ICT Model delivers integrated Primary Healthcare and Allied Services in Developing Countries? Evidence from India

Author(s) Atanu Garai1.
Affiliation(s) 1Odisha Modernising Economy, Governance, and Administration (OMEGA), IPE Global, Bhubaneswar, India.
Country - ies of focus Global, India
Relevant to the conference tracks Innovation and Technologies
Summary Various functional units of a health system depend on data and communication generated by its peer units and stakeholders for effective planning, implementing, and assessing its own functions. Currently, functional units maintain aggregated MIS data that does not provide the peer units and stakeholders any option to plan, deliver, and assess requirements, access, and usage of health services for individual beneficiaries. Effectiveness of planning, delivery, and assessment of health system functions depends on data and communication from other units. With practical examples from India, this paper designs an ICT model for better data communication by healthcare systems in order to improve outcomes.
Background Providers remain handicapped in delivering patient (beneficiary)-centric care due to the fragmentation of their functional operations. In primary and secondary care in promotional, preventive, curative, and rehabilitate health areas, providers and beneficiaries perform and access eight functions – i) planning, monitoring, and supervision, ii) service delivery (including medical and clinical aspects), iii) information and communication, iv) human resources management, v) financial management, vi) procurement and supply chain management, vii) asset and facility management, and viii) transport services management (Figure 1: Eight health system functions). Different units of health providers, sometimes different organizations, perform these functions with limited or no coordination among themselves. As a result, access and use of healthcare often remains unavailable due to actions by different agencies separated by time and space. Aggregated MIS data does not provide the peer units and stakeholders any option to plan, deliver, and assess requirements, access, and usage of health services for individual beneficiaries. This drawback can be overcome by using data on individual beneficiaries and the data can be used by all peer units for undertaking various functions.
Objectives WHO (2000) in its report “World Health Report 2000: Health systems: Improving performance” demonstrated the linkages of functional services with health system outputs and outcomes (Figure 2: Relations between functions and objectives of a health system). This paper identifies eight different functions that providers and beneficiaries access, perform, or use in various promotional, preventive, curative, and rehabilitative health areas in Indian health system. Discussions with select providers show that their organizational units have been performing their allocated functions with limited or no coordination. Besides, they do not get or use data from their peer units in planning and performing their activities. Therefore, providers disregards need, ability, and health status of the beneficiaries in the delivery of those services. This paper explores the linkages and impact across these eight functions and their sub-activities to intended health system outcomes.To improve access, delivery, and usage of health services, different units, organizations, and stakeholders shall plan, manage, and evaluate their respective functions by communicating data on beneficiaries. ICTs can effectively record, retrieve, and communicate data. This paper explores how ICT helps providers in primary and secondary care settings in India are using in these eight functions. This paper uses the functional relationships to explore the role of ICTs providing responsible functional units coordinate with other units in promoting coordination. It is argued that coordination among different functional units leads to integrated service access and delivery to achieve patient-centric integrated service delivery.
This paper has following objectives:
a) To establish causal linkages of different health system functions with outcomes, showing the dependency of different functional units within providers in promoting access and usage of health services.
b) To assess the status of limited coordination among peer units in planning, performing, and evaluating health services and its suboptimal impact on the health outcomes.
c) To assess the role and effectiveness of ICTs in allowing different units to plan, perform, and evaluate their functions to provide beneficiaries integrated and planned access to health services.
d) To evolve a patient-centric ICT model which allows the multiple units and stakeholders of providers leverage data and communication.
Methodology A literature review provides data to support analysis. The literature review uses systematic review method to search major databases including Academic Search Complete, Econlit, Google Scholar, MEDLINE, PubMED, SocINDEX, among others. Then, we screen the title and abstracts to examine their relevance for the key questions. It is likely that most literature shall use qualitative methods to examine the questions of linkages of health system functions and outcomes.
On the issue of the effect of limited coordination on the effectiveness of the functions carried out by different organizational units and stakeholders, we shall conduct interviews with select practitioners in the health sector in India.There is a growing body of literature examining the effectiveness of ICTs in various health system functions. This paper only shows the applicability and effectiveness of ICTs for specific functions. We shall use case studies showing projects implemented in India or other developing countries to show the applicability and relevance.
We shall analyze the data gathered through literature review and interviews to extrapolate key findings. Based on those findings, we shall develop a model which demonstrates the use of ICTs to generate useful data and communication for planning, management, and assessment of various health system functions.
Results This paper expects to show that the ICT applications can be effective in improving eight health system functions: i) planning, monitoring, and supervision, ii) service delivery (including medical and clinical aspects), iii) information and communication, iv) human resources management, v) financial management, vi) procurement and supply chain management, vii) asset and facility management, and viii) transport services management (Figure 1: Eight health system functions).It also shows that the data and communications from ICT applications used for planning, monitoring, and supervision can  improve the seven functions. Similarly, data and communications from service delivery can help program managers improve their monitoring and supervision.Until now, the responsibility of information and communication was delegated to mass and media organizations. The emergence of ICTs among populations has now enabled the service providers to communicate directly with their beneficiaries. Besides, data and communication from applications managing human, finances, and transport services can help improving various services.
Conclusion This paper helps the stakeholders underline the usage of data and communication by multiple functional units generated by their peer units. For generating data and communication, functional units shall use appropriate ICTs. This discussion on appropriate ICTs and their role in providing data and communication for various functional units plan, manage, and implement actions can help health providers implement a patient-centric integrated delivery.

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