Decline in mortality with the Belize Integrated Patient-Centred Country Wide Health Information System (BHIS) with Embedded Program Management

• Belize has a countrywide fully integrated patient-centred health information system.
• BHIS uptake by health care workers was rapid across the country.
• Post deployment mortality in 8 algorithm domains dropped sharply; not in 3 without.
• Post deployment public health care expenditures stabilized and then dropped.
• With BHIS, Belize achieved the Millenium Development Goals 4A and 5A in 2011.

BackgroundBelize deployed a country-wide fully integrated patient centred health information system with eight embedded disease management algorithms and simple analytics in 2007 for $4 (Cad)/citizen.ObjectivesThis study evaluated BHIS uptake by health care workers, and pre and post BHIS deployment mortality in selected areas and public health care expenditures.MethodsBHIS encounter data were compared to encounter data from required Ministry of Health reports from licensed health care entities. De-identified vital statistics death data for the eight BHIS protocol disease domains and three non-protocol domains were compared from 2005 to 2011. Belize population data came from the Statistical Institute of Belize (2005–2009) and from Belize census (2010) and estimate (2011). Public health system expenditures were compared by fiscal years (2000–2012).ResultsBHIS captured over 90% healthcare encounters by year one, 95% by year two. Mortality rates decreased in the eight BHIS protocol domains (each 2005 vs. 2011, all p < 0.02) vs. an increase or little change in the three domains without protocols. Hypertension related deaths dropped from 1st cause of death in 2003 to 9th by 2010. Public expenditures on healthcare steadily rose until 2009 but then declined slightly for the next 3 years.ConclusionFor modest investment, BHIS was well accepted nationwide and following deployment, mortality in the eight BHIS disease management algorithm domains declined significantly and expenditures on public healthcare stabilized.