eTransform Africa: Health Sector
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eTransform Africa: Health Sector
The World Bank | African Development Bank | African Union
PEER REVIEW WORKSHOP
Johannesburg, South Africa
January 28, 2011
Brooke PartridgeCEO
Brendan SmithDirector of Consulting Services
Nam MokwunyeSenior Consultant, Tech Transfer
© 2010 Vital Wave ConsultingTM
Proprietary and Confidential: Do not copy or distribute.
Agenda
1
Project Goals & Outcomes1
Chapter 1 Summary2
Chapter 2 Summary3
Chapter 3 Summary4
© 2010 Vital Wave ConsultingTM
Proprietary and Confidential: Do not copy or distribute.
Intended OutcomesThe study provide an overview and analysis of current ICT for Health across SSA and beyond. It will also recommend ways in which to scale up the successful application of ICTs to further operationalize their use within the Health sector, while paying appropriate attention to associated risks.
Project Goals and Outcomes
2
Overarching Project GoalRaise awareness and stimulate action, among African
governments and development practitioners, of how ICTs can contribute to the improvement and transformation of traditional
and new economic and social activities in the Health sector.
© 2010 Vital Wave ConsultingTM
Proprietary and Confidential: Do not copy or distribute.
Chapter 1: Role of ICT in Health SectorSummary (1)
• Defines ICT ICT in the health sector, also called eHealth, is the use of information and communication
technology (ICT)—such as computers, mobile phones, satellites, applications, information systems and digital platforms —to enable, support and deliver health services to patients and populations.
• Discusses state of health care in African countries in reference to MDGs 4, 5 and 6
• Establishes a framework for looking at health sector development and determines that most African countries are transitioning from phase 1 to 2 with some transitioning from phase 2 to 3
• Establishes that progress has been made in MDGs 4,5, and 6 but still much left to do …under-five child mortality is 20 times (1 in 8) as severe in sub-Saharan Africa it is in OECD
regions (1 in 167) and 1.75 times as in Southern Asia (1 in 14), Nigeria (10%) and India (21%) account for nearly one-third and Southern Asia and Sub-Saharan Africa (42%) accounts for 92% of the global under-five mortality cases.
3
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© 2010 Vital Wave ConsultingTM
Proprietary and Confidential: Do not copy or distribute.
Chapter 1: Role of ICT in Health SectorSummary (2)
• Establishes that some African countries are doing better while other are not Some African countries, such as Eritrea, Liberia, Ethiopia and Madagascar (4 of the world’s
top-10 performers) either reduced under-five deaths by 100 per 1,000 lives, at least 50% or at a reduction rate of at least 5%., The Millennium Development Goals Report 2010
• Establishes why ICT could be a game changer for MDGs 4,5 and 6 Enables curbing of wasteful spending Provides tools to help address 5 obstacles to affordable health discussed further in chap. 3
Funding shortage Equipment and supplies shortages Insufficient quantity of skilled health care workers Population uneducated about prevention and treatment of preventable diseases Lack of health system infrastructure and communication between rural and urban
centers
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© 2010 Vital Wave ConsultingTM
Proprietary and Confidential: Do not copy or distribute.
Chapter 2: Landscape Analysis of eHealthSummary• Provides landscape analysis of ICT in health sector, first worldwide, then within Africa
• Identifies early evidence of eHealth activity in African countries with a focus on Botswana (eLearning and Health Chat by SMS) South Africa/Tanzania/Botswana (BEANISH/HIS) Gabon (Gamelto e-health record cards) Ghana (MoTech mid-wife survey and advisory) Rwanda (TracNet, national eHealth system) Tunisia (Visionet, video network for physicians)
• Concludes that health indicators improve with GDP per capita and ICT prevelance
• Provides graphed data sets comparing African countries to themselves Also to Thailand, which has a well-regarded health system, and highlights Tunisia which is
possibly transitioning from phase 3 to 4, unlike other African countries• Provides substantial resources: interventions, blogs and publications
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© 2010 Vital Wave ConsultingTM
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Chapter 2: Landscape AnalysisOnline Comments and Recommendations• “Interesting perspective on the ICT landscape across selected countries in
Africa and Thailand. The examples provided were interesting showing the wide use of ICT programs with external financing in selected countries.”
-Egbe Osifo-Dawodu
• Mention role of physicians and local developers (software)
• More private sector examples
• Role of telecom sector in making e/mHealth possible
• More government uses examples
mobile phone based Internet in south African clinics
mobile-phone armed midwives in Nigeria
• Group by services
• Group by country size
6
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Chapter 3: Challenges and OpportunitiesSummary (1)
• Expounds on chapter 2’s discussion of obstacles to affordable health care and identifies them as micro-challenges Funding shortage Equipment and supplies shortages Insufficient quantity of skilled health care workers Population uneducated about prevention and treatment of preventable diseases Lack of health system infrastructure and communication between rural and urban centers
• Identifies opportunities to use ICT to overcome micro-challenges SMS (educational/instructional) IVR (voice menus) Video (tele-medicine) Radio
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© 2010 Vital Wave ConsultingTM
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Chapter 3: Challenges and OpportunitiesSummary (2)
• Posits that systemic (macro-) challenges make it difficult for African nations to overcome sector-specific micro-challenges—as is being experienced by the health sector Capital constraints (financial, human—urbanization, intellectual—brain drain) Capacity building Organizational issues Process considerations Infrastructure Social cultural pressures Inadequate safety net
• Offers that eHealth intervention opportunities are equally dependent on macro-challenges being addressed
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© 2010 Vital Wave ConsultingTM
Proprietary and Confidential: Do not copy or distribute.
Chapter 3: Challenges and OpportunitiesSummary (3)
• Provides tools for analyzing the relationship between macro, micro and ICT challenges in the health sector
• Graphs data sets that compare micro, macro and ICT challenges between African countries with highlights of Thailand
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Chapter 3: Challenges and OpportunitiesMatrix (1.1): Micro, Macro and ICT
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Health Sector (Micro-level)
Challenge System-wide (Macro-Level)
Influencer Impact on Citizens ICT Opportunity ICT Challenge Path to Health
1 Funding Shortage Relatively high cost to provide civil services
Limited revenue sources Health deprioritized
Reduced confidence in leaders’ ability to deliver public services
Residual impact on quality of life
High mortality Loss of economic
productivity
Reduce costs (mHealth/tele-medicine)/increase cross-sector revenues with ICT platform (telco/mMoney)
Fund health with ICT-assisted savings/revenues
Insufficient infrastructure (telecom/power)
Existing intellectual assets (spectrum) not maximized
No cross-sectoral collaboration
Commitment of leadership
0.5-1YR: low-cost, preventive interventions; reprioritize health funding in policies and budget
1-5YRS: resolve ICT challenges; high-cost interventions
2 Equipment and Supplies Shortage
Funding shortage Limited access between
urban and rural areas Inefficient manual supply
chain mgmt. (SCM) processes
Service gaps More deaths related to
“multiple delays” Reduced trust levels Higher preventable
mortality
Deploy real-time ICT to enable 1) urban-rural communication (tele-medicine) 2) mobile-assisted supply chain management (MASCM)
Low rural connectivity Device interoperability Inefficient supply chain
process (done by hand) Commitment of leadership
0.5-1YR: target rural providers for low-capacity (mobile) supply chain interventions
1-5YRS: increase rural connectivity, roads transportation; higher-capacity database systems
3 Insufficient Quantity of Skilled Healthcare Workers
Underfunded skilled education system
High unemployment “Brain drain”
Increase in “third delay”-related mortality
Spread of communicable diseases
Loss of economic productivity due to third delay
Reduce training cost and increase penetration with ICT (broadband, video/IVR/SMS)
Increase rural access to specialized care training with ICT (tele-medicine)
Low rural connectivity Device and service usability
for healthcare workers No proven scalable and
stainable business model Commitment of leadership
0.5-1YR: video broadband group training at urban and rural health centers; low-cost mobile continuing education
1-5YRS: increase rural connectivity; improve education system
© 2010 Vital Wave ConsultingTM
Proprietary and Confidential: Do not copy or distribute.
Chapter 3: Challenges and OpportunitiesMatrix (1.2): Micro, Macro and ICT
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Health Sector (Micro-level)
Challenge System-wide (Macro-Level)
Influencer Impact on Citizens ICT Opportunity ICT Challenge Path to Health
4 Population Uneducated About Prevention and
Treatment of Preventable Diseases
Underfunded primary and secondary education system
Sociocultural norms that encourage misunderstanding of communicable diseases and unhealthy behaviors
Avoidable high rates of transmission and mortality due to preventable diseases
Spread of epidemics
Radio, TV, and mobile education campaigns promoting disease prevention healthy living
Patient reminders improve timing and quality of treatment
Literacy of rural populace Mobile phone ownership Cultural norms Commitment of leadership
0.5-1YR: maximize telecom networks for SMS/voice/video training
1-5YR: improve mobile and broadband connectivity; increase investment in education
5 Lack of Health System Infrastructure to Enable
Communication Between Rural and Urban Centers
Lack of financial capital to develop and maintain health care system
Inadequate rural connectivity due to licensing regimes, rapid payback models and reduced ROI for operators
Limited access to proper medical care
Low levels of trust in healthcare system
Bad health translates to low economic productivity
Use ICT to maximize community-based health/reduce need for HSI.
Complete patients’ medical record database
Implement VPNs and inter-connect rural and urban health centers
Low rural connectivity Commitment to inefficient
data collection process Commitment of leadership
0.5-1YR: establish broadband VPNs between centers; arm healthcare workers with useful technology; digitize records system
1-5YRS: Improve broadband connectivity; maximize tele-medicine
© 2010 Vital Wave ConsultingTM
Proprietary and Confidential: Do not copy or distribute.
Chapter 3: Challenges and OpportunitiesMatrix (3): ICT and Macro
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ICT
INTERVENTIONS METHOD
SYSTEMIC (macro-level) CHALLENGES
Capital Constraints Capacity Building Infrastructure Socio-Cultural Norms Social Safety Net
Financial Human Intellectual Organiz- Ational
Process Regulatory
Telecom Power Devices Diet & Medi-cation
Gender issues
Language Leader-ship
Insu-rance
Social security
1 Digital Health Ecosystem (DHE)
X X X X X X
2 SMS X X X X X X X
3 IVR X X X X X X
4 Video (tele-medicine)
X X X X X X X
5 Radio X X X X X X
6 TV X X X X X X X
7 HMIS X X X X X X X
Thank you
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