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


... of the African continent that are not considered part of political North ... shown in the map the North and Sub Sahara regions of Africa have been separated ... – PowerPoint PPT presentation

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

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

  • 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

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

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

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,
Picture Own Source
  • 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

  • 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?

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

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
  • 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?

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//

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
  • 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,

  • SSA countries are becoming more aware of the
    potentials of ICTs especially in the health care
  • 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???

Barriers to e-health implementation in Sub Sahara
  • 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)

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
  • 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
  • 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

  • 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
  • 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
  • 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

  • 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

  • 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
  • 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

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

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

  • 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

  • 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
  • Can a solution to these problematic barriers
    result to the elimination of all other barriers
  • Proffer solutions to tackle them

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

So what should governments do?
  • Education should be provided free in primary
  • ICTs should be made compulsory in the national
    curriculum in primary, secondary and tertiary
  • Governments should offer scholarships for
    students to be trained in advanced ICT

  • 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
  • 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
  • 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