Over time, PEPFAR leadership may have discovered that it is not possible to practice philanthropy in the air - it has to be in someone's jurisdiction - who needs to care that they Americans are being philanthropic. Although the partners meeting I attended was full of representatives of NGOs supported by PEPFAR, it struck me how the agenda and presentations had undertones of leadership and control by the government. It was also impressive to see the relatively young and professional representation from the government.
Perhaps some readers will frown or cringe at the thought of government stewardship of the eHealth agenda. Consider the scenario where donor funded NGOs have to use this nice MS Access Application developed by this wonderful self taught American Programmer. That would be a self made 'geek' sitting at some place in the US offering great support and maintenance whenever MS Access bugs crop up or whenever the dismal functionality MS Access must be pushed to some impossible limits. Of course once in a while there is also a need for them to offer support on matters like 'which Microsoft Office 2003 service pack to install' and so on. You might also say that I am not the greatest fun of Microsoft products or proprietary systems. However Kenya is a country with quite a wealth of job seeking, highly skilled, economically frustrated software developers - some of them quite accomplished. The picture appears wrong for huge sums of donor aid to a country with jobless software software developers having their 'donor aid' monitored through what might appears to be a makeshift MS Access application managed overseas.
The above picture has been possible because the government of Kenya and its economic sectors have not been keen enough to take full ownership of the aid given to the country. However, the increasing government stewardship of the eHealth agenda in Kenya promises to help in ensuring that its people and its economic sectors directly benefit from the very aid that donor initiatives purport to give. It might be fair enough for donor money to bounce back to its origin through purchase of anti-retro-viral drugs, bed nets, condoms, computers and mobile phones. However, it appears unfair for the aid to dodge our fledgling software development talent, bouncing back through the so-called technical assistance expenses like developing and supporting an MS Access application.
During the meeting which had a lot of eHealth talk, I was particularly impressed by presentations delivered by government officials. The presentations outlined progress made and planned initiatives around eHealth which included :-
- A presentation of plans to rollout a District Health Information System to replace the existing MS Excel Based FTP site for health facility reporting - I gladly observed a silent drift towards DHIS2 - an open source platform that could challenge the use of the KePMS system. A proposed overall initial implementation budget of Ksh 54M appeared realistic to me (peanuts for donors).
- A presentation and demonstration of the Community Based Program Activity Reporting (COBPAR) system - developed in-house at the National AIDS Control Council on an Open Source Platform (currently only available through their VPN).
- A presentation on the almost ready standards for EMR systems in the country (with functional/ interoperability profiles and guidelines for implementation and human resource capacity building). Government seems to have seen the sense that it only needs to encourage an environment of efficient interoperability - away from an earlier drift to push for a default national EMR system (read controversial).
- A clarification that the division of Health Information Systems is pursuing ideas around building an enterprise architecture (EA) for systems in the the health sector - see my earlier post on the importance of EA
- Some profound thoughts on NASCOP's strategy for HIV/AIDS and STI disease surveillance (to be supported by eHealth sub-systems)
One might say that success of eHealth initiatives is a default expectation and that 'government can only be interfering'. I would disagree and see the important role of government in providing the conducive environment for eHealth systems flourishing and efficiently co-existing. Government involvement is also a sure way of ensuring that eHealth initiatives are efficiently tapping from our donor generosity. If the current trend is upheld and protected from adverse political changes, eHealth initiatives including OpenMRS, DHIS2, Child Count, iDart, Jacaranda Health , FrontlineSMS:medic and others are destined for success in Kenya.