Micro computers in primary health care: a report on field experience in Kenya.

This discussion focuses on the applications of and experiences with a microcomputer in a rural primary health care (PHC) program in Kenya. In 1984 Tenwek Hospital a mission hospital located in Western Kenya initiated a primary health care program to serve the estimated 300000 people in its catchment area. The program will eventually provide 200 community health workers (CHWs) for the area. A microcomputer was provided to the program from its inception for use as the project saw fit. A Kay Pro II microcomputer with Epsom Printer was selected for the project. Computer programming was done by 1 of the hospital doctors under the direction of a professional programmer. Several programs were purchased including word processing and a data spread sheet. Additional programming for project was done using O-Basic language. The potential uses of the computer were determined at the start of the project and included preparing training materials data summarization research data input general office typing and accounting. Each of these uses is described. The training of the CHWs is a 4-week process using inductive techniques for adult education. Topics focus on simple curative care basic preventive care and family planning. Each subject matter has a review handout prepared. This amounts to some 25 different printings for each class of CHWs. The word processor of the computer has replaced traditional stencils for such preparations. This allows for frequent editing and is less expensive on the computer in this hospital setting. The computer has been most useful in the area of data summaries. The CHWs maintain a record of their activities which are used for management by exception project evaluation and as an incentive to the workers. With the computer feedback is provided to the CHWs within 1 month. CHW reports carry information on users methods dropouts and side effects. This is all entered into the computer and a monthly summary prepared. The fact that this date is immediately available for analysis has greatly decreased the time and money required to carry out appropriate analysis. General office typing now done on the computer results in time savings on those office jobs. Program difficulties have made accounting the weakest computer activity better programming ought to remedy this weakness. The Community Health Program demonstrates the usefulness of a microcomputer in a rural primary health care program. Of greatest importance computers facilitate the information flow. This is critical in 2 areas: feedback to CHWs; and program evaluation.