Healthcare systems process reengineering for developing countries: a report to IMIA Working Group 9.

To discover what kinds of health informatics the developing countries need, we look first to the underlying social structures that informatics is to support. Developing countries face severe problems in their goal of assuring access to quality healthcare to their citizens. Nor is it comforting to look to the example of the developed countries, themselves uncomfortable with the tremendous commitment of resources that they use. It seems clear that if developing countries are to succeed their systems for assuring health will need to achieve radical improvements over those currently employed by the developed countries. They need to build systems that are directed to the heart of the problems; they need to make the best use of their existing human and economic resources; and they need to do this while respecting the human potential and aspirations of their people. Any such system will need to be built around planning, organizing and measuring the long-term, rather than episodic, health of citizens. In particular, health interventions need to be moved upstream where they are more effective and less expensive. The job of health informatics is to provide the fundamental enabling infrastructure that would allow individuals to cooperate in the fluid, effective ways required. We describe some of the requisites for such a system. Certainly, its construction will depend on the use of an open, standards-based distributed object software architecture.