PowerPointPrsentation

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eHEALTH NETWORK FOR AFRICA NEED FOR LOW-COST
MOBILE/WIRELESS INFRASTRUCTURES
RESEARCH DEVELOPMENT PROPOSAL
Adesina Iluyemi PhD Candidate CHMI, Univ of
Portsmouth, UK Member, eMobility
ETP Adesina.iluyemi_at_port.ac.uk 22.04.2008 WWRF 20
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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

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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 Africas population pays out of pocket
• Human resources impact

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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

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Policy for eHealth in Africa

• Africa Union/ New Partnership for Africas
  Development (NEPAD)
• NEPADs Action Plan Strategy on sector
  development
• Alignment between telecom and health sectors
• Calls for a continental-wide eHealth
  infrastructure based on wireless telecom
  infrastructure
• NEPADs eHealth for
• Communication system
• Integration of access to vertical HISs
• Extending healthcare to isolated and rural
  communities and populations

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Global Policy for eHealth

• 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

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Why eHealth for Africa

• 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

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Rationale for Wireless eHealth in 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

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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
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Health Workers using mobile devices
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A Innovative Concept Proposal

• 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

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i-DeHI Innovation
i-DeHI

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

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A District eHealth Network

• Basic architecture for health care delivery in
  Africa

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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

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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-
  WANLAN, VSAT- expensive, policy barriers
• Considering 3G
• Desktop Laptops
  WiFi -CellPhones
• Solar Energy

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A District eHealth Network
FMFI 2007

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

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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

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Barrier 1 Telecom/Technological Infrastructures

• 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

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MiMCom continent-wide eHealth Network in Africa

• This depicts national nodes with different
  networks

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Lessons from African Cases

• Melanges of devices and networks Need for
  Ambient Network

FMFI 2007
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Barrier 2 Financial Infrastructure

• 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

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Introducing DigitalWorld EU Project

• 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

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User-centric mHealth conceptual model
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mHealth Users Context
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Users issues 1

• Technical
• Human Computer Interface (HCI)
• Open Source (Hardware Software)
• Social
• Adoption issues (Development Implementation)
• Culture
• Local Knowledge
• Language

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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

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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

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Users issues Hardware 2

• Device Morphology/Transition
• mobile portable nomadic
• Ultra mobile portable devices (UMPCs)?
• Isomerism?
• Users opinion from Africa
• Desktop Laptops
  WiFi -CellPhones

• Device Morphology/Transition
• mobile portable nomadic
• Ultra mobile portable devices (UMPCs)?
• Isomerism?
• Users opinion from Africa
• Desktop Laptops
  WiFi -CellPhones

• Device Morphology/Transition
• mobile portable nomadic
• Ultra mobile portable devices (UMPCs)?
• Isomerism?
• Users opinion from Africa
• Desktop Laptops
  WiFi -CellPhones

• Device Morphology/Transition
• mobile portable nomadic
• Ultra mobile portable devices (UMPCs)?
• Isomerism?
• Users opinion from Africa
• Desktop Laptops
  WiFi -CellPhones

• Device Morphology/Transition
• mobile portable nomadic
• Ultra mobile portable devices (UMPCs)?
• Isomerism?
• Users opinion from Africa
• Desktop Laptops
  WiFi -CellPhones

• Device Morphology/Transition
• mobile portable nomadic
• Ultra mobile portable devices (UMPCs)?
• Isomerism?
• Users opinion from Africa
• Desktop Laptops
  WiFi -CellPhones

UMPCs
UMPCs
UMPCs
UMPCs

• Low-cost UMPCs for Health
• OLPC case

• Low-cost UMPCs for Health
• OLPC case

• Low-cost UMPCs for Health
• OLPC case

• Low-cost UMPCs for Health
• OLPC case

• Low-cost UMPCs for Health
• OLPC case

• Low-cost UMPCs for Health
• OLPC case

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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)

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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)

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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)

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Sustaining eHealth projects in Africa

• 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

80 cause of IT Failure
Page 35
WWRF20 Adesina Iluyemi adesina.iluyemi_at_port
.ac.uk 22.04.2008 Wireless eHealth for Africa
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Sustainability issues

• 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?

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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

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Opportunities for WWRF-WG 1

• 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

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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

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Ongoing Research Work _at_ CHMI

• 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

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Conclusion

• 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!

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eHEALTH NETWORK FOR AFRICA NEED FOR LOW-COST
MOBILE/WIRELESS INFRASTRUCTURES
RESEARCH DEVELOPMENT PROPOSAL
Dr Adesina Iluyemi PhD Candidate CHMI, Univ of
Portsmouth, UK Member, eMobility
ETP Adesina.iluyemi_at_port.ac.uk 22.04.2008 WWRF 20