• Strategy
  • There’s a template for developing mHealth strategies

    With Africa’s score on the WHO results from its global eHealth survey approaching 60%, there’s still plenty to do. A survey by Spok offers some good practices for the next steps. The start point’s that there isn’t a single definition. Instead, organisations have different interpretations. Common purposes seem to be:

    • Align mobile objectives with organisational goals
    • Feed the framework for all mHealth projects
    • Answer questions such as:

    o   How can mHealth enhance patient care

    o   What strategic initiatives need including in plans for mobile enablement, such as shorter ED and inpatient discharge processes

    o   What integrations are needed meet the larger goals of the hospital, such as easier communication between healthcare teams

    o   How can mHealth improve health workers’ productivity.

    As mobile technology and opportunities develop, healthcare’s mHealth strategies need to move on to match. This needs regularly updated policies. US experience is that mHealth strategies are quite fluid, with organisations amending them as needed:


    Shifting end users’ mobile needs

    44%

    New devices available

    35%

    New EHR provider capabilities

    36%

    Changed strategic goals

    23%

    Challenging strategy implementation

    21%

    Leadership changes

    16%

    Mobility strategy not updated

    7%


    A common feature’s that stated strategic goals aren’t embedded sufficiently or explicitly enough in mHealth strategic goals. Examples are:

    • Communications between doctors
    • Nurse to doctor communications
    • Communications between nurses
    • Code team or rapid response team communications
    • Communication with health systems’ doctors networks and and other health professionals
    • Managing critical test results
    • Nurse call and patient monitoring alerts to mobile devices
    • Patient satisfaction scores
    • Patient throughput
    • ED and bed turnover
    • Alarm fatigue.

     Improving on these needs a range of engaged stakeholders. They include ICT, clinical leaders, telecommunication experts, all appropriate healthcare professionals and other health workers and the organisations’ executives. Setting them up as permanent mHealth strategy teams is a priority for Africa’s health systems.

  • Africa’s health ministers set a firm eHealth direction

    Health ministers at the African Ministerial Dialogue on Digital Health in Geneva, reported on eHNA, emphasised eHealth’s direction. A core component will be the eHealth report from the Broadband Commission on February 2017.

    Digital Health: A Call for Government Leadership and Cooperation between ICT and Health set out the role of governments and government leaders as playing a fundamental role in fostering eHealth’s enabling environment and resolving some of the challenges, such as unsustainable funding, high capital expenditures, limited workforce capacity, and poor collaboration between the health and ICT sectors. Governments can also help to avoid duplication of effort, adopting Interoperability (IOp) standards and coordinating stakeholders across public and private sectors. 

    Legislation and regulation are important too. Data protection and privacy measures, regulating medical devices and cyber-security are priorities.

    The report refers to the report from WHO that 73 of 116, 63%, of its member states have national eHealth strategies. Africa’s lagging behind at about 40%. There’s more to do. For national Health information System (HIS) policy and strategy, Africa’s above average at about 80% coverage. 

    There is one African member of the Broadband Commission. It’s Hon. Jean Philbert Nsengimana, from the Government of Rwanda.

  • More mHealth strategies are in place

    As mHealth expands across Africa, a report from Spok identifies an expansion of mHealth strategies. It’s improving, but there’s still plenty to do. From 2012 to 2017, healthcare organisations with mHealth strategies have increased from 34% to 65%. The Evolution of Mobile Strategies in Healthcare also identifies areas for improvement. 

    While many healthcare organisations have explicit healthcare development goals for clinical and working practices, it seems that mHealth’s contribution’s lagging behind. Spok’s findings are:

     

    Stated goal

    In mHealth strategy

    Physician-to-physician communications                 

    53%

    19%

    Nurse-to-physician communications    

    53%

    18%

    Nurse-to-nurse communications

    43%

    13%

    Code team or rapid response team communication

    43%

    16%

    Communication with health professionals networks

    40%       

    18%

     

    Critical test results management

    38%

    10%

    Nurse call and patient monitoring alerts to mobile devices

    37%

    13%

    Patient satisfaction scores

    36%

    9%

    Patient throughput        

    35%

    7%

    ER and bed turnover

    33%

    5%

    Alarm fatigue    

    31%

    9%


    The findings provide a lesson for Africa’s health systems to ensure their mHealth plans and initiatives aren’t left outside conventional healthcare improvement projects. It seems it’s easy to overlook mHealth’s potential.

  • Senegal’s eHealth strategy has valuable lessons

    All African countries have valuable lessons to impart as they pursue their eHealth initiatives. Senegal’s have been complied into a case study with support from USAID and Knowledge for Health (K4H). Senegal’s Journey Toward an eHealth Strategy: Highlights from the Development Process sets out approaches to:

    • Senegal’s methods
    • Its process to develop its eHealth strategic plan
    • Engaging stakeholders
    • Desk reviews
    • Situational analysis
    • The Drafting Committee activities
    • Financial resources
    • Critical Success Factors (CSF)
    • Challenges and barriers
    • Comparison to WHO/ITU eHealth Guideline
    • Recommendations to a useful eHealth Strategic Plan, successful implementation , monitoring implementation and for other countries’ eHealth strategies. 

    General lessons for other countries:

    • Leadership by the health ministries of health
    • Development of governance and co-ordination mechanisms
    • Harmonise health and ICT experts contributions
    • Integrate with existing initiatives, such as Rwanda’s electronic identity cards integrated with eHealth programmes
    • Engage with and co-ordination stakeholders
    • Identify  human and financial resources needed
    • Look for ICT impacts of ICT rather than the technology itself
    • Use actors and systems already in place
    • Protect personal health data confidentiality
    • Build in measurement and evaluation.

    People who participated in the Senegal eHealth Strategy have concrete recommendations based on their personal and collective experiences:

    • Allocate sufficient time to develop credible scientific documents
    • Anticipate the financial resources needed
    • Start with a baseline evaluation or situational analysis that includes reviews of existing eHealth projects and players
    • Apply a consultative, participatory approach where key players with diverse expertise are brought together for brainstorming
    • Refer to countries that have an operational strategic plan and learn from their model while taking into account socio-economic factors
    • Assess infrastructure
    • Ensure appropriate legal norms are in place
    • Establish realistic activity calendars
    • Seek high-level support for strategies
    • Refer to the WHO/ITU toolkit.

    Acfee has identified other essential features for Africa’s eHealth. Two are an eHealth leadership triumvirate of clinical, political and executive personnel that permeates across all eHealth activities, and a considerable emphasis on benefits realisations through health and healthcare transformation.

  • AeHIN’s strategy has lessons for Africa’s eHealth

    Last week I returned from an Asian eHealth conference in Myanmar. The trip was extraordinary for a number of reasons: exploring places, people and cultures quite different to the African environment I call home, learning about our Asian colleagues' approach to eHealth leadership, and learning first-hand how ubiquitous the open source DHIS2 platform has become.

    As our African countries health systems move towards eHealth goals, looking at other global regions provides valuable insights.

    Set up in 2011, the Asian eHealth Information Network (AeHIN) provides an overview of eHealth in that part of the world. When it started, it identified a shared problem of, at best, minimal Interoperability (IOp) “Even within Ministries of Health.”

    AeHIN has a clear trajectory for its 25 country members. The Asia eHealth Information Network: Strategic Roadmap 2016-2020 sets out a wide array of initiatives to support national eHealth development in Asia. There are four strategic goals:

    1. Build eHealth capacity for Health Information Systems (HIS) and Civil Registration and Vital Statistics (CRVS)
    2. Effective networking to increase peer assistance and knowledge exchange and sharing
    3. Promote IOp in and between countries
    4. Enhance leadership, sustainable governance and M&E.

    eHealth governance framework for enterprise ICT is based on COBIT5, from the Information Systems Audit and Control Association (ISACA). It’s an internationally recognised framework for ICT governance. Its three overarching themes are evaluate, direct and monitor. There are four main parts in AeHIN’s model:

    1. Align, plan and organise
    2. Build, acquire and implement
    3. Deliver, service and support
    4. M&E and assess.

    AeHIN has eHealth blueprints for enterprise architecture. Its four components are business, data, application and technology. It also has a Regional Enterprise Architecture Council for Health (REACH). Its eHealth capacity framework has seven modules:

    1. eHealth service agreements
    2. Management, plans, policies and procedures
    3. IOp profiles and terminology services
    4. Health Information Exchange (HIE)
    5. National Standards and IOp framework
    6. eHealth governance framework
    7. National eHealth action plans.

    Supporting these initiatives are special interest groups. They include:

    1. Geographic Information Systems (GIS) lab
    2. Routine HISs
    3. District Health information Systems (DHIS) 2, implemented in twelve countries
    4. Research, with ten PhDs to work on AeHIN topics
    5. Community of IOp labs.

    The African Centre for eHealth Excellence (Acfee) has much in common with AeHIN and its aspirations. A working relationship has been initiated between Acfee and AeHIN to begin sharing African and Asia lessons for mutual benefit.

    This structured approach offers a template for Africa’s eHealth. Modest, steady, sustained investment can start to achieve it.

  • Will your eHealth New Year resolutions help secure better health for Africans?

    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.

  • African countries need more than good strategy – unpacking WHO's 3rd Global Survey on eHealth

    Chapter 1 of the WHO and 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.” It describes eHealth’s foundations and sees a national eHealth strategy as a core. That 58% of countries have a national eHealth strategy is an important start.

    Good components for these strategies are described as:

    • What citizens value and understand
    • The context of the health priorities
    • A vision
    • A plan of action for delivering the vision
    • Monitoring and evaluation
    • Stakeholder engagement
    • Governance
    • eHealth components of standards, legislation, technical and service delivery solutions
    • Finance
    • Human resources to deliver them.

    Acfee’s African eHealth Forum (AeF) report in 2015, Advancing eHealth in Africa, identified some 60 long-standing eHealth challenges that need addressing too. These included connectivity, improving dependencies beyond healthcare, such as registration of births and deaths, integration with research, procurement, better risk management and cyber-crime. In 2015, the AeF concluded that “African countries’ successful, expanded eHealth investment depends on dealing with long-standing eHealth challenges.” Solutions are seen as comprising thirteen measures:

    • Strategies
    • Human eHealth capacity
    • Leading and managing complex change                          
    • Relationships with suppliers
    • Sustainability
    • eHealth performance
    • Health informatics
    • Business cases
    • Benefits realisation
    • Regulation and governance
    • Procurement
    • Medical Education
    • Country scale.

    Evidence of eHealth’s performance and net benefits is sparse. eHNA has referred to numerous evaluations that show a range of studies with incompatible findings that range across eHealth’s success, its unexpected extra costs, modest benefits and financial disasters.

    This year’s AeF report, Advancing eHealth 2016, identified five themes, one of which is National eHealth Strategies, and set out seven priorities as:

    • Cyber-security
    • Cloud computing
    • eHealth surveillance
    • Establish technical working groups for Interoperability (IOp) and support an IOp workshop and development programme
    • Develop eHealth curricula
    • Engage professional bodies
    • Collaborate with regional bodies.

    Progress is underway and Africa’s regional bodies have an important role to play in eHealth’s development. They will need to expand their views beyond the WHO report contents to consider recent challenges to eHealth development, such as the growth in cybercrime and the need for countries to take effective countermeasures. For Africa, this will put extra strain on already stretched resourcing for eHealth foundations. National eHealth Strategies will need to be agile and well supported across local stakeholders to fulfill their important foundational role. 

    ------------------------------

    Image from the global eHealth observatory report 

  • Acfee’s Advancing eHealth 2016 report is out

    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.

  • FSDoH’s eHealth implementation plan’s on the way

    While South Africa has a national eHealth strategy, provinces have different starting points. At this year’s eHealthALIVE conference, Ms Thato Lekhu set out the Free State’s eHealth status for its five municipalities.

    The Free State Department of Health (FSDoH) provides a diverse and interwoven healthcare programmes at different stages of maturity. These service areas start from basic healthcare, such as outreach teams, to specialised disciplines. Using eHealth to support these services should align with the complexities of each them is a core part of FSDoH’s eHealth strategy. A parallel goal’s to ensure that eHealth’s enabled with the bigger health and healthcare picture.

    High speed connectivity is seen as linking the front and back ends. Front end content includes:

    1. Care-based surveillance with patient-level data in EMRs
    2. Information, Monitoring and Evaluation (M&E)
    3. Management dashboards and routine data for policy and decision makers
    4. Graphical User Interfaces (GUI)
    5. Access security
    6. User-defined queries
    7. Management reports.

    The back end includes:

    1. Web-based application architecture
    2. Content management systems
    3. Central database, Structured Query Language (SQL)
    4. Cloud computing
    5. Data warehouse infrastructure
    6. Automated backup
    7. Data capture.

    The main systems for patient information and research include:

    1. District Health Information System 2 (DHISs) database
    2. ETR.net
    3. Tier.NET
    4. Patient admission and billing (PADS)
    5. MEDITECH
    6. Pharmacy and other database systems
    7. Mosiac for oncology
    8. Occupational Health and Safety Information System (OHASIS)
    9. Picture Archiving and Communication System (PACS).

    Current initiatives to enable the FSDoH eHealth strategy include:

    1. Connecting clinics using:
    • vSat
    • Microwaves
    • Distribution of 3Gs
    1. Some clinics have data initiatives with a minimum of 128k
    2. Tertiary, central and regional hospitals range from 512k to 2Mb.

    Ms Lekhu’s clear that all these initiatives aren’t enough to run all systems simultaneously. More investment’s needed to deal with practicalities such as:

    1. Scheduled backups and patches or updates to run at night
    2. Data being depleted before month ends, hampering services
    3. Delayed email deliveries, followed by  telephone call confirmations
    4. Connectivity strategies need expanding to roll out the Integrated Patient Information System (IPIS)
    5. An improved integration platform for information systems
    6. More people with ICT skills and programmers
    7. Need for a single patient information system
    8. Projects to implement the National eHealth and mHealth Strategy
    9. More capacity to import patient data, information and clinical notes into new databases
    10. Inadequate funding
    11. Enhanced in house skills of employees, including data capturers and healthcare practitioners.

    These are not exceptional just for FSDoH. Many health systems in many countries face equivalent challenges. The critical feature is dealing with them at pace that’s sustainable and successful. Ms Lekhu as three main recommendations to achieve them:

    1. A national driven eHealth implementation plan to guide provinces on when, where and how to invest
    2. A costed and funded business plan and conditional grant for implementing eHealth nationally
    3. Improved computer literacy for coalface officials.

    These will benefit the whole of South Africa’s health system. They also have a resonance with other countries’ eHealth strategies. Implementing eHealth strategies looks set to be a recurring eHealthALIVE theme.

  • Senegal’s recorded its eHealth strategy process for lessons learned

    Completing a realistic eHealth strategy’s not an easy task. Senegal’s done it and published how it’s done it through the Knowledge for Health (K4Health) IntraHealth International project. The Senegal team identified nine lessons learned:

    1. Allocate sufficient time to develop a credible scientific document and anticipate the financial resources needed
    2. Start with a baseline evaluation or a situational analysis that includes reviews of existing eHealth projects and players
    3. Apply a consultative, participatory approach where key players with diverse expertise are brought together for brainstorming
    4. Refer to countries that have an operational strategic plan and learn from their model while taking socio-economic factors into account
    5. Assess infrastructure
    6. Ensure that your country has appropriate legal norms in place
    7. Establish a realistic activity calendar
    8. Seek high level support for the strategy
    9. Refer to the WHO/ITU toolkit for guidance and tools.

    These are drawn from a Senegal setting of many eHealth initiatives intended to strengthen its health system. Needing to strengthening coordination and collaboration among all health system stakeholders, including ministries, partners, donors and the private sector, the Ministry of Health and Social Action (MOHSA) started working on national eHealth strategy in 2014. Early in 2015, with support from the United States Agency for International Development (USAID), the WHO, and the K4Health Project, MOHSA coordinated its eHealth Strategic Plan.

    The process was:

    1. Form a temporary technical committee with representatives from government and key implementing partners and donors to co-ordinate the process through regular meetings
    2. A desktop review of other countries eHealth strategies and processes used to develop them
    3. A situational analysis from interviews with government bodies, partners, and the private sector
    4. Inclusive and participatory working with stakeholders
    5. Create a dynamic national eHealth registry to record and update eHealth initiatives to support government’s decision making and unveil new business opportunities for the private sector
    6. Set critical success factors for developing Senegal’s eHealth strategy, including strong governmental engagement and support, commitment of partners for collective action, good financial backing, and strong leadership from the Office of the Director General for Health.

    While the process was inclusive and participatory, the scope of participation was limited to government and some implementing partners. This made the process more manageable. WHO provided technical assistance.

    Senegal’s recommendations to ensure the eHealth Strategic Plan is useful include:

    1. Establish an institutional framework to organise and coordinate all eHealth interventions.
    2. Establish a strong national steering committee that stimulates action and integrates M&E
    3. Ensure a multi-sectoral approach, with all services and directions in MOHSA engaged in implementation and M&E
    4. Integrate eHealth throughout the hierarchical structure of the health system, a health pyramid, and consider decentralising to a focal person supervising eHealth systems at national, regional, and district levels

    Other recommendations deal with:

    1. Finance and human resources
    2. Dissemination
    3. M&E
    4. Successful strategy implementation
    5. Monitoring implementation
    6. Approaches by other countries planning an eHealth strategy.

    Senegal’s strategy was completed in August 2015, six months after stakeholder engagement began in February 2015. It’d now be valuable if K4Health sponsored a commentary on progress on implementation and M&E, two activities many countries in and beyond Africa find challenging.