Health information challenges in ensuring patient-centred MNCH care in urban Bangladesh

Purpose: Use of interoperable, digitized heath management information systems (HMIS) have the potential to enable systematic reporting and coordinated care across facilities. Identifying ways to track women throughout... [ view full abstract ]

Purpose: Use of interoperable, digitized heath management information systems (HMIS) have the potential to enable systematic reporting and coordinated care across facilities. Identifying ways to track women throughout pregnancy, and facilitate movement between facilities might assist in improving effective coverage of maternal, neonatal and child care (MNCH) services. This study explores health information systems for MNCH services employed by selected urban NGO facilities in Dhaka City Corporation to assess opportunities for shared digital records between facilities.
Methods: Formative qualitative research was conducted in six NGO-run MNCH facilities (2 from 3 different NGOs) in Dhaka consisting of in-depth interviews with 20 service providers, 8 key informants, 25 patients, as well as 15 semi-structured observations.
Results: In all six facilities, women have to rotate through 3-4 different points to obtain a service. Patient and service related information is generated at every point of care and most is paper-based. Digitization only starts when aggregating data for use in preparing performance monitoring reports. Women are required to bring membership cards along with diagnostic reports when seeking services. In the case of loss, locating patient records becomes difficult. Information systems that permit interoperability among facilities run by the same NGO, or between different NGOs, do not exist.
Conclusions:
As currently configured, health information systems in urban NGOs offering MNCH services are not conducive to providing a coordinated continuum of care. This increases costs for women as repeated tests may be necessary, and opportunities to address other health needs may be missed. In urban areas, to improve the quality and responsiveness of MNCH services through a common digital platform comprised of a minimum acceptable shared data base is urgently needed. Current Government initiatives promoting HMIS and Digital Bangladesh offer a timely opportunity to introduce Electronic Health Records as a tool for effective service delivery and referral.