ehealth network for africa: need for low-cost mobile/wireless infrastructures

Adesina IluyemiPhD CandidateCHMI, Univ of Portsmouth, UKMember, eMobility [email protected] #20

eHEALTH NETWORK FOR AFRICA: NEED FOR LOW-COST MOBILE/WIRELESS INFRASTRUCTURES

RESEARCH & DEVELOPMENT PROPOSAL

Content

• Health Problems in Africa

• Definition and Policy drivers for eHealth in Africa through wireless technologies

• Introducing the concept of wireless i-DeHI in Africa

• Barriers to wireless i-DeHI in AfricA

• Opportunities for WWRF

• Research and Development proposal

WWRF#20 · Adesina Iluyemi · [email protected] · 22.04.2008 · Wireless eHealth for Africa

Health Problems in Africa

• Africa has a population of about ONE billion people- Up to 70% lives in isolated rural areas

- Half lives on half a dollar per day

- Poor telecom & transportation infrastructure• 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- 50% of Africa’s population pays out of pocket- Human resources impact


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.

• Health System is information, data and communication intensive and requires more than SMS

- Health Workers as “Knowledge Workers”- Patients as citizens (Citizen-centric eHealth)- Health System as Data processing organization

• Wireless technologies plus eHealth = mHealth


Policy for eHealth in Africa

• Africa Union/ New Partnership for Africa’s Development (NEPAD)

• NEPAD’s Action Plan Strategy on sector development

- Alignment between telecom and health sectors

- Calls for a continental-wide eHealth infrastructure based on

wireless telecom infrastructure

• NEPAD’s eHealth for:

- Communication system

- Integration of & access to vertical HISs

- Extending healthcare to isolated and rural communities and

populations


• 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)

• The European Union has plans for eHealth in Africa

- Using wireless/mobile technologies

• 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 interest in mobile/wireless technologies

especially in developing countries

• All support Public-Private Partnerships (PPPs) for eHealth

Global Policy for eHealth


• 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

• But there are issues: Cost, telecom infrastructure, existing health problems etc

Why eHealth for Africa


• 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

Rationale for Wireless eHealth in Africa


Wireless tools use for eHealth in 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.

FMFI 2007


Health Workers using mobile devices


• Health Systems in Africa are operated through a District Health System (DHS)

- Hierarchical and pyramidal territorial enterprise

- A distributed and geographically dispersed Enterprise

- An information and process intensive Enterprise

- A central urban hospital linked to peripheral semi-urban/rural health

centres

- Has different cadres of Health (Knowledge) Workers with information

needs for patient care & enterprise management

• Integrated District eHealth Infrastructure (i-DeHI)- Built on Wireless Infrastructure- Including mobile/portable hardware, software & wireless networks

A Innovative Concept Proposal


i-DeHI Innovationi-DeHI as the basic unit for an Africa-wide eHealth

Infrastructure

i-DeHI


A District eHealth Network

Basic architecture for health care delivery in Africa


A Cluster of District Wireless eHealth Network = Regional eHealth Network

Regional or National eHealth Infrastructure will require use of different devices

and wireless networks with implications for interoperability and integration


Lessons from African Cases

• UHIN-GPRS:- still limited in bandwidth

- Early generation PDAs-Planning for Smartphones

• Solar Energy

• Cell-Life- GPRS/3G- Business model

- PDAs/Smartphones

• FMFI/MUTI Telehealth- Long distance WiFi- WAN&LAN, VSAT- expensive, policy barriers

- Considering 3G

- Desktop Laptops WiFi -CellPhones

- Solar Energy


A District eHealth Network

A rural eHealth project in rural South Africa using low-cost Mesh Wi-Fi networks

FM

FI 2007


Barriers to Wireless eHealth in Africa

• Technological

• Telecommunication Infrastructure ( policy, high investment costs , availability)

• Power /Electrical Infrastructure

• Economic/Financial Infrastructure - Low-income

• Organizational/Management issues


• Lessons from an Africa-wide eHealth Network

• Multilateral Initiative on Malaria Communication Network (MiMCom)

- A continental-wide eHealth Infrastructure with 12 National nodes

• Inter-national nodes mostly with VSATs

- VSATs chosen over fibre-optics at inception

• Intra-national communication with terrestrial wireless-WiFi, microwave link

• Devices-Laptops, PDAs, PCs

• Reveals different solutions for national nodes- depends on availability and costs of bandwidths

Barrier 1: Telecom/Technological Infrastructures


MiMCom continent-wide eHealth Network in Africa

This depicts national nodes with different networks


Lessons from African CasesMelanges of devices and networks: Need for Ambient Network

FMFI 2007WWRF#20 · Adesina Iluyemi · [email protected] · 22.04.2008 · Wireless eHealth for Africa

• Issues

- Non-availability of Low-cost Broadband Access

- High costs of broadband access especially of satellite connectivity

access

• Possible solution ?

- Low-cost Broadband Wireless Infrastructure

- Introducing EU funded Digital World Foundation project on Low-cost

Technology initiative

- Bring this issue into global business and developmental agendas

Barrier 2: Financial Infrastructure


• European Research Framework

– Framework Programme 7 (2007-2013) just started

– DigitalWorld FP7-216513 is an 18 month research project

• ICT-1-9.1 - International Cooperation (Africa and Latin America)

• Coordination and Support Action

• Started January 1, 2008

• Duration: 18 Months

Introducing DigitalWorld EU Project


User-centric mHealth conceptual model

Web Applications

Technology

EHR DDS HMIS Teleme-dicine

Human & Organisational issues

IntegrationInteroperability

ConnectivityAccess

MobilityDevices: Mobile, Nomadic & Portable

Wireless Infrastructure

Location: Homes, Facility & Community Levels

Geography: Rural/Urban

USERS: HEALTH WORKERS/ PATIENTS

mHealth Users’ Context

USERS: Health Workers/Patients

Geography

Rural/U

rban

Com

munity

Facility

Applications/C

ontents

Devices

Mobile/F

ixed

Wireless N

etworks

Ad-hoc/R

eal-time

Users issues 1

• Technical

- Human Computer Interface (HCI)

- Open Source (Hardware & Software)

• Social

- Adoption issues (Development & Implementation)

- Culture

- Local Knowledge

- Language

Users issues: software & interface design

• HCI- Screen size and design

(Adaptive)- Network Configuration-Thin &

Thick clients, remote & located synchronisation

• Software

- Palm OS

- Symbian

- Windows Mobile

- Google Android

Users issues: Hardware 1

• Open Source design?• Multi-wireless connectivity• Power- Solar? (Global Green

Movement)• Memory (Stable and Labile)• Security• Structure- (Ruggedized)• Low-cost devices-• Simputer

- OLPC- Classmate,- EeePC

Users issues: Hardware 2

• Device Morphology/Transition - mobile portable nomadic

• Ultra mobile portable devices (UMPCs)?• Isomerism?

• Users’ opinion from Africa- Desktop Laptops WiFi -CellPhones

UMPCs

•Low-cost UMPCs for Health•OLPC case









UMPCs





UMPCs





UMPCs





Users: Social issues

• Doctors in South Africa (Banderker et al 2005)

- Job relevance

- Usefulness

- Perceived User resources

- Device Characteristics

- Supports from Public National government & hospital administrators

- Patient influence

- Legal issues (Decision Support Systems, Drug directories)

Organizational issues 1

Technology• Technology is not enough! • Positive economic benefits• Users led and focus• Social and ethical issues • Health workers’ responsibility• Device and applications development and regulation.

(HealthService 24- 2006)

Organizational issues 2

Environment• Health Policies, regulation, structure and financing• Evaluation in real-life contexts• Multiple actors and structures• Health IT infrastructure (organisation).• Users’ Trust• Users’ led model

(MOSAIC -2005)

• 70% of IT investments globally are failures: Note failure here is multifaceted

• Africa is not faring better either

• Same problem with eHealth projects especially in Africa

• Hence, problem is sustainability which can be:- Organisational /Environmental

- Social/cultural

- Human (Health Workers)

- Technological

Sustaining eHealth projects in Africa

80% cause of IT Failure


• Building a sustainable Business Model for ‘Win-Win Situation’- Understanding and Meeting Multiple Stakeholders

- End-users needs for design: Pro Poor vs. Niche markets- Understanding Organizational Process for innovation diffusion

- Understanding Environmental Constraints and Enablers: Policies/Regulation, Electricity (Renewable Energy), Financial/Economic/Funding

- Instituting sustainable Global & Local Public-Private Partnerships (PPPs)- Supporting Local Small & Medium Enterprise (SMEs) - Supporting Low Access/Entry costs models

• Technological- Low cost Broadband Infrastructure- Wireless Telecom such as WiMax, WiFi, Broadband Satellite- Low cost mobiles devices and Laptops (OLPC, Intel Classmate etc- Open Source vs. Proprietary Software & Hardware?

Sustainability issues


Sustainable Solutions

• High investment, implementation and purchasing costs of wireless telecom infrastructures as barriers (Gilhooly 2005, World Bank 2008)

• Policy needed to stimulate:- Public service innovation/re-engineering (eHealth)- Mass and low-cost production of components- Appropriate Business models- “Bottom of the Pyramid” (BOP) model- Local and Global Public-Private Partnerships (PPPs) (NEPAD e-Schools

project)- Social and developmental inputs in Telecom regulation & business


• User-centric wireless products & services in developing countries

- Case studies demonstrate the feasibility of mHealth in Africa

Health System

- Low-cost portable and mobile devices like the OLPC are needed

- Low-cost broadband wireless infrastructure are also required

• Research to influence future design and development

• To support wireless eHealth business model in developing countries

- Being developed with Rural Living Labs Europe- To be instituted in four regions of Africa- To develop a sustainable wireless eHealth model

Opportunities for WWRF-WG 1


Opportunities for WWRF-WG 2

• Transmission - Wireless Broadband for eHealth web services and applications

• Development of optimal/low-cost mobile/portable/nomadic devices, infrastructures 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


• 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

• Funding required for field trips to Africa

Ongoing Research Work @ CHMI


• A call to WWRF to support research into:• Low-cost mobile/wireless technologies for Development in Africa

- eHealth - e-Education- e-Agriculture- e-Business, e-Commerce, e-Banking

• Scoping change management issues in using mobile/wireless technologies for eHealth in Africa / Developing countries

• THANK YOU FOR LISTENING!

Conclusion


Dr Adesina IluyemiPhD CandidateCHMI, Univ of Portsmouth, UKMember, eMobility [email protected] #20

eHEALTH NETWORK FOR AFRICA: NEED FOR LOW-COST MOBILE/WIRELESS INFRASTRUCTURES

RESEARCH & DEVELOPMENT PROPOSAL

ehealth network for africa: need for low-cost mobile/wireless infrastructures

Documents

wireless ehealth

africa page

ehealth strategy

ehealth projects

favour of ehealth

ehealth network

africa barriers

africa opportunities