Advancing Digital Transformation in Salvador, Brazil's Public Health Sector

At 9:30 a.m. on a bustling Friday morning at the Imbuí Basic Health Unit in Salvador, Dr. Suzane Araújo is with Clayton Arapiraca, a 62-year-old retiree in for a routine post-surgery check-up. Instead of sifting through physical files, Araújo, a scholarship recipient of the Doctors for Brazil program, simply logs into the Vida+ system on her computer. This digital tool, a key component of the municipality's public health digital overhaul, allows her to review Clayton's medical history, medications, vaccinations, and more, and to update his records on the spot.

"Back when I worked in rural areas, I dealt with countless aged, yellowing paper files. Going digital has simplified everything," Dr. Araújo remarks. Digital storage also offers the added benefit of safeguarding information, particularly in disaster scenarios.

The Vida+ system's development and deployment stand out as significant achievements of the Salvador Social Project, an initiative led by the mayor's office of Bahia's capital with the World Bank's support. Over five years, the project has spurred the local government's long-held aspirations in healthcare, education, and social welfare.

Healthcare professionals across 175 locations, including basic health units, dental specialty centers (CEO), specialized care services (SAES), and polyclinics, now utilize the Vida+ system—surpassing the original target of 126 sites. The next step is to integrate the system into the Psychosocial Care Centers (CAPS) and Emergency Care Units (UPAs).

"Once Vida+ is up and running in the CAPS and UPAs, we'll be able to track a patient's entire therapeutic journey within our network," explains Alcione Anunciação, the strategic project unit coordinator for Salvador's Municipal Health Secretariat (SMS).

The platform also plays a crucial role in prenatal care, linked to the mayor's office's Madre Salvador program. It ensures that vulnerable women have access to essential services, including transportation cards for expectant mothers and birth support.

Setting up such a comprehensive service demanded meticulous coordination among SMS's data and IT professionals, along with significant infrastructure investments. Not all health units were initially equipped for high-speed internet, which is essential for the Vida+ system's data input and transmission. The project also required the procurement of printers and other hardware, with the Salvador Social project providing substantial support.

Privacy is paramount when handling sensitive health information. "We take it very seriously," states Rosa Fernandes, the chief advisor to the SMS's Planning Advisory.

Information Mapping for Decision-Making

As thousands of patients receive care across various health centers, a diverse team of professionals operates within the newly established Situation Room at the Municipal Health Secretariat. Launched in December 2022, this hybrid physical and digital workspace gathers sanitarians, epidemiologists, statisticians, system analysts, and administrative personnel to analyze healthcare data, aiding policymakers in swift decision-making. They employ a business intelligence dashboard that visualizes data through charts and maps.

Rosa reflects on the realization of this long-held vision, made possible by the Salvador Social project's phases 1 and 2: "The project funded the necessary equipment and software to set up the room."

She recalls the pivotal role of the COVID-19 Emergency Operations Center (COE) pilot project, which harnessed data from Vida+, as a precursor to the Situation Room.

Previously, healthcare data were scattered across uncoordinated spreadsheets. "We used to spend 80% of our time generating information and only 20% on decision-making. Now, that ratio has flipped," says Jessidenes Leal, known as Jessi, the SMS's strategic projects manager. Beyond technology and skilled professionals, standardizing data collection and analysis was crucial, achieved by collaborating with health surveillance, primary care, and regulatory departments.

The SMS team, utilizing business intelligence tools, uncovered that 85-95% of Salvador's complex medical cases originated from the surrounding rural areas. This insight led the municipality to renegotiate service costs and payments with other Bahian municipalities.

Looking Ahead: Ambitions and Challenges

With the Situation Room in full swing, the SMS team is setting its sights on integrating artificial intelligence to enhance predictive capabilities. "It's an ambitious goal, but it's the direction the world is heading. We aim to set the standard," Rosa declares.

To achieve this, training health managers to effectively utilize data for planning and action is essential. A data science course for SMS's strategic leadership, funded by the Salvador Social project, marked the first step, teaching professionals to collaboratively develop situation room indicators through hands-on case studies.

Another focus is designing integrated care strategies for mental health and geriatric services, considering the impacts of the COVID-19 pandemic and an aging population.

Regardless of the obstacles, Salvador's healthcare professionals are now equipped with state-of-the-art technology, a transformation that will influence both managerial decisions and the everyday interactions between doctors and patients like Dr. Araújo and Clayton.