Description of Session
The WHO has been advocating for task shifting and task sharing in human resource-limited health systems. However, there is limited evidence of task shifting or task sharing in the management of electronic health records (EHR). We implemented an EHR system at 10 rural health centres in Malawi, where we trained low-skilled support staff to manage the EHR system. These included security guards, janitors, patient attendants, hospital attendants and home craft workers. We conducted qualitative interviews with them seven months and twenty-four months after implementing the EHR system. Health centres were categorised as Early Adopters, Later Majority and Laggards. This presentation will describe in their own words the staff shortages and workload at the health centres that prompted their engagement in managing the EHR system, and how that changed over time. It will narrate how health centre leadership affected their engagement, the impact of the quality of training and supervision of these low-skilled staff by the IT team, their perception of the ensuing computer skills and digital enablement, and the quality and role of IT support. Then, using Bland-Altman analysis, we shall report on the accuracy and completeness of their data entry, and the factors they perceived as affecting that data quality. Finally, our presentation will depict how the data entered by these low-skilled staff was used for service delivery, HMIS reporting and financial management at the health centres. This presentation will finally summarise the determinants, challenges and opportunities of engaging low-skilled staff in managing EHR systems.
