Leveraging eHealth to improve national health systems in the African Region

Emil Asamoah-Odei
Derege Kebede
Chris Zielinski
Edoh-William Soumbey-Alley
Miguel Peixoto
Matshidiso Moeti

World Health Organization, Regional
Office for Africa, Brazzaville, Congo

Corresponding author
Derege Kebede
E-mail:kebeded@afro.who.int

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ABSTRACT

The World Health Organization defines eHealth as the cost-effective and secure use of information and communication technologies (ICTs) for health and health-related fields. ICTs provide a range of technologies for gathering, storing, retrieving, processing, analysing, transmitting and receiving data and information. These include radio, television, mobile phones, computer and network hardware and software, as well as the services and applications associated with them, including videoconferencing and distance learning. eHealth is an umbrella term that covers a variety of areas such as health informatics, digital health, teleHealth, telemedicine, eLearning and mobile health. The WHO Regional Committee for Africa has called on Member States to adopt and implement eHealth strategies to improve their health systems. The Ouagadougou and Algiers declarations and the Framework for Implementation of the Algiers Declaration also underscore the importance of eHealth in health systems. This paper highlights some key issues that need to be addressed and proposes concrete actions for adopting eHealth solutions as tools for strengthening health systems in order to accelerate progress towards achieving the Millennium Development Goals and improving health outcomes in the Region.



RÉSUMÉ

L'Organisation Mondiale de la Santé définit la cybersanté (eHealth) comme l'utilisation rentable et sécurisée des technologies de l'information et de la communication (TIC) pour la santé et les secteurs connexes. Les TIC fournissent une gamme de technologies destinées à rassembler, stocker, récupérer, traiter, analyser, transmettre et recevoir des données et des informations. Elles comprennent la radio, la télévision, les téléphones portables, les ordinateurs, le matériel de réseau informatique et les logiciels, ainsi que les services et applications qui leur sont associés, y compris la vidéoconférence et l'apprentissage à distance. La cybersanté est un terme générique qui recouvre différents domaines tels que l'informatique de la santé, la santé numérique, la télésanté, la télémédecine, l'apprentissage à distance et la santé mobile. Le Comité régional de l'OMS pour l'Afrique a appelé les états Membres à adopter et à mettre en œuvre des stratégies de cybersanté pour améliorer leurs systèmes de santé. Les Déclarations de Ouagadougou et d'Alger et le Cadre pour la mise en œuvre de la Déclaration d'Alger soulignent également l'importance de la cybersanté dans les systèmes de santé. Ce document met en lumière certaines questions clés à traiter et propose des actions concrètes pour adopter des solutions de cybersanté, en tant qu'outils visant à renforcer les systèmes de santé afin d'accélérer les progrès en vue de la réalisation des objectifs du Millénaire pour le développement et de l'amélioration des résultats sanitaires dans la Région.

RESUMO

A Organização Mundial da Saúde define cibersaúde (eHealth) como a utilização segura e rentável da informação e tecnologias da informação e comunicação para os campos relacionados com a saúde e da saúde. As TIC fornecem uma gama de tecnologias para recolha, armazenamento, recuperação, processamento, análise, transmissão e recepção de dados e informação. Estas incluem rádio, televisão, telemóvel, computador e hardware e software de rede, assim como os serviços e aplicações associados com estes, incluindo vídeo-conferência e ensino à distância. Cibersaúde é um termo geral que abrange uma variedade de áreas, tais como a informática médica, saúde digital, telesaúde, telemedicina, ciberensino e saúde móvel. O Comité Regional Africano da OMS foi convocado pelos Estados Membros a adoptar e implementar estratégias de cibersaúde para melhorar o seu sistema de saúde. As declarações de Ouagadougou e Argel e o enquadramento para a implementação da Declaração de Argel também sublinham a import ância da cibersaúde nos sistemas de saúde. Este documento destaca alguns problemas-chave que necessitam ser abordados e propõe acções concretas para adoptar soluções de cibersaúde como ferramentas para reforçar os sistemas de saúde, de modo a acelerar o progresso em direcção à consecução dos Objectivos de Desenvolvimento do Milénio e à melhoria dos resultados da saúde na Região.


Introduction

The World Health Organization (WHO) defines eHealth as the cost-effective and secure use of information and communication technologies (ICTs) for health and health-related fields.(1) ICTs provide a range of technologies for gathering, storing, retrieving, processing, analysing, transmitting and receiving data and information. These include radio, television, mobile phones, computer and network hardware and software, as well as the services and applications associated with them, including videoconferencing and distance learning. eHealth is an umbrella term that covers a variety of areas such as health informatics, digital health, teleHealth, telemedicine, eLearning and mobile health.(2)

Recognizing the significant developmental role and cross-cutting impact of ICTs in regard to all aspects of national life, including health, an ICT-related target was included in Millennium Development Goal number 8.(5) The World Health Assembly resolution on eHealth, WHA58.28,(4) noted the potential impact that ICT could have on health-care delivery. Subsequently the WHO Executive Board endorsed a set of activities to be implemented by the WHO Secretariat aimed at, among others, creating an environment that ensures data privacy, security and confidentiality, and improves interoperability.(5) This included the establishment of the Global Observatory for eHealth to improve the evidence base and guide policies for integrating eHealth into health systems.(6)

Through Resolution AFR/RC56/R8,(7) Member States were called on to adopt and implement eHealth strategies to improve their health systems. The Ouagadougou(8) and Algiers(9) declarations and the Framework for Implementation of the Algiers Declaration10 also underscore the importance of eHealth in health systems strengthening.

Major eHealth projects in the Region include the Telemedicine Network for Francophone African Countries (RAFT),(11) HINARI Access to Research in Health Programme,(12) ePortuguese Network(13) and Pan-African e-Network Project.(14) Several countries in the Region are implementing telemedicine and eLearning projects, including Algeria, Benin, Burkina Faso, Burundi, Cameroon, Chad, Republic of Congo, Cote d’Ivoire, Ethiopia, Ghana, Kenya, Madagascar, Mali, Mauritania, Niger, Rwanda, Senegal and South Africa. Some of these are using mobile phones to support the delivery of health care, awareness and education; remote data collection; remote monitoring and home care; communicating treatments to patients; and reporting and responding to disease outbreaks and emergencies. Others are using satellite technologies to broadcast health promotion to patients and health workers in hospitals and clinics.

While eHealth projects in the Region continue to be on a small scale and are fragmented, the rapid advances in ICT have put countries under intense market pressure to adopt ICT-associated services. There is a need to ensure that the introduction of ICT in the health sector is driven by country needs and appropriate policies, rather than by pressures from technology producers.

This document highlights some key issues that need to be addressed and proposes concrete actions for adopting eHealth solutions as tools for strengthening health systems in order to accelerate progress towards the achievement of the MDGs and the improvement of health outcomes in the Region.

Issues and Challenges

Some major issues in the Region include the “digital divide,” i.e. inadequacy of ICT infrastructure and services and the limited ability and skills to use them. It is estimated that in sub-Saharan Africa, access to fixed telephone lines in 2007 was 1.5 per 100 population, access to mobile phone subscriptions was 22.9 per 100 population, and the level of internet use was 3.7 per 100 population. This contrasts with the global average of 19.0 per 100 population, 50.3 per 100 population and 20.6 per 100 population, respectively.(15) While mobile phone services are booming, the African Region has extremely little bandwidth, and the costs of internet services are beyond the reach of the majority of the people.

Development and maintenance of ICT infrastructure are expensive and the costs are beyond the budget of many institutions in Africa, particularly when technology is sought for large-scale use. The ICT infrastructure development needs of the health sector are not within the purview of ministries of health. Economic situations and financial constraints both countrywide and in the health sector are such that many health facilities and medical training institutions are unable to cater for their needs, including computerization. Dependence on external resources or donor funding for the introduction of eHealth in the Region has become the rule rather than the exception.

The key challenges countries need to address include limited awareness about eHealth; lack of an enabling policy environment; weak leadership and coordination; inadequate human capacity; weak ICT infrastructure and services; inadequate financial resources; and weak monitoring and evaluation systems.

Limited Awareness of eHealth

Policy-makers, health authorities and health practitioners are not fully aware of the potential benefits of the use of ICT for health. Neither has the health sector developed medium- or long-term strategic plans for developing eHealth infrastructure and services.

Lack of an enabling policy environment

Most countries in the Region have not developed national policies, strategies or regulatory frameworks that are necessary for establishing common technical infrastructure, interoperability and standardization protocols. Countries also need to address ownership, confidentiality, security of data and quality of information.

Weak leadership and coordination

In several countries, there is a multiplicity of players and partners in several eHealth projects being implemented with limited capability for interoperability. The challenge is to strengthen coordination and collaboration among all stakeholders, partners and donors as well as improve the capacity of the health sector to lead the process.

Inadequate human capacity to plan and apply eHealth solutions

The number of health workers capable of leveraging ICT in their work remains limited. Health workers are not systematically trained in the use of ICT. There are insufficient numbers of health workers with the capacity to design, deploy and effectively manage eHealth projects and programmes. The use of ICT facilitated learning remains limited in most health training institutions.

Weak ICT infrastructure and services within the health sector

Existing eHealth projects within the health sector are small scale and fragmented, and their scope and coverage are rather limited. In most countries, the ministries in charge of communications, technology and finance are primarily responsible for national ICT infrastructure. The challenge is for ministries of health to ensure that ICT needs and adequate coverage of the health sector are taken into consideration during the preparation and implementation of national ICT plans.

Inadequate financial resources

Financing eHealth infrastructure and services requires collaboration and coordination between multiple partners from both the private and public sectors. The challenge is for the health sector to partner with other governmental sectors and the private sector to mobilize the resources required for eHealth.

Weak monitoring and evaluation

The majority of the eHealth projects, initiatives, national plans or frameworks implemented so far in the Region have not been adequately monitored or evaluated. Indeed, comprehensive frameworks for monitoring and evaluation have yet to be developed. The challenge is to ensure the availability of efficient systems for monitoring and evaluation and for sharing of experiences and lessons learnt.

Despite these challenges, opportunities exist for planning and deploying eHealth solutions. These include the rapid advances in ICT, increasing access to mobile phones and broadband connectivity, increasing interest by donors and countries in strengthening health systems, and the partnerships being built by agencies such as WHO, International Telecommunication Union, World Bank, United Nations Economic Commission for Africa and others. The partnerships seek to develop national road maps for eHealth, facilitate connectivity of health facilities in districts, and provide health workers access to a suite of eHealth applications and solutions for enhancing professional capacity.

Proposed actions

In order to strengthen national health systems and improve the health of the people, countries should take actions leading to increased access to eHealth tools and services. Crucially, these actions should be taken in the context of the implementation of the Algiers and Ouagadougou declarations, and be integrated with other efforts to strengthen national health systems.

Promote national political commitment and awareness of eHealth: It is necessary to raise the awareness of policy-makers and the general public on the benefits of eHealth, including the identification and use of champions (e.g. celebrities within and outside the health sector) for that purpose. It is important to develop health sector capacity to advocate for eHealth solutions, negotiate with other ministries and lead the national process.

Develop an enabling policy environment: All countries should carry out a national needs assessment for eHealth and follow this with the development of long-term strategic plans and frameworks for eHealth. Countries should develop policies on eHealth which articulate the commitment of the government to invest in an ICT-based health system that will improve access to quality services at affordable prices. The policies should be based on the national ICT policy. Countries should also develop strategies, norms and appropriate governance mechanisms related to legal liability, ethical standards, and confidentiality and privacy protection.

Strengthen leadership and coordination: A multisectoral and multidisciplinary consultative process involving all key stakeholders, including the users and beneficiaries, should be used to develop national plans, policies, strategies, and ethical and legal frameworks. Each country should consider establishing multidisciplinary and intersectoral support mechanisms. The top leadership in the health sector should lead by example in acquiring the skills and utilizing the relevant technologies.

Build infrastructure and establish services for eHealth: Countries should select appropriate technologies and solutions to be used within their specific environments, bearing in mind the current state of power supply standards, health systems and telecommunications infrastructure. Health needs should drive technology acquisition and adoption. Some of the key areas of focus include building the ICT infrastructure necessary to support eHealth services; establishing internet connections for health institutions; establishing web sites for ministries of health; building local area networks and establishing telemedicine facilities. The adoption of open ICT platform technologies should be encouraged, and maintenance of adopted technologies should be given high priority.

Develop human capacity for eHealth: Systematic education in eHealth for health personnel must be at the heart of any strategy designed to facilitate eHealth. Countries need to introduce ICT in the curricula of all health training institutions. Training in eHealth should be included in continuing education programmes for health workers. The use of eLearning programmes for professional education should be promoted in the health sciences as well as in ongoing professional development. Local academics and researchers as well as external technical experts should be involved in these efforts. Countries should consider establishing centres of excellence to train eHealth professionals and reach a critical mass of expertise for service, training and research. Experts in eHealth are also to be recruited.

Mobilize financial resources for eHealth: Countries need to make the necessary investments in ICT infrastructure and services in the health sector, using domestic and external financing. Countries will need to ensure integration of ICT in all budgetary processes to promote sustainability.

International partners and donors should be encouraged to support national efforts. Governments should establish an enabling policy environment that will encourage the private sector to seek funds for capital investments that will allow the introduction of new cost-effective technologies.

Monitor and evaluate national eHealth plans and frameworks: Countries should establish monitoring and evaluation systems to measure progress in the implementation of national eHealth strategic plans. This is crucial to ensure delivery of the expected benefits.

In conclusion, countries can benefit from using eHealth tools to strengthen their health systems and improve the health of their populations. They should, however, tackle existing eHealth challenges related to limited awareness, policies, leadership, infrastructure, human and financial resources.

REFERENCES