The Perspective
Atlanta, Georgia
July 14, 2020

Introduction

The social and economic perspectives in the early phase of the 21st century, deriving from progress in technology in general and information and communication technologies in particular, have demanded new forms of organizational management in all types of companies (Clark, 2004). Many of the longstanding paradigms of the management field have been changing and adapting to this new reality. This reformist context around company management models prevails irrespective of what they do or of their respective sectors of activity (McVea and Freeman, 2005). 

This means, in the 21st century development approaches are strictly in conformity with the 4th industrial revolution, which has the influence to shape how we live and engage the modern work environment. It is incumbent upon us therefore to grasp the existing opportunity and the power we have to shape the current era and direct it towards a future that reflects our common objectives. To do this, however, we must develop a comprehensive and globally shared view of how technology is affecting our lives and reshaping our economic, social, cultural, and human environments and values.

The Liberian healthcare system has undergone series of systemic evolution ranging from traditional healthcare services to the practice of modern medicine yet, lot more efforts need to be exerted to integrate the advancement of Information Communication Technology (ICT) in our healthcare management system. These technologies include wireless sensor networks, robotics, vision recognition, 5G, smart tags, microcontrollers, mobile devices, near-field communications (NFC), drones, radio frequency identifiers (RFID), bar codes, social networks, ICT global networks, Wi-Fi, cloud computing, CoAP, 6LowPAN, geographic information systems (GIS), GPRS, actuators and satellite technologies, to name but a few. 

Of course, the path to achieving this requires huge investment in the ICT sector with full supports from development partners and stakeholders. While analyzing and issuing policy directives are good, they are actually not enough when it comes to this kind of major transition and transformations of a whole sector such as health care delivery. That automating the healthcare delivery system will place an emphasis on the effectiveness of the network infrastructures: municipal, local area, and wider area networks respectively. 

In a book recently published (April 2018) entitled “The Beginning and Growth of Modern Medicine in Liberia and the Founding of the John F. Kennedy Medical Center, Liberia,” by retired senior Medical practitioner and Chairman of Internal Medicine Department of JFK Medical Center, Prof. Joseph N’joh espoused that the book traces the early history of modern medicine in Liberia and the gradual evolution of the nation’s health care delivery system from its inchoate stage to what it is today – a highly organized nationwide health care delivery system. Within it, there is information about the early physicians and nurses, when and where they practiced, the nature of the health issues they grappled with (e.g. chronic diseases of general debility, nose bleeds, dropsy and anasarca, dysentery and diarrhea, intestinal worms, consumption, remittent and intermittent tropical fever, various ulcers, enlarged liver, and spleen, etc.), the various treatments they administered, and the fate of the physicians themselves who worked under some of the hardest conditions.

Also available is information about some of the nation’s earliest hospitals (St. Mark’s Hospital, Cape Palmas (1860) of the Protestant Episcopal Church – 1st hospital in Liberia; McKane’s Hospital and Training School, Monrovia (1895) of Dr. and Dr. (Mrs.) McKane – 1st hospital in Monrovia; Tubman National Hospital, later renamed James Jenkins Dossen Memorial Hospital, Cape Palmas; St. Timothy’s Hospital, Robertsport, Cape Mount County of the Protestant Episcopal Mission, the only hospital in existence in Liberia in early 20th century (1918); Phebe Hospital, Muhlenburg, Montserrado County of the American Lutheran Mission (1916); Holy Cross Hospital, Bolahun, Lofa County, of the Episcopal Mission of Holy Cross (1925); Carrie V. Dyer Memorial Hospital, Monrovia, of the Women Baptist Mission – 1st Maternal and Child Health Hospital in Liberia (1926); United Methodist Dispensary, later Methodist Hospital, Ganta, Nimba County (1926); Firestone Hospital, Harbel (1926); the Liberian Government Hospital, Monrovia – the 1st Government Hospital in Liberia (1927); etc.) – their founders, when and why they were founded, where they were located, and how they fared ( Joseph 2018).

These historical accounts potentially give a comprehensive understanding of the stages of evolution of the Liberian healthcare delivery system and how policymakers could use this basic information to further support efforts geared to building a resilient healthcare system that would align with modern standards and technologies. However, this article seeks to draw comparative analyses of countries from the global and regional perspectives that have harnessed huge potentials of technologies through the establishment of relevant institutions such as Ministries of Information Communication Technology, Innovation centers, Commission of ICT, etc., that have supported the effectiveness of the E-government platforms. As mentioned, the article looks deeply at the best practice approaches used by Japan, Rwanda, and Ghana, on their success stories on the digitalization of their systems and the subsequent implementation of the Electronic Health Management Information System. These comprehensive analyses will provide justifications and guide policy directions to stakeholders of the Liberian government on the implementation of Liberia Electronic Health Management Information System, which would seek to manage, process, store and share accurate and comprehensive health statistics across the country. 

ICT has many importance and applications in the health sector. These may include wearable staff support systems to locate both doctor and education in a hospital at any point in time. It may also include IoT-based knowledge systems to detect adverse reactions to drugs in patients. The combination of sensors, Wi-Fi, and other technologies come handy in the monitoring of vital functions of the body such as the technologies that support the IoT are what we are traditionally familiar with. These technologies include wireless sensor networks, robotics, AI, vision recognition, smart tags, microcontrollers, mobile devices, near-field communications (NFC), radiofrequency identifiers (RFID), bar codes, social networks, ICT global networks, Wi-Fi, cloud computing, CoAP, 6LowPAN, geographic information systems (GIS), GPRS, actuators and satellite technologies, to name but a few. 

Learning Institutions, specifically primary schools must create an environment for their schools in which creativity is valued by utilizing the internet. Successful ICT reengineering and the internet as a driver requires an environ- Innovation Strategy Model that can foster creativity (Amabile, Conti, Coon, Lazenby, & Heron, 1996; Cooper, 2000).

Information and Communication Technology for Disaster Risk Management in Japan

How Digital Solutions are leveraged to increase resilience through Improving Early Warnings and Disaster Information Sharing is indeed paradigmatic and worth mentioning in this write-up.

Japan is one of the most technologically advanced countries in the world, and equally one of the most exposed to natural disasters, including earthquakes, tsunamis, volcanic eruptions, typhoons, rainstorms, flooding, landslides, and snowstorms (Government of Japan 2006). Faced with diverse and significant disaster risks, Japan has accumulated significant experience in recovering from diverse disaster impacts and has gained sufficient experience in the deployment of required resources to maximum effect. Large-scale earthquakes, though less frequent than floods, have strongly impacted Japanese society. For example, in 1995 the Great Hanshin-Awaji Earthquake (magnitude 7.3) caused six thousand deaths and property damages valued at USD 100 billion (World Bank 2011). In 2011, the magnitude 9.0 5 Great East Japan Earthquake (GEJE), one of the largest earthquakes ever recorded in the world, and the giant tsunami it triggered, devastated the northeastern coastal regions on the main island of Japan. The destruction included more than 17,500 fatalities and estimated economic damage of USD 210 billion (World Bank 2012).

Breakthroughs in information and communication technology (ICT) increasingly offer new tools to support disaster risk management (DRM). Due to the rapid advancement of computing and communication devices, ICT’s capacity to improve the DRM framework became a critical factor to strengthen resilience. As a nation with high levels of disaster risk and technological development, Japan has developed several forward-looking ICT for DRM. This report highlights the application of ICT for DRM in two specific areas: Early Warning System (EWS) and Disaster Information Management System (DIMS). The lessons learned from the Japanese case studies are intended to support practitioners and decision-makers in other countries to envision and explore ways to better leverage ICT to strengthen resilience as well as their health care delivery systems.

Rwanda’s Transition to E-Health Platform and the Digitalization of Services

Rwanda is one of the fast-growing countries in terms of science and technology not only in Africa but globally. The country has invested heavily in its science and technology sector; thus building the country’s hub for a technology named and designed “Kigali Innovation City” mainly built to support the country’s transition to technology. In 2016, Rwanda ranked 80th worldwide in terms of networked readiness, with a very strong political and regulatory environment and good government usage of ICTs. The country is also ranked first worldwide in terms of government ICT promotion and ranks highly (top in Africa) in terms of the social impact of ICTs. As part of moving forward in its desire to better the quality of life for all Rwandans, the eHealth Strategy was adopted in 2008. Rwanda has embraced the use of digital health with the Ministry of digitalizing systems such as Rwanda's health management information system, a tool used in validation and analysis of statistical data tailored to integrate health information management activities. There is also the electronic logistic management information system that provides an effective and sustainable supply chain system for medicines and other health commodities, electronic medical records, telemedicine, mobile health (mHealth), health IT systems, and virtual healthcare.

As a country harnessing the potential impact of technology, Rwanda has made headlines as the first country to pilot blood deliveries by drone. Technology can save lives and this is a reality in Rwanda where drones are used to deliver medical supplies in remote areas. As the fight against the global pandemic intensifies, robots are now being part of Rwanda’s fight against COVID-19 and will help minimize the risk of infections among health care workers. Five anti-epidemic robots – named Akazuba, Ikirezi, Mwiza, Ngabo, and Urumuri – will be mainly used to administer temperature checks, monitor patient status, and keep medical records of COVID-19 patients. These high-tech robots can screen 50 to 150 people per minute, deliver food and medication to patient rooms, capture data, and notify officers on duty about detected abnormalities.

How Ghana’s Innovative Health Information Management System Gains African Recognition?

The Ghana Health Service (GHS) implemented an innovative district health information management system (DHIMS) that has led to significant improvements in data collection, reporting, and analysis and has strengthened the country’s health systems. The system has enhanced access to timely health information for managers within the GHS, empowering them to assess the performance of the health system and respond to identified challenges in a timely fashion. In September 2013, the African Development Bank recognized Ghana’s achievement with an e-health award for improving access to health information.

That said, for years Ghana relied on a paper-based vertical system to capture and report data on health service delivery and surveillance. Then, in 2012, PMI provided support to develop a more robust web-based system. The DHIMS 2 system enables health facilities to enter their summary reports directly into an electronic database. It also can auto-generate reports; map data through geographic information systems (GIS) interface, and aid managers and users to process raw facility-level data into graphs that can be easily interpreted.

Conclusion

As stated interalia, this article looks deep into the significance of implementing an electronic health management information system by the Liberian government which will improve data collection, reporting, and analysis as well as strengthens the country’s health systems. As per the case studies reviewed, the e-health platforms in Japan, Rwanda, and Ghana have multiplier effects in building resilient healthcare delivery systems for the individual countries. The article argues a huge potential for Liberia to harness and gain from the experiences of the mentioned countries, were the country to decide on automating health services and run the “Liberia Health Management Information System”. This System will provide support to policymakers and health practitioners in regards to comprehensive data collection and analysis on health, patient records, payment system, processing, and sharing. 

Furthermore, the system, when implemented will serve as a catalyst for coordination amongst key institutions and stakeholders in the Liberian Healthcare delivery sector. The governments of Japan, Rwanda, and Ghana have prioritized the need for health financing as an indicator for achieving the global standard of health and preparing their countries against global health crises through the utilization of ICT.

The 21st century development approaches are strictly in conformity with the 4th industrial revolution, which has the influence to shape how we live and we should thus grasp the opportunity and power we have to shape the Fourth Industrial Revolution and direct it towards a future that reflects our common objectives. To do this, however, we must develop a comprehensive and globally shared view of how technology is affecting our lives and reshaping our economic, social, cultural, and human environments and values. Therefore, the Liberian government should and must learn from good practices and approaches to ensuring sustainable health sector financing as a developing country willing to build a resilient healthcare system. The government, key policymakers and all concerned have to come to terms with adapting and developing innovative technologies that have proven to have statistical influences on the quality healthcare delivery system. Conventional wisdom will inform you that technology is leading the universe and the way of life. The current COVID 19 pandemic has further justified the increasing significance of ICT innovation in public and private bureaucracies. 

Recommendations for Policy actions 

To strengthen the capacity of the Liberian healthcare delivery system and the implementation of the e-health platform, the article recommends the following:
❖ National electronic medical records in both public and private institutions
❖ Build an automated dashboard that will coordinate all health-related data from government facilities including JFK Medical Center, Jackson F. Doe, and Phebe among several others.
❖ Health insurance information system.
❖ Automated drug utilization system.
❖ Implement Liberia Health Management Information System which will allow for the accumulation of real-time patient data, storage, and sharing of health statistics to ensure better monitoring of the quality.
All referral medical centers are certified by the International Organization of Standard (ISO) in terms of quality improvement and control

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About the Author:Amara Quardu Mohammed Kamara can be reached at: amaraquardumohammed@gmail.com

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