Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

Christabel Ngwashi, IHTM 2021, co-authored this article, which was published in the International Journal of Health Sciences and Research Vol.13; Issue: 3; March 2023 Original Research Article ISSN: 2249-9571

Ngwashi Christabel Apholung sitting at her desk, IHTM aluna

Christabel Apholung Ngwashi1, Vera Oliveira2, Carine Asnong1, Bruno Holthof1
1Centre for Tropical Medicine and Global health, Nuffield Department of Medicine, University of Oxford, Oxford, UK 2Elephant Healthcare Ltd London, UK
Corresponding Author: Christabel Apholung Ngwashi



Background: In Sub-Saharan Africa, hospital information management systems (HIMS) are

predominantly paper based. Countries like Kenya are adopting digital HIMS. However, there is

limited evidence about their impact. This study aimed to evaluate the impact of a digital HIMS on the

operational and financial performance of Kenyan health facilities.

Methods: A retrospective analysis was done using longitudinal data collected at 21 health facilities in

Kenya that had actively used the outpatient and/or billing modules of the Elephant HIMS (EHIMS)

for at least 9 months. Trends of operational and financial performance indicators across months 3,6,9

after EHIMS adoption were compared to pre-adoption baseline values. The Wilcoxon test was

performed to determine the statistical significance of the difference between baseline and 9 months


Results: The EHIMS had positive impact on operational performance evidenced by statistically

significant reduction, between baseline and 9 months after adoption, in monthly waiting (43.55 vs

35.79 minutes) and journey times (59.90 vs 60.34 minutes). Positive impact was also observed on

financial performance as shown by an increase in recorded monthly revenue (100000 vs 210000 KES)

and improved tracking of unpaid revenue (0.57 vs 1.19). The above changes were associated with and

not directly caused by the EHIMS.

Conclusion: The EHIMS was found to have a positive impact on the performance of health facilities

at the time points analysed in this study. To demonstrate the full impact of digital HIMS and for

clearer attribution, further research should be done to analyse the confounding factors that affect

health facility performance.

Read the full article: DOI: