Leadership (71)

Happy New Year to everyone. Congratulations on your 2016 eHealth efforts. It's been quite a year, setting us up for an extraordinary African 2017.

Thank you for reading our stories of Africa’s eHealth development. They reflect a small part of our passion to explore and support eHealth’s role in securing better health for Africans. They showcase some of the exceptional work already underway through you and our international eHealth colleagues.

At the September African eHealth Forum (AeF), our Advisory Board set out African eHealth priorities. Details are in the AeF Report, Advancing eHealth 2016, and summarised in posts on eHNA.

Acfee’s response will be delivered in the New Year. It will focus on bringing our five priorities to life in tangible ways that can help lead to healthier Africans.

1. eHealth strategy

Acfee’s research and support for African countries’ national eHealth strategies will expand. This includes a special focus on issues highlighted by the Acfee Advisory Board, including:

  • Cloud computing: learn from global experiences of the challenges and opportunities and synthesise these for health ministries to review
  • eHealth surveillance: explore the contribution of Acfee’s eHealth impact and benefits realisation research and expertise for HISP’s planned eHealth surveillance initiative in West Africa
  • Architecture: finalise the commentary on eHealth architecture to fit expanding mHealth and social media for health ministries to review
  • Interoperability (IOp): seek finance to establish Acfee technical working groups for IOp and support an IOp workshop on a use case and a development programme in an African country in collaboration with Integrating the Healthcare Enterprise (IHE) to set the process of use case development in Africa

2. eHealth governance

Acfee’s review of start-up measures for health ministries will be published in an eBook, leading on to sophisticated arrangements as reported on eHNA.

3. eHealth regulation

Acfee will continue to develop affordable, sustainable approaches to eHealth regulation for health ministries to review.

4. eHealth cyber-security

Acfee’s on-going review of global threats, initiatives and actions will be synthesised in an expanding eBook for health ministries to use to combat cyber-threats, as reported on eHNA.

5. eHealth impact

Acfee will continue to develop sophisticated impact models appropriate to Africa’s needs, to help health ministries to select good initiatives, monitor and evaluate them and promote positive socioeconomic impact.

The 2017 programme will include Acfee’s internal development, such as the internship programme to develop emerging professionals and future leaders and promote their contributions to eHealth’s advancement across Africa.

Engagement of partners is critical too, such as professional bodies, with an important step being to work with Africa’s Public Health Associations (PHA). Developing Acfee’s eHealth curriculum will advance too with collaboration with Health Information Systems Program (HISP) and selected African and international universities, including New York University, Monash South Africa and Rome Business School for Masters degrees for Africans.

Finally, Acfee’s two landmark events will continue, with the eHealthALIVE broad stakeholder forum planned to run in Southern Africa and the East African Community (EAC) in 2017. AEF meetings of Permanent Secretaries and other health leaders will follow these, to extract the lessons from the eHealthALIVE platform and channel them into decisions by ministries.

Acfee’s relationships with African health ministries are growing, as are our efforts to collaborate with like-minded partners to expand stakeholder engagement to advance African eHealth.

Our shared goal is healthier Africans, in 2017 and beyond.

WHO’s third global eHealth observatory report is a meaningful update on global developments and trends and poses important challenges for African countries embracing eHealth for their health systems’ transformation.

Helping to review content for the report, along with colleagues from the WHO eTAG and many other eHealth experts, I was exposed to the considerable work underway globally, and the extraordinary teams helping to explore eHealth's role in improving our health and health systems.   

At Acfee, we're especially interested in the implications for Africa. eHNA will post separately on each of the eight chapters in WHO’s report. Each post will take an African perspective to offer an assessment of features of its eHealth and Universal Healthcare Coverage (UHC) opportunities and constraints.

It’s widely recognised that Africa has a considerable healthcare deficit and high disease burden. The combination creates a constant, long-standing struggle and much more than the policy and management euphemism of a challenge. Africa’s average healthcare spending per head’s some US$145, about 14% of the World Bank global average of about US$1,061. The highest’s about 62%, the lowest less than 2%. These aren’t adjusted for the high disease burden, or the difficulties of providing healthcare to extremely remote communities. It’s unrealistic to expect Africa to achieve the huge productivity increase needed to provide UHC, provide the extra cash and capacity needed, or a combination of both over the medium-term.

Aiming to achieve UHC in this economic context is a lot more than demanding. The Global Observatory for eHealth (GOe) publication Report of the third global survey on eHealth Global diffusion of eHealth: Making universal health coverage achievable, says “It has become increasingly clear that UHC cannot be achieved without the support of eHealth.” I've heard similar sentiments expressed by African colleagues such as Liberia's Luke Bawo, speaking about his country's response to Ebola and Acfee's Ousmane Ly, describing the eHealth initiatives he's leading in West Africa.

It's a reasonable proposition, but for Africa, it’s not enough for all people to receive the high-quality health services they need without suffering financial hardship.

Africa’s UHC solutions are a combination of:

  • Substantial and rapid economic growth
  • Significant, sustainable increase in finance for health and healthcare
  • Converting the extra cash into sustainable real healthcare resources, including all types of healthcare workers, medicines, medical and surgical supplies and extra and better facilities
  • Proven eHealth, especially proven mHealth.

WHO’s report says 90% of eHealth strategies reference the UHC objectives or its key elements. This is for the 58% of countries that have eHealth policies or strategies, so about 52% of all countries. For Africa, 39% of countries report having an eHealth strategy, of which 58% have UHC objectives, so about 23% of countries. Consequently, Africa’s eHealth role in UHC isn’t specified formally yet, indicating the need to enhance or replace them.

Other limitations are that Africa’s eHealth strategies seldom integrate with related economic growth, healthcare finance and real resource strategies and plans, and none have sustainable, longer-term horizons. Africa’s eHealth strategies need upgrading for other factors either understated or not referred to in the report. Four are:

  • Effective, consistent patient unique ID
  • Interoperability (IOp), which is in its infancy across Africa
  • Cyber-security, which is becoming an increasing global challenge
  • eHealth governance, not yet well developed across Africa.

Acfee’s African eHealth Forum (AeF) report included these in its identified priorities. Acfee will release commentaries on cyber-security and eHealth governance early in 2017. It will also be able to offer health systems opportunities to participate in developing IOp use cases using a globally recognised methodology and standard.

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Image from the global eHealth observatory report 

The African Centre for eHealth Excellence (Acfee) has released its Advancing eHealth 2016 report. The report findings are that eHealth initiatives are expanding in African countries, though their impact on health systems strengthening and transformation, and ultimately their contribution to healthy Africans, is less certain.

The African eHealth Forum is where Acfee’s management team consults with its Advisory Board, industry partners and other stakeholders, to exchange their experiences of eHealth in Africa to find ways to support eHealth to strengthen healthcare and make Africans healthier. The second annual forum was in Sandton, South Africa on 8 and 9 September 2016. It followed the successful eHealthALIVE event.

During AeF, Acfee's Advisory Board identified five eHealth priorities. They are:

  • eHealth strategy
  • eHealth governance
  • eHealth regulation
  • eHealth cyber-security
  • eHealth impact.

The AeF believes that developing these will help eHealth to advance. They are discussed and elaborated on in the report and Acfee will be investing in moving each one forward.

eHealth in Africa still has a long way to go. The AeF report sets out some of Acfee’s contributions to moving it on. eHNA’ll be reporting on its progress.


The AeF followed the first annual eHealthALIVE Southern Africa conference, a broad stakeholder engagement platform for exploring eHealth's opportunities in the region. Read it's report here.

The exuberance and energy of eHealthALIVE still smoulders. It was a first and a success, bringing together a wide spectrum of stakeholders, who found good value in the unique opportunity to engage, challenge and debate the rapidly developing eHealth sector in Southern Africa.  

The eHealth spectrum of the event in Johannesburg early September is captured in eHealthALIVE 2016 Southern Africa The Report. The African Centre for eHealth Excellence (Acfee) and eHealth News have now released it.

Prof Peter Nyasulu, Acfee executive director is clear about why eHealth, is important. “Healthy Africans is eHealth’s most important goal in Africa. Achieving it needs eHealth to support health professionals to help them transform healthcare. Africans can be healthy and while we all know of the considerable challenges, eHealth is a powerful tool to help Africans be healthy.”

This was a core focus of the event. I was struck by how comparable eHealth challenges were across African Countries and beyond. Presentations were drawn from eHealth initiatives and programmes from Namibia, South Africa, Sri Lanka, Swaziland, Uganda, Zambia, Zimbabwe and the East African Community. Master classes supplemented these, covering interoperability, a deep dive into MomConnect and presentation of multiple District Health Information System (DHIS) use cases. The spread reflects Acfee’s goal to help advance eHealth and eHealth capacity in African countries.

The lessons learned at the event are set out in the report. It helped delegates to:

  1. Fix eHealth challenges and support extended data use, such as analytics and research, through Interoperability masterclasses
    1. Develop use cases for eHealth initiatives
      1. Design structured, formal eHealth capacity-building programmes for healthcare professionals
      2. Emphasise the need to expand eHealth’s role in direct and clinical benefits for patients and health workers
      3. Set an eHealth balance between managing reporting and data for patients and healthcare professionals
      4. Explore benchmarks for eHealth strategies and plans.

eHealthALIVE 2016 brought them together. It was” a unique forum for stakeholders in health systems transformation to come together to engage on real-world practical issues and find opportunities to bring about tangible change - a platform for engagement we hope to continue to build year on year” according to Taryn Springhall, Editor at eHealth News.

Planning is already underway for next year’s SA event; set to be a highlight on Southern Africa’s annual eHealth calendar. In parallel, planning is underway for an equivalent event with the East Africa Community (EAC). These help to lift eHealth’s profile and promote its value and benefits.


eHealthALIVE was followed by the African eHealth Forum, a platform for strategic discussions between Acfee, its Advisory Board of eminent African health leaders, and representatives from the sector. Read about it here.



It’s not often one gets to be part of a rapidly expanding eHealth programme supporting health systems transformation. For innovative software developers looking for such an opportunity in South Africa, this one’s a gem.

Health Information Systems Program HISP South Africa’s created seven new positions for software engineers. It’s a substantial expansion. HISP's website has the adverts or you can contact me directly for more information.

New developers will work with HISP’s existing software team to build health information solutions for use in South Africa and abroad. Together, they will help shape HISP’s software development strategy and its role in supporting governments’ health strengthening efforts. It’s an opportunity to collaborate, grow your skills and contribute to Africa’s emerging digital health industry.

Applications close 30 July.

There’s a lot of eHealth innovation underway in African countries to transform our experience of healthcare and how we stay healthy. In my home country, South Africa, the Health Information Systems Programme of South Africa (HISP-SA) makes an important contribution, extending from its DHIS health data platform, now in use in 46 countries, to projects stretching from building mHealth apps, to training and support to help public health and facility managers take sound decisions.

It’s a foundation for expanding eHealth’s health strengthening role for the future, which is a strategic goal for HISP-SA and HISP entities around the world. There’s regular collaboration between country teams to move this vision forward, with significant support from HISP-SA.

HISP-SA meets a growing demand for eHealth expertise and services. In the last five years it’s expanded from a team of twelve people to now over one hundred. They cover a range of skills across public health, informatics, data management and computer science.

I’ve been asked to help lead HISP’s ICT strategy and its implementation. It’s a Chief Technology Officer role with a team of analysts, software developers, data specialists and ICT infrastructure experts. Everyone in HISP-SA’s dynamic and experienced team has a valuable contribution to make to the way ahead and to guiding HISP-SA to grasp the numerous eHealth opportunities across Africa and deal with their challenges.

I now work alongside well-known eHealth and public health personalities, such as Vincent Shaw, Gugulethu Ngubane, Calle Hedberg, Phumzile Zondo, Mohammed Jeena and Christa van den Bergh. An essential activity’s engaging closely with former colleagues and government eHealth leaders, including recently appointed National Director of Health Information Systems, eHealth stalwart Mr Mbulelo Cabuko, his colleague Julius Nkgapele, their Chief Director Ms Thulile Zondi and their teams.

Our relationship with provincial and district health is important too, to boost using information to improve health experiences at the point of care, for patients and health workers, and with key population groups.

HISP-SA’s priority is to support South Africa government’s health information systems. They exist to secure and support how South Africa delivers better health for all. It’s an honour to be part of this endeavor. I look forward to what we will accomplish during our time together.

It’s another eHealth step for Rwanda. An article in the New Times says Rwanda’s Ministry of Health has signed a Memorandum of Understanding (MoU) with the Republic of South Korea. The aim’s to improve technology in healthcare, including telemedicine, Hospital Information Systems (HIS) and ICT-based medical services. The MoU enables collaboration on eHealth between Korea Telecom (KT), Yonsei University Health System, including Severance Hospital, and University Teaching Hospital of Kigali (CHUK).

At a media briefing, Kwon Deok-cheol, the visiting Korean Deputy Minister for Health and Welfare, said eHealth’s now an effective tool for sharing information needed for healthcare and controlling Non-Communicable Diseases (NCD). “eHealth would be very crucial in providing information, especially now that Rwanda has potential to expand modern health services across the country. Through working together, information between the two countries will be shared.”

Rwanda’s Health Minister, Dr Agnes Binagwaho, said technology will be distributed across all levels of the health sector so everyone benefits. Her vision’s to “Use technology right from the rural areas to the national level that is how we can manage e-Health. Although we still have a long way to go in terms of improved management, access to information, advice from health personnel and distance towards health care facilities, this arrangement is one of the opportunities for us to improve.”

As eHealth expands, it becomes more complex and challenging. Collaboration is an increasingly constructive approach. Rwanda’s collaborative strategy offers a model for all African countries.

As a new technology, eHealth’s ICT components are still maturing and evolving. It’s far from perfect, and may never be. Vince Lombardi, the USA footballer, had a less demanding, more realistic goal when he said “Perfection is not attainable, but if we chase perfection we can catch excellence.” In a blog on the site of the Healthcare Information and Management Systems Society (HIMSS), some USA doctors have set out five eHealth challenges and how to fix them. They fit eHealth in Africa.

1: Navigation

Issue: information isn’t organised to support clinical workflow and the way clinicians think.

Why it persists: clinician workflows are complex, nonlinear, and dependent on a variety of sources, all of which differ significantly between specialties and individual providers, but eHealth’s designed for generic tasks and steps that impose new workflows that don’t support decision making

How to fix it: observe and record workflows in a structured publicly available form to allow the industry to understand commonalities and best practices without recreating them and offer clinicians flexibility to customise task sequences to fit their work habits and quicken accurate decision making.

2: Data entry

Issue: consulting with a patient in an office visit needs numerous tasks, including eye contact with a patient, listening, processing nonverbal cues, keeping laboratories, allergies, and medication lists in mind, formulating a range of diagnoses, documenting granularly for ICD-10 codes, entering hundreds of items of structured data to comply with multiple quality and value programmes, and avoiding malpractice.

Why it persists: data entry’s assigned to the busiest, highest trained members of the healthcare team, the front-line clinicians, and the increased cognitive load and decreased situational awareness impairs their focus, comprehension and potential to solve a patient’s problems.

How to fix it: standardise, simplify, automate, delegate, harmonise and decrease data entry requirements to focus only on the most meaningful data, so EHRs collect and populate appropriate quantitative data automatically, and expand capabilities to allocate tasks to other team members.

3: Structured documentation

Issue: documentation tools make it difficult to communicate complex details of patients’ care and nuanced clinical reasoning, and don’t incorporate complicated data into notes efficiently, track several high complexity problems or maintain continuity of medical decision making.

How to fix it: documentation process needs to be re-envisioned and redesigned, such as sections of  medical records, such as allergies, medical history, and family history, change infrequently and don’t need repeating, so flexible specialty templates should emphasise the interval history, clinical reasoning, and recommendations most important to the current visit, with EHRs aggregating information pertinent to the problem at hand.

4: Interoperability (IoP)

The issue: disparate, non-integrative health ICT impedes care across the continuum, so manual reconciliation is persistent due to lack of IoP across vendors, increasing the risk of errors, gaps in care and delays

Why it persists: differing platforms, clinical vocabularies, and information architecture make it difficult and expensive to achieve IoP or for clinicians to switch away from stand-alone EHRs, so rigorous research support is needed for innovative technologies that improve care across the continuum.

5: Clinical Decision Support (CDS)

The issue: many CDS tools are interruptive and fail to integrate key data needed in workflow, leading to alert fatigue and hindering decision-making with increased cognitive loads.

Why it persists: clinical practice differences makes it extremely difficult to design tools that provide the right information to the right person in the right CDS format through the right channel at the right point in workflow.

How to fix it: need to understand clinical workflows and clinician conceptual models better and have regulatory incentives for extensive formative, user-centred design testing to achieve better balance of clarity, scope, and prominence in CDS interventions.

Some of these require daunting, but essential changes. Lombardi had something to say on this too. “It's not whether you get knocked down, it's whether you get up.” eHealth will, and Africa’s doctors have to take the lead to make sure it happens for their health systems.

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Image from KevinMD.com

eHealth leadership’s part of a healthcare leaders role, but now, the digital components seen as a core requirement for general leadership. It applies to leaders in Africa’s health systems, but it may not be in the same ways as it applies to business. 

This view’s come out of the UK, with a global reach. The Institute of Directors (IoD) magazine, the Director, has a article by Jeroen Hoencamp, CEO of Vodafone UK, saying digital leadership is transforming the CEO’s role. It’s imperative that they understand how the workplace is changing and how their organisations can stay ahead of the curve by equipping employees with the tools they need to succeed. It also creates opportunities that they need to grasp. The requirements are:

  • Know how digital developments change work
  • Understand digital transformation
  • Be collaborative and flexible
  • Value people
  • Seize new challenges and experiences
  • Recognises opportunities to innovate and be more competitive. 

City A.M., a free newspaper, follows on from the Panama Papers leaks to shine a light put cyber-security. It refers to report by FTI Consulting say “43% of global institutional investors believe that board members have barely acceptable or unacceptable understanding of the key information held by the company and the potential impact of losing that data.” FTI says that someone at the top must take total ownership instead of specialists pushing their recommendations to the top for reviews and decisions.

Both add valuable perspectives to eHealth and health leadership. For Africa’s health systems, it creates a constant, career-long learning requirement to keep up with eHealth’s changing solutions and opportunities. A challenge is how to keep up. eHNA sees its role to provide some of the insights they need.

Success in eHealth depends as much on good soft skills as the hard ICT ones. Soft skills are sometimes called people skills. They include leadership, learning, engagement, culture and change. In eHealth, there’s rarely enough of them simultaneously, so developing them’s a priority. 

As Africa’s health systems move ahead on eHealth, it’s important they see the latest trends, assess them critically and adopt what’s relevant. Deloitte has published its Global Human Capital Trends 2016. It sets out ten trends. Five of these are important for Africa’s eHealth@ Leadership, learning, culture, engagement and organisational design. They’re also the top five of the ten trends, and they’re all connected.

Leadership needs improving. That’s what 89% of executive say. About 56% say their organisations aren’t ready to meet their leadership needs. This confirms that, like most organisations, Africa’s health systems should review their eHealth leadership strengths and weaknesses, then take any steps needed to improve it. As eHealth opportunities keep moving on, eHealth leadership needs frequent and regular reviews.

Learning’s expanding. About 84% of executives say it’s important or very important. Learning opportunities are seen as the largest drivers of employee engagement and strong workplace culture, so directly linked to two other top priorities, and part of the employee value proposition, not just a way to build and expand skills. Since 2015, companies are adopting new technologies and learning models. Some 43%, up 13% points, are comfortable using Massive Open Online Courses (MOOC).

Engagement and culture are closely integrated. Culture’s described as “the way things work around here.” Engagement’s “how people feel about the way things work around here.” It’s also seen as “employee listening” and “Always on.” Some of the engagement tools picked up in the trends might be helpful to Africa’s eHealth, but they’re not enough. Engaging health professionals on eHealth needs a more direct and personal model that represents the professions’ willingness to change and the direction and types of eHealth change that they want to pursue. It’s an immensely challenging endeavour for eHealth. 

About 85% of executives see engagement as a top priority. Only 46% say they’re ready for it. Thre rate of improvement’s modest over the last year. For eHealth, there may be much more to do. Two themes from the trends are essential. One’s listening, and extended into doing something about it, the second’s always on. For eHealth, engagement, and its culture counterpart, should start early, with the initial eHealth strategies and investment decisions, then be sustained into operation and benefits realisation. From these, the engagement model and culture’ll be ready to deal with the next wave of eHealth investment.

Organisational design is a shift from traditional, functional models and structures toward interconnected, flexible and agile teams. It’s prevalent in customer-focused organisations, so fits healthcare. Some 92% of executives say it’s a top priority. Deloitte says network teams that are empowered to work on specific business projects and challenges are new organisational models. 

It’s not a new concept for healthcare. The UK’s National Institute for Health and Care Excellence (NICE) has many reports on the topic in clinical setting, some going back as far as 2003. In addition to learning from big business, Africa’s health systems can always learn from other health systems, and compare them to their ehealth initiatives.

For Africa’s eHealth, Deloitte’s trends show that there’s more to do. They also show that eHealth’s not the same as running corporates. Africa’s eHealth needs its own, bespoke solutions.