It is 3.30pm when we arrive at Kamuzu Central Hospital in Lilongwe and the end of Chawanangwa Khuwi’s day at work in the facility’s busy laboratory has just begun.
However, samples of blood, other fluids and body tissue from congested wards, where patients are eagerly waiting to know the conditions haunting them, keep trickling in. Even the guardians, who bring the samples to the lab headed by Khuwi, cannot wait to know the status of the patients. To them, a timely medical test is a springboard to effective treatment, care and support.
However, stories are told of patients who died of treatable conditions because the results either delayed to come or went missing in stacks of paper clogging the laboratory which handles up to 700 samples a day.
“There are 28 people working in 10 departments here,” she says. “In the haematology section, we usually get no less than 200 blood samples every day, but we could only test about 75 previously. Not anymore. Since we stopped using pen and paper, we clear the daily workload on time, meaning the patients get to see the doctors on time and they receive treatment before it is too late to save their lives.”
Paperwork has dwindled since Baobab Health installed a laboratory information management system (Lims) at KCH in 2006. Now, all central hospitals—Queen Elizabeth in Blantyre, Zomba and Mzuzu—have also been connected alongside district hospitals in Thyolo, Mzimba and Nsanje.
In their line of duty, Khuwi and her team credit the computer-based system with improving the tracking of samples, analysis of patients’ conditions, storage of findings and reporting of vital data microscopes and laboratory machines churn out.
During the visit, we saw front desk staff receiving samples, logging them in a computer, sorting them and typing details from a reference form before relaying the specimen for applicable tests. The computers offer lab technicians the ease to track the duration and quantities of chemicals tests take.
In fact, says Khuwi, the electronic system has almost the time we take to produce the results. She completed a full blood count and printed results in 15 minutes as we looked on.
“Previously, we were using a manual system which required one to take down notes, which was not only tedious but also not always accurate and easy to interpret and store. This is why clients were complaining of delays and lost samples.
“With the electronic system, all information from the laboratory is stored in a central server which interacts with other facilities using Lims and cases of missing samples have been reduced. At a click of a button, we access it and generate different reports.
“In this way, the system has almost halved the time vital tests take, including a full blood count and viral load tests for people living with HIV.
“Tests that took 60 to 90 minutes previously now require just 30 to 40 minutes. In the process, we can track the number of tests conducted per day and how much reagents were used, effectively gauging the supplies needed per month. The main winner is the patient in need of timely treatment and quality services. No patient should die without knowing the results,” states Khuwi.
However, she bemoaned skewed connectivity as the laboratory-based digital solution is mostly cut off from the rest of the hospital.
“The whole hospital has to be connected so that the doctor assisting the patient accesses the results with ease. Currently, only the laboratory is connected,” says the laboratory technologist.
For Dr Andrew Likaka, the director of quality management and digital health in the Ministry of Health, bridging the gap will help leave no one in a gradual push to connect all health facilities countrywide.
“We want to phase out paper and set up an efficient system that looks at the complete person regardless of condition and where they are. We want to digitalise every point where a person is interacting with the healthcare system,” he states.
Baobab Health has been a catalyst of digital health solutions in the country for 15 years, says Likaka.
“Being a local organisation, they are working in an area they understand really well. Currently, one of the areas Malawi is moving forward is that we use data in real time, not six months. We don’t want to react to things that happened half a year ago, but as they happen,” he explains.
Lims aside, Baobab Health has connected 121 health facilities to a national antiretroviral therapy information management system designed to fast-track the treatment, monitoring and prevention of HIV and Aids as well as reducing stock-outs of life-prolonging drugs.
Likaka waxes lyrical: “As we are talking, I can get information from Makanjira in Mangochi and Thekerani in Thyolo. If we track their records, we will all know if they are receiving quality care.”
Meanwhile, work is in progress to connect 141 health facilities this year, says Baobab Health spokesperson Mathews Malata.
As Khuwi’s experience in the laboratory has illustrated, improving information management systems accelerates the way healthcare workers tackle the country’s huge disease burden, including HIV and Aids.
He explains: “Currently, Lims is available in all central hospitals and Thyolo District Hospital with high chances of expansion. It strengthens laboratory processes, resulting in a timely release of different reports which help patients to know their status and get the right treatment without delays.
“It also enhances the reporting of viral load results, addressing the third 90 in the 90-90-90 agenda: Ensuring 90 percent of people diagnosed with HIV are virally suppressed.”