Implementing Clinical Information Systems in Sub-Saharan Africa: Report and Lessons Learned From the MatLook Project in Cameroon

Background Yaoundé Central Hospital (YCH), located in the capital of Cameroon, is one of the leading referral hospitals in Cameroon. The hospital has several departments, including the Department of Gynecology-Obstetrics (hereinafter referred to as “the Maternity”). This clinical department has faced numerous problems with clinical information management, including the lack of high-quality and reliable clinical information, lack of access to this information, and poor use of this information. Objective We aim to improve the management of clinical information generated at the Maternity at YCH and to describe the challenges, success factors, and lessons learned during its implementation and use. Methods Based on an open-source hospital information system (HIS), this intervention implemented a clinical information system (CIS) at the Maternity at YCH and was carried out using the HERMES model—the first part aimed to cover outpatient consultations, billing, and cash management of the Maternity. Geneva University Hospitals supported this project, and several outcomes were measured at the end. The following outcomes were assessed: project management, technical and organizational aspects, leadership, change management, user training, and system use. Implementation (Results) The first part of the project was completed, and the CIS was deployed in the Maternity at YCH. The main technical activities were adapting the open-source HIS to manage outpatient consultations and develop integrated billing and cash management software. In addition to technical aspects, we implemented several other activities. They consisted of the implementation of appropriate project governance or management, improvement of the organizational processes at the Maternity, promotion of the local digital health leadership and performance of change management, and implementation of the training and support of users. Despite barriers encountered during the project, the 6-month evaluation showed that the CIS was effectively used during the first 6 months. Conclusions Implementation of the HIS or CIS is feasible in a resource-limited setting such as Cameroon. The CIS was implemented based on good practices at the Maternity at YCH. This project had successes but also many challenges. Beyond project management and technical and financial aspects, the other main problems of implementing health information systems or HISs in Africa lie in digital health leadership, governance, and change management. This digital health leadership, governance, and change management should prioritize data as a tool for improving productivity and managing health institutions, and promote a data culture among health professionals to support a change in mindset and the acquisition of information management skills. Moreover, in countries with a highly centralized political system like ours, a high-level strategic and political anchor for such projects is often necessary to guarantee their success.


Target (M)
The target refers to the focus or recipient of the intervention.It is the specific person, group, system, or problem that the intervention aims to change or improve.The characteristics of the targeted "site(s)" (locations, staff, resources, etc.) for implementation and any eligibility criteria.The population targeted by the intervention and any eligibility criteria.
10 Data (M) Describe the data governance, including life cycle (collection, processing, storage, modification, sharing, suppression), the data ownership (mention whether patients actually have access to the data), data protection measures, confidential use of routine data, expected level of data integration, data for research, cross-border data agreement, if any, the applicable legal framework, and how the project complies with it.Data consent: Has patient consent been obtained?Describe the approach to data protection and cybersecurity (e.g.security by design, privacy by design, etc.) and where the data is hosted.(e.g., in-country, cloud based, hybrid model etc.).Describe, if applicable, the government preferences in terms of data policies.
11 Interoperability (M) Describe the interfaces (what other systems does the tool connect to) and the standards that were used (which specific ones and rationale of choice) (e.g., semantic ontologies such ICD as SNOMED, LOINC or technical standards such as HL7 FHIR, etc.).

Participating entities (M)
Describe the implementing organization(s): Type of organisation(s), mission, leadership, vision, etc.
Government involvement: Describe whether the government was involved in the implementation, at what level and at what stage(s).
Partners: Describe all partners (organisations) and their role in the implementation.
Funders: List all actors and stakeholders who have funded or invested in the development of the implementation (if different from the implementation, e.g. using an existing digital health intervention).Indicate their level of involvement in terms of funding.
Mention which entity will own the final product and intellectual property after the implementation phase.Describe whether the coverage of implementation is international, national, regional or at the level of e.g.municipalities.If coverage is sub-national, describe the regions.Provide information on the relative importance of the coverage (e.g. % of eligible population covered).
Describe the geographical areas, organizations, target populations and implementation context.Consider social, cultural, economic, political, health care and organizational barriers, infrastructures and facilitators that may influence implementation elsewhere.Explicitly highlight whether a national digital health strategy exists and whether implementation is aligned with the strategy.
For example: indicators or proxy-indicators measuring direct health outcomes (e.g., HbA1c for diabetic patients); Key Performance Indicators (e.g., number of users, number of users that are properly trained, user satisfaction); Indicator assessing a particular process (e.g., administrative time for patient admission); (If there was no evaluation, provide detailed explanation for reasoning) 7Blueprint summary (M)Describe the design and key features of the intervention and key points of the implementation strategy and roadmap.
If possible, include actual costs, otherwise describe the range or percentage of the total budget.Indicate the period covered by the budget.Describe the budget for the intervention (e.g.development, purchase or adaptation of a free tool); if possible include real costs, otherwise describe as a percentage of the total budget.Indicate the duration covered by the budget.Describe the Business model including the sustainability model (financial, economic, environment etc.).If possible, put outcomes in relation to cost to assess sustainability.Describe long term exit strategies, and all dimensions considered to sustain the project after the end of funding.If applicable, describe potential institutionalization of the project.