Project Lead(s): Bruce Dahlman
Primary care providers in developing countries often do not have access to medical libraries or Internet services.
Despite frequent calls to ‘connect Africa’, the cost and bandwidth problems associated with web-based solutions make access to relevant clinical decision support information a distant promise in most rural African health facilities.
Smartphone-based decision support tools are common in Canada, but subscriptions are expensive and means of payment are inaccessible to African physicians.
In 2009, a non-integrated, personal digital assistant (PDA)-based collection of information resources was used as the basis for the Kenyan Point-of-Care Health Information. This study demonstrated that mobile devices can be used to help Kenyan healthcare workers access medical information, in order to facilitate decision-making at the point-of-care.
Based on the results of these studies, a prototype, smartphone-based, locally relevant, and integrated point-of-care decision support tool (Digital Library) was created, in collaboration with the University of Nairobi and the University of Calgary Global Health and International Partnerships. The prototype was distributed to 200+ users in five countries, to test the feasibility of remote download and installation of large amounts of data.
The Digital Library combines ten different category resources – five Oxford Handbooks, an integrated, journal-based information resource (DynaMed), Africa Health Journal CME information, the British National Formulary and CALS emergency care guidelines – all within a single search function, combining relevance to Africa, evidence-based validity and value.
Appreciating generously discounted royalties from the above resource providers, a subscription-based sales model was established to make the project sustainable. Relationships built in the five countries involved in the earlier, smaller-scale prototype were utilized to launch the product and the project was expanded to two additional countries.
The RHealth Advisor is an additional resource that has now been linked to the library, which provides a differential diagnosis that incorporates the epidemiologic prevelances of disease in Africa. Although this requires an Internet connection to operate, its clinical value is important to the usefulness of the Digital Library, especially for front-line primary healthcare workers.
Collaborations are ongoing to incorporate the guidelines of Ministries of Health from several countries into the Digital Library.
The Digital Library is in the final stages of being registered as a corporate entity, within a legal framework that allows it to function as a registered business, and the website designed for promotion and sales was inaugurated and optimized.
The project demonstrated that the Digital African Health Library (Digital Library) prototype could be successfully transitioned to a subscription product that will be self-sustaining in all aspects once a scale-up has occurred.
Data obtained in surveys submitted by users and ongoing audit information has confirmed that healthcare workers find the library helpful in their work to provide improved patient care. A total of 147 users were surveyed, with a 34% response rate.
Analysis of data showed that the Digital Library has the right resources to answer questions (87.8 % agreement); can help make more decisions while with the patient (89.8% agreement) and can provide answers to change the plan the provider had for patient care (67.3% agreement). Finally, 67.4% of healthcare workers who used the Digital Library prototype expressed an interest in purchasing the device if the subscription price was offered for $30–$50 per year.
The project team benefited from connections made to additional partners during the grant period. They were connected to the Swedish International Development Agency (SIDA) through their global information technology partner, SPIDER. Digital Library support and expansion has been made a part of their 2015–2019 funding application and this five-year support will provide the necessary continuity for the roll-out and the scale-up of the project.
Knowledge of the project has been disseminated through workshops and conferences.