Opportunities for eHealth to improve public health need developing and promoting by Public Health Associations (PHA). These are the conclusions of an article in the Journal of Public Health Policy, Digital technologies for population health and health equity gains: the perspective of public health associations, by an international team. How did it reach them?
The World Federation of Public Health Associations (WFPHA) conducted a semi-structured interview with its national PHA members about their eHealth use, their eHealth challenges, and their experiences and thoughts on how to assess its impact. There were 17 responses, with more detailed discussions with ten PHAs, including Cameroon and Uganda.
A survey of the relative public health priorities showed:
This led onto three questions:
- How does eHealth facilitate the capacity of a PHA to achieve its mandate?
- How do PHAs use eHealth as a core element in their programmatic and advocacy activities?
- How do PHAs assess eHealth’s impact on population health and health equity?
How they use eHealth is:
These fulfil three main roles:
- Communicate with members
- Disseminate information about public health issues, best practices, and policies to members, stakeholders, and the general public
- Advocate, primarily to government representatives, policies and programmes to improve their country’s health system and have a positive impact on the public’s health.
Examples of PHAs eHealth use are:
- Policy and advocacy
- Mobilising partnerships
- Identifying and solving health problems
- Informing, educating, and empowering people about health issues
- Analysing and investigating health problems and hazards
- Contributing to create and maintain a competent public health workforce
- Improving effectiveness, accessibility and quality of public health services.
Alongside these initiatives, advancing PHA’s eHealth has to address a long list of challenges and constraints that limit their capacity:
- Lack of qualified people to design and manage websites
- Lack of internal ICT competency in PHAs
- Internal human resource ICT capacity in PHAs is limited
- Using volunteers to design and manage their websites helps, but it’s insufficient
- Lack of resources, including donor funding, to support core operational costs
- While external funding can provide funds to start eHealth, it doesn’t extend to operating costs
- Some eHealth initiatives are specific to other projects and operate as long as funding is available
- Several projects share similar aims but use incompatible apps that can’t be scaled to national systems
- Lack of an explicit communications strategy that includes eHealth
- Need for leadership that encourages and supports change management to overcome internal resistance, experiments with new technologies, and improving effectiveness
- For PHAs in low income countries, problems with local infrastructure, Internet connectivity, low bandwidth capacity, interruptions in electricity supply, high costs of hardware and software maintenance, and inadequate real-time videoconferencing capability.
For Africa’s PHAs these are insurmountable on a significant scale in the short, and probably medium, term. Health systems also endure these constraints for their eHealth programmes.
A very encouraging consensus emerged from the survey. PHAs should include evaluation of eHealth impact on population health and health equity gains in their strategies’ communications components. This requires PHAs to use eHealth to identify all determinants that affect health and to explore how to exploit eHealth fully. Acfee’s working on frameworks and methodologies the help PHAs and health ministries to do this. It’s a welcome finding from the WFPHA.
The study suggests that PHAs should:
- Examine their eHealth’s impact
- Incorporate eHealth and allocate and reallocate resources for adoption and management into strategic and business plans and plans to assess eHealth’s impact the PHAs’ mandates and health and health equity
- Where PHAs have experiences using and assessing eHealth, mentor other PHAs and provide financial and technical assistance to help build eHealth capacity
- Put into place a programme to help PHAs, especially in middle and lower income countries, develop their capacity to use and assess eHealth
- Work with PHA members to develop an eHealth evaluation framework
- Customise and adapt methodologies and metrics to the needs of PHAs, including assessing inter-sectoral eHealth impact on health and building relationships with software developers
Host a session during the 15th World Congress on Public Health, bringing together PHAs, multilateral organisations, Canada’s International Development Research Centre (IDRC), and organisations outside of the health sector with experience in using and assessing eHealth impact, laying the groundwork for a global action plan on eHealth use and assessment of population health and health equity.
It’s a set of ambitious initiatives. As eHealth expands, these activities will have to expand with it.