen retrieved articles out of 2492 were included in the study, of which 13 (92.9%) were qualitative. All of them dealt with issues related to HIS in 12 African countries. All 12 countries (100.0%) had opted for a data warehouse approach to improve their HIS. This approach, supported by the DHIS2 system, has enabled providing reliable data. However, 11 out of the 12 countries (92.0%) frameworks were aligned with funding donors' strategies and lacked any national strategy. CONCLUSION: This study suggests that the lack of a national health information management strategy will always be a threat to HIS performance in African countries. Ideally, rigorous upstream thinking to strengthen HIS governance should be undertaken by defining and proposing a coherent conceptual framework to analyze and guide the development and integration of digital applications into HIS over the long term.

Implementation of a national electronic health information system in Gabon: a survey of healthcare providers' perceptions.

BACKGROUND: The Health Information System (HIS) is a set of computerized tools for the collection, storage, management, and transmission of health data. The role of such tools in supporting the modernization of health systems, improving access to quality healthcare, and reducing costs in developing countries is unquestionable, but their implementation faces several challenges. In Gabon, a unique national electronic HIS has been launched. It will connect healthcare institutions and providers at all levels in the whole country. OBJECTIVE: This study aims to explore and identify the factors influencing healthcare providers' perceptions of the national electronic HIS in Gabon. METHODS: A 44-item questionnaire based on the Information System Success Model (ISSM) was administered between February and April 2018 among 2600 healthcare providers across the country. The questions assessed the different aspects of the HIS that could influence its perceived impact on a 5-level Likert scale (from fully agree to totally disagree). The reliability and construct validity of the questionnaire were checked using Cronbach alpha and congeneric reliability coefficients. A logistic regression was used to identify the factors influencing healthcare providers' perceptions of the system. RESULTS: A total of 2327 questionnaires were completed (i.e. 89.5% response rate). The logistic regression identified five elements that significantly influenced perceived system impact: System Quality (Odds Ratio-OR = 1.70), Information Quality (OR = 1.69), Actual Use (OR = 1.41), Support Quality (OR = 1.37), and Useful Functions (OR = 1.14). The model explained 30% of the variance in providers' perception that the national HIS leads to positive impacts. DISCUSSION: The results show that healthcare providers' perceptions regarding the positive impact of the national HIS in Gabon are influenced by their previous use of an HIS, the scope of their usage, and the quality of the system, information, and support provided to users. These results could inform the development of strategies to ensure adequate change of management and user experience for the implementation of the national HIS in Gabon, and eventually in other low resource environments.

État des lieux du système d'information sanitaire du Gabon.

OBJECTIVE: The need for an efficient and reliable health information system motivated Gabon, with the support of the World Bank, to finance a project to reinforce its health information system. An audit of this system was required to report on the reality of the existing system and tools. METHODS: Over the course of two periods, May to September 2016 and April to May 2018, information was collected using both qualitative and quantitative approaches. In this framework, were carried out successively: participative workshops including health actors in Gabon, a survey of health care workers, an analysis of reference documents relating to national health policies, and an analysis of the strengths, weaknesses, opportunities, and threats to the system. RESULTS: In total, 171 health care professionals participated in the different workshops, and 770 others were questioned among 150 health care establishments from 10 health care regions of the country. At the end of this research work, organizational and technical problems were noted at the level of the health information system of Gabon, notably the absence of a judicial framework defining the roles and responsibilities of the different actors of the system, weak data management, a stovepipe information system, several non-interoperable IT applications, and weak completeness rate, at 30%. Among the 770 health care professionals surveyed, 539 (70%) were favorable to a new information system. As for the main assets, we noted the existence of computing equipment and acceptable internet coverage, 31.5% of the health care establishments are connected via cable. CONCLUSION: This research sheds light on the existing health information system and should enable the implementation of a new system.