This work will concretely advance Zimbabwe’s vision for a unified, country-wide, patient-level data system by building on the Impilo platform (the Zimbabwean-designed and built national EHR platform) to create a central client registry (CR) for the Ministry of Health and Child Care (MoHCC) as well as package and distribute the improved CR as an open-source global good to benefit all. The MoHCC and Vital Wave will achieve this through an iterative and collaborative process by drawing on their existing partnership, complementary skills and expertise, and coordination with the broader digital health community.
Over a period of ten months, the MoHCC will work closely with the Vital Wave team to accomplish the following: 1) strengthen the Zimbabwe digital health system through the creation of a central client registry based on the existing component of the Impilo platform in accordance to global standards (e.g., OpenHIE), and 2) package and distribute the standalone client registry as an open-source global good to be used in other low-resource settings.
Zimbabwe offers a unique opportunity to develop and contextualize a client registry solution to benefit the MoHCC and the global digital health community at large. Recently, the MoHCC created a unified vision for a national, locally built EHR (Impilo), which has high-level support under the Permanent Secretary for Health and Child Care. Multiple government agencies, donors, and implementing partners have backed this vision, which centers on a patient-level system as a central component of the national digital health architecture. Most importantly, this vision and the unification of stakeholders has already realized initial funding investments. Therefore, the advantages to this project opportunity and approach are numerous, including:
Supports and benefits complementary investments: The funding from this project will support and benefit from complementary investments made by other donors such as PEPFAR/CDC, UNFPA, Cordaid Memisa, the Global Fund, and GAVI to improve Impilo system functionality, develop new modules, and extend deployment to additional health facilities. Alignment and support of investments such as this, exemplifies The Principles of Donor Alignment for Digital Health as well as increases the overall impact of investment funds.
Builds on existing, testable technology already in operation: The MoHCC has already driven the design and initial implementation of the Impilo client registry. This locally appropriate solution was derived through a human-centered design approach, focusing on health worker and facility needs. Any enhancements made can be pushed out and immediately tested at the 146 health facilities already using the Impilo platform, resulting in a robust, tested client registry and global good that is fit-for-purpose.
Strengthens overall Zimbabwe health system including COVID-19 response, chronic disease management, and medical research: A central client registry will benefit other areas of the health information system. For instance, it will provide valuable patient identification data and services for direct-to-beneficiary applications now being rolled out for the national COVID-19 response, including self-registration, suspected case reporting, and contact tracing. It will yield the ability to uniquely identify patients across multiple service delivery points and systems to improve longitudinal tracking of clients including linking mother and baby pairs, as well as the ability to provide de-identified clinical data for research. It will also provide visibility into silent transfers of patients with chronic disease (e.g., HIV and TB) between facilities which would otherwise be recorded as patients lost to follow up.
Together, the consortium partners will work collaboratively on all activities to build capacities of MoHCC staff and leverage their current partnership, such as work to establish a Community of Practice for the Impilo platform to accelerate progress toward global good packaging and dissemination. In addition, the MoHCC and Vital Wave are already successfully executing work throughout the COVID-19 pandemic. Best practices and established project processes will be employed for this opportunity as well.
The Ministry of Health and Child Care (MoHCC) of Zimbabwe is currently working closely with the Vital Wave team through funding from the Bill and Melinda Gates Foundation to conduct a countrywide EHR landscape analysis, with the aim of creating a more coherent digital health architecture. Within this context, the two organizations have formed a strong partnership. For this particular opportunity, the two organizations will join forces, each bringing a unique set of complementary skills to ensure project success.
The MoHCC will serve as the Consortium Lead, driving the overall strategic direction and execution of the project. The MoHCC brings strong government leadership and existing alignment across the ministries and partner organizations as well as the ability to advocate with peers in other country governments. In addition, the MoHCC brings a skilled software development team with applied experience in Docker containerization, event-sourcing architecture, and interoperability-layer implementation. This is bolstered by their well-established software development operations and user-centered processes for patient-level system design, testing, and implementation. This includes access to a cohort of 146 health facilities actively using the current version of the client registry (within the Impilo EHR system), allowing immediate implementation of developments in low-resource settings. Concurrent investments by other donors will increase the number of active health facilities over the course of the project, leading to a direct increase in its impact.
Vital Wave will serve as Technical Assistant and Coordinator for this project. The firm will support client management and coordination across stakeholders as well as provide technical assistance to the MoHCC. Aspects of this work will include applying OpenHIE client registry specifications and data standards to the Impilo platform, provision of technical trainings to MoHCC staff, facilitating testing and feedback processes with the wider global community, and packaging and distributing the Impilo client registry as a global good. Within digital health, Vital Wave is a recognized leader in designing and implementing digital health solutions at a national scale for low-resource environments. For 15 years, Vital Wave has designed digital health solutions, led national implementations, and contributed to the global goods space, including engagement in the OpenHIE Leadership Committee, Africa CDC Task Force, and stewardship of the DSME Community. The firm’s approach to facilitation and coordination extends to its work with national governments, which enables the transfer of skills and strengthening of local capacity.
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The MoHCC is in the process of selecting and applying the appropriate open-source software license to the code (currently stored in private repositories) and plans to migrate the code to public repositories on GitHub by October 2020.