Development and implementation of a digital clinical decision support system to increase the quality of primary healthcare delivery in a refugee setting in Chad.

BACKGROUND

Digital clinical decision support systems (CDSS) enhance the quality of primary healthcare service delivery for vulnerable populations in resource-limited settings. This improvement occurs by strengthening healthcare providers' clinical skills and enabling them to operate more independently while adhering to standard treatment guidelines. From January 2019 to June 2023, we developed and implemented a digital, tablet-based CDSS for children aged 2-59 months. The phases of development, validation, and implementation, as well as lessons learnt and bottlenecks requiring attention, are analysed.

METHODS

The project was carried out in three primary healthcare facilities within a health district in southern Chad, covering a population of 48,000, which includes a significant number of refugees from the Central African Republic. The intended end users were nurses, nurse assistants, and midwives, with supervision provided by health district teams.

RESULTS

The CDSS, based on the WHO's Integrated Management of Childhood Illness (IMCI) and national guidelines, was tailored to the context of available resources and epidemiological patterns. From the outset, the active involvement of a diverse group of local, national, and international technical stakeholders (clinicians, information and communication technology (ICT) specialists, health workers, and district health authorities) facilitated mutual knowledge sharing and product co-creation processes. The CDSS was adapted to the local context, which enhanced local ownership. However, its complexity requires significant effort from clinicians and ICT specialists for development and validation. Additionally, health centres must rely on a technical infrastructure (electricity, internet connection, and server solutions).

CONCLUSIONS

From the outset, a participatory approach involving key stakeholders from the local to the national level of the health system significantly contributed to the successful development and implementation of the CDSS. The sustainability of such an intervention necessitates ongoing long-term commitment. This includes establishing and maintaining the infrastructure, ensuring continuous human resources and technical expertise for implementation and quality assurance, and updating content to reflect advancements in clinical medicine.