Running head: HEALTH INFORMATICS IN DEVELOPING COUNTRIES

Health Informatics in Developing Countries

Ken McIntyre
Ferris State University

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Health Informatics in Developing Countries

This paper will discuss the role economics plays in the implementation and maintenance
of health informatics in developing countries, and what measures are needed to provide that
technology to those nations.
Summary of the Reviewed Paper
In the article Economics of Health Informatics in Developing Countries, Hebert
discusses the implementation of informatics in developing countries, with a developing country
being defined as a country with a Gross Domestic Product (GDP) per capita [person] of less than
ten-thousand U.S. dollars. According to the Central Intelligence Agency (CIA), in 2015 there
were estimated to be ninety-four countries that met this GDP criteria (Central Intelligence
Agency, n.d.-b). Of those ninety-four countries, 7 of these countries Liberia, Burundi, the
Democratic Republic of the Congo, Central African Republic, Somalia, Kosovo, and Anguilla
had a GDP of less than one-thousand U.S. dollars (Central Intelligence Agency, n.d.-b). A large
majority of those countries with a GDP of less than ten-thousand U.S. dollars are located in the
African continent.
Launched in May of 2005, the Health Metrics Network (HMN) was an initiative by the
World Health Organization (WHO) to improve public health decision-making through better
health information (American National Standards Institute (ANSI), 2005). Under the HMN
initiative, over 100 developing countries were provided with money by the WHO to examine
their health informatics (HI) structures to determine and report on what systems were in place
(Hebert, 2011, p. 162). The information generated from these surveys was intended to be shared
among both developed and developing countries with the expectations of learning from each
other. What was to be learned is rather vague and sketchy.

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Hebert explains, Many lessons have been learnt, however these lessons could not be
expected to be known to the key government officials, or taken very seriously by their paid
consultants, and, The bottom line answer is that HI is a very complex matter in the same
category as Reverse-Engineer the Brian (Hebert, 2011, p. 164). Despite Heberts pessimistic
outlook of the lessons to be learned in implementing an HI system in a developing country, he
did list several recommendations that he must have extrapolated from the information generated
by, or learned from the HMN.
Heberts recommendations for developing countries are to get started and progress
slowly, start with a Patient Administration System (PAS), limit the cost to no more than 1% of
the annual health budget, use low cost desktop devices, train groups of individuals using the
train-the-trainer method, use online conferencing software to reduce travel costs, standardize
all system components, and use open source software to reduce licensing costs (Hebert, 2011,
p. 164-165). Many, if not all, of Heberts recommendations are easily within the capabilities of
all developing countries, if the infrastructure needed is in place.
However, in many developing countries, infrastructure that developed countries have in
place and take for granted are not available, such as an educated workforce, a reliable electrical
supply, and internet access. In these instances, alternate approaches will have to be developed or
new ideas conceived to address infrastructure issues.
Relevance to the Course
Throughout COHP 300 we have focused on informatics and how it affects delivery of
healthcare, and the consequences that it has on healthcare providers and patients. According to
the syllabus,

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The course will introduce software applications used in HCIS. The student will develop
an understanding of the implications of integrated versus interfacing disparate HCIS
applications, database management, and patient privacy issues. The course will examine
emerging technology in the areas of rural health care, telemedicine, access to Electronic
Medical Records, and Regional Health Information Organizations (Reger, 2016, p. 1).
To better understand economics and the implementation of health informatics in
developing countries, it is important to first understand the intricacies and limitations of these
systems as they are currently being used. COHP 300 Health Information Systems helps the
student to have a better understanding of this technology and how it is applied. The economic
impact and efficacy of this technology we learned in this class then can be associated to, and
generalized to outcomes in other geographical areas.
Informatics is an extremely important aspect of healthcare in todays world. Not only
does informatics improve patient safety and quality of care, it is a vital tool in fighting disease
throughout the world. Babbage, Nagisetty, Larmore, & Fiore wrote, Not all diseases exist in
locations where they are easy to study, and researchers have used the capabilities of healthcare
informatics to deliver on the specific research requirements in a fast, accurate, and secure way
in a developing country (2012, p. 1). Informatics is a very valuable tool that goes far beyond
hardware, software, and convenience, and as a result of COHP 300, I have developed a better
sense of how important this tool is.
Significance to the Future of Informatics
Economics is a substantial force driving the use, or non-use of informatics in the United
States and other countries. In the United States, the American Recovery and Reinvestment Act
includes financial incentives to encourage the use of informatics in the form of Electronic Health

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Records (EHR) or Electronic Medical Records (EMR) by healthcare providers. Financial

incentives from the government are not generally available in developing countries, unless the
moneys are provided by an outside source from international programs such HMN, which
ironically, was subsequently discontinued in May of 2013 due to a lack of funds. Due to limited
financial resources, and sometimes corrupt governments in developing countries, economics
plays a vital role in the future of informatics in those nations. The needed technology, software
licensing fees, and skilled labor needed to implement, use, and maintain sophisticated computer
hardware and software can be prohibitively expensive.
In his article, Economics of Health Informatics in Developing Countries, Hebert
compares the per capita spending for PAS in Jamaica, a developing country, and Canada, a
developed country. Hebert points out that in Canada, the annual per capita cost for PAS is
approximately 12.00 U.S. dollars, whereas in Jamaica, the annual per capita cost for PAS is
approximately 0.81 U.S. cents (2011, p. 164). The reason for this discrepancy in annual costs
between the two counties is due to the Jamaican PAS lacks additional clinical modules such as
pharmacy, diagnostic imaging, laboratory, dietary, etc. (Hebert, 2011, p. 164), and most likely
other substantial factors, such as labor rates are lower.
In Canada, the average annual wage in 2012 was 32,688 U.S. dollars, and in Jamaica, the
average annual wage was 13,620 U.S. dollars (Statista Inc., n.d.). To the casual observer, it
would seem that the average Jamaican could easily afford the extra 11.19 U.S. dollars each year
to have a more comprehensive PAS. With a population of approximately 3 million people, the
additional cost would be roughly 33.57 million U.S. dollars. Since the Jamaican government
receives approximately 3.7 billion U.S. dollars per year in revenue (Central Intelligence Agency,
n.d.-a), this additional money would account for less than 1 percent of the total revenue the

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government receives. Even with the current annual spending of 0.81 U.S. cents in Jamaica on
PAS, the total cost would still be less than 1 percent of the total revenue the government
receives.
Is the lack of a health informatics system (PAS, EMR, EHR), or an inferior health
informatics system an economic issue, or is there some other reason? That is a question that will
have to be decided on a country by country basis.
Recommendations based on the Significance to the Future of Informatics
The obstacles to providing health informatics systems in developing countries can be at
times considerable, or even overwhelming. In addition to a lack of a rudimentary, functional
government, Developing countries have considerable structural deficits in their physical
networks, due to high costs, geographic dispersion, and high percentages of the people living in
rural areas (Luna, Almerares, Mayan, Gonzlez Bernaldo de Quirs, & Otero, 2014, p. 4). In
countries where basic needs such as food, clothing, shelter, and basic healthcare are difficult to
secure for the average citizen, it seems that implementing a health informatics system would be a
low priority for those people. Especially when electricity is considered a luxury.
According to The World Bank Group, Africas power infrastructure delivers only a
fraction of the service found elsewhere in the developing world, and in the 48 countries of SubSaharan Africa, Power consumption, at 124 kilowatt hours per capita per year and falling, is
only a tenth of that found elsewhere in the developing world, barely enough to power one 100watt light bulb per person for three hours a day (2013). Most technology is basically useless
without a reliable energy source.
Additionally, most of this technology is basically useless without a skilled workforce that
is able to operate it. One of the challenges to implementing health information and

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communication technology is the need for a skilled workforce that understands health care,
information and communication technology, and the people and organizational challenges
involved (Hersh, Margolis, Quiros, & Otero, 2010, p. 275). It would be too time consuming to
train an individual to use medical informatics technology if that individual had to be taught how
to read and write first.
My recommendations in those developing countries with an existing infrastructure and
educated workforce, would be to use current technology that is familiar to the healthcare
providers when possible. If the software or technology is not familiar to local staff, training local
staff to be trainers would be the most effective method of developing a sustainable workforce
capable of utilizing the technology. In addition, local staff would be more effective for the
reason that they would not be as susceptible to language or cultural barriers. Software should be
open-source whenever possible to help reduce costs. Current technology could be cell-phones,
netbooks, or tablets.
In those countries without any infrastructure, the use of vehicles such as the mobile
clinics being used to provide primary healthcare in the remote areas of Eritrea where there are
no healthcare facilities (Mobile Medical Solutions, 2015), or in particularly remote areas where
there are no roads, specialty vehicles such as hovercraft could be used. Medical informatics
systems could be incorporated into those vehicles [mobile clinics, hovercraft] to help enhance
patient safety and outcomes, and provide an interim solution until the countrys infrastructure
can support a more conventional medical informatics system.
If a shortage of educated residents exists in the country where the healthcare informatics
system is to be used, then there is no alternative but to provide non-nationals to perform the work
needed to utilize the technology. The local culture must also be considered. Varied health care

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system needs must also be considered as the system is developed and the required workforce is
recruited and trained (Hersh, Margolis, Quiros, & Otero, 2010, p. 276). Training non-nationals
to implement and manage informatics systems must also include training to be culturally
competent and sensitive in the areas where they serve.
Another aspect that impacts the economics of health informatics in developing countries
is safety. Many undeveloped countries experience unstable or corrupt governments, anarchy,
and rogue groups. Resources used to provide security are resources that cannot be used to
purchase hardware, software, or pay for staff.
Conclusion
There is little doubt that medical informatics increase patient safety, quality of care, and
will help reduce healthcare costs over time. It is also known that informatics is essential to help
control disease and aid in the research to cure illnesses. To exploit the full potential of health
informatics in developing countries, three main economic factors [deficient infrastructure, an
under-educated labor force, safety concerns] in those countries must be considered, and the
associated barriers to those factors be overcome or mitigated.

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References

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Mobile Medical Solutions. (2015). All terrain mobile clinic. Retrieved March 27, 2016, from
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https://fsulearn.ferris.edu/webapps/blackboard/content/listContent.jsp?course_id=_21424
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