Feng Zhao, Ph.D, MPH,MD eHealth Coordinator Africa HNP, World Bank.

Feng Zhao, Ph.D, MPH,MD eHealth Coordinator Africa HNP, World Bank

Outline See todays World through Telecomm World 2009 Geneva Address health challenges using ICT Demystify eHealth/mHealth Identify major bottlenecks in scaling up eHealth Recognize the importance of eHealth Why Bank should care about eHealth Take advantage of eHealth -Options for the Bank

Telecomm World 2009 Geneva Open Networks - Connected Minds

President Paul Kagame

Nelson Mandela

African Countries at Telecomm 2009

Consensus The world is a very different place from it was just a few years ago. By the end of 2009, the world will reach 4.6 billion mobile phone subscriptions and 1.8 billion internet users (more than half have broadband access). ICTs have been an engine for economic growth in both developed and developing countries; are resilient to the financial crisis. ICTs are directly responsible for job creation in the knowledge economy. ICTs are answers to many challenges we are facing, and it can help achieve MDGs. ICTs are part of everything we do in the modern world. We are at a historic time, and should take advantage of the new environment and not miss the opportunity.

eHealth at Telecomm 2009

Implications to the health sector We are dealing with a new world: A world that is increasingly connected. A world that presents a new meaning for access particularly for rural population. With a mobile phone in the hand, the world is just one call away. A world that provides a new set of tools and options for health service delivery and utilization. A world that requires strategic vision and change of behavior to proactively adapt to the new environment

Roles of ICT in Health From the well-know models The Classic two-level health production function: H = f(S, O); S = f(H, C, O) ICTs can alter both the inputs (H, C, O) and efficiency (f) Service delivery function = Availability + accessibility + utilization + continuation +quality (+information/data management)

Evidence Availability Brazils eHealth Program Accessibility Zambia eHealth centers to expand coverage Utilization Indias mobile phone games for HIV knowledge Continuation South Africa mobile message for TB treatment Quality Ethiopia patient smart card and follow up Information/data management - Uganda PDA Projects ICTs contributions to service delivery are comprehensive and systematic

New ways of health planning for addressing long-standing health challenges Shortage of health professionals (telemedicine, diasporas programs) Resource allocation M&E and information

Demystify eHealth/mHealth Perception 1: Developing countries are not ready for eHealth due to its limited infrastructure and connectivity

Connectivity The speed for improving connectivity has been amazing for the past decade. It can only get better. Just two years after the Connect Africa Summit in Kigali in October 2007: Investments in communications infrastructure alone exceeded eight billion US dollars, and have produced returns of over 40 billion US dollars for the investors. Planned investments totalling USD 55 billion were announced to expand ICT connectivity and services to the entire continent by 2015, including a goal of interconnecting cities to broadband by 2012.

Connectivity vs. Content/Application eHealth/mHealth are broad areas and reliance on connectivity varies. Some effective mHealth/eHealth programs are built on dial-up connection Start small and create demand for better connectivity. Given the urgency of health problems and MDGs, waiting is not an option.

Demystify eHealth/mHealth Perception 2: eHealth/mHealth programs are too costly for developing countries

Paying too much The relative price for ICT services is highest in Africa, the region with the lowest income level Significant room for cost reduction. Actually, the ICT service charges were reduced by 30% in Africa after 2007. Economist: The price of a basic model of a mobile handset steadily fell, from around $250 in 1997 to around $20 today. Cell phone service charges can be as low as $5 (in India). Low cost model is possible for developing countries

Cost and effectiveness Investment in ICT, as other health infrastructure investment, will yield high return and efficiency gain. Cost-effective (Uganda PDA): The Uganda PDA project not only results in better data but also achieved 24 percent cost savings over traditional paper-and-pencil methods Saving money: Studies in developed countries (Australia, Greek, US, Canada, etc.) indicated that eHealth approaches (virtual consultation, tele-pediatric, home-based monitoring of chronic disease management, school-based telehealth centers) are cost saving when comparing to traditional ways.

Demystify eHealth/mHealth Perception 3: eHealth is something for rich countries.

Developing countries are in greater need of ICT Developed countries: cost and quality Developing countries: access and basic health need For developing countries, eHealth/mHealth is not an option; it is necessity Developing countries need ICT even more

Traditional way to seek health care

New ways of health care delivery

Major bottlenecks Knowledge Integration and coordination Policy development (eHealth strategy/mater plan) Capacity and skills Lacking of hard evidence and impact evaluation

Knowledge In favor of eHealth services Uganda 96.6% Pakistan 86.5% Bhutan 87.5% Sri Lanka 81% Saudi Arabia 90.7% Mongolia 77%

What is nesessary to speed up the implementation?

Why Bank Should Care About eHealth/mHealth ICTs can help achieve health-related MDGs ICTs become essential instruments for health system strengthening, a focus of the Bank HNP strategy ICTs represent a new ways to tackle health challenges ICTs can help improve the performance of the Bank health operations

Banks Comparative Advantages The Bank is financing health operations and ICT projects in almost all the developing countries Increasingly, the Bank is working with countries to assist the development of health and ICT policies and strategies The Bank is supporting (sometimes leading) donor coordination and harmonization (e.g. IHP, HHS) The Banks HD, ICT, and IFC provide skills and implementation capacity to mainstream eHealth

Application of ICTs in HNP Projects is lagging behind Education: For the fiscal years 2006-2008, 114 projects approved by the Education Sector Board contained an ICT various components. Agriculture and Rural development: An FY08 portfolio review shows that over 80% of FY08 projects included ICT as an "implementation approach and instrument", up from just over 20% in 2004. Governance and Public Sector Reform is perhaps the Bank sector that has shown the most interest in ICT in recent years. A growing number of "e-Government" projects seek to use a range of ICT to improve information flows and information analysis within government HNP: Only a handful of projects explicitly included ICTs components. There is no strategic plan to mainstream ICTs in health operations.

Options for the Bank Service line 1: Knowledge sharing Service line 2: Policy, framework and guideline development Service line 3: Capacity building Service line 4: Piloting and evaluation Service line 5: Mainstreaming ICT in health operations -At project design stage eHealth as an option -At project implementation stage eHealth as a mean to achieve PDOs

Partnership eHealth is a multidisciplinary field which requires strong partnership with clients, ITU, WHO, Foundations, Academia, private sector, etc. Internally, HD, ICT and IFC need to work closely We are working closely with WHO and ITU to develop eHealth guideline and training materials We are working with several universities on evidence and piloting We will need technical input from partners on strategy and plans for mainstreaming eHealth in our projects.

True Partnership Not eMarriage

Feng Zhao, Ph.D, MPH,MD eHealth Coordinator Africa HNP, World Bank.

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