ALMANACH Libya - Implementation of a Digital Clinical Decision Support System / ICRC Libya
In Libya, access to high quality of preventive and curative care services is very limited for large parts of the population. Since 2011, the current violent political conflict has caused a general deterioration of the health care system, with lack of well-trained medical staff, medical equipment and supplies. This affects especially the vulnerable population, like children under five years of age, suffering from infectious diseases like diarrhea, respiratory conditions (asthma, pneumonia) or nutritional deficiencies.
The project objective is to enhance the quality of health care provision for children under five substantially in Libyan Primary Health Care clinics (PHCC). By implementation of a digital health tool, designed to provide clinical decision support for health care providers in PHCCs, the project is aiming to improve the adherence to evidence-based clinical guidelines at point of care. This measure fosters quality of care, patient oriented services, and ultimately strengthens the local health delivery system. In parallel, automated uploading of aggregated data from the clinical consultations enables Public Health decision makers to monitor remotely the epidemiological situation in hard-to-reach areas.
To improve the quality of care delivery for children under the age of five years, Swiss TPH has developed an innovative digital Health tool called ‘ALMANACH’ (short for ALgorithm for the MANAgement of CHildhood illness). It is a digital Clinical Decision Support System (CDSS) running on smartphones or tablet computers, which provides evidence-based diagnostic and therapeutic decision support to health care providers in resource-constraint settings. ALMANACH is based on WHO’s Integrated Management of Childhood Illness (IMCI) guidelines, and furthermore tailored to the local context, which means it includes conditions relevant to the epidemiological profile of the geographic region and takes into account the resources available in PHCCs in terms of drug supply, equipment and staff. In a stepwise, user-friendly format, clinical algorithms guide healthcare providers to take a structured clinical history, perform relevant physical examinations and diagnostic tests, and finally provide diagnoses and evidence-based treatment recommendations.
In addition, aggregated clinical data from ALMANACH consultations are regularly uploaded to a Health Management Information System (DHIS2). Review of this data enables healthcare managers to monitor more closely clinical case management, trends of diseases like respiratory conditions as well as other outbreak-prone infectious diseases.
Since 2016, Swiss TPH, in partnership with the International Committee of the Red Cross (ICRC), has successfully implemented the ALMANACH CDSS in northeastern Nigeria (400+ PHC facilities) and Somalia. The initiative’s positive impact on quality of care and health outcomes had been proven in a large-scale scientific evaluation (Schmitz T, Beynon F et al. BMJ Open 2022; doi:10.1136/bmjopen-2021-055315).
In 2021, ICRC decided to replicate the ALMANACH project for PHCCs in Libya and commissioned Swiss TPH to develop an ALMANACH version tailored to the Libyan context and support its implementation in a joint project.
In January 2022, the project was launched and entered the Inception Phase, in which the relevant preparatory work for the later introduction of the digital CDSS was realized. From 2023 – 2024 the Libyan ALMANACH will gradually be implemented in about 25 PHCCs throughout the country.
ALMANACH targets all the children between 2 months and 5 years of age attending ICRC-supported PHC facilities in Libya.
Swiss TPH's involvement/tasks
Swiss TPH’ role is to provide the conceptual and technical expertise to develop, validate, implement and maintain the ALMANACH CDSS. This includes:
- Transcription of relevant clinical guidelines in algorithm (i.e. clinical decision tree) format and validation of the content in cooperation with a designated clinical Expert Panel appointed by the Libyan Ministry of Health
- Development of the ICT code to transcribe the clinical content to be processed by an open-source software called Community Health Toolkit (CHT)
- Elaboration of training material and facilitation of training to end-users and their supervisors
- Evaluation of the project’s outcomes
- Presentation and advocating for the initiative to gain acceptance from key stakeholders in country