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Table 2 Description of study sites and systems

From: Sustainability of health information systems: a three-country qualitative study in southern Africa

Baobab Health Trust (Baobab) is a non-governmental organization in Malawi that develops and deploys a national electronic medical record system (EMRS). It began its work in 2001, and following an agreement with Luke International in 2012, took the EMRS to national scale. As of 2014, 1.9 million Malawians had been registered in the system. The EMRS targets high-HIV burden facilities and has several modules, including an antiretroviral therapy (ART) module. This supports the clinical management of HIV patients and populates the National HIV Monitoring and Evaluation System. Antenatal care and maternity modules inform the prevention of mother-to-child transmission of HIV (PMTCT) and reproductive health programs. The system also includes an outpatient care module and additional modules for the management of tuberculosis, diabetes and hypertension, for laboratory management, and for national registration and vital statistics. The architecture is open-source and standards-based.
Zambia’s SmartCare is also an EMRS system. The system was introduced in 2005 based on more than five years of prior EMRS work in Zambia, and was conceived primarily to improve continuity of care. It remains a patient-oriented system though it has data aggregation capabilities for reporting and analysis at other levels as well. All ART sites in Zambia are required to utilize SmartCare per MOH instructions. The SmartCare system includes multiple clinical modules including ART, voluntary counseling and testing, maternal and child health, and outpatient services. Additional modules are under development. Data from each visit are copied to a local database and to a portable SmartCard that is retained by patients. This dual data collection system allows transfer of an individual’s medical record across facilities. As of November 2013, the program had been deployed to approximately one-third of the country’s 1800 facilities.
Zimbabwe’s Human Resources Information System (ZHRIS) was launched in 2009 in collaboration with Emory University. The goals of the system include providing an integrated and interoperable system to routinely produce accurate, high-quality workforce surveillance information for effective decision-making and to advance Zimbabwe’s health leadership capacity in tracking their workforce. The current Zimbabwean National Health Information Strategy calls for a single, central data repository system that integrates routine data on logistics, laboratories, administration, transportation and human resources. The Health Informatics Training and Research Advancement Centre (HITRAC) at the University of Zimbabwe is contracted to develop and deploy ZHRIS, which (as of August 2013) was utilized in all eight provinces and both of the two main cities’ central hospitals in Zimbabwe. Ultimately, the system aims to include real-time data on the training, employment and demographics of the more than 30,000 health personnel working in the country including both those working for the public sector and those employed in the private sector.