Operationalizing eHealth in subSaharan Africa the Role of WHOAFRO

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Operationalizing eHealth in sub-Saharan
Africathe Role of WHO/AFRO

• E. Asamoah-Odei
• Medical Officer
• WHO/AFRO

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WHO Definition eHealth

• eHealth or Telemedicine is defined as
• the delivery of health services, where
  distance is a critical factor, by all health
  professionals using information and communication
  technologies for the exchange of valid
  information for diagnosis, treatment and
  prevention of diseases and injuries, research and
  evaluation, and for the continuing education of
  health care providers, all in the interests of
  advancing the health of individuals and their
  communities

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How can eHealth contribute to the strengthening
of health systems? (1)

• Health information at the point of care
• Map of Medicine for quick access at the point of
  care
• Point of care hand-held assistants that enable
  health care providers to record, store, retrieve
  and transmit the essential elements of clinical
  encounters
• Reference materials, diagnostic and treatment
  decision aids can be included to facilitate
  patient care, skill maintenance and updating
  training
• Electronic health records HMIS
• Clinical Services telemedicine

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How can eHealth contribute to the strengthening
of health systems? (2)

• Disease surveillance handheld computing devices
  are powerful tools for data collection and for
  providing rapid access to information needed to
  prevent or respond to disease outbreaks
• Health promotion for the general public and
  specific target groups
• Human resources for health

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Where are we with eHealth in sub-Saharan Africa ?

• The work of MoHs and other stakeholders already
  has some eHealth components
• However, generally acknowledged that eHealth is
  weak
• Scope and coverage rather limited
• Access to ICT limited
• Policy-makers, health practitioners and
  communities often lack relevant information for
  action
• Lack of formal policies, norms, standards, etc
• 2005 First Survey of the Global Observatory on
  eHealth
• To describe and analyze eHealth profiles in
  countries, regions and internationally
• To identify and evaluate measures taken in key
  action areas to support the development of
  eHealth in countries
• To establish the usefulness of WHO providing
  generic eHealth tools and service for Member
  States
• Survey Themes
• Enabling environment
• Infrastructure
• Content
• Cultural and linguistic variety
• Capacity
• National centres for eHealth
• eHealth systems and services

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Challenges (1)- The Digital Divide

• Between countries the global digital divide
• Between groups of people within countries - the
  domestic digital divide
• Phones people in developed countries enjoy five
  times better
• access to fixed and mobile
  phone services
• Internet Accounts and Hosts - more Internet
  accounts in London than all of Africa, One in two
  Americans is online, compared with only one in
  250 Africans 
• Bandwidth and Speed - Africa has extremely little
  bandwidth
• reaching
  Europe and the USA
• Costs - internet access costs US 1 -2 , Uganda,
  over 100 (as a percentage of average monthly
  income), costs of PCs beyond the reach of the
  average African

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The Digital Divide PCs

• Developed states 311.2 per 1,000
• Globally 70.6 per 1,000
• South Asia 2.9 per 1,000
• Sub-Saharan Africa 0.75 per 1,000

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Challenges (2)

• Limited awareness of the potentials of eHealth
• Limited human capacity
• Funding
• Lack of legal, legislative, ethical, and
  constitutional frameworks

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Opportunities

• Increasing awareness, interest and commitment by
  policy-makers and professionals
• Growing number of partners
• Advancing technology

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National Health IT programme of the National
Health Service, UK (1)

• The NHS Care Records Service (NHS CRS) with an
  individual electronic NHS Care Record for every
  patient in England, securely accessible by the
  patient and those caring for them
• The electronic booking service, Choose and Book -
  offering patients greater choice of hospital or
  clinic and more convenience in the date and time
  of their appointment
• Electronic Transmission of Prescriptions (ETP) -
  to make prescribing and dispensing safer, easier
  and more convenient for patients

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National Health IT programme of the National
Health Service, UK (2)

• Contact a central email and directory service
  for the NHS, to enable staff to transfer patient
  information, swiftly, securely and efficiently
• Picture Archiving and Communications Systems
  (PACS) - to capture, store, display and
  distribute static and moving digital medical
  images, providing clearer x-rays and scans and
  faster, more accurate diagnosis
• IT supporting GPs, including the Quality
  Management and Analysis System (QMAS), support
  for the Quality and Outcomes Framework and system
  for GP to GP record transfer

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Whats Possible Today Wireless Hospital
Built 2002 for 60M First hospital in the United
States to store, record, and display patient data
electronically Information accessible to staff
inside or outside the hospital Driven by
Centricity Information System from GE Medical
Systems

• electronic Physician Order Entry (ePOE)
• Portable electronic prescription data entry
• Requires wireless pharmacy system data access
• Integration with pharmacy, POC, remote access to
  clinical pathways lab values

• Point of Care (POC)
• Drug Delivery Management
• Care Management

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Whats Possible Today

Remote Patient Monitoring
Allows the care provider--who might be hundreds
of miles away-- to access patient vital signs and
receive patient-initiated medical tests. The
patient or her in-home informal caregiver has
been trained to use electronic monitoring or test
equipment that sends the relevant video snapshots
or numeric data electronically to the formal
caregiver.
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What is possible Epidemic / Emergency / Disaster
Communications and Connectivity Networking
Disaster Site
Patients haveTracking/locationTriage/Medical
StatusTreatmentDisposition
Responders haveTracking/locationProvider
StatusProvider Safety
Hospital ED 1
Internet
802.11Bubble
Incident Command/Emergency Operations Center
Database
Hospital ED 2
Connectivity
Cellular 3G 802.11
LAN
LEO Satellite
Note Figure adapted from Journal of Academic
Emergency Medicine, Nov. 2004, Vol. 11, No.11, p.
1234.
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What needs to be done (1)

• Constitute National Task Force/Committee on
  eHealth
• Conduct National Needs Assessment for eHealth
• Develop National Policies, Standards and Norms
  for eHealth
• Prepare National Strategic Plan for eHealth

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What needs to be done (2)

• Build National Capacity for eHealth
• Mobilize Resources and Build Partnerships to
  Support Implementation of National eHealth Plan
• Implement, Monitor and Evaluate National eHealth
  Plan

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Role of WHO/AFRO (1)

• Core WHO Functions
• Providing leadership on matters critical to
  health and engaging in partnerships where joint
  action is needed   
• Shaping the research agenda and stimulating the
  generation, translation and dissemination of
  knowledge
• Setting norms and standards, and promoting and
  monitoring their implementation 
• Articulating ethical and evidence-based  policy
  options
• Providing technical support, catalysing change,
  and building sustainable institutional capacity
• Monitoring the health situation and assessing
  health trends   

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Role of WHO/AFRO (2)

• Advocacy
• Promote better understanding of eHealth
• Strengthen eHealth systems in countries
• Support capacity building
• Promote the use of norms, standards
• Foster public-private partnerships

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Advocacy

• WHO/AFRO Regional Committee Resolution on
  Knowledge Management, Addis Ababa, Sep 2006
• Urged Member States and WHO/AFRO to plan,
  implement, monitor and evaluate eHealthrelated
  actions
• Member States
• Prepare national strategic directions
• Establish national norms and standards
• Strengthen national capacity
• Include the health sector in national ICT
  development plans
• Build sustainable partnerships

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Coordinating Strategic Partnerships

• Health Information Network Access to Research
  Initiative (HINARI)
• AU Pan African eNetwork
• EU/WHO/AU partnership for Telemedicine
• Africa Health Infoway

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H.I.N.A.R.I.

• Collaborative effort between WHO and the private
  sector to provide access to medical literature
  free of charge or at a reduced rate
• Over 35 publishers of medical journals have
  agreed to provide access to their journals to
  countries that have a GNP less than US 1000, and
  to charge US 1000 per annum per institution in
  countries with GNP less than US 3000
• Independent review of HINARI recently conducted
  showed it is viewed as an important resource that
  is making a valuable contribution to research and
  teaching
• Following the review, the partners agreed that
  HINARI should be continued at least to meet the
  time scale of the MDGs

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AU's Pan African e-Network
Tele-education - Telehealth
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EU/WHO/AU Partnership for Telemedicine

• The European Commission is interested in
  supporting the application of satellite
  telecommunication technology to strengthen health
  systems in sub-Saharan Africa
• TTF established in January 2006
• To define a roadmap for identifying a suitable
  set of actions for implementing a Telemedicine
  programmatic framework in the Sub-Saharan African
  region
• To support the definition of a technology neutral
  cost-benefit study to evaluate the relevance of
  a pan-African network of Telemedicine
• The TTF comprises representatives from the AU,
  the NEPAD eCommission for Africa, WHO, EC and ESA
• The work of the TTF is in progress and its report
  which is expected during the first quarter of
  2007 will guide the preparation of the ECs
  roadmap for the implementation of Telemedicine
  services in the Sub-Saharan Africa

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Africa Health Infoway

• Info structure
• District health information systems
• Translating information and knowledge into policy
  and action

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Provision of Technical Support to Countries

• AFRO Web-site
• CD ROM publishing and distribution
• Collaboration with eSchools project
• Electronic Health Records
• National policies, strategies, plans

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Monitoring evaluation, and international
reporting

• Participation in the activities of the Global
  Observatory on eHealth (GOe)
• The mission of the GOe is to improve health by
  providing Member States with strategic
  information and guidance on best practice,
  policies and standards in eHealth
• First global survey on eHealth conducted in 2005
• Will work with Ministries of Health to establish
  M E systems for eHealth in Member States

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Availability Coverage (SAM)
Availability coverage shows what resources are
available in what amount for delivering an
intervention.
The Service Availability Mapping tool (SAM) is
designed to provide monitoring information on the
availability of services and resources.
http//www.who.int/healthinfo/systems/serviceavail
abilitymapping/en/
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Conclusion (1)

• eHealth is particularly relevant for developing
  countries for health development as it eHealth
  offers solutions for -
• long-distance consultation
• emergency medical assistance administration
  and logistics
• supervision and quality assurance
• management of epidemics
• education and training for health care staff

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Conclusion (2)

• In operationalizing eHealth in countries in
  the African Region, consideration must be given
  to the 5 Cs
• Context
• Content
• Connectivity
• Capacity
• Community

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Conclusion (3)

• Let us all work together to achieve the
  conference theme of
• eHealth for All
• and help address the inequalities in health care
  in our world, and especially in sub-Saharan Africa