ehealth : the promise of ict for improving health in africa
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eHealth : the promise of ICT for improving health in Africa, by Prof. S. Yunkap KwankamExecutive DirectorInternational Society for Telemedicine and eHealth (ISfTeH)TRANSCRIPT
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)
ECOSOS Conference on eHealth, Accra 12th June 2009
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
ECOSOS Conference on eHealth, Accra 12th June 2009
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
ECOSOS Conference on eHealth, Accra 12th June 2009
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
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
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 deliveryService delivery
FinancingFinancing
SYSTEM BUILDING BLOCKS GOALS OF THE HEALTH SYSTEM
HealthHealth
Financial protectionFinancial protection
Responsiveness Responsiveness
Information
Medical products, technologies
Health workforce
Leadership / governanceLeadership / governance
Building blocks combine to meet health system goals
Coverage
Provider performanceQuality, safety, efficiency
Equitable distributionSource: WHO
ECOSOS Conference on eHealth, Accra 12th June 2009
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
ECOSOS Conference on eHealth, Accra 12th June 2009
Countries with a critical shortage of health service providers (doctors, nurses and midwives)
ECOSOS Conference on eHealth, Accra 12th June 2009
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
ECOSOS Conference on eHealth, Accra 12th June 2009
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
ECOSOS Conference on eHealth, Accra 12th June 2009
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
ECOSOS Conference on eHealth, Accra 12th June 2009
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
ECOSOS Conference on eHealth, Accra 12th June 2009
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
ECOSOS Conference on eHealth, Accra 12th June 2009
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
ECOSOS Conference on eHealth, Accra 12th June 2009
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