Africa's Health System Development and Mobile/Wireless eHealth


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Africa's Health System Development and Mobile/Wireless eHealth

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