CHAK has rolled out a Health Systems Strengthening initiative to enhance capacity, efficiency and effectiveness in the management of its member health facilities. This development has been inspired by the need to address the growing challenges of sustainability and demands for quality services despite scarce resources.

To give CHAK member health facilities a competitive edge and optimize efficiency in resource mobilization, use and accountability, two types of software will be developed as part of CHAK’s health systems strengthening initiative; an immediate software to be used by smaller health facilities and larger hospitals that do not currently have a HMIS system and a comprehensive software to be used by larger hospitals that are already using a HMIS software but which has failed to meet their needs.

The immediate software has already been developed and is currently being piloted in two CHAK health facilities. Development of the comprehensive software is still in the initial stages. The IT system is built on an open-source platform. To adequately cover both financial and patient records management, the CHAK HMIS Software has interlinked Care2X, a health care system, with an accounting  and resource management system, WebERP.

The software development process is at an advanced stage and piloting has been initiated at Maseno Hospital in Kisumu and Soweto Kayole Health Centre in Nairobi’s Kayole area. We are pleased and encouraged to see the enthusiasm and excitement of health workers as they switch from manual systems to this new IT solution.

The software has the following modules which were requested by member hospitals at a workshop that CHAK hosted in May 2009:
• In-patient
• Out-patient
• Consultants clinic
• OPD Registration
• MCH
• Laboratory
• Pharmacy
• X-Ray/radiology services
• Patient records
• Billing module
• Inventory/stores module
• School of nursing
• Cash Book
• Accounting module
• Services module (maintenance and transport)
• Project based reporting module
• Report writing module – that is able to generate various financial and HMIS reports

Our dream at CHAK is to have all hospitals and lower level health facilities computerized using this solution. CHAK Secretariat will build a support team to provide training and technical support. We also intend to provide support on-line through the Internet but site-based training, mentorship and support will also be provided.

Our target is to complete the pilot stage within a period of six months and thereafter formerly launch the product for national scale up. Our vision stretches even further towards building the same on an elaborate medical dictionary platform that would allow the system to also support clinicians in making decisions on patient diagnosis and management.

Why the need for a software for CHAK health facilities?

• Development of the HMIS software is part of the broader CHAK health systems strengthening initiative whose aim is to address weaknesses in health service delivery support systems in church health facilities. 
• Computing and information technology has been identified by CHAK as one of the areas that can greatly improve systems at facility level. CHAK has been providing adhoc IT support to its members based on institutional requests. However, there has been a pressing need to have this support structured and well coordinated.
• CHAK health facilities that are already using computerized systems have reported marked improvement in the way they do business. However, many facilities have been experiencing challenges with their computerized systems, the major one being inadequate or unreliable support from vendors. As such, health facilities have been left with expensive software that does not adequately address many of their needs as was intended when the system was procured.    

The new software will be supported from CHAK. CHAK MHUs rejected a proprietary system where the software is owned by an individual as it would be impossible to change it to suit the diverse needs of the network. 

Developing the software
During a consultative workshop held at the CHAK Guest House and Conference Centre, members expressed their desire for open source software that could be easily adapted to individual health facility needs. Two softwares have already been identified; Care2X which is fairly developed but lacks a financial system and Open MRS. Care2X will be used as immediate software while Open MRS will be developed to suit the needs of the larger health facilities.

Adaptation of the Care2X system has been completed following the embedding of a financial system and cashbook. The idea to embed the financial system, WebERP, was borrowed from the Evangelical Lutheran Church of Tanzania which was already using Care2X in some of its health facilities. However, the system still lacked a cash book which was subsequently developed by CHAK and embedded into the software.

The WebERP was also adjusted to ensure it worked well. In addition, a Patient Bill Management module was created from scratch at CHAK since this was not present in Care2X. The Care2X software is currently being piloted in two sites out of the initial four selected.
 
Selection of pilot sites for immediate software 
Initially, four pilot sites were selected, namely, AEE Soweto Kayole PHC Clinic, Redeemed Gospel Huruma Clinic, ACK St Lukes Kaloleni Hospital and ACK Maseno Hospital. The criteria for selection were as follows: 

•  The system was to be tested in two small health facilities.
• It would also be tested in two hospitals.
• The size of the facility and number of patients were also determining factors. 
• It was preferred that the pilot site not have a HMIS software in use as it would be difficult to interrupt health facility operations to test the new system.
• Availability of computers was mandatory since the budget did not provide for purchase of computers. Soweto Kayole had four working, brand new computers and was therefore considered a good site for a pilot.
• AIDSRelief was willing to provide a budget for purchase and networking of computers for its sites selected for the pilot. Maseno and St Lukes therefore proved to be good options.
  

The pilot phase is currently ongoing. If found suitable, Care2X will be adopted for use by smaller CHAK health facilities and hospitals that have previously not had a HMIS system. The software will be made available for use by all CHAK members.

Training for the pilot phase 
Training was carried out according to user areas. Staff were trained at their workstations and on the module (s) they would be using. This proved quite effective and the training was completed within a short time. 

 
Anticipated challenges in rolling out the system to the CHAK member network

• Computer illiteracy as many lower health facilities lack computers
• Hardware in most sites is inadequate
• Challenges with power supply as most sites do not have generators
• The time allocated to the pilot was quite short.
• Distance to some pilot sites is quite large hence higher expenses.
• Health facilities have adopted certain systems that have been used over a long period of time and that patients have become used to. To use the HMIS software, some of these systems have to be changed, posing a challenge for both staff and clients.

Advantages of Care2X 

• Fairly simple and easy to use
• Comprehensive or integrated system
• Web-based. One works and saves their work on the server. All data is stored on the server and thus cannot be easily lost.
• Portability: the software can operate with Morzilla Firefox, Internet Explorer, Windows, Linux and other operating systems
• Ease of deployment: there is not much programming at the field level, hence the software is quite adaptable.
• A key advantage of the system is that one can easily select the modules to use and adopt them to the circumstances at hand. Smaller health facilities will activate less modules compared to larger hospitals.
• Where a health facility’s current software has a database running on SQL or MYSQL, or the data can be exported to CSV, it may be possible to migrate data to the new system.
   
  

What do health facilities need to be able to use this software? 

• In a dispensary or health centre, the requirements are one computer per clinician, a computer each for the pharmacy, registration desk, cashier and laboratory. In big hospitals, a computer is required at each service point. 
• System requirements: a computer with 40GB space, 1GB RAM, browser e.g. Morzilla Firefox. Internet may not be necessary but intranet is essential. The internet is important for updating the programme when need arises.
• Two receipt printers

Open MRS
Big hospitals, most of which already have HMIS software, will benefit from a comprehensive system complete with a concept dictionary. This will be an open MRS system which unlike Care2X is not very well developed and is Java-based. The plan is to have an intelligent system and a concept has already been prepared awaiting funding . CHAK is working together with AIC Kijabe Hospital on this initiative. The main targets for this comprehensive software are the big hospitals that already have software that is not meeting their needs. We wish to thank CMMB for its support in this project.