Patients and doctors have to deal with lost records in some hospitals.
In five months, all public health institutions – hospitals and clinics – will be connected to the e-health system. This promise was made by Renganaden Padayachy during the last budget exercise. In the meantime, the daily lives of patients in hospitals still depend on paper files, which are often misplaced. As for the implementation of the system, skepticism is spreading… At Victoria Hospital in Candos, cancer patients find themselves in a ridiculous situation. After losing their files, they are admitted to the ward for no reason and informed that a decision will be made according to their case when the files containing the X-rays and test results are found. “There are cases dating from this week. Faced with this situation, even the new hospital dedicated to cancer and inaugurated with great fanfare finds itself stuck. How to treat patients without records? castigates Dr Farhad Aumeer, MP of the PTr.
Dark Grant
The problem is not limited to this department. As Dr Kailesh Jagutpal said in January this year, the public health system manages five million active cases and nine million «casualty cards»or the famous “appointment card”. The astronomical volume of 2,300 tons of documents annually had been put forward. This was during the launch of the e-health project in collaboration with the United Nations Development Programme (UNDP). This launch was a glimmer of hope to see this project dating back several decades finally come to fruition. However, the implementation of the system was not done calmly. Shortly after the launch, Dr Neena Ramdenee, head of the health file of Linion Moris, had highlighted that the selected consortium had made an offer of Rs 600 million, while among the others, there was a company whose offer was Rs 300 million in the shortlisted bids. “The UNDP is financing the project to the tune of Rs 200 million. If the Rs 300 million contract had been retained, Mauritius would have had less to pay., she points out. She also spoke about the unexplained extensions of the call for tenders for this project, as well as one of the people in the consortium who won the contract and who had his photo taken with a member of the government in India during the G20. Subsequently, this person also thanked the minister on the networks. This was before the contract was awarded. “I’m not saying you can’t have your picture taken. But it’s not ethical and it’s not good for transparency.”
These were not the only grey areas. One of the bidders had made a bid for almost the same amount, but which included a complete project. The project was reportedly led by a global giant in the field that has already set up this type of system in countries like Qatar and had set up in Mauritius for three years to ensure that everything was done to standard. “Moreover, the tender only mentioned the computer system, but there was no mention of the computers. How will this system work if the hardware is installed separately,” wonders one of our sources who worked on this project. On this point, the Minister of Health had announced, during the launch, that the tender for the hardware had been done separately to ensure a greater number of bidders and competition while eliminating the risk of a single point failure that would bring the system down. As a reminder, these gray areas had been the subject of an investigation by Liberation Moris, which had highlighted the conflicts of interest in the committees, the lack of experience of the bidder who won the contract, the unexplained extensions of the evaluation and the advice given to the bidder to ensure that it complied with the call, among other things. With supporting documents, the investigation had proven that the contract had been signed in October 2023.
Long promise
Will the project be ready in November as promised? Nothing is less sure. The e-health project appeared for the first time in the government budget speech led by the MSM in… 2015. «A number of new projects will be implemented ranging from the setting up of a New Cancer Centre, to the imple- mentation of the e-health project (…)» Vishnu Lutchmeenaraidoo said in the 2015-2016 budget speech. Then, in 2018, during the same financial year, Pravind Jugnauth granted Rs 100 million to e-health. This was also included in the 2019-2020 Budget. “The e-health project will soon be implemented as a major reform in the public health sector so that data on the medical history of patients are available to all hospitals across the country in real time.”In 2022, it was planned to move forward with a strategy to have a framework law for e-health. In 2023, the promise was more concrete. «The e-Health system will be implemented in hospital facilities as from July 2023. Rs 180 million is being provided for the implementation of the e-health project which will start at the Jawaharlal Nehru Hospital.» This year it was said that the pilot project had been launched and that in November the entire hospital network will be connected.
As for costs, in the 2015-2016 Budget Estimates, the project was estimated at around Rs 509 million. In that of 2017-2018, it was announced that India would assist Mauritius to the tune of 15 million dollars for this item. The estimate for the financial year 2016-17 has increased to Rs 700 million. For the year 2018-2019, it was Rs 633 million and has not changed since then. Other items were added. In the estimates for the year 2024-2025, the item “renting of cloud space (e-health)” was budgeted at Rs 15 million.
As for the schedule, the dates have often been pushed back. For the 2019-2020 financial year, it was said that 10% of health establishments were computerized, and the goal was to reach 60% for the 2022-2023 financial year. Then, in 2022-2023, it was planned that the «patient administration system» be developed by May 2023.
Abandoned several times
Where are we? The Ministry of Health has been asked for details on the pilot project, and the response is awaited. But the various stakeholders are skeptical. Dr Neena Ramdenee, for her part, is more categorical. “According to the contract, the first phase, which concerns making appointments, must be ready in 18 months. With this deadline, we will then be well beyond November”she says. The final product, which will also include inventory management, is to be delivered three years after the contract is signed. “This makes sense, because imagine the amount of data from all the hospitals, dispensaries and Mediclinics that needs to be entered into the system. It is very unlikely that everything will be ready in a few months. Is this an announcement to calm the population before the elections?she asks herself.
This does not surprise anyone in the field. Dr Vasantrao Gujadhur, former director of public health services, suggests that this promise dates back to the 1990s, when Kishore Deerpalsing installed a computer at the Lady Sushil Mediclinic. “It all stopped there”, he said. Subsequently, when he was director of Jeetoo Hospital, the project was relaunched. *“We worked on the system for a year. Everything was ready, we just had to launch it.”*Once again, in 2016, the project was shelved without giving reasons. As for the pilot project, he questions its implementation. “If the project was financed by the government and the UNDP, why was Rs 180 million injected into it again last year?” The other question that raises questions concerns connectivity. “Are all our hospitals and clinics connected to the Internet and have computers? If not, how will the system work?”asks Dr. Farhad Aumeer. According to him, digitalization is not a luxury, and Mauritius is already behind. For the November date, he argues that Mauritians are used to announcements. “We also need to see how it will be, if a botched system will be launched, like the Electronic Inventory Management System launched to manage drug stocks but which is not fully operational because not all establishments are connected to it.”
