Clos­ing the health­care data gap

Financial Mirror (Cyprus) - - FRONT PAGE -

While much of the world to­day suf­fers from in­for­ma­tion over­load, there are still places where in­for­ma­tion is scarce. And that scarcity some­times costs peo­ple their lives.

In the ma­ter­nity ward of Zanz­ibar’s largest pub­lic-health fa­cil­ity, Mnazi Mmoja Hospi­tal, pa­tient data are listed on a dry-erase board. The in­for­ma­tion on the board con­sists of the num­ber of women ad­mit­ted, the type and sever­ity of their con­di­tions, and whether or not they sur­vived.

Th­ese data may be bet­ter than noth­ing, but not by much. There are no dates or time­stamps or long-term fil­ing sys­tems. With photographs of the board strictly for­bid­den, records last only as long as they are on it.

Zanz­ibar’s at­ti­tude to­ward health records is not unique. In fact, Zanz­ibar is prob­a­bly more care­ful than many other places through­out Africa and Asia, where data-col­lec­tion sys­tems sim­ply do not ex­ist.

When a coun­try suf­fers from such a data deficit, its pub­lichealth poli­cies, bud­gets, and strate­gies are de­cided by po­lit­i­cal ex­pe­di­ency or guess­work. Some­times the guesses are right, but most of­ten they are not.

This is a ma­jor chal­lenge for health-care sys­tems in the de­vel­op­ing world. Col­lect­ing ac­cu­rate in­for­ma­tion on all pa­tients (while still re­spect­ing pri­vacy) is vi­tal to track­ing pub­lic-health threats, lapses in care, and med­i­cal er­rors, and is a nec­es­sary and essential con­di­tion for hold­ing open and hon­est de­bates about health-care is­sues that can af­fect en­tire com­mu­ni­ties or coun­tries.

Ac­cord­ing to a Bri­tish Med­i­cal Jour­nal anal­y­sis by Martin Makary and Michael Daniel of the Johns Hop­kins Univer­sity School of Medicine, in the United States, med­i­cal er­rors alone are the third lead­ing cause of death, af­ter heart dis­ease and can­cer. In the con­text of their anal­y­sis, med­i­cal er­rors could in­clude bad doc­tors, poor clin­i­cal judg­ment, mis­com­mu­ni­ca­tions be­tween staff mem­bers or de­part­ments, and in­cor­rect di­ag­noses.

There is no rea­son to think this prob­lem is con­fined to the US. Health-care set­tings in the de­vel­op­ing world of­ten face even steeper chal­lenges, such as lack of tech­ni­cal ca­pac­ity among hospi­tal man­age­ment, staff short­ages, poor train­ing, low-qual­ity medicines, and rel­a­tive im­punity for med­i­cal mal­prac­tice. Un­for­tu­nately, be­cause we have such lim­ited data, we can­not know the ex­tent to which any of th­ese fac­tors con­trib­ute to poor health out­comes and avoid­able deaths in de­vel­op­ing coun­tries.

Aside from potentially sav­ing count­less lives, re­li­able data can re­duce costs, fi­nan­cially and psy­cho­log­i­cally. The fi­nan­cial bur­den of health care in low- and mid­dle-in­come coun­tries is sub­stan­tial, de­spite the progress that has been made in fight­ing HIV, malaria, and tu­ber­cu­lo­sis. Be­yond th­ese dis­eases, for which there is treat­ment and track­ing, thanks partly to am­ple aware­ness, many ill­nesses go uniden­ti­fied and con­tinue to strain pub­lic-health ser­vices.

Un­der­stand­ing com­mon causes of death is the only way to im­prove health care in com­mu­ni­ties with a high dis­ease bur­den, pa­tri­ar­chal hi­er­ar­chies, and large and dis­persed ru­ral pop­u­la­tions that rely on tra­di­tional medicine. In th­ese set­tings, pa­tient in­ter­ac­tions with doc­tors are rare, so it is im­por­tant to col­lect records on them at ev­ery op­por­tu­nity.

Dif­fer­ent societies have dif­fer­ent health-care needs, and fully com­pre­hend­ing what they are is no easy task. But we can be­gin the process with three steps.

The first is to cre­ate aware­ness within com­mu­ni­ties. All peo­ple want healthy and pro­duc­tive lives for them­selves and their loved ones, so they will wel­come new in­sights into why peo­ple in their com­mu­nity die or get sick. With the advent of ci­ti­zen jour­nal­ism and so­cial me­dia, even in poor coun­tries, pub­lic-aware­ness cam­paigns are now more af­ford­able than ever.

The sec­ond step is to de­vise bet­ter ways to col­lect data. Many de­vel­op­ing coun­tries lack the funds, in­fras­truc­ture, and train­ing needed to use so­phis­ti­cated data-col­lec­tion tools; but that doesn’t mean they can’t make sig­nif­i­cant im­prove­ments in data col­lec­tion. As Atul Gawande of Har­vard Univer­sity’s School of Pub­lic Health has shown, sim­ple check­lists can be ef­fec­tive in both col­lect­ing data and mak­ing bet­ter de­ci­sions. If health-care work­ers and pol­i­cy­mak­ers know which data are use­ful and why, they will al­ready be in a bet­ter po­si­tion to change pub­lic-health out­comes.

The fi­nal step is to es­tab­lish trans­par­ent over­sight of the data be­ing col­lected. Some data may point to po­lit­i­cally in­con­ve­nient or coun­ter­in­tu­itive con­clu­sions, and politi­cians could be tempted to sweep it un­der the rug. In the age of so­cial me­dia and open-ac­cess jour­nals, we should de­mand that newly col­lected data be made avail­able to a broad range of peo­ple re­search­ing pub­lic-health is­sues and work­ing in health-care set­tings.

Ul­ti­mately, we may not be able to pre­vent deaths caused by cer­tain ill­nesses. But with more in­for­ma­tion, it is within our power to pre­vent those deaths that are caused by our own com­pla­cency or in­com­pe­tence.

Newspapers in English

Newspapers from Cyprus

© PressReader. All rights reserved.