Five Questions with Dr. Charlie Maere
Charlie Maere, PhD, is the global digital health and data analytics director at the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF). Previously, he was the health information systems director at EGPAF-Malawi, where he led a team to develop and implement a digital health system across the country.
Before joining EGPAF, Charlie was a chief technical officer and project manager in biohealth technology, working in San Francisco, United States; Cape Town South Africa; Shenzhen, China; and Kyiv, Ukraine on joint rehabilitation systems. He was also the IT director at the University of Malawi.
Now in a global role at EGPAF, Charlie is working with nations across sub-Saharan Africa to improve and create patient-centered digital health systems, building upon the success in Malawi. We sat down with Charlie to learn more about the value of his work.
Why is digital health particularly important at this moment across sub-Saharan Africa?
It has always been important, but at this moment, we are looking to the last mile to make sure that the HIV pandemic is mitigated. Are we making progress or are we going backwards? There are populations that we are still not reaching adequately—and this especially includes children. Data tells us where the gaps are.
The approach that we bring into that space is a bit unique from previous approaches. Collecting data is just one part of establishing an effective digital health system. We want to collect data in a seamless way that informs clinicians to make decisions, to improve the quality of care. We are going to facilities and looking at the processes—and then bringing in digital technology to improve those processes.
In Malawi, we have demonstrated our ability at a hospital level to have a 360-degree view of the patient. And we have improved the patient experience—from queuing for service, to diagnosis, to the consistent application of clinical guidelines.
We don’t want to turn a clinician into a data clerk, keeping them busy inputting data rather than taking care of the patient.
We want them to interact personally and professionally with the patient. The system guides the health worker, like a co-pilot, to enhance the clinical visit.
The benefits of digital health have been taken for granted in nations where the technology has been well established. We want this for all people. We are democratizing data.
What are some of the signs of success that you’ve seen in Malawi as a result of the enhanced health information system?
In Malawi, there are about 1,000 hospitals. 800 of them have been digitized. This means that every facility with programs for care and treatment of HIV is now digitized. Over the past five years, we have trained health workers at all of these facilities to manage patients using the new systems.
Technology really played a key role in the improvement of services. When you look at statistics, there has been a drastic improvement regarding people living with HIV staying on treatment. So the digital health information system has undoubtedly furthered progress towards the 95-95-95 goals.
95% of the total population knows their HIV status
95% of those who test positive are enrolled in ART
95% of those enrolled in ART are virally suppressed
Feedback from health workers has been positive. They feel that they have improved the quality of care by following the guidelines. Each clinician provides a standard of care through the prompts and aids of the electronic interface. They can address health issues they wouldn’t have previously recognized. For example, a patient may be eligible for a TB screening, and the electronic health system will take them through a TB screening process.
Apart from that, officials at the Minister of Health can now log onto one platform and see all the reports, all the statistics on how the facilities are performing. This tells them where they should focus in terms of intervention.
It’s mind blowing.
What are some of the challenges to establishing a digital health system?
So within the African context there are a lot of logistical issues we have to figure out, such as connectivity, access to electricity, and so on. In Malawi, we established a secure central data lake that is a reservoir for all of the data from clinicians and facilities. But we needed to have the means to transfer data from the facilities to that lake.
This meant that we needed to reinforce the power and internet infrastructure across all facilities. We installed solar panels at vulnerable facilities as the primary power source. We rewired some facilities and improved connections to the internet. It was all about problem solving for those remote locations that are not yet well connected with a hybrid system to collect and store data electronically on-site and periodically unload it to the data lake. Our plan is to eventually have all sites connected to the internet so that information is immediately available across the system.
Then we needed to make sure that each health worker has access to a tablet, laptop, or desktop computer, as the situation demands. So there is an initial investment in hardware as well.
Improving infrastructure is a bit costly, so we had to convince the donors, who are mostly looking at the disease side. We had to demonstrate that these infrastructure improvements directly improve outcomes.
A holistic electronic system does exactly that.
Let’s say that a TB patient goes to the outpatient department when they have malaria. Now that patient is tracked, and the outpatient clinician knows the patient’s history. Or let’s say that a woman living with HIV goes to an antenatal care clinic. She will now get more appropriate care for her condition.
I recently heard from a clinician in charge at a Cameroon facility who told me about a patient who came in with the sudden abdominal pains. The electronic system prompted some questions to guide him. He discovered that that patient had a chronic disease that had been previously missed. This electronic aid targeted them to the right diagnosis and helped that patient get better. So this investment is directly linked to quality of care.
Some donors have been responsive because they see the benefits. We are still lobbying other donors. But we have gotten good support from the Ministry of Health because they see that we are strengthening the health system, and we are helping to standardize their processes across the system.
How do you feel about handing over your work to the Ministry of Health and other partners—collaborating instead of creating a product solely owned by EGPAF?
Collaboration or co-creation is a priority for us. We have a lot of partners, so we put that in the forefront to say that we don’t patent things for ourselves. It is worth noting that the software we developed is based on OpenMRS, which meets a “global good” standard. We deliberately do that because what we want is to create this tool for anyone to modify and use to save lives.
As a global partner we are bringing technical expertise, but our goal is to build on local expertise.
We have technical people, we have developers, we have engineers, we have AI teams, all bringing their knowledge and skills to create open-source tools—to really share and hand that over to the ministry, to countries, to collaborating partners.
As we speak, in Malawi, our development team is sitting together with the Ministry of Health development team to transfer our knowledge to them so that they can sustain this technology moving forward.
We are doing the same with Mozambique. There is a multinational team from Cameroon, from Malawi, from Zimbabwe working with the Mozambique Minister of Health to build their own product in their own way. We want to make sure that whatever they’re building is sustainable, so that even if international funding goes away, the country can still maintain it and add to it.
In the Democratic Republic of Congo, we worked with the existing care and treatment system by implementing patient management systems. We did the same in Cameroon. And we are working with partners in other nations to transfer our knowledge, to enhance their systems. The movement to digital health is a revolution across the continent.
Why are you passionate about this work?
If you look at my background, I wasn’t within the NGO space. I was working with startups in Silicon Valley and in Shenzhen, China. But in that work, there wasn’t a mission to impact vulnerable populations. Here at EGPAF, there’s a clear mission to end AIDS in children, and you can actually see the impact of your work. My main reason to move back to Malawi was to join EGPAF and make a difference.
I am grateful to be part of creating national systems to save lives.
Eric Bond
Malawi; Cameroon; Democratic Republic of Congo; Mozambique; Zimbabwe
Digital Health; Strengthening Local Capacity
