The findings obtained in this study have several meaningful implications. First and foremost, this research supports the view that even though the technology is available, it may be possible to solve many potential healthcare issues in Angola. HIT is not without its people, organizational, technological, and environmental issues.
Making a description of the profile of the health institutions studied, consider the type of administration or legal nature, they can be identified as public, administered by a government, or a private entity belonging to a non-governmental entity (the legal person under private or religious). The results (Table 1) show that most health institutions are small, indicating that the type of care is level II.
Some authors state that the number of staff is influenced by the hospital building's size and complexity; there are no international standards to guide the definition of goals or standards for staff per bed. The staff per bed ratio leads us to consider teams' ability to respond to each patient's needs. That is an indicator of the availability and use of hospital resources. The general average of this index is 1.8, varying from 0.8 to 3.9, regardless of the type of assistance provided by the health institution.
The results of our studies (tabela1) found the rate of staff per bed in the health institution ranges from 0.5 to 4.1, adequate numbers if we compare to the recommended available ratios. Approximate results can be found in a study that, comparing the rate of staff per bed in twelve countries(Germany, Austria, Belgium, Finland, Greece, Ireland, Italy, Japan, New Zealand, Portugal, United Kingdom, Switzerland), of the Organization for Economic Cooperation and Development(OECD), found an average index of 1.50 and a variation of 0.70 to 2.60 among the health institutions studied40.
A brief assessment of HIS and infrastructure IT, in public and private health institutions, based on the research question of this study, results show that a limitation or almost no use of IT to support HIS in public and private health institutions at the level of the province of Huila (municipality of Lubango) it can be concluded that health data are not yet correctly used to guarantee the rights of the patient.
A department specifically responsible for the information system in the hierarchical structure that guarantees the collection, analysis, and treatment of data, is considered a positive indicator. There is no information technology department in the hierarchical structure for most of these health institutions, specifically responsible for maintaining computerized systems and creating projects that envisage the creation or adoption of information systems supported by HIT. These data can indicate that there are limitations in using information technologies at health institutions in this health region16 17. A database server is one of the fundamental requirements for ensuring the secure storage of information. The non-existence in most health institutions indicates a fragility in the safety and storage of hospital data.
Studies show that, the use of technology in healthcare is associated with many advantages such as cutting down healthcare costs and improving the quality of care41. Despite such advantages, the rate of adoption of health IT in North America is much lower compared to other developed countries42. Alternative models of technology innovation, software development and service provision are needed to address the issues challenging the wide adoption of health IT.
In the results (table 2), we found the computer/employee ratio for each health organization studied and obtained an indicator that allowed us to understand the degree of computerization of these institutions. The percentages for private-sector health institutions [0.1, 0.3] are higher than those of the public sector [0.0; 0.1]. A similar study of 2012, carried out in 9 health institutions (public and private), in the health region of Mato Grosso Brazil, we found results close to ours, where the private health institutions have a higher ratio [0.39; 058] computer/employee about public institutions [0.07; 0.20]2.
These results reflect the level of investment in the computerization of health institutions' services, with a more significant investment in HIS by the private sector. It should remember that the existence of computers in the health institutions studied, despite being an indicator to consider, is not enough to indicate these institutions have a HIS based-on IT. There is evidence when costs and benefits are weighed together, technological advances have proven to be worth much more than their costs, so it is essential to invest in information technologies, especially in healthcare in developing countries4, 7 8 43.
The results (see Table 2) showed no electronic clinical record in most health institutions we investigated (90%). Thus, even though there are clear benefits to electronic clinical records, there are still barriers that need to be overcome to facilitate incorporating this vital tool into the practices of health professionals. Nevertheless, several studies have shown, the benefits of the combination of computers, telecommunications networks, medical information, and electronic patient data can improve the quality of healthcare, the productivity of health professionals, facilitate access to available services, and reduce administrative costs associated with the provision of services17 33. The dynamics of Open-source software development are potential solutions for the low adoption of technology in healthcare. Which can be adapted mainly in developing countries such as Angola. In particular the low cost of acquisition and maintenance, the high degree of customizability, and the community of users are important advantages of electronic medical record system44 25.
Concerning the use of specific software by services area in public and private health Institutions, the findings in (table 3) show that private health institutions tend to adopt more and more electronic hospital information systems than public health institutions is essential to highlight that information technologies seem to support primarily administrative and financial information management activities in most health institutions since 70% of them have specific software for the accounting and financial area. Results, approximate if found in a study conducted in 14 hospitals in Jordan and Palestine in 2017, show that 67% of respondents reported that hospital departments were using computer systems to perform their services, especially financial management28 34 45. Another approximate results, if found in one of a study conducted in 39 hospitals in Mongolia, concluded that the adoption rate of HIT is low and that its adoption is mainly associated with hospital bed capacity, status and location of hospitals. In addition, they found that ownership type is partially affected by the adoption of HIT14.
Among other studies that address the subject, we find approximate results in a similar survey conducted in Brazil where the nine health institutions studied (public and private) that all used management support software (information management system of administrative and financial nature), and only one small public hospital used, although still incipiently, a software for managing clinical information (an electronic patient record)2 4.
While the only small-scale religious health institution is being organized to implement an electronic clinical record, studies have shown that electronic clinical records do not take place rapidly. Quickly, many factors make it a challenge to incorporate these services, with those cited in the literature relating to resistance by health professionals, shift in the work process associated with a lack of technology infrastructure46 38.
The question on internet access by hospital service areas in the health institutions studied (table 4) shows that IT does not support clinical information management activities. None of the public hospitals' statistics departments uses any specific software highlighting barriers to using and the lack of implementation of IT in this health institutions1 37. It is a challenge for health leaders in developing countries to ensure the materialization of HIT, adoption policies20. Many suggestions for solutions have been proposed. Finally, we have the example of, telemedicine experience between two hospitals from Angola and Spain. The study carried out in Burkina Faso on the Current Situation of e-Health19, 21.
The result in (Table 5) shows that type of internet infrastructure for hospital services with internet access in public and private health institutions investigated that most use wireless internet (modem). That indicates the weak investment in internet infrastructure at the level of these institutions. It is important to note that the H6 has wired network infrastructure installed (project running) without Internet access32. Different studies show that, generally, developing countries are lagging in e-governments adoption39 36.
Conclusions of a study carried out in hospitals in Indonesia that employees perceive the benefits of using hospital information systems greatly determine their intention to use hospital information systems9. The opinion of the health institution's management managers shows that even in the face of their difficulties, they are aware of the importance of using hospital information technology systems. Despite the barriers to implementing health information technologies, they believed that it was essential to have the hospital information system computerized in their institutions. However, several studies show that this need for HIT is no different when compared to other hospitals in developing countries45 15.
This willingness (awareness) of the administrators should be seen as a strong point if we consider that the studies show that among the barriers to implementing health information technologies, user acceptance appears as a critical factor in determining the success or failure of the project of information systems implementation.