IST-Africa 2020 Conference Proceedings

Miriam Cunningham and Paul Cunningham (Eds)

IST-Africa Institute and IIMC, 2020
ISBN: 978-1-905824-64-9

A Web Based Application for National

Healthcare System
M. Padoca CALADO, Dikiefu FABIANO
Faculdade de Ciências da Universidade Agostinho Neto, Luanda, Angola
Email: [email protected], [email protected]
Abstract: Having to deal with an undersized National Healthcare System obligates
us to present technological solutions to optimize the use of its scarce resources. Our
paper presents a web-based application to tackle some of the challenges posed by
those constraints. The system integrates several aspects to be used by general public,
patients, doctors and other healthcare professionals. It introduces the main
development technologies used, the reason of their choice and presents the
implemented system architecture.
Keywords: Web Based Application, Healthcare, Development Framework, Data
Management.

1. Introduction
The Public Healthcare System is the main healthcare provider at a national level in Angola
[1]. It struggles and frequently fails to provide services with the desired quality. The for-
profit private sector is more present in urban areas and charged prices are exaggerated.
National Healthcare System includes also non-profit organizations, usually providing
healthcare in more remote regions, such as rural areas. Physicians, nurses and technical
professionals often work both in private and public institutions, thus leaving a lack of
human resources on both sides.
Although World Health Organization recommends the approval of national strategic
plans concerning traditional medicine [2, 3], Angola does not have such a plan. Traditional
medicines are sold at informal and herbal markets without regulation and supervision. The
inexistence of a regulatory framework and collaboration between occidental’ and African
traditional medicines and thus is not properly used for the benefit of people´s health
The distribution of medicines in public health units does not meet the needs of patients,
thus obliging them to acquire those medications in the informal market. Lack of prices
control contributes to a reduced accessibility to medicines. At pharmaceutical facilities
throughout the country the prices of a same medication vary greatly and may amount to
three times the official value.
All the above problems motivated us to write this paper.

2. Objectives
Our goal is to contribute to an improvement of national healthcare services using a
technological solution. To improve these services, we focused our system on facilitating
healthcare management in the following aspects:
 Workflow and data management in healthcare institutions – a component manages
patient’s waiting lists, patient’s attendance to consultations, transfer between services
and resources allocation. An agenda module synchronizes the services, scheduling
tasks, meetings, etc, and informs those involved by email or SMS. An SMS service is
used to notify consultations, reservations, interactions and clinical observations;

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 Pharmacies – there is a module to integrate the information about medicine stocks with
the resource allocation in healthcare institutions;
 Blood Bank - having the blood donor registration implemented, a module manages
donations, blood transfers between institutions, stocks and priority waiting lists.

3. Methodology
For the development of software, strict standards must be achieved. These standards are
ensured by the correct choice of methodology and life cycle model of software
development that fits the problem resolution. To develop the application, it was used the
Object-Oriented Hypermedia Design Model (OOHDM).
With the need for a model to develop hypermedia applications, the OOHDM
methodology was developed in 1994 by Schwabe & Rossi in order to enable a systematic
and comprehensive approach in which all aspects of hypermedia projects are recorded to be
tracked and reused later
The OOHDM authoring model presents an object-oriented approach, separating
structural modelling from enabling the development of hypermedia applications such as
Web, information systems, virtual learning environments, educational simulators, websites,
among others [4]. The method uses a model-based approach to project the composed of
four steps: Requirements Planning and Survey, Conceptual Model, Navigation, Abstract
Interface, Implementation, Evaluation and Maintenance. The development of the
application is obtained by mapping the navigation and abstract interface models into
concrete objects with direct support to the execution environment.
This methodology enables the development of modular software with easy maintenance
as it deals with conceptual design, navigation design and interface design separately. Thus,
it is possible to return to any of these steps as needed. We carried out the activities in a
phased manner as depicted in Figure 1, in which the first step activities are detailed
(planning, requirement analysis, viability analysis and estimate resources).

Figure 1: overview of the project activities.

4. Technologies
We used several technologies to design and develop the application. Next the most
significant ones will be introduced considering our system implementation, along with the
reasons of their choice.
4.1 Ruby
Ruby is a dynamic and strong multi-paradigm interpreted programming language with
automatic memory management and it was originally planned and developed to be used as a

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scripting language [5]. The choice of Ruby was because it is a scripted language more
powerful than Perl and more object oriented than Python. Ruby supports functional, object-
oriented, imperative and reflective programming paradigms, which allowed us to use
distinct paradigms in order to solve different issues.
4.2 Ruby on Rails Application Framework
Ruby on Rails is a framework to develop web applications easier than with other
frameworks by providing a fully integrated platform [6]. We used Rails because it is a
framework created in Ruby programming language that enables agile development and has
a high productivity by writing fewer lines of code.
4.3 Git
One of the issues when developing software is the myriad of source code versions being
created along the project lifetime cycle. Git is a distributed version control system that
tackles the problem of having several code versions. Each Git working directory is a
repository with a complete history and version-tracking abilities of the source code. We
used gitkraken as the interface application to manipulate Git commands (Figure 2).

Figure 2: Working directories as seen with gitkraken.

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4.4 PostgreSQL
PostgreSQL is a free and open-source object-relational database management system [7].
There are tens of relational database management systems, as Oracle, SQLServer, MySQL,
MariaDB, and so on. PostgreSQL was chosen for having a good concurrency support, a
good performance specially in read/write operations and when it is necessary an extensive
data analysis, and for its security characteristics having native encrypted client-server
communications.
4.5 Bootstrap / Syntactically Awesome Style Sheets
Bootstrap is the most popular open source framework for HTML, Cascade Style Sheet and
JavaScript development. The Syntactically Awesome Style Sheets is a stylesheet language
that helped us keeping organized and clear stylesheets. As our application was developed
with the Ruby on Rails framework, we used the Ruby SaaS compiler.

5. Implementation
The deployment diagram, also known as the execution diagram, shows the representation of
the system hardware and software architecture.
Users can access the system with PCs, mobile platforms and browsers and with SMS
messages. The components of the application are depicted in Figure 3 and their main tasks
are:
 Application server: the application runs on Puma, which is an enhanced version of
Apache for Ruby on Rails;
 Two message (SMS) servers - these are micro-services associated with the system.
TelcoSMS offers the service that is used to make sure the application sends SMS to
registered users. Twilio offers the service that allows users to send SMS to the
application to consult some of the provided services;
 Dropbox file server to store files are submitted to the system;
 PostgreSQL Database Server that stores the data.

Figure 3: System architecture.

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 Figure 4: Application routing a patient to the hospital.

6. Business Benefits
Healthcare is a topic with great relevance to Angolan society and the application
contributes to the improvement of the services provided, presenting several benefits and
they are remarkable in all aspects in which act:
 The system gives patients the ability to screen their symptoms in the event of an
emergency, identifies the disease, indicates the treating hospital and the route to get to
the hospital unit avoiding so many embarrassment and waste of time. Figure 4 shows a
patient diagnosis and the route to the recommended hospital
 Allows everyone (even those with no system registration) to search for medication and
as a result is given a pharmacy where to find it and at what price it is being sold;
 The system ensures that patients ask for help requests online and health professionals
registered in the system can respond to patients suggesting precautions to take, such as
first aid, medication and other important information;
 The system guarantees information about diseases such as causes, symptoms, treatment
and care thus keeping users informed and knowledgeable about various diseases as well
as up-to-date information about hospitals, pharmacies, healthcare providers;
 The application supports the possibility to do a small research in the system from a
mobile phone without Internet access.

7. Conclusions
The National Healthcare System in Angola has a long way to go to achieve recommended
International Health Systems levels and standards by the World Health Organization, but it
has been noted the efforts to obtain them – for instance, [8], [9], [10], [11]. However, we
must mitigate many of the problems that the Healthcare System has been facing in terms of
coordination of some areas such as the area of medical emergencies, blood donation and
medications.
For hospitals (public and private), in the case of medical emergencies this solution the
makes a brief patient screening to find out what is the patient's condition and which hospital
is closest to him considering the pathology resulting from screening before referring. The
system and the hospital in turn receives a notification containing all patient and symptom
data indicated.
In the blood donation area, it is possible to have control of all donors, and ensure
effective donation management allowing hospitals to have real-time blood information
donated in order to apply as needed.

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 In the medicines section, for better coordination and to avoid waste, we advocate a
centralized purchasing policy of all sectors of the health sector, under the Ministry of
Health. Thus, there is a greater ability to negotiate advantageous prices.

References
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services, IST-Africa 2015 Conference Proceedings, Paul Cunningham and Miriam Cunningham (Eds),
IIMC International Information Management Corporation, 2015. ISBN: 978-1-905824-50-2.
[2] World Health Organization. WHO traditional medicine strategy 2014-2023. 2014.
[3] World Health Organization. Promoting the role of traditional medicine in health systems: a strategy for the
African region. 2000.
[4] D. Schwabe. The Object Oriented Hypermedia Design Model. 2000. [Online]. Available:
www.telemidia.puc-rio.br/oohdm/oohdm.html. [Last accessed 10 December 2019].
[5] About Ruby. [Online]. Available: www.ruby-lang.org. [Last accessed 10 December 2019].
[6] Ruby on Rails. [Online]. Available: https://rubyonrails.org. [Last accessed 10 December 2019].
[7] PostgreSQL. [Online]. Available: https://www.postgresql.org. [Last accessed 10 December 2019].
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Paul Cunningham and Miriam Cunningham (Eds), IIMC International Information Management
Corporation, 2016. ISBN: 978-1-905824-54-0.
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IIMC International Information Management Corporation, 2017. ISBN: 978-1-905824-56-4.
[10] M. Calado, L. Antunes, A. Ramos, D. Fabiano; Integrated System for Health Services Management, IST-
Africa 2018 Conference Proceedings, Paul Cunningham and Miriam Cunningham (Eds), IIMC
International Information Management Corporation, 2018. ISBN: 978-1-905824-59-5.
[11] M. Calado, L. Antunes, A. Ramos: Managing the Access to Medical Emergencies Services. In: Omatu S.
et al. (eds) Distributed Computing and Artificial Intelligence, 13th International Conference. Advances in
Intelligent Systems and Computing, vol 474. Springer, Cham.

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