Experience in Implementing an Electronic Clinical Decision Support System for Maternal Care in Rural Primary Healthcare Facilities in Sub-Saharan Africa

Presenter: Felix Sukums, Muhimbili University of Health and Allied Sciences

Background: Appropriate use of ehealth solutions have potential to improve health care provision. The QUALMAT project successfully implemented an electronic clinical decision support system (eCDSS) for maternal care in rural Ghana and Tanzania.

Aim: To describe implementation and use of the eCDSS for maternal care in rural primary health care (PHC) facilities of Ghana and Tanzania and to identify factors affecting successful adoption of such a system.

Methods: eCDSS was implemented at six PHC facilities in Lindi rural district in Tanzania and Kassena-Nankana district in Ghana between October 2011 and December 2013. Healthcare workers who were involved in the provision of maternal care in six rural PHC facilities at the respective district in each country where trained on computer skills and on the use of eCDSS.  The eCDSS usage was monitored using a standard tool and midterm and final assessment of user perception was done using mixed methods.

Results: 61 and 56 health providers participated at midterm and final assessments on eCDSS use. The eCDSS was used in 71% (2,703/3,798) and 59% (14,189/24,204) of all ANC clients in Tanzania and Ghana respectively, while it was also used in 83% (1,185/1,427) and 67% (1,435/2,144) of all deliveries in Tanzania and Ghana, respectively. Barriers reported to hinder eCDSS use were related to individual users, tasks, technology, and health system organizational attributes.

Conclusion: Implementation of an eCDSS in resource-constrained PHC facilities in sub-Saharan Africa was feasible and the health workers accepted and continuously used the system for maternal care. Facilitators for eCDSS use included sufficient user training and regular support whereas the challenges to sustained use were unreliable power supply and perceived high workload. However our study also shows that most of the perceived challenges did not substantially hinder adoption and utilization of the eCDSS during patient care.