National eHealth Policy 2016 today eHealth... · 2018. 9. 4. · National eHealth Strategy (2013),...

RepublicofUganda

Ministry of Health

UgandaNationaleHealthPolicy

November2016

Foreword

TheUgandanhealthcaresystem,throughitsongoinghealthsectorreforms,aimstoimprovehealthoutcomes.Aspartofthesereforms,theMinistryofHealth(MOH)developedtheHealthSectorDevelopmentPlan(HSDP)2015/16-2019/20toaddressthekeychallengesfacingUganda’shealthsystem,setoutprioritiesandkeyareasonwhichtofocushealthinvestmentinthemediumterm,forbothpublicandprivatepartners,inordertooptimallycontributetotheattainmentofboththehealthsectorgoalsandthenationalgoalsasoutlinedintheNationalDevelopmentPlanII.AlthoughimplementationofHSSPIIIpromisedtoproducemanypositiveresults,realizingthebestoutcomesinthefaceofincreasingpressuresonthehealthcaresystemrequiresafundamentaltransformationinthewayhealthcareisdeliveredandmanaged.

TheMinistryrecognizesthepotentialofinformationandcommunicationtechnology(ICT)intransforminghealthcaredeliverybyenablinginformationaccessandsupportinghealthcareoperations,management,anddecisionmaking.However,theUgandanhealthsectorischaracterizedbyafragmentedlandscapeofICTpilotprojectsandnumerousdataandhealthinformationsystem(HIS)siloswithsignificantbarrierstotheeffectivesharingofinformationbetweenhealthcareparticipants.

Althoughthegovernment,partners,andprivateinstitutionsarecontinuingtoinvestinvariousICTinitiatives,withoutsomeformofanationalplanandcoordination,thereisarealriskofcontinuedduplication,ineffectiveexpenditure,andthecreationofnewsolutionsthatcannotbeintegratedorscaledacrossthecontinuumofcare.

Toformanationalplanandcommunication,theMOHdevelopedaNationaleHealthPolicy(2013),aNationaleHealthStrategy(2013),andsubsequentlyadraftNationaleHealthPolicy(2016)toguidetheuseofICTinsupportinghealthsectortransformation.Aspartoftheseprocesses,theMinistry,throughaneHealthTechnicalWorkingGroup(eHealthTWG)supportedbyUnitedNationsChildren’sFund(UNICEF)andWorldHealthOrganization(WHO),conductedaseriesofnationalconsultationsthatincludedhealthsectorprofessionals,partners,faith-basedorganizations,Government,non-governmentalorganizations(NGOs),andotherstakeholders.

In2016,theMinistry,throughtechnicalandfinancialsupportfromUNICEFandWHOunderthestewardshipoftheeHealthTWGreviewedthedrafteHealthPolicyandstrategy,seekingareasforimprovement.ThereviewprocessalsofollowedaparticipatoryapproachdrivenbyHSDPstrategicobjectives.TheNationaleHealthPolicyandStrategyprovideanappropriatebasistoguidethedevelopmentofeHealthinUganda.Itadoptsenterprisearchitecture(EA)-drivendevelopmentapproachtodevelopingeHealthcapabilities:

• LeveragewhatcurrentlyexistsintheUgandaneHealthlandscape.• Understandwhatthenewcomponentsareandwheretheyfitinexistingstructures.• Defineinformationstructurestofitcurrentneedsandtosupportanticipatedones.• Demonstratehowtechnologyandresourceconstraintsdictatebothwhatisfeasibleandthe

pathforward.

TheimplementationofthiseHealthpolicyandstrategywillacceleratetheongoingreformsandsustainthegainswitnessedinthesectorsince2015,whenthesectorstartedtheimplementationof

HSDP.Inaddition,thepolicyandstrategywilladdresssomeofthekeychallengesexperiencedduringHSDP,thatincludeashortageofqualifiedhealthcareprofessionalsatalllevelsofthehealthsystem;epidemicssuchasHIV/AIDS,tuberculosis(TB),andmalaria;andlimitedaccesstohealthfacilitiesandhealthprofessionalsduetopoorinfrastructure,inefficienciesofthehealthcaresystem,poverty,andignorance.

TheNationaleHealthPolicyandStrategywilldelivertheeventualbenefitofasafer,high-quality,equitable,efficient,andsustainablehealthsystemthatisequippedtorespondtoemerginghealthsectorcostanddemandpressures.TheUgandanhealthcaresystemenhancementswillalsodrivestrongerworkforceproductivitythatisvitaltoUganda’slong-termeconomicdevelopment.

TheNationaleHealthPolicyandStrategyisapplaudedasausefulguidetothenextstepsforUgandainitseHealthjourney.ThePolicyandStrategyarepragmatic,balancesdifferentpriorities,andwillhelptoleadUgandatowardthedeliveryofasafer,betterconnected,andmoresustainablehealthcaresystem.

Dr.JaneRuthAceng

MinisterofHealth

TableofContents

Foreword.................................................................................................................................................i

TableofContents..................................................................................................................................iii

Executivesummary................................................................................................................................1

Acknowledgements...............................................................................................................................3

ListofAcronymsandAbbreviations......................................................................................................4

DefinitionsofKeyTerms........................................................................................................................9

ListofTables........................................................................................................................................11

ListofFigures.......................................................................................................................................12

PolicyDeclaration................................................................................................................................13

1. Introduction.................................................................................................................................14

1.1 eHealthBackground............................................................................................................14

1.2 eHealthServices..................................................................................................................14

2 StrategicContextforeHealth......................................................................................................15

2.1 TheInternationalPerspective..............................................................................................15

2.2 TheUgandaHealthcareSystem...........................................................................................17

2.3 JustificationofeHealthinUganda.......................................................................................19

3 SituationAnalysis.........................................................................................................................19

3.1 UgandaeHealthSituationAnalysis......................................................................................19

3.1.1 LeadershipandGovernanceofeHealth.......................................................................19

3.1.2 eHealthEnterpriseArchitecture,InteroperabilityandStandards...............................20

3.1.3 eHealthServices,InformationSharingandDataManagement...................................20

3.1.4 Infrastructure...............................................................................................................21

3.1.5 eHealthInformationAssurance...................................................................................21

3.1.6 Ethics............................................................................................................................22

3.1.7 HumanResourcesandCapacityBuilding.....................................................................22

3.1.8 MainstreamingSpecialInterestGroups......................................................................23

3.1.9 Research,InnovationandDevelopment......................................................................23

3.1.10 eHealthInvestment.....................................................................................................24

3.1.11 StakeholderEngagement,Collaborations,AdvocacyandSmartPartnerships............24

3.1.12 BusinessProcessRe-Engineering.................................................................................25

3.1.13 LegalandRegulatoryFrameworkforeHealth.............................................................25

4 FoundationoftheeHealthPolicy................................................................................................26

4.1 RationaleoftheeHealthPolicy............................................................................................26

4.2 ScopeofthePolicy...............................................................................................................26

5 Vision,Mission,GoalandGuidingPrinciples...............................................................................26

5.1 Vision...................................................................................................................................26

5.2 Mission.................................................................................................................................26

5.3 Goal......................................................................................................................................26

5.1 PolicyGuidingPrinciples......................................................................................................27

6 Pillars/priorityareasfortheeHealthPolicy................................................................................27

7 PolicyObjectivesandStrategies..................................................................................................28

7.1 LeadershipandGovernanceforeHealth.............................................................................28

7.1.1 Objective......................................................................................................................28

7.1.2 Scope...........................................................................................................................28

7.1.3 PolicyStrategies...........................................................................................................28

7.1.4 ResponsibilitiesandProcedure....................................................................................29

7.2 eHealthEnterpriseArchitectureandInteroperabilityFrameworkandStandards..............29

7.2.1 Objective......................................................................................................................29

7.2.2 Scope...........................................................................................................................29

7.2.4 ResponsibilitiesandProcedures..................................................................................30

7.3 eHealthServices,InformationSharingandDataManagement,.........................................30

7.3.1 Objective......................................................................................................................30

7.3.2 Scope...........................................................................................................................30

7.4 Infrastructure.......................................................................................................................31

7.4.1 Objective......................................................................................................................31

7.4.2 Scope...........................................................................................................................31

7.5 eHealthInformationAssurance...........................................................................................32

7.5.1 Objective......................................................................................................................32

7.5.2 Scope...........................................................................................................................33

7.6 Ethics....................................................................................................................................34

7.6.1 Objective......................................................................................................................34

7.6.2 Scope...........................................................................................................................34

7.7 HumanResourcesandCapacityBuilding.............................................................................34

7.7.1 Objective......................................................................................................................34

7.7.2 Scope...........................................................................................................................34

7.8 MainstreamingSpecialInterestGroups(SIGs)....................................................................35

7.8.1 Objective......................................................................................................................35

7.8.2 Scope...........................................................................................................................35

7.9 Research,InnovationandDevelopment..............................................................................36

7.9.1 Objective......................................................................................................................36

7.9.2 Scope...........................................................................................................................36

7.10 eHealthInvestment.............................................................................................................37

7.10.1 Objective......................................................................................................................37

7.10.2 Scope...........................................................................................................................37

7.10.4 ResponsibilitiesandProcedure....................................................................................37

7.11 StakeholderEngagement,Collaborations,AdvocacyandSmartPartnerships....................37

7.11.1 Objective......................................................................................................................37

7.11.2 Scope...........................................................................................................................38

7.11.3 PolicyStrategy.............................................................................................................38

7.12 BusinessProcessRe-Engineering.........................................................................................38

7.12.1 Objective......................................................................................................................38

7.12.2 Scope...........................................................................................................................38

7.13 LegalandRegulatoryFramework........................................................................................39

7.13.1 Objective......................................................................................................................39

7.13.2 Scope...........................................................................................................................39

8 PolicyImplementation.................................................................................................................40

8.1 Framework...........................................................................................................................40

8.2 PolicyDisseminationandSensitization................................................................................40

8.3 Planning,Budgeting,ResourceMobilizationandInvestment.............................................40

8.3.1 PlanningandBudgeting...............................................................................................41

8.3.2 ResourceMobilization.................................................................................................41

8.4 Monitoring,EvaluationandComplianceAssessment.........................................................41

8.4.1 MonitoringandEvaluation..........................................................................................41

8.4.2 ComplianceAssessment..............................................................................................41

Executivesummary

TheNationaleHealthPolicyandStrategyaredirectionaldocumentsthatdescribeslong-termvisionforeHealth,withastrongfocusontangiblebenefitsanddeliverables.Italsodescribestheleadershipandgovernancestructure,canteredontheNationaleHealthTechnicalWorkingGroupthatwillhelpensurethetimelyimplementationofeHealthinitiatives.

Inordertohaveapolicyandstrategythatisholisticandinclusive,thedevelopmentofthepolicyandstrategyusedaparticipatoryprocess.ThereforetheStrategyincludestheviewsofmultiplegroupsandsectorsandistheresultofmanyhoursofdebateanddeliberation.

VisionEffectiveuseofinformationandcommunicationtechnologyforbetterhealthoutcomesoftheUgandanpopulation.

MissionTotransformthehealthofthepeopleofUgandabypromotingeffectiveutilizationofinformationandcommunicationtechnology.

ObjectiveTocreateanenablingenvironmentforthedevelopment,deploymentandutilizationofsustainable,ethicallysoundandharmonizedeHealthinitiativesatalllevels.

StrategicAreasofImplementation

• LeadershipandGovernanceofeHealth• eHealthEnterpriseArchitecture,InteroperabilityandStandards• eHealthServices,InformationSharingandDataManagement• Infrastructure• eHealthInformationAssurance• Ethics• HumanResourcesandCapacityBuilding• MainstreamingSpecialInterestGroups• Research,InnovationandDevelopment• eHealthInvestment• StakeholderEngagement,Collaborations,AdvocacyandSmartPartnerships• BusinessProcessRe-Engineering• LegalandRegulatoryFrameworkforeHealth

Principles

a) ClientfocusedeHealthagendab) Equityc) User-friendlytechnologyapplicationsd) MultiSectoralApproache) HumanRightsbasedapproachf) QualityInformationgenerationg) GenerateQualityInformationbaseforstrategicplanningandpolicydevelopment

GovernanceandManagement

SuccessfulimplementationoftheNationaleHealthPolicyandStrategyrequiresawell-definedgovernancestructuretoprovideimprovedvisibility,coordination,andcontrolofeHealthactivitiesthatareoccurringacrossthecountry’shealthsector.Themaingoalofgovernanceistoassureallstakeholdersthatoperationswillgoasexpected—thattheresultsachievedwillbeinlinewiththedecisionsmade.

Implementation

ThefollowingpillarsrepresentthefourkeyareaswherewemustexcelinordertoachieveournationaleHealthvision:

• eHealthFoundations:ThebasicinfrastructuralbuildingblocksrequiredtoenabletheeffectiveelectronicsharingofinformationacrosstheTanzanianhealthsector

• eHealthSolutions:Thespecificcomputingsystemsandtoolstoaddressthehigh-priorityneedsofconsumers,careproviders,andhealthcaremanagersthatimproveefficiencyandeffectiveness

• ChangeandAdoption:TheactualactionsthatneedtobecarriedouttoencourageandenableparticipantsinthehealthcaresystemtoadopteHealthsolutionsandchangetheirworkpracticestobeabletousethesesolutionseffectively.

• eHealthGovernance:TheappropriatenationaleHealthgovernancestructuresandmechanismsneededprovideleadership,coordination,andoversighttoensuresuccessfulimplementationofthenationaleHealthprogram

Acknowledgements

Therealizationofthepolicyandstrategyhasbeenachievedthroughtremendouseffortandcommitmentofseveralindividuals,organizations,andpartnerswhohavecontributedtothedevelopmentofthisstrategydocument.

ThisstrategyhasbeendevelopedthroughaparticipatoryprocessthatwasspearheadedbytheeHealthTechnicalWorkingGroupappointedbytheMinistryofHealth(MOH).Theyheldnumerousformalmeetingsplusinformalsessions,technicalconsultations,extensiveinputfromstakeholdersthroughworkshops,discussiongroups,interviews,reviewthroughtheWorldHealthOrganization(WHO)eHealthdevelopmenttoolkit,andothersurveys

ThisprocessproducedadrafteHealthPolicyandStrategy.Toeachofthecontributorstothedraftpolicyandstrategy,aswellastothosewhoassistedandsupportedthem,wesendourprofoundappreciation.SpecificappreciationisgiventotheUNICEFandWHO.

SpecialthankstotheMOH,particularlyMinisterofHealthforhersincereencouragementandfollow-uponeHealthissues,aswellasstakeholderswhoparticipatedintheworkshopsandcontributedideasthataretheframeofthepolicyandstrategy.

MOHstaffworkedwithvigourtomakesurethattheMinistryfinalizedtheNationaleHealthPolicyandStrategy.

Allcontributionsandeffortsarehighlyappreciated.

Dr.DianaAtwineKanzira.

PermanentSecretary,

MinistryofHealth

ListofAcronymsandAbbreviations

AIN AlienIdentificationNumber

BC BusinessContinuity

CIS ClinicalInformationSystems

CPD ContinuingProfessionalDevelopment

CSO CivilSocietyOrganization

DR DisasterRecovery

DGHS DirectorGeneralofHealthServices

EAC EastAfricanCommunity

EGI e-GovernmentInfrastructure

eHP eHealthPolicy

EHR ElectronicHealthRecord

EMR ElectronicMedicalRecord

eTWG eHealthTechnicalWorkingGroup

GOe GlobalObservatoryforeHealth

HCI HealthCentre1

HCII HealthCentre2

HCIII HealthCentre3

HCIV HealthCentre4

HDPs HealthDevelopmentPartners

HEA-IF HealthEnterpriseArchitectureandInteroperabilityFramework

HIS HealthInformationSystem

HMIS HealthManagementInformationSystem

HPA HealthProfessionalAssociations

HPAC HealthPolicyAdvisoryCommittee

HRHIS HumanResourcesforHealthInformationSystem

HRIS HumanResourceInformationsystem

HSC HealthServiceCommission

HSDP HealthSectorDevelopmentPlan

HSSIP HealthSectorStrategicandInvestmentPlan

ICT InformationandCommunicationTechnology

IFMS IntegratedFinancialManagementSystems

IHRMS IntegratedHumanResourceManagementSystem

IT InformationTechnology

LIMS LandInformationManagementSystem

LSMIS LogisticsandSuppliesManagementInformationSystem

LIS LibraryInformationsystem

LOGICS LocalGovernmentInformationCommunicationSystem

LRC LawReformCommission

MDAs MinistriesDepartmentsandAgencies

MDGs MillenniumDevelopmentGoals

MoEI MinistryofEthicsandIntegrity

MoES MinistryofEducation&Sports

MoFPED MinistryofFinance,PlanningandEconomicDevelopment

MoH MinistryofHealth

MoICT MinistryofInformationCommunicationsandTechnology

MoJCA MinistryofJusticeandConstitutionalAffairs

MoLG MinistryofLocalGovernment

MoPS, MinistryofPublicService

MoSTI MinistryofScience,TechnologyandInnovation

NASH NationalAuthenticationServiceforHealth

NBI NationalBackboneInfrastructure

NDC NationalDataCentre

NDP NationalDevelopmentPlan

NeHP NationaleHealthPolicy

NeHS NationaleHealthStrategy

NeHSC NationaleHealthSteeringCommittee

NHP NationalHealthPolicy

NIN NationalIdentificationNumber

NISF NationalInformationSecurityFramework

NITA-U NationalInformationTechnologyAuthority-Uganda

NITP NationalInformationTechnologyPolicy

NRH NationalReferralHospitals

PDA PersonalDigitalAssistant

PHR PersonalHealthRecord

PHI PersonalHealthInformation

PI PersonalInformation

PFP Private-for-Profit

PNFP Private-Not-for-Profit

PPP PublicPrivatePartnership

RC ResourceCentre

RCDF RuralCommunicationsDevelopmentFund

RRH RegionalReferralHospitals

SMART Specific,Measurable,Achievable,RealisticandTime-bound

SOP StandardOperatingProcedure

SIGs SpecialInterestGroups

TMC TopManagementCommittee

TV Television

TWG TechnicalWorkingGroup

UCC UgandaCommunicationsCommission

UCMB UgandaCatholicMedicalBureau

UHI UniqueHealthcareIdentifiers

UN UnitedNations

UNMHCP UgandaNationalMinimumHealthCarePackage

VHTs VillageHealthTeams

WHA WorldHealthAssembly

WHO WorldHealthOrganization

DefinitionsofKeyTerms

BusinessContinuity(BC):isdefinedasthecapabilityoftheorganizationtocontinuedeliveryofproductsorservicesatacceptablepredefinedlevelsfollowingadisruptiveincident.(Source:ISO22301:2012)

Businessprocessreengineering(BPR):Thefundamentalrethinkingandredesignofbusinessprocessestoachievedramaticimprovementsincriticalcontemporarymeasuresofperformancesuchascost,quality,service,andspeed.

ClinicalInformationSystem(CIS):Acomputerbasedsystemthatisdesignedforcollecting,storing,manipulatingandmakingavailableclinicalinformationimportanttothehealthcaredeliveryprocess.

Disasterrecovery(DR):involvesasetofpoliciesandprocedurestoenabletherecoveryorcontinuationofvitaltechnologyinfrastructureandsystemsfollowinganaturalorhuman-induceddisaster.

Distance learning for health professionals (eLearning): eLearning services compriseeducationandtraininginelectronicformforhealthpprofessionals.eLearningimprovesthequality of education and increase access to learning resources. Examples of use includecontinuing professional development for doctors and nurses, and training on preventiveservicesatthehouseholdlevelforcommunityhealthworkers.eLearningtoolsvarywidely,andmayallowinteractionbetweenthelearnerandinstructor,accesstodigitallibrariesandonline courses, networks to share experiences, or the use of mobile devices to accessinformationtosupportdeliveryofcare.eHealth:Acost-effectiveandsecureuseofinformationandcommunicationtechnology(ICT)insupportofhealthandhealth-relatedfields,includinghealthcareservices;healthsurveillance;healthliterature;andhealtheducation,knowledge,andresearch.

ElectronicHealthRecord(EHR):AnEHRisadigitalrecordbuilttogobeyondstandardclinicaldatacollectedinaprovider’sofficeandinclusiveofabroaderviewofapatient’scare.EHRscontaininformationfromallthecliniciansinvolvedinapatient’scareandallauthorizedcliniciansinvolvedinapatient’scarecanaccesstheinformationtoprovidecaretothatpatient.EHRsalsoshareinformationwithotherhealthcareproviders,suchaslaboratoriesandspecialists.EHRsfollowpatients–tothespecialist,thehospital,thenursinghome,orevenacrossthecountry.

Electronicmedicalrecords(EMR):AnEMRisadigitalversionofthepaperchartsinclinicianoffices,clinics,andhospitals.EMRscontainnotesandinformationcollectedbyandforthecliniciansinthatoffice,clinic,orhospitalandaremostlyusedbyprovidersfordiagnosisandtreatment.EMRsaremorevaluablethanpaperrecordsbecausetheyenableprovidersto

trackdataovertime,identifypatientsforpreventivevisitsandscreenings,monitorpatients,andimprovehealthcarequality.

EmergingTechnologies:Newtechnologiesthatarecurrentlydevelopingorwillbedevelopedoverthenextfivetotenyears,andwhichwillsubstantiallyalterthebusinessandsocialenvironment.

EnterpriseArchitecture(EA):EAistheprocessoftranslatingbusinessvisionandstrategyintoeffectiveenterprisechangebycreating,communicating,andimprovingthekeyprinciplesandmodelsthatdescribetheenterprise'sfuturestateandenableitsevolution.

HealthInformationSystems(HIS):Itisasystemsthatfacilitatesgathering,aggregating,analysingandsynthesizingofdatafrommultiplesourcestoreportonhealthsituationandtrends(diseaseburden,patternsofriskbehaviour,healthservicecoverageandhealthsystemmetrics).CountriesmayhaveinplaceoneormoreHISsupportingreportingondiseasesorprograms.TheymayalsohaveHISstrategiesaimedatimprovingdecision-making,policydevelopment,healthservicesmanagement,responsetoemergingthreatsandbetterallocationofhealthresources

MatureTechnologies:Thisreferrerstoatechnologythathasbeeninuseforlongenoughthatmostofitsinitialfaultsandinherentproblemshavebeenremovedorreducedbyfurtherdevelopment.Insomecontexts,itmayalsorefertotechnologythathasnotseenwidespreaduse,butwhosescientificbackgroundiswellunderstood.

Mobilehealth:mHealthormobilehealthisdefinedasmedicalandpublichealthpracticesupportedbymobiledevices,suchasmobilephones,patientmonitoringdevices,personaldigitalassistants(PDAs),andotherwirelessdevices.

Examplesincludetheuseofmobiledevicesfor:• Datacollectionforsurveillanceandpublichealth(e.g.outbreakinvestigation)• Real-timemonitoringofanindividual’shealth• Treatmentsupport,healthadviceandmedicationcompliance• Healthinformationtopractitioners,researchersandpatients• Healtheducationandawarenessprograms• Diagnosticandtreatmentsupport,communicationforhealth-careworkers.

PatientRegistry:APatientRegistryisanorganized.systemthatusesobservationalstudymethodstocollectuniformdata(clinicalandother)toevaluatespecifiedoutcomesforapopulationdefinedbyaparticulardisease,condition,orexposure,andthatservesapredeterminedscientific,clinical,orpolicypurpose(s).

Personalhealthrecords(PHR):APHRisarecordthatcontainsthesametypesofinformationasEHRs—diagnoses,medications,immunizations,familymedicalhistories,andprovidercontactinformation—butaredesignedtobesetup,accessed,andmanagedby

patients.PatientscanusePHRstomaintainandmanagetheirhealthinformationinaprivate,secure,andconfidentialenvironment.PHRscanincludeinformationfromavarietyofsourcesincludingclinicians,homemonitoringdevices,andpatientsthemselves.

Telemedicine:Thisisthedeliveryofhealthcareservices,wheredistanceisacriticalfactor,byallhealthcareprofessionalsusinginformationandcommunicationtechnologiesfortheexchangeofvalidinformationfordiagnosis,treatmentandpreventionofdiseaseandinjuries,researchandevaluation,andforthecontinuingeducationofhealthcareproviders,allintheinterestsofadvancingthehealthofindividualsandtheircommunities.Examplesoftelemedicineservicesareprovidedbelow.

• Store-and-forwardservices involveacquiringmedicaldata for transmission laterbythehealth-careproviderforofflineassessmentandtreatmentrecommendation.

• Remotemonitoringservicesenablehealth-careproviderstomonitoranindividual’sconditionremotely,usinginformationtechnologies.

• Interactive services enable real-time interaction between health-care providerthrough means such as telephone, web conference, video conference and otherformsofonlineandremotecommunication.

ListofTables

Notableoffiguresentriesfound.

ListofFigures

Notableoffiguresentriesfound.

PolicyDeclaration

AllMedicalPractitioners,UsersandStakeholdersSHALLbelawful,efficient,economicalandethical in theiruseof thee-Health resources,whichareprovided tocreate,preserveandexecutethemissionoftheHealthSector.

1. Introduction

1.1 eHealthBackground

eHealth refers to theuseof InformationandCommunicationTechnologies (ICT) inhealthcare.TheWorldHealthOrganization(WHO)hasdefinede-Healthas“thecost-effectiveandsecure use of ICT in support of health and health-related fields, including health careservices,healthsurveillance,healthliterature,healtheducation,knowledgeandresearch1”

GovernmentofUgandarecognizedtheuseof informationandcommunicationtechnology(ICT) intheNationalDevelopmentPlanII2015/16-2019/20asanenablerto improvethedelivery of services to its citizens across its sectors. The Ministry of Health too hasrecognized eHealth in the Health Sector Development Plan 2015/16 - 2019/20 as a keyenablerforsupportingthehealthsysteminordertodelivergoodhealthtothepopulation.TheNationaleHealthPolicyprovidesguidanceonhowtouseICTtofacilitateimprovementin the flow of information, through electronic means, to support the delivery of healthservicesandthemanagementofthehealthsysteminabidtofacilitateuniversalaccesstocare,healthsectorefficiency,andsocialtransformation.TheNationaleHealthPolicyhasbeendeveloped throughaparticipatoryandconsultativeprocess of engagement with multisectoral stakeholders. Stakeholder identification wasbasedontheir influence,knowledge,expertiseandinterest ineHealth.ThiswastoensureaninformednationaleHealthpolicythatisrelevantto,andsupportedbystakeholdersfrom;thehealthandICTsectorsandotherrelevantgovernmentministries,HealthDevelopmentPartners(HDPs),UNAgencies,thePrivatesector,CivilSociety,Serviceconsumers,ResearchOrganisations,LocalgovernmentsandAcademia.Healthmanagersandadministratorsfromurbanandruralareaswerealsoconsulted.ThesuccessofeHealthishingedtoproperpolicy,planning,implementationandregulation.Harmonizationoftheinitiativesto-daterequiresaholisticapproachbasedoninternationalbestpracticeandrelevancetothelocalenvironment.

1.2 eHealthServices

Theapplicationsofe-HealthhavebeenclassifiedasuseofeHealthintheprovisionofhealthservicesatadistance(telehealth),managementofclinicalandadministrativeinformation(healthinformatics),andsharinginformationandknowledgewithhealthcareproviders,patients,andcommunities(e-learning).

1WorldHealthOrganization,EasternMediterraneanRegion.AboutEHealth.2007;Availablefrom:http://www.emro.who.int/his/ehealth/AboutEhealth.htm

2 StrategicContextforeHealth

2.1 TheInternationalPerspective

The fifty-eight World Health Assembly in May 2005 adopted a resolution setting up a“GlobaleHealthStrategy”within theWorldHealthOrganisation.Thesameyear theWHOsetup the“GlobalObservatory foreHealth (GOe)”with the remitof studying,monitoringand promoting the role of eHealth in health services and systems globally. The GOe haspublished many documents looking at areas such as telemedicine, internet safety andsecurity,mobility,legalissuesandpatientrecords.

TheWHOhasstatedthat“eHealthischanginghealth-caredeliverytodayandisatthecoreof responsive health systems. The daily business of health relies on information andcommunicationand, increasingly,on the technologies thatenable it,atevery leveland inevery country. This is equally so in delivering care, deploying personnel, managingprogrammes or conducting research. The case for adopting these technologies has beenevident for over a decade. However, it has taken a crisis in the health sector in manycountriestomoveeHealthfromtheperipherytothecentreofstrategichealthplanning.Inanincreasinglydigitalworld,spurredbytechnologicaladvances,economicinvestment,andsocial and cultural changes, there is growing recognition that inevitably the health sectormustintegrateICTintoitswayofdoingbusiness.Thisapplieswhetherthegoalistoreachall citizens with high-quality, equitable and safe care, or to meet obligations for publichealthresearch,reportingandhumanitarianaction”.

In support of this, theWHO have published an eHealth Strategy Development Toolkit tohelpcountriesalongthepathtoeHealthmaturity.ThedocumentoutlinesarecommendedapproachtodevelopmentofanationaleHealthstrategyandincludesconsiderationssuchasstakeholderengagement,policyandgovernancemodels.

ToensurethatacountryrealizesthepotentialfromeHealth,itisimportanttoestablishaneffective governance, management and implementation structure. To support theidentification of such structure and help define its essential characteristics, a review ofinternationaleHealthexperienceshasbeenundertakentoexaminebest-practicecriteriaforsuccess. This review included Australia, England, Scotland, Northern Ireland, Denmark,Cuba,PhilippinesandCanada.ThesewereselectedastheyrepresentvariousapproachestoeHealth implementation and have shown varying degrees of success and therefore keyfactorsofbothsuccessandfailurecanbeexamined.

Inaddition,reviewlookedatAfricancountries;SouthAfrica,Nigeria,Ghana,KenyaandTanzaniatoensurethatregionalexperiencesarealsobroughtintoperspective.

Themajoroutputofthisreviewwasthedefinitionofbest-practiceguidelinesandcriteriatoidentifytheoptimumgovernanceandoperationalstructurerequiredforimplementation.ThesecriteriaareusedtoidentifyanoptimummodelforUgandaofthisstrategy.

ThefollowingareasummaryoftheInternationalPerspective:

(a) Governance.Stronggovernanceandleadershipisrequiredandclearoperationalmodels/roadmapsneedtobeagreedbyallearlyonintheexecutionphases.Thedeliveryentityshouldhaveoverallgovernanceforimplementationandmanagefundingallocations.Thefundingshouldbeallocatedonamilestone/deliverablestage-gatebasis,heldcentrallyandawardedtolocaldeliveryorganisationsasaninnovationincentive.

(b) DeployinPhases:Usingaphasedapproachtoimplementationbasedonnationalprioritiesandbuildinguptoscalemakesmoresensethanlarger‘bigbang’deployments.

(c) EnterpriseArchitecture,InteroperabilityandStandards:DeploymentsshouldbebasedandconformtoaneHealthEnterpriseArchitecture,InteroperabilityFrameworkandstandards.

(d) eHealthServices:eHealthServicesshouldbebasedonanapprovedeHealthEnterpriseArchitecturetoenablestandardization,interoperabilityandservicesthatarealignedtothehealthcarebusinessobjectivesinaholisticmanner

(e) Infrastructure:Developmentofasecurenetworkinfrastructureisimportantandthisshouldbesharedacrosspublicandprivatehealthcaresystems.Publicinvestmentinthese‘buildingblocks’iswarrantedandisakey‘enabler’totheapplicationsthatwillbedeployedontop.

(f) BusinessProcessRe-Engineering:eHealthdeploymentsshouldbeviewedasBusinessprocessre-engineeringandchangemanagementenablingthroughtheuseofinformationsystemsratherthanICTprojectsperse.Muchupfronteffortneedstobedirectedatorganisationalimpactanalysisandchangemanagementaspects.

(g) NationalOversight,LocalInnovation:Anationaloversightapproachforkeyaspectssuchasstandardsandinteroperabilitycombinedwithlocalinnovationandincentivesshouldbeadopted.

(h) StakeholderEngagement:Frontlineandclinicalengagementiscriticalandthesestakeholdersshouldbe‘champions’ofeHealthsolutions.Engagementwithfurtherstakeholdersincludingpatientgroups,advocacyorganisationsandstandardsbodiesshouldbefactoredinearlyintheprocess.

(i) HealthIdentifier:AuniqueidentifierisacornerstoneofmosteHealthsystems.Whatneedstobedecidedistheformatthistakes.Ideallyre-useofexistinginitiativesandpublicinfrastructureisadvisable.Properlegislationneedstoaccountforprivacyandsecurityissues.

(j) Leverageexistinginvestments:Leverageexistinginvestmentswhereverpossible.ForexampleinIrelandtheIntegratedServicesFramework(ISF).

(k) BrandingandAwareness:Thedeliveryentityshouldbestronglybrandedandthereshouldbestrongandearlyengagementwiththepublic.Campaignsofpublicawareness,educationandbenefitsshouldbelaunched.

(l) Skills:Thedeficitofadequatehealthinformaticsskillsneedstobeaddressed.Skillsdevelopmentandtrainingarethereforenecessarypartsofanimplementationprogram.

2.2 TheUgandaHealthcareSystem

InplanningforthemoresystematicandexpandedapplicationofeHealthtothehealthsectorinUganda,itisimportanttounderstandtheorganizationofthehealthcaresystemwithinthemainland.

Ugandaasacountryisdividedinto112districtsandonecity(thecapitalcityofKampala).ThedistrictsarespreadacrossfouradministrativeregionsofNorthern,Eastern,CentralandWestern.Thedistrictsaresubdividedinto181countiesand22municipalitiesand174towncouncilswhicharefurthersubdividedinto1,382subcounties,7,138parishesand66,036villages(CensusReport2014).ParallelwiththeadministrationaretraditionalKingdomsthatenjoysomedegreeofmainlyculturalautonomy.Thedistrictsaresemi-autonomousinhealthplanningandimplementation,whichisanimportantpointtotakeintoaccountwhenplanningthedeploymentofeHealththroughoutthecountry.

TheUgandaHealthcareSystemisgovernedandsupportedthroughanumberofinstitutions:

i) TheMinistryofHealth(MoH)

ii) HealthServiceCommission(HSC)

iii) PublicServiceCommission(PSC)

iv) MinistryofLocalGovernment(MoLG)

v) NationalDrugAuthority(NDA)

vi) NationalMedicalStores(NMS)

vii) UgandaAidsCommission

viii) UgandaNationalHealthResearchOrganisation(UNHRO)

ix) CentralPublicHealthLaboratory(CPHL)

x) UgandaBloodTransfusionServices(UBTS)

xi) UgandaVirusResearchInstitute(UVRI)

xii) UgandaHeartInstitute(UHI)

xiii) UgandaCancerInstitute(UCI)

xiv) JointClinicalResearchCenter(JCRC)

xv) NaturalChemotherapeuticsResearchLaboratory

xvi) UgandaMedicalandDentalPractitionersCouncil(UMDPC)

xvii) PharmacyBoard

xviii) UgandaNursesandMidwivesCouncil(UNMC)

xix) AlliedHealthProfessionalsCouncil(AHPC)

xx) PharmaceuticalSocietyofUganda

xxi) HealthCommitteeofParliament

xxii) ICTCommitteeofParliament

xxiii) ICTAssociationofUganda

xxiv) UgandaManufacturersAssociation

xxv) WorldHealthOrganization(WHO)

xxvi) UNICEF

xxvii) USAID

xxviii) CDC-Uganda

TheinstitutionsabovehavebeenputintoconsiderationwhendevelopingtheeHP

TheGovernmentofUganda(GOU)hasdedicatedsignificanteffort,throughpublicandprivateproviders,todeliverprimaryhealthcareservicestoitscitizens.Allthe112districtsinUgandaeitherhaveahospitalorHCIVorboth.

Currentlythereareapproximately831clinics,2,941HealthCentreII,1,289HealthCentreIII,197HealthCentreIV,144GH,14RRH,and2NationalReferralHospital.About72%ofthepopulationliveswithinfivekilometresofaprimaryhealthfacility;however,themajorityofthepopulationlivesinruralareasatadistancefromhospitalsandthecareofspecialists.

EffortsbytheGoUandPartnershavefacilitatedrecruitmentofmuch-neededstaffincreasingtheproportionofapprovedpostsfrom56%in2010to69%in2013/2014.ThishoweverleavesUgandawithahumanresources(HR)deficit.Thiscrisis,togetherwithotherchallengesfacingtheUgandanhealthsector,callsfortheimmediateimplementationofeHealthinthecountry.eHealthdevelopmentcanbesupportedthroughtheformulationandimplementationofaneHealthpolicyasawayofsupportingprogressinthesector.

2.3 JustificationofeHealthinUganda

Someofthekeypressuresfacingthehealthsectorincludethefollowing:

• Shortageofqualifiedhealthcareprofessionalsatalllevelsofthehealthsystem;• Diseaseburden;• Limitedaccesstohealthfacilitiesduetopoorinfrastructure;• Fragmentationofhealthrelatedinformationandinsufficientinteroperability;• Weakhealthinformationmanagement;• Inefficienciesofthehealthcaresystem;• Underdevelopment;• Inadequatefunding;• Insufficientknowledge.

Tobeabletomitigatethechallenges,thereisneedtocontinuouslyimprovetheperformanceandcapacityofthesupplysidetomeetsomeofthegrowthindemandonhealthcareservices.TheimplementationofeHealthislookedatasoneofthesolutionstomitigatethechallengesfacedintheHealthSystem.

3 SituationAnalysis

3.1 UgandaeHealthSituationAnalysis

ThesuccessofeHealthtofacilitateimprovementofhealthservicesispremisedonbeingabletoovercomespecificICTinHealthchallenges.ThiscanbeachievedbyusingexistingopportunitiesandensuringthatthethreatsareminimisedbytakingadvantageoftheOpportunitiessuchasthe(i)theexistenceofDevelopmentPartnersupportedprograms/projects,(ii)theavailabilityofnewtechnologiessuchasmHealth,(iii)theexistenceofpublic-privatepartnershipslegalframeworktosupporteHealthdevelopmentprojects,andetc.Anassessmenttoidentifythesewascarriedoutthroughdocumentreview,keystakeholderconsultationsandphysicalobservations.TheassessmentincludedaninvestigationofthecurrentICTservicesandinfrastructureinthecountry,howdatainthehealthsystemarecollectedandmanaged,referralambiguitiesthatresultinlossofpatients’follow-up,bestpracticesformonitoringandevaluation(M&E),andtheinformationpathwayforanetworkofserviceproviderswhocouldbebettersupportedthroughICT.

InlinewiththeInternationalSituationanalysis,adetailedanalysisisgivenbelow.

3.1.1 LeadershipandGovernanceofeHealth

eHealthisincludedasoneoftheprioritiesinUganda’sNationalDevelopmentPlanIIandwellelaboratedintheHealthSectorStrategicandInvestmentPlanIIasanasakeyenablerforsupportingthehealthsysteminordertodelivergoodhealthtothepopulation.

CurrentlyeHealthleadershipandgovernancefunctionatnationallevelisexecutedbytheeHealthTechnicalWorkingGroup(eHTWG)oftheMinistryofHealth.eHTWGischairedby

theDirectorGeneralofHealthServices(DGHS)withtheDepartmentofHealthInformationastheSecretariat,andisresponsibleforthedevelopmentoftheNationaleHealthPolicyandStrategy.eHealthleadershipandgovernanceatthedistrictandcommunitylevelsisnotclear.Thishasledtobottlenecksininformationflowbetweenthevariouslevelsofthehealthsystemleadingtopoorperformance.

Summarily,thereislackofpropercoordinationofeHealthrelatedimplementationnationallywithinMinistries,Departments,andAgencies(MDAs),aswellasbetweenotherstakeholderssuchasthePrivateSector,DevelopmentPartners,andPractitioners.

3.1.2 eHealthEnterpriseArchitecture,InteroperabilityandStandards

Currentlythereareseveralstandards,e.g.StandardforSystemsandsoftwareengineering-SystemsandsoftwareQualityRequirementsandEvaluation(SQuaRE),StandardforStructuredCabling,etc.thathavebeendeveloped,adoptedoradaptedtofacilitateuseofInformationTechnology.ThesestandardshavenothoweverbeenreviewedspecificallyforeHealth.ThedevelopmentofaNationalEnterpriseArchitectureande-GovernmentInteroperabilityFrameworkisbeingspearheadedbyNITA-UandtobeinplaceinFY2017/18.Thereisneedtocapitalizeontheexistinginitiativestodevelopthisarea.

ThereisachallengeofseveralSilosofeHealthsolutionsthatarenotintegrated.

3.1.3 eHealthServices,InformationSharingandDataManagement

TherearesomeeHealthservicesbeingimplementedacrossthehealthsectorsuchastheHealthManagementInformationSystems(HMIS),DHIS2andHumanResourcesforHealthInformationSystem(HRHIS)amongothers.TheMoHhasaKnowledgeManagementPortal;anonlineresourcethatintegrateshealthandhealthrelatedinformationresourcesfromtheMinistryofHealthandbeyond.Thisprovidesasinglepointofaccesstovaluableinformationthatfacilitatesevidencebaseddecisionmaking.

TheaffiliatedInstitutionsincollaborationwithMoHhavesomenotableeHealthServicessuchastheWarehouseManagementSystem(WMS)andthecomputerizedLogisticManagementInformationSystem(LMIS)amongothers.OthereHealthinitiativesincludemTrac,U-Report;Inpatientandspecialtyservices,CommunityVillageHealthTeam(VHT)activitiesandroutinereportingofdatafromtheHealthFacilitiestotheNationalHealthDataBank/RC.

Therearealsoisolatedmobileapplicationsdevelopedbylocalinnovatorswhichhavenotgonefullytothemarket.SeveralTelemedicineprojectsinitiatedinthecountryovertheyearshaveseldomgonebeyondpilotphase.Thereislimitedrelevantcontentonhealthissuesinthelocallanguage.

ManyoftheexistingeHealthServicesaredevelopmentpartnerfundedprojectsandhavetendedtobeproof-of-conceptpilots,whereICTisintroduced(orimported)todemonstrateinnovativeuseoftechnologyinalimitedcontextandtheylacklocalownership,supportand

fundingforroll-out.Theyoftenstallwhenthedevelopmentpartnerfundingisended.Theprojectsalsofailduetothesustainabilityintermsofthesupportinginfrastructuresuchasaffordableandreliablepower,connectivityetc.;maintenance,hostingoptions,etc.

ThechallengeisthattheexistingeHealthServicesarenotbasedonstandards,nouniqueidentifierofhealthrecordsandthehealthrecordsareduplicated.

3.1.4 Infrastructure

CurrentlydataconnectivityandnetworkinginUgandacoversalmost100%ofthewholecountryincluding;urban,district,ruralandremoteareas.Thishasbeenachievedthroughfibreforthemajortownsandwireless(mobilephone)connectivityforthedistrict,ruralandremoteareasprovidedthroughthegovernmentNationalDataTransmissionBackbone(NBI),andtheprivatesectorfibreandwirelessnetworks.TheGovernmenthasalsobuiltaNationalDataCentre(NDC)hostingsomeMDAsystems.Mobilephonepenetrationisover57.6%,andinternetpenetrationof39.8%.

ICThardwareismainlycomprisedofelectronicmedicaldevices,computerhardwareandmobiletelephones.Howeverthecostofinternetisstillhighcompoundedbyunreliableorunavailablepowersupplyespeciallyinlowerhealthunitsandruralcommunities.InadditionICThardwaresuchascomputersarefew,poorlymaintainedandunderutilizedparticularlyinruralandremotehealthfacilities.Currentlythereisrelianceonimportedhardwareandsoftwareinthefaceoffastchangingtechnology.Thishasledtotheproliferationofhardware,softwareandcommunicationequipmentusedinthenumerousfragmenteddonor-fundedprojects,whichdonotshareinformationandprovidelimitedinformationtohealthcareprofessionalsformanagingpatientseffectively.

Currently,thereisachallengeofcomplementaryinfrastructuresuchasgreenandaffordablebackuppowertosupporteHealth.ThereisneedstoconsideroptionslikeSolarEnergyandInverterSystemstosupporteHealth.

TherearematuretechnologiesthatareembracedinUgandasuchasCloudComputing,BigData&OpenData,DataAnalytics,SmartSystems,DigitalServicesandInternetofThings.Thesetechnologieshavebeenadoptedbutnotinanorganizedway.Thereisneedtoformalizetheiradoptionandutilizationtogaintargetedbenefitsfromthem.Therearealsosomecontinuouslyemergingtechnologiesthatareupcomingandusedinanisolatedmannerandneedtobeexploredforutilization.

Althoughsomeinfrastructureexists,itremainsinsufficienttosupporttheeffectiveandefficientimplementationofe-Health.

3.1.5 eHealthInformationAssurance

ANationalInformationSecurityFramework(NISF)wasdevelopedandadoptedbytheGOUandithasattendantpolicies,standardsandguidelines.Itsimplementationhasnotbeen

commencedintheHealthSector.ThereisneedtoreviewandimplementtheNISFintheHealthSectorandalsodevelopattendantmechanismstoenhanceinformationassurance.

ThereisalsoaDataProtectionandPrivacyBillbeforeParliamentforapprovalintolaw.ThisshallsupporttheimplementationofprivacyforeHealth.TheDataProtectionandPrivacyBillincludes;PrinciplesofDataProtection,DataCollectionandProcessing,SecurityofData,RightofDataSubjects,DataProtectionRegister,ComplaintsandOffences.Thereisalsoneedtoreviewitandensurethatittakescareofalltherequisiteprivacyissuesrelatedtohealthcare.

3.1.6 Ethics

TheUgandaMedicalandDentalPractitionersCouncil(UMDPC),PharmacyRegulatoryBodies(PharmacyBoardandPharmacySocietyofUganda),UgandaNursesandMidwivesCouncil(UNMC)andAlliedHealthProfessionalsCouncil(AHPC)areinplacetoensurethatethicsareadheredtooinhealthcare2.Inaddition,theMinistryinchargeofEthicsandIntegrityisalsomandatedtosetstandardsfortherebuildingandpromotionofethicsandintegrityinsociety3.TheexistenceoftheaforementionedrolesprovidesgenericprovisionsforethicsandintegritythatmightnotapplyinanICTenvironment.ThereisneedtoreviewimplementationandsufficiencyofthecodesofethicsandintegritytoensurethattheICTenvironmentapplicabilityisfullytakencareof.

ThereisalsotheNISFandtheDataProtectionandPrivacyBilldevelopedtocaterforTrust,Privacy,Ownership,Dignity,Equity,andProportionalityofICTrelateddata.Thesearenothealthspecific.Thereisneedtoreviewthesufficiencyoftheexistinginitiativesforcompletenessanddevelopsupplementarypoliciesforahealthenvironment.

3.1.7 HumanResourcesandCapacityBuilding

eHealthcapacitybuildingreferstothecreationofanenvironmentthatfosterstechnology-enabledimprovementstohealthsystemsanddelivery,includingorganizational,policyandtechnicalinterventions.

HumanresourcesforeHealthcompriseoftwocomponents;healthworkforceandhealthICTworkforce.HealthconsumerswhoareindividualsorcommunitiesalsorequireknowledgeandskillstouseITequipmentandsystems.Oneofthebiggestissuesfacinghealthcareorganizationsistheabilitytotrain,attractandretaineHealthandITprofessionals.

MostHealthworkersandconsumersarenotcomputerliterate.Inaddition,mostnursesanddoctorsfeeloverwhelmedbytheirroutineworkandfeelthatICTisanextraburdenthatwilldrawthemawayfromtheircoreduties.However,insomehealthinstitutions/facilitieswherehealthworkersarecomputerliterate,computersarenotusedforroutineofficial

2http://health.go.ug/affiliated-institutions/professional-councils3http://www.dei.go.ug/

work.Insummary,thereisachallengeofinsufficienteHealthskillsandtrainedhumanresource.

ITprofessionalstomanageandmaintaintheITequipmentandsupportthehealthworkersintheuseofITequipmentandsystems,arenotavailable.TheaboveconstraintshavehamperedtherealizationofthebenefitsofeHealthinimprovingthehealthsystemandhealthoutcomesthroughelectronic;

• Collection,management,storageandtransmissionofroutineHMISdata.• managementofpatientrecordsbecausethepaperrecordsgetmisplacedormay

notbeavailablewhenapatientreportsinanotherhealthfacilityawayfromhome• Followupofpatientsinthecommunityandprovidingrelevantinformationtothe

healthworkerinthelowerhealthunit.• Consultationonpatientmanagementandreferralofpatientsamonghealthworkers

atadistance.• Managementofprocessessuchasprocurementandsupplychainmanagement.• Planning,policyformulationandanalysis,monitoring,evaluationanddissemination,

reporting.

TheHumanResourcesituationiscompoundedbythenon-existenceofaneHealthWorkforceStructureandaneHealthSkillsFrameworktoguidecurriculumdevelopmentforeHealth.

3.1.8 MainstreamingSpecialInterestGroups

TheneedformainstreamingSpecialInterestgroupsforICTutilizationisincludedintheNationalICTPolicyandintheNationalICTSectorStrategyandInvestmentPlan.ThisexistencethoughisnotspecifictoeHealth.ThereisneedtodevelopaspecificStrategyformainstreamingSpecialInterestGroupsforeHealthbasedonthenationalguidanceandInternationalbestpractice.

3.1.9 Research,InnovationandDevelopment

ThereisgrowingrecognitionamongtheGovernment,DevelopmentsPartners,PrivateSector,AcademiaandtheCivilSocietyabouttheimportanceofResearchandInnovationanditspotentialforthetransformationofthecountryaswellastheassociatedeconomicbenefits.ThishasbeenmanifestedintheNationalDevelopmentPlan,HealthSectorStrategicPlan,theNationalHealthPolicy,andtheNationalICTPolicyamongothers.

Inaddition,therearemanyeHealthInnovationsthathavecomeupthroughamultiplicityofInnovationHubs.SeveralICTInnovationincubationsandHackathonshavebeingconductedinthecountry(e.g.ACIA,MarieStopesHealthAppChallenge,andVodafone2016HealthAppChallenge).

Althoughseveralstrideshavebeentaken,eHealthrelatedInnovationisfacedwiththefollowingchallenges;

• NostructuredandcentralizedfundingforeHealthResearch,InnovationandDevelopment;

• FragmentedeffortsineHealthResearch,InnovationandDevelopment;• InsufficientcollaborationbytheInnovatorswiththeHealthexpertsandother

disciplinescomplementarytotheHealthSector;• MosteHealthInnovationsdonottranslateintomarketableproducts;• Insufficientresearchsupporttools(highcostofinnovationspace,computing

resources,accesstoonlinematerial,internetbandwidth,etc.)

Thechallengesabovearecompoundedwiththelackofstandardstosupportinnovation,insufficiententrepreneurshipskillsamongstinnovatorsandInsufficientnationaloversightforlocalinnovation.

3.1.10 eHealthInvestment

TheGovernmentandthePrivateSectorhaveinvestedinInfrastructurethatcanbeusedtosupporteHealth,liketheNationalBackboneInfrastructure(NBI),theNationalDataCentre(NDC),andothercomputinginfrastructure.TheseinvestmentsstillremainfragmentedandInvestmentineHealthismainlyintheformofdonorfundedfragmentedeHealthprojects.TheGovernmenthasalsoinvestedinmedicalequipmentthatiscomplementarytoeHealth.ThePrivateSectoronitssidehasalsoinvestedsubstantiallyinisolatedsystemscomplementarytoeHealthwithoutproperguidance.Theinvestmentsarenotbasedonanystandardandthusnotproperlyguided.ThishasresultedinnumerousfragmentedverticaleHealthprojects/initiativeswhichdonotshareinformationandarenotaccountabletotheMinistryofHealth.ThereisneedtodevelopaneHealthArchitectureandInteroperabilityFrameworktoguideallinvestmentsineHealth.

3.1.11 StakeholderEngagement,Collaborations,AdvocacyandSmartPartnerships

ANationalPolicyonPublic-Private-PartnershipinHealth4wasdevelopedtoprovideguidancetomainstreaming,establishing,implementing,coordinating,monitoringandevaluatingpartnershipsbetweentheGovernmentofUgandaandtheprivatehealthsectorwithinexistinglaws,policiesandplans.

Thereareexistingpartnerships5buttheyareisolated6andnotSMART.ThereareopportunitiesforpartnershipineHealththatneedtobeexploited7.ThereisaneedtoreviewtheNationalPolicyonPublic-Private-Partnership(PPP)inHealthtoensurecoverageintermsofeHealthPPPwithmeasurableoutcomesandalsodevelopandimplementa

4https://www.usaid.gov/sites/default/files/documents/1860/Uganda-National-Policy-on-PPPH-2012.pdf5http://www.swecare.se/Portals/swecare/Documents/Uganda-Health-Sector-and-Partnership-Opportunities-final.pdf6http://www.ictworks.org/2012/02/22/ugandan-mhealth-moratorium-good-thing/7http://www.swecare.se/Portals/swecare/Documents/Uganda-Health-Sector-and-Partnership-Opportunities-final.pdf

specificanddeliberatePartnershipandRelationshipManagementStrategyforeHealth.ThereisinsufficientawarenessofeHealthanditsbenefits.

3.1.12 BusinessProcessRe-Engineering

TherearecurrentlyisolatedeffortsintheHealthSector(PrivateandPublic)toreviewtheirBusinessProcessesinordertoembraceeHealth,however,theyremain.ThereisneedtocomeupwithadeliberatestrategyforBusinessProcessRe-engineeringspecifictoeHealthledbytheMOHandthisshouldbecompliedtobyallstakeholders.

3.1.13 LegalandRegulatoryFrameworkforeHealth

CurrentlythelegalandregulatoryframeworkscompriseofseverallawsandregulationswhichsupportbutarenotspecifictoeHealth,including:

(a) TheNITA-UAct,2009(b) TheComputerMisuseAct,2010(c) TheElectronicTransactionsAct,2011(d) TheElectronicSignaturesAct,2011(e) NationalDatabankRegulations,2015(f) TheRegistrationsofPersonsAct,2015(g) TheUgandaCommunicationsCommissionAct,2013(h) TheUgandaNationalCouncilforScienceandTechnologyAct,1990(i) CopyrightsandNeighbouringRightsAct,2006,(j) NationalRecordsandRetentionAct,2001

Policies(k) NationalDevelopmentPlan(NDP)II(l) NationalICTPolicy,2015(m) RuralCommunicationsDevelopmentPolicy,2001(n) UgandaNationalCouncilforScienceandTechnology(UNCST)Nationalguidelinesfor

researchinvolvinghumansasresearchparticipants,2007Strategies

(o) NationalDevelopmentPlanII(p) HealthSectorDevelopmentPlan2015/16-2019/20(q) ICTSectorStrategyandInvestmentPlan

ThereisneedtoreviewindetailthecurrentlegalandregulatoryframeworktoestablishwhetherthesetakecareofalleHealthregulatoryareas.ThereisalsoneedtoputinplacealegalandregulatoryfunctionforeHealthtooverseethereviewaswellascoordinationoftheenforcementandcompliancetothelegalandregulatoryframework.

4 FoundationoftheeHealthPolicy

4.1 RationaleoftheeHealthPolicy

Advancements in ICT, as awhole, and the internet in particular, and the convergence oftelephony,computingandmediahaveresulted inmanydevices includinghand-heldones.Thesedevicesarewidelyusedforaccessinghealthinformationandcarewherebybreachofsecurity, confidentiality, and privacy of personal information is a big threat. Uganda hasdeveloped the national Health Sector Policy and the Health Sector Development Plan IIwhich provide for the principles and action in health in the country and the national ICTPolicy framework which provides for appropriate laws and guidelines for the planning,development, implementation, utilization, maintenance, monitoring and evaluation anddisposalofICTsfornationaldevelopment.ThereisaneedforthedevelopmentofaNationaleHealthPolicytoaddressthechallengesuniquetotheutilizationofICTsforhealth.InthisscenarioICTsareusedforaccessinghealthservicesandsharinghealthinformation,inordertoachievelongtermgoalsofuniversalhealthcoverage.

4.2 ScopeofthePolicy

ThePolicyshallapplytoPublic,Private,andDevelopmentPartner,Non-Governmental,Academic,andCivilSocietyInstitutions.Itwillalsocoverfullrangeofhealthcareservicesfromoperational,preventive,curative,rehabilitation,researchandlearning.Thecoverageofthescopeshallincludetheentirecountry.

5 Vision,Mission,GoalandGuidingPrinciples

5.1 Vision

Effectiveuseof informationandcommunicationtechnologyforbetterhealthoutcomesoftheUgandanpopulation

5.2 Mission

To transform the health of the people of Uganda by promoting effective utilization ofinformationandcommunicationtechnology.

5.3 Goal

To create an enabling environment for the development/deployment and utilization ofsustainable,ethically soundandharmonizedeHealthapproaches/initiativesatall levelsofthehealthsystemstopromotehealthandimprovehealthservicesdelivery.

5.1 PolicyGuidingPrinciples

a) ClientfocusedeHealthagendaEstablisheHealthagendathatisclientfocusedandwithstrongleadership,thatisdrivenbycountryhealthneedsandpriorities

b) EquityProvidingequitableaccesstoappropriateelectronichealthinformationandserviceswithrespecttogender,ageandemphasisonvulnerablegroupsandindividuals.

c) User-friendlytechnologyapplicationsAdopttechnologyapplicationsandsystemsthatareuser-friendly,affordable,sustainableandbasedonappropriatenationalstandards.Thestandardsshouldensureconfidentiality,privacy,security,quality,safetyandintegrityofhealthinformation

d) MultiSectoralApproachHarnessexistinginitiativesthroughpublicprivatepartnershipandcollaborationwiththerelevantstakeholders

FostereHealthresearchanddevelopmentincludingresearchonthesocialdeterminantsofhealthandtheimpactonthehealthoftheUgandanpopulatione) HumanRightsbasedapproach

ObserveHumanRightsthroughouttheeHealthpracticesandupholdingHumandignity.f) QualityInformationgenerationg) GenerateQualityInformationbaseforstrategicplanningandpolicydevelopment.

6 Pillars/priorityareasfortheeHealthPolicy

ThefigurebelowshowsthepillarswhichrepresentthekeyareaswherepolicymustgivedirectioninordertoachieveoureHealthVision.Foreachpillar,thescope,responsibilitiesandprocedurehavebeendescribed.

Figure1-UgandaNationaleHealthPillars

7 PolicyObjectivesandStrategies

Tocreateanenablingenvironmentforthedevelopment,deploymentandutilizationofsustainable,ethicallysoundandharmonizedeHealthinitiativesatalllevels,thefollowingarethepolicyobjectivesandstrategies:

7.1 LeadershipandGovernanceforeHealth

GovernanceforeHealthincludesinstitutionalframeworksforpolicyoversight,coordinationandcollaboration,advocacyandpartnership,clinicalsafety,managementandoperation,programmanagement,strategicarchitecture,monitoringandevaluation

7.1.1 Objective

ToprovideeffectiveoversightleadershipandgovernanceforthedevelopmentandprogressionofeHealthinUganda.

7.1.2 Scope

ThispolicyappliestoallHealthpractitioners,HealthrelatedGovernmentMinistries,DepartmentsandAgencies(MDAs),Employees,Management,StudentInterns,andVolunteers.ThescopeshallcoverInter-AgencyPolicyGovernance,Inter-AgencyTechnicalGovernance,eHealthManagementwithintheMinistryofHealth,RegulatoryGovernance,EnterpriseArchitectureGovernance,PractitionerandUserGovernance.

7.1.3 PolicyStrategies

PolicyStrategy1:Design,establishandoperationaliseGovernanceandManagementStructurestolead,oversee,coordinateandmanagethenationaleHealthprogramatall

levelsofthehealthsystem,takingintoaccountexistingmandates,roles,relationshipsandresponsibilities.

PolicyStrategy2:Defineandformalizerelationshipandgovernanceinteractionswithrelevantexistingnational,andlocalgovernancebodies.

PolicyStrategy3:EstablishandimplementmechanismsforcompliancetonationaleHealthregulatoryframeworkstakingintoaccountrelationshipsandinteractionswithexistingregulatorybodiesandfunctions.

7.1.4 ResponsibilitiesandProcedure

• TheMinisterofHealthShallConstituteaSteeringCommitteewithappropriateTermsofReference

• TheSteeringCommitteeshallestablishotherrequiredGovernanceStructuresandconstitutetheStructureswithappropriateTermsofReference

• MoHshallensurethatallGovernanceandManagementcompliestotheTermsofReferenceandreportappropriatelytotheappointingauthority

7.2 eHealthEnterpriseArchitectureandInteroperabilityFrameworkandStandards

7.2.1 Objective

ToestablishaprocessandblueprintfortransformingthehealthsectorbusinessvisionandstrategyusingICTintoeffectiveenterprisechangebycreating,communicatingandimprovingthekeyprinciplesandmodelsthatdescribetheentity’sfuturestate.ThisactsasthedesignofhoweHealthshallbeimplemented.

7.2.2 Scope

ThispolicyappliestoallhealthstakeholdersincludingallHealthpractitioners,HealthrelatedGovernmentMinistries,DepartmentsandAgencies(MDAs),Developmentpartners,Clients/Patients,researchersandVendors.

TheEnterpriseArchitecturespellsouttheBusinessArchitecture,DataandInformationArchitecture,ApplicationsandeHealthSolutionsArchitecture,TechnologyArchitecture,theInformationSecurityArchitectureandthePrivacyArchitectureandattendantstandards.

PolicyStrategy1:Plan,designanddevelopmenteHealthEnterpriseArchitectureandInteroperabilityFrameworktoguidetheimplementationofalleHealthServicesandInfrastructureinthecountry

PolicyStrategy2:DevelopandimplementcomplianceandreviewmechanismfortheeHealthEnterpriseArchitectureandInteroperabilityFramework.

PolicyStrategy3:eHealthServicesshallbeestablishedandimplementedinlinewiththeeHealthEnterpriseArchitectureandInteroperabilityFramework

7.2.4 ResponsibilitiesandProcedures

(a) TheeHealthSteeringCommitteeshallsteertheestablishmentoftheeHealthEnterpriseArchitectureandInteroperabilityFramework

(b) TheMinistryofHealthtogetherwithNITA-UandotherestablishedGovernanceStructuresshalldeveloptheeHealthEnterpriseArchitectureandInteroperabilityFramework

(c) TheMoHshallensurecompliancetotheeHealthEnterpriseArchitectureandInteroperabilityFramework

(d) TheMoHshallputinplaceperiodicreviewmechanismfortheeHealthEnterpriseArchitectureandInteroperabilityFramework

7.3 eHealthServices,InformationSharingandDataManagement,

7.3.1 Objective

ToestablisheHealthservicesandtoolsthataddresstheprioritybusinessneedsandtofacilitatetheestablishmentofaprocessofauthorization,sharingandmanagingelectronicdata,information,knowledge,andpracticesbetweenorganizationsandstakeholdersinthehealthindustryincludingpatients/clients,healthcareproviders,andhealthcaremanagers.

7.3.2 Scope

Thispolicyappliestoallhealthstakeholdersincludingpractitioners,HealthrelatedGovernmentMinistries,DepartmentsandAgencies(MDAs),Employees,Management,Clients/Patients,StudentInterns,researchers,vendorsandvolunteers.

PolicyStrategy1:Establishaunique,standardized,comprehensiveandcomprehensibleElectronicMedicalRecord(EMR),ElectronicHealthRecord(EHR)andPersonalHealthRecord(PHR).

PolicyStrategy2:Establishacomprehensivehealthfacility,provider,andclientregistrieswithcompleteandcurrentinformationthatmeetsstakeholders’needs.

PolicyStrategy3:Establish,prioritizeandimplementeHealthServicesinlinewiththeeHealthEnterpriseArchitectureandInteroperabilityFramework

PolicyStrategy4:DevelopandoperationalizeaneHealthDataManagementandUtilizationSystemacrossalllevelsofhealthcare.

PolicyStrategy5:AligneHealthDataManagementandUtilizationtootherexistinggovernmentlawsandregulations.

(a) TheeHealthSteeringCommitteeshalloverseetheeHealthServices,InformationSharingandDataManagementProgramwhileensuringBusinesscontinuity,Disasterandriskmanagement.

(b) TheMinistryofHealthtogetherwithMoICT,NITA-UandotherestablishedGovernanceStructuresshalldevelopandimplementtheeHealthServices,InformationSharingandDataManagementProgramthatpreservesdataqualityincompliancewiththeeHealthEnterpriseArchitectureandInteroperabilityFramework

7.4 Infrastructure

7.4.1 Objective

TofacilitateestablishmentandsustainabilityofICTInfrastructureandconnectivitytosupporttheeffectivedeliveryandmonitoringofeHealthasanenablerofbetterhealthcareservices.Thisshallincludeallthecomponentsofinfrastructurewhicharecomputinginfrastructure,databases,directoryservices,infrastructuredevelopment&management,connectivityandstorage.Thisalsoincludescomplementaryinfrastructurelikepowerandbuildings.

7.4.2 Scope

ThispolicyappliestoallHealthpractitionersandeHealthrelatedGovernmentMinistries,DepartmentsandAgencies(MDAs).

PolicyStrategy1:ConnectallpriorityhealthfacilitiestotheNationalBackboneandtheNationalDataCentrewithaviewofhavingsecure,reliableandaffordabledataconnectivityandinternetservices.

PolicyStrategy2:Ensureallhealthpractitioners(includingpublicandprivate)develop,utilizeandmaintainICTInfrastructure.TheInstitutionalICTinfrastructureshallconformtothee-HealthEnterpriseArchitectureandInteroperabilityFrameworkandNationalITStandards.

PolicyStrategy3:Ensureallhealthpractitioners(includingpublicandprivate)implementaseamlessconnectedICTnetworksystem(LocalArea/WideAreaNetwork)ofembeddedobjects/devices,withidentifiersandsupportforsensors(InternetofThings(IoT)).TheInstitutionalNetworkshallconformtothee-HealthEnterpriseArchitectureandInteroperabilityFrameworkandNationalITStandards.

PolicyStrategy4:TheMOHincollaborationwiththeMinistryinchargeofWorksshalldevelop,enforceandmonitorMedicalFacilityBuildingStandardsandArchitecturereadyfore-HealthinconformitywiththeBuildingControlAct.

PolicyStrategy5:EnsurethatallMedicalPractitionerscomplywiththeMedicalFacilityBuildingInfrastructureStandardsandArchitecturereadinessfore-Health.

PolicyStrategy6:Ensurethatallhealthpractitioners(publicandprivate)develop,utilizeandmaintaingreenandaffordablebackuppowersysteminconformancewiththeRenewableEnergyPolicyofUganda

PolicyStrategy7:EnsurethatallHealthPractitionersutilizematureandemergingtechnologieswhileadheringtotheeHealthEnterpriseArchitectureandInteroperabilityFrameworkwiththeguidanceoftheMinistryofHealth,MoICTandNITA-U.

PolicyStrategy8:EnsurethatICTInfrastructureisestablishedinacoordinatedmannerandmeetsthestandardswithguidancefromMoHinconjunctionwithMoICTandNITA-U.

7.4.4 ResponsibilitiesandProcedures(a) MinistryofHealthinconjunctionwithMoICTandNITA-Ushallensurethe

connectivitytotheNBIandNDCandprovisionofaffordableInternetBandwidthtoHealthFacilitiesandrelatedinstitutions

(b) MoHandMinistryofWorksandTransportshallensurethattheeHealthreadyBuildingInfrastructureisinplaceinconformancewithestablishedguidelines

(c) MoHandtheMinistryofEnergyandMineralDevelopmentshallensurethatrenewableenergyeHealthreadyBuildingsinconformancewithestablishedregulatoryframework

(d) TheMinistryofHealth,MoICTandNITA-Ushallensureutilizationofmatureandemergingtechnologiesinlinewithestablishedguidelines

(e) TheaboveministriesshalldeveloptherelevantguidelinesforeHealth,securefundingforeHealthactivitiesandalsocarryourM&E.

(f) PractitionersofeHealthatalllevelswillberesponsibleforadherencetotheeHealthEnterpriseArchitectureandInteroperabilityFrameworkandstandardsintheprocessofprocurement,implementationanddecommissioningofeHealthinfrastructureattheirrespectiveinstitutions.PractitionersshallputinplacetheoptimalstaffwithskillsmixnecessarytoexecuteeHealthinhealthcaredelivery.

7.5 eHealthInformationAssurance

7.5.1 Objective

Thepurposeofthispolicyistoensuretheeffectiveutilizationofsecure,confidential,qualityandauthenticelectronichealthinformation,togetherwithmechanismsofdisasterrecovery.

7.5.2 Scope

ThispolicyappliestoallHealthpractitionersandHealthrelatedGovernmentMinistries,DepartmentsandAgencies(MDAs),ClientsandotherstakeholdersthatwillgovernorutilizeinformationthrougheHealthplatforms.

PolicyStrategy1:InformationSecurityisobservedtoensureconfidentiality,integrity,qualityandavailabilityofinformationwhendesigning,procuring,implementing,maintainingandretiringeHealthInfrastructureandSolutionsbyallHealthPractitionersandstakeholdersinlinewiththeNationalInformationSecurityFramework(NISF)andtheeHealthEnterpriseArchitectureandInteroperabilityFrameworkandStandardswithguidancefromMoH,MoICTandNITA-U.

PolicyStrategy2:EnsurethatInformationProtectionandPrivacyismaintainedbyallhealthpractitionersandstakeholdersinlinewiththeDataProtectionandPrivacyLaw,internationalprotocols&conventionsandwithguidancefromtheMOH,MoICTandNITA-U.

PolicyStatement3:EnsurethatallHealthPractitionersdevelop,implementandenforceaBusinessContinuityandDisasterRecoveryPlanforeHealthinlinewiththeNationalInformationSecurityFramework(NISF)andtheeHealthEnterpriseArchitectureandInteroperabilityFrameworkandStandardswithguidancefromMoHinconjunctionwithMoICTandNITA-U

(a) HealthPractitionersshalldevelop,operationalizeandmaintainanInstitutionaleHealthInformationPrivacyProtectionProgramthatcomprisescomprehensiveandalignedInformationsecuritysafeguards,andprograms,practices,processes,toolsandtechniquesinconformancewiththeNISFwithguidancefromMoH,MoICTandNITA-U.

(b) HealthPractitionersshalldevelop,operationalizeandmaintainanInstitutionaleHealthInformationSecurityProgramthatcomprisescomprehensiveandalignedInformationsecuritysafeguards,andprograms,practices,processes,toolsandtechniquesinconformancewiththeNISFwithguidancefromMoH,MoICTandNITA-U.

(c) MoH,MoICTandNITA-Uconducttraining,awarenessandsensitizationrelatedtoInformationSecurity,PrivacyandBusinessContinuityandDisasterRecovery.

(d) MoH,MoICTandNITA-UshallmonitorcompliancetoInformationSecurity,Authenticity,PrivacyandBusinessContinuityandDisasterRecovery.

(e) MinistryofHealthinconjunctionwithotherrelevantMDAsshallensurethateHealth-readyBuildingInfrastructureisinplaceinconformancewithestablishedregulatoryframework.

(f) MoH,MoICTandNITA-UshallensureauthenticityoftheinstitutionaleHealthInformationprivacyprotectionprogram

7.6 Ethics

7.6.1 Objective

Thepurposeofthispolicyistoensurethatallstakeholders(Patients,clients,Institutions,allserviceprovidersanddevelopmentpartners)conformtoallprinciplesofethicalbehaviorinmanaging their own health and the health of those in their care while utilizing eHealthservices.

7.6.2 Scope

The policy applies to all eHealth Stakeholders including practitioners both public andprivate,GovernmentMDAs,healthcaremanagersandclients.

PolicyStrategy1:PutinplaceeHealthEthicalStandardsandguidelinesinconformancetoculturalandreligiousvaluesaswellasinternationalbestpractice.PolicyStrategy2:PutinplaceandenforceaneHealthCodeofEthics

The MoH in conjunction with MoEI, MoICT, NITA-U, UNBS and the Health ProfessionalCouncils and other related bodies shall develop and enforce eHealth Ethical Standards,GuidelinesandCodeofEthics.TheMoHthroughtheeHealthregulatoryfunctionshallmonitorcompliancetotheeHealthEthicalStandards,GuidelinesandCodeofEthics

7.7 HumanResourcesandCapacityBuilding

7.7.1 Objective

ThepurposeofthispolicyistofacilitatetheestablishmentandbuildingasufficientskilledeHealthHumanResourcetoensurethesustainedimplementationoftheeHealthinthecountry.

7.7.2 Scope

ThispolicyappliestoallHealthpractitionersandHealthrelatedGovernmentMinistries,DepartmentsandAgencies(MDAs),ClientsandotherstakeholdersthatgovernorutilizeinformationthrougheHealthplatforms.

PolicyStrategy1:EvaluatethecurrentreadinessoftheHealthWorkerstoembraceandsupporttheimplementationofeHealthandestablish,enforceandmonitoraneHealthWorkforceStructureforallMedicalFacilitiesandGovernmentMDAs.

PolicyStrategy2:EmbedeHealthtrainingandcertificationatalllevelsofeducationandtraininginthecountry.

PolicyStrategy3:PromoteaccesstocontinuousprofessionaldevelopmentbyHealthpractitioners,throughe-learninganddigitalresources.

(a) TheMoHincollaborationwithlineMDAsshall:

I. EvaluatethecurrentreadinessoftheHealthWorkerstoembraceandsupporttheimplementationofeHealth

II. Establish,enforceandmaintainaneHealthWorkforceStructureforallHealthFacilitiesandotherrelevantinstitutions.

III. PutinplaceamechanismtoembedeHealthtrainingandcertificationatalllevelsofeducationandtraininginthecountry.

(b) HealthPractitionersshallconformtotheWorkforceStructure,TrainingandCertificationrequirementsforeHealth

7.8 MainstreamingSpecialInterestGroups(SIGs)

7.8.1 Objective

ThepurposeofthispolicyistoputinplaceamechanismtomitigatethebarriersthatmighthampertheutilizationofeHealthbySpecialInterestGroup-specificbarriers;suchasSIG-relevantcontentanddigitalservices,safetyissuesandculturenorms.

7.8.2 Scope

ThispolicyappliestoallHealthpractitionersandHealthrelatedGovernmentMinistries,DepartmentsandAgencies(MDAs),Vendors,Clientsandotherstakeholdersthatwillprocure,governorutilizeinformationthrougheHealthplatforms.TheSIGsincludebutarenotlimitedtoWomen,theDisabled,theAgedPersons,theIlliterate,etc.

PolicyStrategy1:Supportandenhancetheaccessto,acceptanceandutilizationofeHealthbySpecialInterestGroups(SIGs)byputtinginplacemechanismstomitigatechallengesanticipatedbytheSIGs.

(a) TheMoHtogetherwithMoICT,NITA-UshallsupportthesetupandinstitutionalizationofaSpecialInterestGroupForumundertheeHealthUsersForum

(b) TheMoHtogetherwithMoICT,NITA-Uandotherrelevantinstitutions/regulatorsshalldevelop,enforceandevaluateconformancetoStandards,PoliciesandGuidelinesforeHealthforSIGs

(c) AllHealthPractitioners(Public,PrivateandNGOs)shallconformtotheStandards,PoliciesandGuidelinesforeHealthforSIGs

7.9 Research,InnovationandDevelopment

7.9.1 Objective

Thepurposeofthispolicyistopromoteresearch,innovationanddevelopmentineHealthinordertooptimallyaddressthecountry’sevolvingneedsinthehealthcarelandscape.

7.9.2 Scope

ThispolicyappliestoallHealthpractitioners,Innovators,andHealthrelatedGovernmentMinistries,DepartmentsandAgencies(MDAs),Vendors,Clientsandotherstakeholdersthatprocure,governorutilizeinformationthrougheHealthplatforms.

PolicyStrategy1:EnhanceHealthResearchandInnovationusingInformationandCommunicationsTechnology.

PolicyStrategy2:EstablishanopenmultidisciplinaryapproachtoResearch,InnovationDevelopment,TranslationandCommercializationofeHealthforhealthproviders,academia,andthegeneralpublic.

PolicyStratgey3:PromoteResearch,InnovationDevelopment,TranslationandCommercializationofeHealthforinnovators,Providers,AcademiaandtheGeneralPublic.

(a) MoHincollaborationwithlineMDAsshall:I. DesignandoperationalizeaNationalHealthCareWebPortalII. DevelopaResearchand InnovationStrategy (includinganAgenda forpriority

ResearchandInnovation)foreHealth

III. IdentifyandmaintainarecordofallplayersintheeHealthInnovationEcosystemwiththeirstakeandresponsibilities;

IV. PutinplaceaneHealthInnovationGovernanceandPartnershipmechanism

7.10 eHealthInvestment

7.10.1 Objective

Thepurposeofthispolicyistoestablishasustainable,affordable,robustfundingmechanisms,rationalselection,acquisitionanddeploymentofcosteffectiveeHealthsystemsinthecountry.

7.10.2 Scope

ThepolicyappliestoallGovernmentMDAs&LocalGovernments(LGs),DevelopmentPartners,CSOs,NGOs,PrivatePractitionersandcommunities.

PolicyStrategy1:MainstreamandintegratefundingforeHealthprogrammesandProjectsintothenationalHealthandICTplansandbudgets

PolicyStrategy2:LeverageavailableresourcesthroughPublic-Private-Partnerships(PPP)tosupporteHealthProgrammesandProjects

PolicyStrategy3:Develop,implementandmonitoreHealthInvestmentPlantoguideallinvestmentsrelatedtoeHealth

PolicyStrategy4:CoordinateDevelopmentPartnerSupporttoeHealthprogrammesandprojects

7.10.4 ResponsibilitiesandProcedure

(a) Develop guidelines for developing, planning and implementing eHealthprojects aswell asmainstreaming theprojects in theGovernmentPlanning,ProcurementandReportingsystem.

(b) Developandimplementamechanismforeffectivecollaborationandpartnershipinthe planning, organization and management of all eHealth PPP projects andprograms

(c) DevelopandensureimplementationofaneHealthInvestmentPlan.

7.11 StakeholderEngagement,Collaborations,AdvocacyandSmartPartnerships

7.11.1 Objective

ThepurposeofthisPolicyistoensureeffectivestakeholderengagementandcollaborationinordertoimproveinformationexchange,mobilizationofsupport,identificationofopportunities,highlightingpriorities,managingandmitigatingrisk.

7.11.2 Scope

ThepolicyappliestoalleHealthStakeholdersincludingpractitionersbothpublicandprivate,GovernmentMDAs,academia,civilsocietyorganizations,developmentpartnersandclients.

7.11.3 PolicyStrategy

PolicyStrategy1:IdentifyandengageappropriatelyalleHealthStakeholdersatNational,RegionalandInternationalleveltoensureownership,participationandcontributiontothenationalstrategy.

(a) TheMoHshalldevelopandregularlyupdateStakeholderRegisterincludingbutnotlimitedtohealthconsumers,healthcareproviders,health-servicemanagers,GovernmentMDAs,DevelopmentPartners

(b) TheMoHshalldevelop,implementandcontinuouslyreviewtheStakeholderandPartnershipEngagementPlan

7.12 BusinessProcessRe-Engineering

7.12.1 Objective

ThepurposeofthispolicyistoencourageandenableparticipantsinthehealthsystemtoadopteHealthsolutionsandchangetheirworkpracticestobeabletousethesesolutionseffectively.ItfurthermorefocusesonhowtomanagetherapidchangesintechnologywhileimplementingeHealth.

7.12.2 Scope

ThepolicyappliestoalleHealthStakeholdersincludingpractitioners,GovernmentMDAs,healthcaremanagersandpatients/clients.

PolicyStrategy1:DevelopandimplementacomprehensivechangeandadoptionstrategytopromoteandenforcethedevelopmentanduseofeHealthsolutionsforbothpublicandprivateinstitutionsatalllevels.

PolicyStrategy2:DevelopandimplementacomprehensiveBusinessProcessRe-EngineeringstrategytotaketofacilitatetheuptakeofeHealth.

PolicyStrategy3:DevelopandimplementacomprehensiveeHealthTransitioningstrategytotakecareofrapidchangesintechnology.

(a) TheMoHinconjunctionwithMoICT,NITA-UandHealthProfessionalCouncilshalldevelopandenforceeHealthChangeandAdoptionStrategy.

(b) TheMoHshalldevelopandenforceaneHealthBusinessProcessRe-EngineeringGuidelines

(c) MedicalPractitionersandManagersshallchangetheirBusinessProcessesinlinewiththeguidelines

(d) TheMoHinconjunctionwithMoICT,NITA-UandtheHealthProfessionalCouncilsshallconductcomplianceassessmenttotheBusinessProcessRe-EngineeringGuidelines.

7.13 LegalandRegulatoryFramework

7.13.1 Objective

Thispolicyaimsatputtinginplacetherelevantrules,laws,regulationsandproceduresthatshall facilitate the smooth implementation of eHealth together with mechanisms ofenforcingthem.

7.13.2 Scope

ThepolicyappliestoalleHealthStakeholdersincludingPractitionersbothprivateandpublic,CSO,GovernmentMDAs,HealthcareManagersandClients.

PolicyStrategy1:AlegalandregulatoryfunctionshallbeestablishedintheMOHtooverseethelegalandregulatoryrole,enforcement,audit,complianceassessmentandreviewworkingcloselywithrelevantministriesandRegulatoryBodies.

PolicyStrategy2:TheexistinglegalandregulatoryframeworkrelatedtoeHealthshallbereviewedandmakerecommendationsonrequisiteimprovements.

(a) TheMoH,MoICT,NITA-UMoJCAandtheHealthProfessionalCouncilshallensurethattherelevantlawsandregulationsareinplacetoenabletheimplementationofeHealth.

(b) TheMoHshallenforcethenationallawsandregulationsforlicensure,liabilityandreimbursementforeHealthpracticeandeHealthsystemsandapplications.

(c) TheMoHshallDevelopandimplementappropriatemonitoringandevaluationguidelinesforlegalandregulatoryframeworkforeHealth.

(d) TheeHealthRegulatoryFunctionasestablishedbyMoH,shallmonitorcompliancetotheLegalandRegulatoryFramework

8 PolicyImplementation

8.1 Framework

RecognizingthemultifacetednatureofICTinHealthissuesandthefactorsthatimpactsonthem,theMoHisconsciousthatthesuccessfulimplementationofthispolicyandachievementofitsobjectivesisthroughpartnershipwithotherMDAs,thePrivateSector,CivilSociety,academiaandDevelopmentPartners.Consequently,theparticipationandinvolvementofallkeystakeholdersiscrucial.Inaddition,theMOHandkeyStakeholdershastocontinuetodevelopthenecessarycapacityandinstrument,suchasindicators,tomonitortheimpactofthepoliciesonsocialandeconomicdevelopment.MindfulofthefactthattheICTindustryitselfisoneofthemostdynamicsectorsnecessarymechanismswillhavetobeputinplacetoensurethatthepoliciesarereviewedfromtimetotime.Enhancingofknowledgeandinformationflowsisoneoftheeffectivetoolsthatwouldbeusedtostimulateinnovationandfacilitatefine-tuningofthepoliciesforthemaximumimpactandresponsivenesstochangingtechnologicalandcompetitiveconditions.TheNationaleHealthPolicyimplementationshallbealignedwithtotheNationalHealthPolicyandNationalHealthSectorDevelopmentPlan.TheimplementationshallbethroughtheeHealthStrategyandeHealthInvestmentPlan.TheseplansshallbeimplementedthroughintegratedeHealthprojects/programswhichshallbebasedontheeHealthEnterpriseArchitecturenationalstandardsandshallconstitutetheNationaleHealthProgram.

8.2 PolicyDisseminationandSensitization

TheDisseminationandsensitizationshallbetheresponsibilityoftheauthor.ThedisseminationisaimedatensuringthatallStakeholdersknowthepolicyandtheirrespectiveresponsibilities.ThePolicyshallbedisseminatedthroughthefollowingchannels

(a) ThePolicyshallbesharedwithshareholderselectronically(MoH,GovernmentPortal,MoICT,NITA-Uportalsandwebsites.)

(b) ThroughWorkshopsandAwarenesscampaignsandothercommunicationchannels

8.3 Planning,Budgeting,ResourceMobilizationandInvestment

ThePlanningforpolicyimplementationshallbethroughtheeHealthStrategyandeHealthInvestmentPlan.

8.3.1 PlanningandBudgeting

a) Establish and enforce mechanisms for effective collaboration and partnership in theplanning, organization and management of all eHealth projects and programs at alllevelsofthehealthsystem

b) Promote public private partnerships, pooling of resources by all partners andinternationalcollaborativeprojectsinresearch,educationandtraining,ineHealth

c) DevelopandimplementeHealthinvestmentplan

8.3.2 ResourceMobilization

a) IntegrateeHealthbudgetintothenationalhealthplansandbudget.b) Mobilize resources for thedevelopmentand implementationof standardizedeHealth

systems and solutions for electronic health information sharing and electronic healthservicesdelivery.

8.4 Monitoring,EvaluationandComplianceAssessment

MonitoringandevaluationwillbeperformedtheextenttowhicheHealthhasbeenimplementedandspecificallytocheckforcompliancetothesetstandardsandregulations.

8.4.1 MonitoringandEvaluation

SystematicmonitoringandevaluationoftheeffectivenessofthenationaleHealthpolicyshallbeconductedtoensureitisreallydealingwithproblemsitwasdesignedtosolve.Learningfromexperienceofwhatworksandwhatdoesnotandbuildingonthelessonsbackintothepolicyreview.MonitoringandevaluationshallbeplannedandexecutedwithintheexistingoverallMOHnationalmonitoringandevaluationarrangement.ThespecificmonitoringandevaluationprocessesforeHealthactivitiesshallbealignedwiththenationalapproachandshallincludeeHealthsubjectexperts

Themonitoringandevaluationframeworkshallfocusontheoutcomes,impact,andlevelofchangeanticipatedusingamixtureofquantitativeandqualitativeindicators.M&EeHealthindicatorsandtargetstobemeasuredshallbedeveloped.Theyshallensuremonitoringandevaluationofprogressoverthedurationoftheimplementationplan.Monitoringandevaluationtimeframesshallbealignedwiththeimplementationphasesdefinedintheimplementationplan.HoweverperiodsofveryhigheHealthactivitymayrequireclosermonitoringofparticularindicators.Indicatorsshallalsobelinkedtotimeframesformeasuringotherhealthoutcomeswherepossible(forexample,inthenationalhealthsystemreportingprocesses)toshowthecontributionofeHealthtotheseoutcomesandavoidcreatingseparatereportingprocesses

8.4.2 ComplianceAssessment

AComplianceAssessmentMechanismshallbedeveloped,communicatedandcompliedto.FurthermorethecompliancestallbedonethroughtheeHealthStrategy.

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