Mobile/Wireless eHealth for Health System/Workers development in Africa:

Opportunities for eMobility ETP @

eMobility Mobile Communications &Technology Platform Staying ahead!2nd Workshop on Shaping the Future of Mobile and Wireless Communications

Rome, Italy. September 25 2007

Adesina Iluyemi adesina.iluyemi@port.ac.uk

Content• Exploring eHealth concept• Health Systems in Developing Countries (Africa):

issues and problems• Global/Africa/ EU eHealth policies• Mobile/Wireless Technologies in Developing

Countries (Africa)• Mobile /Wireless eHealth Case Studies from Africa• Opportunities for eMobility ETP• Research agenda

eHealth as a developmental tool• eHealth is the use of information (data) and communication

technologies for health processes (Health System) either locally and at a distance (WHO 2005).

• eHealth involves telemedicine, telehealth, telecare, health management information systems, health knowledge systems etc.

• An opportunity for the development of public health. • strengthening of health systems through eHealth may contribute

to the enjoyment of fundamental human rights by improving equity, solidarity, quality of life and quality of care. WHA 58.28, WHO 2005

• The combination of mobile/wireless technologies with eHealth is known as mHealth

Health Problems in Developing Countries (Africa)• Lack of Infrastructure and Capacity Healthcare delivery• Brain Drain: International and Local (Rural vs. Urban)

• Africa has 10% of world population with 25% of global health burden but with only 3% of global health workforce

• Poverty & Financial constraints– HIV/AIDS accounted for 2.4 million deaths alone in 2002– 40% survive on less than $1 per day– Malaria related mortality is at 1 million deaths (mostly children)

yearly• Enormous economic cost on health systems

– 10% of individual income– Human resources impact

• mHealth offers a potential low-cost alternative for managing these diseases.

Millennium Development Goals• MDGs are 8 Goals set by United Nations in 1999/2000 to

achieve for specific 18 targets by 2015• MDGs, a strategic & operational drivers for Health System

development in developing countries • 3 MDGs are health related

– To reduce child mortality from childhood diseases– To improve maternal health– To combat HIV/AIDS, Tuberculosis (TB) malaria.

• Target #18 of MDGs calls for using ICTs to achieve MDGs.• European Commission has also adopted these goals as

benchmark for developing countries

Why eHealth in developing countries?• To provide access to distributed health knowledge and

information to mostly rural health workers.

• Urgency is required to meet the MDGs targets and to reverse the poor health and developmental ratings

• Geographical barriers to access health service provision especially in Africa (rural areas).

• Connectivity ( wireless telecommunications) is becoming widely accessible and available even in rural communities

• Issues: Cost, existing health problems etc

Global Policy for eHealth 1• Global initiatives in favour of eHealth is being championed by The

World Health Organisation (WHO) under the Global Observatory for eHealth (GOe) (WHA 58.18)

• A document is available for eHealth readiness of its global member states

• WHO eHealth objectives are: – health system performance– health human resource capacity – access to health knowledge– decision and policy making process– better health outcomes for patients.

Global Policy for eHealth 2• WHO(2004) calls for the use of eHealth for PHC

delivery especially in developing countries

• WHO is currently developing an mHealth strategy with specific focus on developing countries

• International Telecommunication Union (ITU) since 1998 has commissioned eHealth projects in developing countries using mostly wireless technologies– The ITU-D Q14 Working Group is focussed on eHealth

strategy and policy development with focus on mobile/wireless technologies especially in developing countries

African Regional Policy for eHealth• Africa Union through New Partnership for Africa’s Development

(NEPAD) calls for using ICTs :• to improve patient care• for sharing health knowledge • To build human resource capacity • for health system development

• e-Africa commission is already a point of collaboration with EU on ICT for development .• A major priority is the building of ICT connectivity and access infrastructure

• NEPAD/EU: eHealth initiatives• The recent European Space Agency (ESA) satellite eHealth proposal for Africa is

an example of this intercontinental collaboration-• The Africa Health Infoway (AHI) is also another initiative with WHO

EU/EC Policy on eHealth for developing countries 1• EU in 2004 (STOA 122EN) developed a policy on eHealth

for health system development in developing countries– Highlights the importance of ICT infrastructure for eHealth

adoption & diffusion

– Encourages the exploration wireless technologies for eHealth connectivity especially WiFi

• Health workforce development in developing countries is an EU priority and eHealth as one of the solutions (COM(2006) 870 final) – eHealth linked with EU strategy for Africa

EU/EC Policy on eHealth for developing countries 2

• EU strategy for Africa [SEC92005)1255]• Recommends the use of sustainable low-cost ICTs

– To help in strengthening Africa’s Health System

– Establishing an EU-Africa Partnership on continental-wide ICT Infrastructure development through terrestrial and satellite means (‘interconnectivity in Africa’)

Existing eHealth applications in Developing Countries: A framework• Using 5Cs Acronym (Peter Drury 2005)

– Content: EHR, referral system, HMIS, CME/e-Learning & Telemedicine platforms etc

– Community: Online Communities of Practice, Knowledge networks

– Communication: Web services; voice and data tools• What is needed? ACCESS, through what?

– Connectivity: wireless/mobile ICTs- Opportunities for eMobility WG

• What is lacking? understanding– Context: Cultural, end-users, social, organisational

economics issues etc.

EU/EC eHealth for developing countries: Mobile/Wireless Technologies

• MOCCA: The Mobile Cooperation and Coordination Action (MOCCA) an initiative by EU in translating wireless and mobile technologies to developing countries under the IST FP6 in a report– This is a previous EU-IST FP6 programme– …………..that appropriate wireless/mobile technologies can be

employed for providing connectivity in developing countries– The success of EHAS eHealth project as an illustration of this

• European strength in wireless networks can be employed like Alcatel Broadband Initiative, Ericsson & Nokia initiatives

Wireless/Mobile tools in Developing Countries (Africa)• Wireless technologies use:

GSM/GPRS/3G, WiFi, WiMAX, WLL (Fixed or Mobile CDMA), Broadband wireless, Satellite, VSAT (Mobility vs Universal Access)

• Mobile devices: PDAs, Smartphone, Cellular phones, Tablet PCs, Laptops, smart cards, memory sticks, USB keys, sensors.

Rationale for mHealth • Mobile devices are relatively cheaper that Fixed computers

• Consumes less power (Lack of electricity)

• They are portable, hence more secured?

• Wireless networks are relatively cheaper and faster to build relative to build than fixed networks. For example , the Nigerian case

• Mobile/ Wireless technologies provide the best opportunity for Africa to achieve the “ Africa interconnectivity objective and for building eHealth Infrastructure (EU strategy)

• Case studies below supports this proposition

mHealth impacts in Africa: Case Study 1• UHIN (Uganda)

– Started in 2003 and has continued to expand within & beyond the Country (Mozambique).– Uses existing GSM/GPRS/ WiFi links with PDAs to support (community) health workers (HWs)

creating a regional eHealth network– Uses solar panels for power– For Primary Health Care service provision– Provides learning materials, health information and e-mail (upcoming) to HWs– Enables timely response to health system needs, diseases outbreaks and enhances organisational

health planning and resource allocation.

BACK

mHealth impacts in Africa: Case Study 2

• Cell-Life (South Africa)– Started in 2003 by 2 universities in SA

– A multiplatform system for the therapeutic and logistic management of HIV/AIDS population

– Mobile devices (Cellphones & PDAs) with 3G/GPRS/SMS networks

– Enable community health volunteers to assist their fellows HIV+ management.

– Enables organisational planning for drug supply and emergency situations

mHealth impacts in Africa: Case Study 3

• MindSet Health (South Africa)– Started about 2002– Uses DVB wireless satellite technology to provide

– Health education (eLearning) to rural health workers in clinics and hospital (datacasting) through PCs/Laptops

– Health promotion to patients and citizens through large screens and TVs (broadcasting) in clinics and community settings in form of documentaries, drama etc.

– Delivers information all aspects of health (TB, HIV, Malaria etc).– Improves health workers’ capacity and empowers citizens’ to keep

healthy

mHealth impacts in Africa: Case Study 4

• EHAS (Peru)– Started in Peru is early 2000 with joint collaboration between a Spanish and two

Peruvian universities & MoH and an international NGO

– Initially with HF/VHF but now with long distance WiFi wireless links connected with Laptops creating a regional eHealth network

– Uses solar panels for power

– For Primary Health Care service provision

– Provides learning materials, e-mail and voice communication and teleconsultation to HWs , organisational health information & data exchange

– Enables timely response to health system needs, diseases outbreaks and enhances organisational health planning and resource allocation.

– BACK

Wireless Networks: Opportunities for eMobility ETP 1

• Transmission – Wireless Internet Protocols (IP) for eHealth web services and

applications

• Development of optimal/low-cost mobile devices and software

• Ambient Wireless Networks– Melanges of wireless networks– Need to explore interoperability for facility, community, district,

provincial, national regional and continental access and connectivity (SEC92005)1255)

– This is line with the recommendation of EU strategy on eHealth technologies in developing countries (STOA 122 EN)

Wireless Networks: Opportunities for eMobility ETP 2

• The case studies presented above demonstrates the feasibility of mHealth in Africa Health System development portbale and mobile devices like the OLPC

• Need for developing and providing low-cost & optimal

• But what is missing is how these wireless networks can be made to interoperate to provide a seamless network

• An opportunity for eMobility ETP to assist in achieving this EU/Africa strategic objective

• And to help in the achievement of Africa Health Infoway (AHI) goal.

The suggested way forward

• There is a need to institute pilot projects on ambient wireless networks for eHealth connectivity and access in Africa.

• This should be deployed within a district health system for ambient wireless eHealth network

• Need to implement pilot within the local environment in Africa as this is an innovation (STOA 122 EN)

• However, detailed knowledge on designing, developing and implementing mHealth system in Africa is lacking at present (STOA 122 EN)

Ambient Wireless eHealth Network: A Vision

Continental

National

Regional

District Hospital

Facility: Health Posts, Health Centres

Community

A District eHealth Network

A Cluster of District Wireless eHealth Network = Regional eHealth Network

A Cluster of Regional eHealth Network = National/Continental Network

Ongoing Research Work @ CHMI

• Reviewing all eHealth projects in developing countries especially on mHealth

• Focus is specifically on the factors affecting eHealth sustainability or success in Africa

• Operational & strategic management of eHealth implementation & use in Africa

• Developing a holistic framework to evaluate existing eHealth systems in Africa i.e. linking operational with strategic (policy) level

• Framework will capture process and outcome impacts from design to implementation and use

Ongoing Research Work @ CHMI

• Specific focus will be on Health workers & Health System impact of implementation & use

• Will aim to:• develop a mHealth readiness framework for Africa

• improve existing projects

• Provide valuable good practice for new projects

• save cost from preventing project failure

• improve health systems

• empower health workers

• eventually to ensure sustainability of projects.

Conclusion• eHealth is strategic to health system development in

Africa/developing countries as in EUAfrica strategic policies• Mobile/wireless ICTs have potentials of providing the much

lacking is access and connectivity• The achievement of ambient wireless network provides the

best opportunity for developing Africa’s health system interconnectivity

• This is an opportunity for eMobility ETP in implementing pilot projects

• Understanding contextual organisational issues is paramount• Funding sources for field studies urgently required!

Thank you for listening!

Questions and Comments