Africa's Health System Development and Mobile/Wireless eHealth
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Transcript of Africa's Health System Development and Mobile/Wireless eHealth
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Mobile/Wireless eHealth for Health System/Workers development in Africa:
Opportunities for eMobility ETP @
eMobility Mobile Communications &Technology Platform Staying ahead!2nd Workshop on Shaping the Future of Mobile and Wireless Communications
Rome, Italy. September 25 2007
Adesina Iluyemi [email protected]
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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
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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
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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.
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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
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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
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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.
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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
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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
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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 countries– 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
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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’)
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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.
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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
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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.
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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
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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
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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
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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
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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
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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)
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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.
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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)
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Ambient Wireless eHealth Network: A Vision
Continental
National
Regional
District Hospital
Facility: Health Posts, Health Centres
Community
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A District eHealth Network
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A Cluster of District Wireless eHealth Network = Regional eHealth Network
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A Cluster of Regional eHealth Network = National/Continental Network
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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
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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.
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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!
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Thank you for listening!
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