Opportunities for ICT in Health

The technology currently used in the Cuban health sector is very limited and out of date, and in many cases, these limitations create systemic inefficiencies. Despite the lack of technology and resources, Cuba has a unique and innovative healthcare system that could be easily replicated in similar contexts. The major challenges of the Cuban health system are related to system inefficiencies as a result of the absence of ICT.

Digitalization of Medical Records

In Cuba, doctors have to write each patient’s medical records by hand. Many doctors complain about the amount of extra work they are forced to put into writing up each patient’s visits throughout the day. Often, doctors cannot go home to rest after a busy day at the clinic because they need to complete their cataloguing of patient records while it is still fresh in their minds. The absence of a digitized system forces doctors to spend their free time transcribing and organizing records. Doctors recognize the inefficient use of their time and are aware that if they were able to allocate more of their time to diagnosing patients instead of performing administrative tasks, they could meet with more patients each day.
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Eighteen year old patient's medical history. Photo by: Ana Diaz

Unrestricted Information Access

Now that Cuba is going through a process of increasing public access to the Internet, doctors hope to improve their chances of accessing more up-to-date information to continue their professional development and to contribute formally to innovations in the medical field. Currently, the Infomed system provides doctors with access to medical publications from Cuba as well as international publications such as The Lancet. However, information is still limited and heavily curated by the State, thereby excluding many publications that might encourage innovation from within Cuba. Aside from a fully-functioning record-keeping system, doctors could benefit from unrestricted access to the Internet. For example, Cuban doctors and medical students would be able communicate and work remotely with doctors outside the country, by conducting medical research or working on international problems/projects to create a global demand for Cuban medical innovations that could influence the development of medicine across the world. Additionally, this would present an opportunity for public health professionals working in low-resource settings to obtain insights from Cuban doctors, who are already experts in delivering health services in contexts with little to no technology. (For more information on this, please visit the Risks for ICT in Health.)

Improving Medicine Supply Chains

Innovation has been key to the success of the Cuban health sector. However, there are many systemic inefficiencies that overshadow the successes of innovation. For example, one of the biggest problems, resulting from the U.S. embargo, is the constancy of medicine stock outs that affect the health of Cubans across the island. Most of the medicines in Cuba are imported or donated from other countries, but because of trade issues, many times medicines do not arrive in Cuba on time, resulting in medicine stock outs. Moreover, if medicines arrive in smaller quantities than originally ordered, pharmacies, clinics, and hospitals in Havana will be prioritized, leaving more rural areas without medicines for extended periods of time. Thus, individuals most affected by stockouts and long waiting periods are in the countryside because of the systemic hierarchy of exclusion built into the supply chain.
Some medicines are manufactured in Cuba, but the active ingredients are often copyrighted and, therefore, unattainable by the Cuban government except through donations. Whenever donations are delayed, medicine manufacturing comes to a complete stop. Medicines can be out of stock in clinics and pharmacies across the island for as long as three months without any idea of when they will be restocked, thereby leaving the lives of patients, who depend on these prescriptions, in the hands of global politics. Innovative supply-chain management softwares could dramatically improve budget allocation for importing medicines as well as avoiding empty pharmacies. According to a report published by the World Health Organization, one potential solution to the problem of stock outs in low-resource settings is an open-source turnkey product, which is “designed to strengthen logistics management through the use of mobile technology.” Users—usually nurses, midwifes, pharmacy workers, or supply chain officers—report stock through SMS platforms, an app running on Java software on tablets or Android phones, or directly from the Internet. This software allows users to manage and report data, such as stock levels, receipts, and orders, in real-time to ensure the most up-to-date information is being used to make decisions about orders and deliveries. This data is then analyzed to develop indicators for subsequent monitoring and evaluation (i.e. monthly consumption, lead times, and order fill rates). Then, appropriate actors are notified of impending stock outs, reorder quantities, and deliveries. According to the report, this product has been tested, used, and approved at scale in countries like Tanzania, Ghana, India, and Malawi, thus demonstrating the feasibility of use in similar resource-constrained settings.

Written by: Ana Caro Diaz and Emily Sylvia