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

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Project Goals & Outcomes1

Chapter 1 Summary2

Chapter 2 Summary3

Chapter 3 Summary4



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

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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.



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.

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Financial ForerunnersRipe & ReadyNext Generation MarketsUnbanked & UnconnectedLast FrontierUnexamined




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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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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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

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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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• 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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• 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



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



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

eTransform Africa: Health Sector

Business

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affordable health

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