EHealth Africa: Overcoming the barriers to its implementation' A Case Study of Sub Sahara Africa'

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E-Health Africa Overcoming the barriers to its
implementation. A Case Study of Sub Sahara Africa.

• Presented by
• Akeh Lucas and Morfaw Zigo
• August , 2007
• Karlstad University

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Introduction

• It is of utmost importance to be in good health.
• Good health will make us happy, means we are
  active and productive since healthy citizens will
  contribute enormously to the growth and
  development of the economy.
• Hence, health is very important and calls for
  concern around the world.
• In Sub Sahara Africa, the health situation
  demands greater attention.
• The region is a DANGER zone.
• Home to thousands of diseases, including

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Introduction Cont

• Malnutrition, malaria, sleeping sickness,
  HIV/AIDS etc these diseases claim millions of
  souls every year.
• Despite efforts carried out so far, the health
  situation seems to be deteriorating everyday.
• More efforts are needed.
• New solutions must be put in place to remedy the
  health situation.
• The authors are of the opinion that e-health will
  go a long way to remedy the health situation.
• However, studies show that a number of barriers
  prevent the successful implementation of E-health
  in this region

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Introduction Cont

• The authors intend to identify these barriers and
  proffer solutions.
• Thus, we intend to answer two very important
  questions
• 1) What are the barriers that prevents the
  successful implementation of E-health in SSA?
• 2) How can we overcome these barriers?

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Methodology
Primary data source (Email Phone call) Medical
students, Health care workers, Local
Expert. Anecdotal evidence
Politics, Economic and socio-cultural Factors
dominated the answers observed from both data
sources. Technology considered not to be an
immediate priority
Knowledge about E-health in SSA

Secondary data source. Online databases, e.g.
Emerald, PubMed and ProQuest Direct
International Development Data WHO, UNESCO,
USAID, UNECA, AU
Results
Picture Own Source
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• What is E-health?
• e-health is an emerging field in the
  intersection of medical informatics, public
  health and business referring to health services
  and information delivered or enhanced through the
  internet and related technologies. In a broader
  sense the term characterises not only a technical
  development but also a state-of-the mind, a way
  of thinking, an attitude and a commitment for a
  networked, global thinking, to improve health
  care locally, regionally and worldwide by using
  information and communication technology.
• Eysenbach (2001), e-health guru

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• Our working definition of e-health is
• the use of ICTs for all aspects of healthcare
  from clinical diagnosis, home care delivery,
  education of health professionals, transparent
  management of health resources to general
  e-commerce involving both healthcare providers
  and consumers
• (Own Source)
• Therefore, what are the benefits of E-health?

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Potential benefits of E-health

• Heeks (2004) identified two benefits such
• 1) task level benefit such as the improvement in
  the cost or speed of data handling tasks
• 2) improvement in the speed and quality of
  health management
• Thus, ICTs can cut the costs of tasks and
  processes and reduce the time to perform these
  tasks and processes
• Mbarika et al, (2002) e-health would link
  hospitals and other medical institutions and
  result to an overall improvement of health care
  services, efficiency, and proper monitoring of
  patients

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Potential benefits of E-health Cont

• Eysenbach (2001), listed 10Es of E-health, some
  of the Es include
• 1) Efficiency
• 2) Empowering of consumers and customers
• 3) Education of physicians through online
  resources
• 4) Ethics as a new form of patient-physician
  interaction etc.
• They argue SSA stands to benefit these and more
  if there is a successful implementation of
  E-health system in the region.
• So, where is Sub Sahara Africa?

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Locating the Region

• Wikipedia defines SSA as a term used to describe
  those countries of the African continent that are
  not considered part of political North Africa.
  The dividing line is the southern edge of the
  Sahara Desert, though Chad, Mali, Mauritania, and
  Niger belong to both regions. As shown in the map
  the North and Sub Sahara regions of Africa have
  been separated by the harsh climate of the
  sparsely populated Sahara.
• Source http//www.idrc.ca/uploads/user-S/111841
  66631Map_-_Africa_LRG.jpg

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Health and ICTs in SSA

• The spread of the internet in various parts of
  the world have highlighted the fact that SSA,
  part of the worlds second largest continent is
  the region with the lowest level of economic,
  technological and internet development in the
  world. There is still very low level of internet
  connectivity.
• UN Global E-government reports (2003, 2004, 2005,
  and 2006) proved that middle Africa has the
  lowest rate of e-readiness in the world
• Internet World Stat (2006) proved that Africa,
  despite the fact that it inhabit 14.10 per cent
  of the worlds total population and way ahead of
  Europe (12.40 per cent), North America (5.10 per
  cent) Middle America (2.9 per cent) etc use only
  2.60 of the worlds total internet usage.
• However,

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However,

• SSA countries are becoming more aware of the
  potentials of ICTs especially in the health care
  sector.
• In many SSA countries sporadic use of ICTs use in
  the health sector have been initiated and carried
  out by government and foreign donors e.g. Ghana,
  Kenya etc.
• But many of these projects fail or do not achieve
  the desired results.
• So, Why do these projects fail? Why is it
  difficult to implement successful e-health
  systems in this region?
• Barriers???

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Barriers to e-health implementation in Sub Sahara
Africa.

• Based on our research method, we have classified
  barriers to e-health in four categories
  political, economic, socio-cultural and technical
  barriers as shown in the diagram
• (Own Source)

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Political barrier has to deal with the following
leadership and vision, political will, self
interest, corruption, low expectancy of
governmental organisationsWHO (2005), few
governments have develop roadmaps for e-health,
but most are still lagging behind due to lack of
vision and insufficient political willOECD
(2005) reports lack of e-health experts or
leaders to champion e-health projectsHaque et
al. (2006) Sub Sahara Africa is governed by
leaders who prefer the status quo or present
state of affairs (leaders are afraid of
change)Ajayi (2006) argues that corruption is
endemic and leaders are pushed by greed to
satisfy their own personal ambitions
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• Transparency International agree that SSA is home
  to the worlds most corrupt countries
• Amokeode (2004) states that about 100 billion
  was stolen from Nigeria alone by its leaders from
  1993 to 1998 during the leadership of Late
  General Sanni Abacha
• These trends have not changed much
• Hence money meant for public expenditures are
  directed to private pockets
• There are also legal barriers that prevent the
  adoption and use of ICTs in the health care
  sector
• WITSA (2006) most government enact laws that
  prevent advances in technology e.g. regulations
  may require health care providers to maintain
  patients record in a paper-based format such
  laws are barriers to the use of ICTs in the
  health sector

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• Economic barriers include financial resources at
  the disposal of the governments. E-health, like
  e-business, e-government and e-education cannot
  succeed without a well established communication
  networks
• WBG (2005) reports, that there are a multitude of
  projects apart from e-health in this region,
  hence, e-health projects will have to compete
  with other projects for the limited resources
• UNDP (2004) citizens in this region are very poor
  and they cannot afford basic essentials such as
  food and clean water and 70 live in rural areas
  far away from the urban areas where most ICTs are
  found
• Also there are frequent power cuts which is a
  barrier to e-health. Frequent power cuts leads to
  loss of data
• UNECA (2005) under developed telecommunication
  infrastructure is another potential barrier to
  e-health development in SSA

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• UNECA argue that SSA has to invest heavily in
  infrastructure in order to benefit from the
  opportunities offered by ICTs
• Internet World Stats, SSA has less than 2 per
  cent of the Worlds telephone lines, less than 1.5
  per cent of the total number of PCs, and less
  than 1 per cent of the total internet users.
  These low figures are all barriers to e-health
  adoption

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• SSA has one of the worlds lowest adult literacy
  rate, with only 60 per cent of the population of
  15 and over able to read and write in 2000.
  UNESCO Global Monitoring Report (2006)
• Lack of trained professionals and skills in
  disseminating ICTs based training in e-health
• Issue of digital divide within and without
  countries in this region
• Shortage of medical personnel, particularly
  specialists
• Some doctors not willing to accept a change to
  new technology (resistance to change)
• Local health care workers fear this change may
  lead to job loss
• Patients also not willing to stay away from their
  doctors for fear of their confidentiality of
  medical records

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• Overcoming barriers to e-health development in
  SSA.
• This part has been broken down into two
• 1) what governments, organisations, individuals,
  scholars have said and have done and are doing
  and,
• 2) What the authors believe ought to be done.

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Solutions to political barriers

• Legislation amended to reduce taxes on ICTs
  equipments
• The need for New Public Management, hence a
  general overhaul of the public service
• Corruption must be stamped and be punishable by
  law
• Embezzled funds must be redirected to finance
  e-health projects
• The need for e-health experts

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• Solutions to Economic barriers
• Infrastructure development
• Poverty alleviation
• Assistance from donor organisations
• Solutions to Socio-Cultural barriers
• Education
• Digital divides
• Use of ICTs in public services

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• What ought to be done
• It is important to identify the barriers first
  and potential barriers.
• Examine their nature, the causes of the barriers
  and which of these barriers are the most
  problematic
• Can a solution to these problematic barriers
  result to the elimination of all other barriers
• Proffer solutions to tackle them

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Priority factor

• Governments, the civil society, organisations
  should concentrate on educating citizens in Sub
  Sahara Africa.
• Education has the potential to eliminate most of
  the barriers to e-health in the region. It will
• Empower citizens of the region
• Create employment
• Provide e-health experts
• Reduce resistance to change
• Bridged the digital divide and produce upright
  citizens.

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So what should governments do?

• Education should be provided free in primary
  schools
• ICTs should be made compulsory in the national
  curriculum in primary, secondary and tertiary
  institutions.
• Governments should offer scholarships for
  students to be trained in advanced ICT
  institutions.

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• Conclusion
• Research was out to
• Identify barriers to the successful
  implementation of E-health in SSA
• Discuss solutions to these barriers.
• This has been done. E-health in SSA faces a
  number challenges which includes political,
  economic, socio-cultural and technological
  challenges.
• So what is the way forward?
• Reforms are needed, bridging the digital divide
  is an urgent issue, education is of primary
  importance to bridge this divide
• Urgent need for better public management and good
  governance.
• Assistance is needed from Multi-national
  Corporation and foreign donors etc
• We would like to say that SSA governments have
  to do better than what they have done. It is not
  a rich institutional arrangement that matters. It
  is not attending conferences and signing papers
  that matters. What is needed is action. Words,
  policies, strategies, must be matched with
  actions.
• THANKS FOR LISTENING