Introduction

Information and Communication Technologies (ICTs) are acknowledged as vital tools to strengthen Primary Health Care (PHC) in low- and middle-income countries (LMICs). However, these technologies have been used only for selected services. Moreover, there is limited evidence on how effective these interventions are in improving comprehensive primary health care in LMICs. Therefore, we developed an integrated digital solution and field-tested its impact on PHC services in an urban community of India.

Methods

An integrated health information system for primary health care (IHIS4PHC) was designed on a free and open source digital platform which provided multiple features for registration of population and tracking for promotive, preventive, and curative health services (e.g. Antenatal Care, Immunization, TB, Malaria, and Hypertension Treatment etc.), and for generation of aggregate reports for real-time monitoring. The IHIS4PHC was implemented in an urban health centre of Chandigarh (India) which catered to about 25,000 population.

A quasi-experimental study design was chosen for analysing the impact of IHIS4PHC on PHC services. Household sample surveys were conducted at baseline and endline in the intervention and comparison community to estimate the coverage of selected health indicators using standard questionnaires. Difference-in-difference method with adjusted generalised estimating equation was used for the assessment of the net impact of IHIS4PHC.

Results

In relation to the comparison community, statistically significant (p < 0.05) increase was observed at the IHIS4PHC implementing centre in primary health care adequacy (7.2 %), and in the care-seeking behaviour for chronic illness (16.5 %). Improvements were also noticed in other health indicators such as mean blood pressure, adherence to antihypertensive medication, intake of dietary salt by hypertensives, intention to quit tobacco, and vitamin A supplementation.

Conclusions

The digital IHIS4PHC design was found to be effective in improving PHC-based health services. Therefore, IHIS4PHC like digital solutions should be considered for strengthening PHC services in LMICs.

中文翻译：

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用于初级卫生保健的数字卫生信息系统的现场测试：来自印度的一项半实验研究。

介绍

信息和通信技术（ICT）被认为是在低收入和中等收入国家（LMIC）加强初级卫生保健（PHC）的重要工具。但是，这些技术仅用于选定的服务。此外，关于这些干预措施对改善中低收入国家的综合初级卫生保健的有效性的证据有限。因此，我们开发了一个集成的数字解决方案，并对其在印度城市社区中PHC服务的影响进行了现场测试。

方法

在一个免费的开放源数字平台上设计了一个用于初级卫生保健的综合健康信息系统（IHIS4PHC），该平台提供了多种功能来注册人口并跟踪促进性，预防性和治愈性卫生服务（例如产前保健，免疫，结核病，疟疾和高血压治疗等），并生成汇总报告以进行实时监控。IHIS4PHC在印度昌迪加尔市的一个城市卫生中心实施，可容纳约25,000人口。

选择了一个准实验研究设计来分析IHIS4PHC对PHC服务的影响。在干预和比较社区的基线和终点进行了家庭抽样调查，以使用标准调查表评估选定健康指标的覆盖范围。使用带有调整后的广义估计方程的差值法评估IHIS4PHC的净影响。

结果

在比较人群中，IHIS4PHC实施中心在初级卫生保健充足率（7.2％）和慢性病就诊行为（16.5％）上具有统计学意义（p <0.05）的增加。其他健康指标也有所改善，例如平均血压，坚持使用降压药，高血压摄入饮食盐，戒烟意愿和补充维生素A。

结论

发现数字IHIS4PHC设计在改善基于PHC的健康服务方面是有效的。因此，应考虑使用类似于IHIS4PHC的数字解决方案来增强LMIC中的PHC服务。