eHealth : the promise of ICT for improving health in Africa

ECOSOS Conference on eHealth, Accra 12th June 2009

eHealth : the promise of ICT for improving health in Africa

Prof. S. Yunkap KwankamExecutive Director

International Society for Telemedicine and eHealth (ISfTeH)


Focus of health investment should be on improving sector productivity, cannot just increase funding

The most effective way to improve productivity is to improve health systems

Source: Nicholas C. Petris Center on Health Care Markets & Consumer Welfare

(UC Berkeley), WHO, A Handbook of Cultural Economics (James Heilbrun)

Level of HC spending is a function of GDP/capita regardless of external funding

Level of HC spending is a function of GDP/capita regardless of external funding

Hea

lth s

pend

per

cap

ita (

2005

)

GDP PPP per capita (2005)

10

100

1000

10000

100 1000 10000 100000

R2 = 0.94


0

50

100

150

200

250

300

100 1000 10000 100000

Effectiveness of health spending widely variableHealth outcomes not tightly linked to income level

Variation in health outcomes highlights considerable room for improvement of inefficient and ineffective health systems

Source: WHOGDP PPP per capita (2005)

Log GDP/Capita (PPP) vs Childhood (<5) Mortality

Chi

ldho

od (

<5)

Mor

talit

y (p

er 1

000)

Country A Country B

Country Y

Country X

Countries with similar health outcomes but very different profiles

Countries with similar profiles but very different health outcomes


Service delivery

Financing

SYSTEM BUILDING BLOCKS GOALS OF THE HEALTH SYSTEM

Health

Financial protection

Responsiveness

Information

Medical products, technologies

Health workforce

Leadership / governance

Building blocks combine to meet health system goals

Coverage

Provider performanceQuality, safety, efficiency

Equitable distribution

Service delivery

Financing


Health


Responsiveness

Information


Health workforce



Coverage



Service delivery

Financing


Health


Responsiveness

Information


Health workforce



Coverage



Service deliveryService delivery

FinancingFinancing


HealthHealth

Financial protectionFinancial protection

Responsiveness Responsiveness

Information


Health workforce

Leadership / governanceLeadership / governance


Coverage


Equitable distributionSource: WHO


Challenge - local capacity for eHealth

Low institutional capacity– Infrastructure and connectivity– Legal and regulatory environment– administrative structures

Limited human capacity– ePractitioners – health workers capable of leveraging ICT in their

clinical or other activities– Informed citizen transformed from passive observer to active

participant in the care giving process– eHealth professionals often not included in the HRH calculus of

many countries– Lack of eHealth corps within MoH, with career prospects

(schemes of service) to attract and retain them


Countries with a critical shortage of health service providers (doctors, nurses and midwives)


eLearning easing healthcare HR crisis in Kenya2

In Kenya, chronic shortage of highly skilled nurses

In Kenya, chronic shortage of highly skilled nurses

Enrolled Nurses (ENs) comprise 70% of nursing and 45% of the health workforce in Kenya

• First point of contact for communities, but are inadequately skilled to manage new and re-emerging diseases like HIV/AIDS

PPP led by the Nursing Council of Kenya (NCK), the African Medical and Research Foundation (AMREF) and Accenture to upgrade 22,000 ENs from ‘enrolled’ to ‘registered’ level within 5 years via eLearning (distance education through ICT) methods

Promising progress since start of program in Sep. 2005

Promising progress since start of program in Sep. 2005

As of Nov. 2006, 3,265 nurses upgraded

27 colleges and schools participating including AMREF’s Virtual Nursing School

Over 100 computer-equipped training centers set up in 8 provinces, including remote and marginalized districts

eLearning can reach goal w/in next decade versus >200 years w/

traditional classroom methods

eLearning can reach goal w/in next decade versus >200 years w/

traditional classroom methods

0

5

10

15

20

25(K)

•~2,800 ENs upgraded/yr

•Cum. cost ~ $2.5M•~$114/nurse

22,000 ENs to upgrade

•~100 ENs upgraded/yr•Cum. cost ~ $50M•~$2,273/nurse

eLearning vs. traditional methods for upgrading ENs

Traditional classroom methodeLearning

Results do not just represent dramatic cost and time improvements over status quo, they are nearly impossible without use of ICT

Source: Source: WHO, AMREF website


Challenge – eHealth “pilotitis”

Conclusions of a workshop organized by the DSF and WDSA, Lyon November 2008

eHealth initiatives often small-scale and not commensurate with the size of the problem

No repository of information and knowledge on what is happening where, how well it works and why


Organized eHealth profession in countriesNational professional societies –

– Stewards of the profession in country– Watchdog of the industry– affiliated with regional and international federations such

International Society for Telemedicine and eHealth (ISfTeH) and International Medical Informatics Associations (IMIA)

National eHealth Councils– Advisory body to governments on eHealth matters – patterned

after national AIDS Councils– A forum for public debate on issues of ICT I health with all

major stakeholder groups represented

Develop evidence – modeling and analysis, identify trends and project future needs


WHO definition of eHealth

eHealth – ICT for health

What produces health?

Where can we bring ICT to bear on this production?

Redress the overwhelming focus on health care

To the neglect of other influence pathways to good health: Water and sanitation Food and nutrition Housing and shelter Education


Africa Health Infoway- an organizing frameworkAn integrated district health network for Africa

AUC's Pan-Africa eNetwork project

eAfrica Commission's eSchools project

Millennium villages etc


ISfTeH International eHealth RegistryTo address one of two Lyon recommendation on

eHealth

Comparable information on eHealth projects around the globe

Shared freely

Linked to other repositories of information on ICT in health


Conclusion

Promote a continent-wide vision, with local insights

Human resources are the key– eHealth predicated on the triad of People Processes

and Technology, with people resources as the key

Partnerships are the modeling– Local, national and continental networks

THINK BIG - START SMALL - ACT NOW


Thank [email protected]

[email protected]

eHealth : the promise of ICT for improving health in Africa

Health & Medicine

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