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Africa's Health System Development and Mobile/Wireless eHealth


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  • 1. Mobile/Wireless eHealth for Health System/Workers development in Africa: Opportunities for eMobility ETP @ eMobility Mobile Communications &Technology Platform Staying ahead! 2 nd Workshop on Shaping the Future of Mobile and Wireless Communications Rome, Italy. September 25 2007 Adesina Iluyemi [email_address]
  • 2. Content
    • Exploring eHealth concept
    • Health Systems in Developing Countries (Africa): issues and problems
    • Global/Africa/ EU eHealth policies
    • Mobile/Wireless Technologies in Developing Countries (Africa)
    • Mobile /Wireless eHealth Case Studies from Africa
    • Opportunities for eMobility ETP
    • Research agenda
  • 3. eHealth as a developmental tool
    • eHealth is the use of information (data) and communication technologies for health processes (Health System) either locally and at a distance (WHO 2005).
    • eHealth involves telemedicine, telehealth, telecare, health management information systems, health knowledge systems etc.
    • An opportunity for the development of public health.
    • strengthening of health systems through eHealth may contribute to the enjoyment of fundamental human rights by improving equity, solidarity, quality of life and quality of care. WHA 58.28, WHO 2005
    • The combination of mobile/wireless technologies with eHealth is known as mHealth
  • 4. Health Problems in Developing Countries (Africa)
    • Lack of Infrastructure and Capacity Healthcare delivery
    • Brain Drain: International and Local (Rural vs. Urban)
      • Africa has 10% of world population with 25% of global health burden but with only 3% of global health workforce
    • Poverty & Financial constraints
      • HIV/AIDS accounted for 2.4 million deaths alone in 2002
      • 40% survive on less than $1 per day
      • Malaria related mortality is at 1 million deaths (mostly children) yearly
    • Enormous economic cost on health systems
      • 10% of individual income
      • Human resources impact
    • mHealth offers a potential low-cost alternative for managing these diseases.
  • 5. Millennium Development Goals
    • MDGs are 8 Goals set by United Nations in 1999/2000 to achieve for specific 18 targets by 2015
    • MDGs, a strategic & operational drivers for Health System development in developing countries
    • 3 MDGs are health related
      • To reduce child mortality from childhood diseases
      • To improve maternal health
      • To combat HIV/AIDS, Tuberculosis (TB) malaria.
    • Target #18 of MDGs calls for using ICTs to achieve MDGs.
    • European Commission has also adopted these goals as benchmark for developing countries
  • 6. Why eHealth in developing countries?
    • To provide access to distributed health knowledge and information to mostly rural health workers.
    • Urgency is required to meet the MDGs targets and to reverse the poor health and developmental ratings
    • Geographical barriers to access health service provision especially in Africa (rural areas).
    • Connectivity ( wireless telecommunications) is becoming widely accessible and available even in rural communities
    • Issues: Cost, existing health problems etc
  • 7. Global Policy for eHealth 1
    • Global initiatives in favour of eHealth is being championed by The World Health Organisation (WHO) under the Global Observatory for eHealth (GOe) (WHA 58.18)
    • A document is available for eHealth readiness of its global member states
    • WHO eHealth objectives are:
      • health system performance
      • health human resource capacity
      • access to health knowledge
      • decision and policy making process
      • better health outcomes for patients.
  • 8. Global Policy for eHealth 2
    • WHO(2004) calls for the use of eHealth for PHC delivery especially in developing countries
    • WHO is currently developing an mHealth strategy with specific focus on developing countries
    • International Telecommunication Union (ITU) since 1998 has commissioned eHealth projects in developing countries using mostly wireless technologies
      • The ITU-D Q14 Working Group is focussed on eHealth strategy and policy development with focus on mobile/wireless technologies especially in developing countries
  • 9. African Regional Policy for eHealth
    • Africa Union through New Partnership for Africa’s Development (NEPAD) calls for using ICTs :
      • to improve patient care
      • for sharing health knowledge
      • To build human resource capacity
      • for health system development
    • e-Africa commission is already a point of collaboration with EU on ICT for development .
      • A major priority is the building of ICT connectivity and access infrastructure
    • NEPAD/EU: eHealth initiatives
      • The recent European Space Agency (ESA) satellite eHealth proposal for Africa is an example of this intercontinental collaboration-
      • The Africa Health Infoway (AHI) is also another initiative with WHO
  • 10. EU/EC Policy on eHealth for developing countries 1
    • EU in 2004 (STOA 122EN) developed a policy on eHealth for health system development in developing count ries
      • Highlights the importance of ICT infrastructure for eHealth adoption & diffusion
      • Encourages the exploration wireless technologies for eHealth connectivity especially WiFi
    • Health workforce development in developing countries is an EU priority and eHealth as one of the solutions (COM(2006) 870 final)
      • eHealth linked with EU strategy for Africa
  • 11. EU/EC Policy on eHealth for developing countries 2
      • EU strategy for Africa [SEC92005)1255]
        • Recommends the use of sustainable low-cost ICTs
      • To help in strengthening Africa’s Health System
      • Establishing an EU-Africa Partnership on continental-wide ICT Infrastructure development through terrestrial and satellite means (‘interconnectivity in Africa’)
  • 12. Existing eHealth applications in Developing Countries: A framework
    • Using 5Cs Acronym (Peter Drury 2005)
      • Content: EHR, referral system, HMIS, CME/e-Learning & Telemedicine platforms etc
      • Community: Online Communities of Practice, Knowledge networks
      • Communication: Web services; voice and data tools
    • What is needed? ACCESS, through what?
      • Connectivity: wireless/mobile ICTs- Opportunities for eMobility WG
    • What is lacking? understanding
      • Context: Cultural, end-users, social, organisational economics issues etc.
  • 13. EU/EC eHealth for developing countries: Mobile/Wireless Technologies
    • MOCCA: The Mobile Cooperation and Coordination Action (MOCCA) an initiative by EU in translating wireless and mobile technologies to developing countries under the IST FP6 in a report
      • This is a previous EU-IST FP6 programme
      • ………… ..that appropriate wireless/mobile technologies can be employed for providing connectivity in developing countries
      • The success of EHAS eHealth project as an illustration of this
    • European strength in wireless networks can be employed like Alcatel Broadband Initiative, Ericsson & Nokia initiatives
  • 14. Wireless/Mobile tools in Developing Countries (Africa)
    • Wireless technologies use: GSM/GPRS/3G, WiFi, WiMAX, WLL (Fixed or Mobile CDMA), Broadband wireless, Satellite, VSAT (Mobility vs Universal Access)
    • Mobile devices: PDAs, Smartphone, Cellular phones, Tablet PCs, Laptops, smart cards, memory sticks, USB keys, sensors.
  • 15. Rationale for mHealth
    • Mobile devices are relatively cheaper that Fixed computers
      • Consumes less power (Lack of electricity)
      • They are portable, hence more secured?
    • Wireless networks are relatively cheaper and faster to build relative to build than fixed networks. For example , the Nigerian case
    • Mobile/ Wireless technologies provide the best opportunity for Africa to achieve the “ Africa interconnectivity objective and for building eHealth Infrastructure (EU strategy)
    • Case studies below supports this proposition
  • 16. mHealth impacts in Africa: Case Study 1
    • UHIN (Uganda)
      • Started in 2003 and has continued to expand within & beyond the Country (Mozambique).
      • Uses existing GSM/GPRS/ WiFi links with PDAs to support (community) health workers (HWs) creating a regional eHealth network
      • Uses solar panels for power
      • For Primary Health Care service provision
      • Provides learning materials, health information and e-mail (upcoming) to HWs
      • Enables timely response to health system needs, diseases outbreaks and enhances organisational health planning and resource allocation.
      • BACK
  • 17. mHealth impacts in Africa: Case Study 2
    • Cell-Life (South Africa)
      • Started in 2003 by 2 universities in SA
      • A multiplatform system for the therapeutic and logistic management of HIV/AIDS population
      • Mobile devices (Cellphones & PDAs) with 3G/GPRS/SMS networks
      • Enable community health volunteers to assist their fellows HIV + management.
      • Enables organisational planning for drug supply and emergency situations
  • 18. mHealth impacts in Africa: Case Study 3
    • MindSet Health (South Africa)
      • Started about 2002
      • Uses DVB wireless satellite technology to provide
        • Health education (eLearning) to rural health workers in clinics and hospital (datacasting) through PCs/Laptops
        • Health promotion to patients and citizens through large screens and TVs (broadcasting) in clinics and community settings in form of documentaries, drama etc.
        • Delivers information all aspects of health (TB, HIV, Malaria etc).
      • Improves health workers’ capacity and empowers citizens’ to keep healthy
  • 19. mHealth impacts in Africa: Case Study 4
    • EHAS (Peru)
      • Started in Peru is early 2000 with joint collaboration between a Spanish and two Peruvian universities & MoH and an international NGO
      • Initially with HF/VHF but now with long distance WiFi wireless links connected with Laptops creating a regional eHealth network
      • Uses solar panels for power
      • For Primary Health Care service provision
      • Provides learning materials, e-mail and voice communication and teleconsultation to HWs , organisational health information & data exchange
      • Enables timely response to health system needs, diseases outbreaks and enhances organisational health planning and resource allocation .
      • BACK
  • 20. Wireless Networks: Opportunities for eMobility ETP 1
    • Transmission
      • Wireless Internet Protocols (IP) for eHealth web services and applications
    • Development of optimal/low-cost mobile devices and software
    • Ambient Wireless Networks
      • Melanges of wireless networks
      • Need to explore interoperability for facility, community, district, provincial, national regional and continental access and connectivity (SEC92005)1255)
      • This is line with the recommendation of EU strategy on eHealth technologies in developing countries (STOA 122 EN)
  • 21. Wireless Networks: Opportunities for eMobility ETP 2
    • The case studies presented above demonstrates the feasibility of mHealth in Africa Health System development portbale and mobile devices like the OLPC
    • Need for developing and providing low-cost & optimal
    • But what is missing is how these wireless networks can be made to interoperate to provide a seamless network
    • An opportunity for eMobility ETP to assist in achieving this EU/Africa strategic objective
    • And to help in the achievement of Africa Health Infoway (AHI) goal.
  • 22. The suggested way forward
    • There is a need to institute pilot projects on ambient wireless networks for eHealth connectivity and access in Africa.
    • This should be deployed within a district health system for ambient wireless eHealth network
    • Need to implement pilot within the local environment in Africa as this is an innovation (STOA 122 EN)
    • However, detailed knowledge on designing, developing and implementing mHealth system in Africa is lacking at present (STOA 122 EN)
  • 23. Ambient Wireless eHealth Network: A Vision Continental National Regional District Hospital Facility: Health Posts, Health Centres Community
  • 24. A District eHealth Network
  • 25. A Cluster of District Wireless eHealth Network = Regional eHealth Network
  • 26. A Cluster of Regional eHealth Network = National/Continental Network
  • 27. Ongoing Research Work @ CHMI
    • Reviewing all eHealth projects in developing countries especially on mHealth
    • Focus is specifically on the factors affecting eHealth sustainability or success in Africa
    • Operational & strategic management of eHealth implementation & use in Africa
    • Developing a holistic framework to evaluate existing eHealth systems in Africa i.e. linking operational with strategic (policy) level
    • Framework will capture process and outcome impacts from design to implementation and use
  • 28. Ongoing Research Work @ CHMI
    • Specific focus will be on Health workers & Health System impact of implementation & use
    • Will aim to:
      • develop a mHealth readiness framework for Africa
      • improve existing projects
      • Provide valuable good practice for new projects
      • save cost from preventing project failure
      • improve health systems
      • empower health workers
      • eventually to ensure sustainability of projects.
  • 29. Conclusion
    • eHealth is strategic to health system development in Africa/developing countries as in EUAfrica strategic policies
    • Mobile/wireless ICTs have potentials of providing the much lacking is access and connectivity
    • The achievement of ambient wireless network provides the best opportunity for developing Africa’s health system interconnectivity
    • This is an opportunity for eMobility ETP in implementing pilot projects
    • Understanding contextual organisational issues is paramount
    • Funding sources for field studies urgently required!
  • 30. Thank you for listening! Questions and Comments