• Leadership
  • AeF: Africa's eHealth solutions are specific

    Too many simultaneous or large-scale eHealth solutions increase the risks of delay and unfulfilled benefits. It’s encouraging that the African eHealth Forum identified a fairly narrow band. It’s consistent with the African Centre for eHealth Excellence’s (Acfee) approach to finding an achievable fit to eHealth priorities. The AeF report Advancing eHealth in Africa sets out more details.

    It isn’t surprising that the range isn’t wide, with the tight sustainability and affordability constraints of African countries. The band includes:

    Integrate health information and management information systems Sharing data between health workers and health and healthcare organisations EHRs, which can incorporate patient and medical records mHealth, which extends across a wide range of health conditions eSurveillance, given increased emphasis by the WHO   Telemedicine, which can include telemonitoring Supply chain management District Health Information System (DHIS) 2 ICT collaboration eLearning for a wide range of health workers, including eHealth and professional training. 

    Each of these carries different levels and relationships of risk and reward. EHRs can be seen as the Himalayas of eHealth. When they’re successful, the benefits are spectacular. Reaching this view is laden with risks, and not everyone achieves them, and in a few cases, they have to be abandoned.

    Other types of eHealth are lower risk, but the benefits are lower too. Reporting and management eHealth has perhaps the lowest risks and offer few benefits for patients, carers, communities and health workers, hence the need for a balance of investment between eHealth at points of care and management reporting. 

    Recent experience for Africa is that eSurveillance investment needs strengthening to achieve greater rewards. The investment risk is quite high, but the risks of insufficient investment are higher. eSureveillance’s priority is increasing. After the Ebola epidemic, it’s a must.

  • AeF: eHealth challenges are massive

    Challenges, is a nice way of describing inhibitors, and eHealth’s full of them. In Africa, they’re pervasive and hard to remove. Ignoring them doesn’t work. They won’t go away.

    There are many different types of eHealth. The potential to improve health and healthcare is considerable. The probability they will is problematic. It’s helpful to spread out an array of contributions before delving into the details. This strategic context is the African Centre for eHealth Excellence’s (Acfee) approach to finding a good fit to eHealth priorities.

    Acfee’s dialogue with its Advisory Board and industry partners at the African eHealth Forum (AeF) identified an enormous range of eHealth challenges, more than 60 of them. The AeF report Advancing eHealth in Africa sets out more details.

    Africa’s eHealth challenges are the critical theme to emerge from the 2015 Forum. Its scale and scope exceed eHealth’s other facets, and it’s essential that countries identify and fix these alongside and before eHealth investment. Countries need to ask several questions. What are our relative priorities? How do we decide? How do we fix them? When do we fix them? 

    A simple picture shows how the challenges are broader than other eHealth topics. It’s an illustrative measure of their relative scale and importance.


    Many participants were surprised at the scale of the eHealth challenges identified in the Forum. They include measures to deal with them in their eHealth policies, strategies and implementation plans. Countries need to allocate resources to put in place the eHealth enablers to overcome them. There are several ways to do this, and they revolve around integrating and timing eHealth enablers and eHealth applications.

    Acfee’s incorporating the new information on eHealth challenges into its eHealth curriculum and courses, eHealth leadership models and human eHealth capacity services, and preparing bespoke advice to countries and projects to provide them.

    An example of the scale is in the diagram.


    It’s only about half the number of challenges identified by the Forum. Another diagram’s in the AeF report along with a classification of:

    Strategies Capacity Relationships with suppliers              Sustainability eHealth performance Health informatics Business cases Benefits realisation Regulation and governance Procurement Medical education Country scale.

    Dealing with this extensive range of eHealth challenges needs a set of steps. Acfee’s earlier research and evaluations of eHealth provides some suggestions. Successful eHealth has shown that the challenges can be addressed in sequence alongside eHealth projects. Success requires that the sequence is right, the measures to deal with them are effective, and that eHealth leadership is of the right type to succeed. Steps are:

    Identify specific eHealth challenges in eHealth strategy Develop risk mitigation plans to track their impact and significance Select the challenges relevant for each eHealth project in the strategy Select the sequence needed for maximised benefits from successful eHealth Design the measures needed to deal with effectively Allocate resources to them Implement them alongside the eHealth project.

    As part of the risk assessment and mitigation, it’s essential that countries and suppliers are clear about the challenges that need fixing for success and maximised benefits. While countries are often clear about the eHealth challenges face, it’s vital the vendors are too.


  • Three African Presidents recognized for their ICT development

    The Internaional Telecommunications Unions (ITU) has launched an annual award recognising leadership in sustainable development through ICTs to drive the global 2030 development agenda. ITU emphasized the vital role that ICT will play in meeting the new Sustainable Development Goals (SDG). An article in BIZTECH Africa says three African Heads of State were recognized for their achievements and were among the recipients of the prestigious award:

    Mr Ali Bongo Ondimba, President of the Gabonese Republic Mr Uhuru Kenyatta, President of the Republic of Kenya Mr Paul Kagame, President of the Republic of Rwanda

    The award was presented by ITU Secretary-General Houlin Zhao at a Gala Dinner hosted by the Global Sustainability Foundation (GSF), which celebrated ITU’s role in ‘Connecting the World’. “The leaders recognized at this event set the benchmark for improving access, affordability and application of ICTs to drive socio-economic development,” said ITU’s Zhao.

    ICTs play a pivotal role in achieving the post-2015 development agenda, enabling access to key development tools. Good health and wellbeing has been identified at the third SDG. eHealth and mHealth will be crucial in attaining these goals. mHealth tools have the potential to open access to medical care, both for health workers and patients, reduce costs for prevention, diagnosis and treatment of non-communicable diseases, and long-term and preventable illnesses. It also needs investment up-front.


    Image from BIZTECH AFRICA 

  • Ibrahim Leadership Fellowship Programme

    The Ibrahim Leadership Fellowship Programme is a selective Fellowship. It prepares the next generation of African leaders by providing them with unique work opportunities at senior levels of prominent African institutions or multilateral organisations whose mandates are to improve Africa’s economic and social prospects. The Fellowship allows talented individuals to increase and enhance their professional capacity, so contribute to the governance and development of their countries. The momentum creates a pipeline of future African leaders.

    New positions have opened for 2016. The anticipated start is early May 2016. The paid fellowship position is available for a twelve month period. Prospective fellows who meet the eligibility criteria are invited to apply directly to the current host, the African Development Bank (AfDB). The position in the AfDB is financed by the Mo Ibrahim Foundation. The Fellow will perform the functions and duties of the position at the headquarters of the Bank in Abidjan in Côte d’Ivoire, or in another location where the Bank carries out its operations. Deadline for submissions is Monday, 9 November 2015.

    To be eligible to apply the applicant must meet the following criteria. More detailed criteria is available on the website. Eligibility criteria include:

    National of an African country Between seven to ten years of relevant work experience Master’s degree Under the age of 40, or 45 for women with children Any additional criteria as set by the AfDB.

    The list of duties to be performed by the fellows is extensive. This is a great opportunity for young Africans waiting to develop their leadership skills and gain valuable insights and knowledge. Applicants can apply online.

    Dr Mohamed "Mo" Ibrahim is a Sudanese-British mobile communications entrepreneur and billionaire. He worked for several other telecommunications companies. His Foundation also produces the Ibrahim Index that measures African countries governance.

  • AeF: eHealth contributions are wide-ranging

    There are many different types of eHealth. The potential to improve health and healthcare is considerable. The probability they will is problematic. It’s helpful to spread out an array of contributions before delving into the details. This strategic context is the African Centre for eHealth Excellence (Acfee) approach to finding a good fit to eHealth priorities.

    Acfee’s dialogue with its Advisory Board and industry partners at the African eHealth Forum (AeF) identified eHealth contributions. The AeF report Advancing eHealth in Africa sets out more details. You can access the report from the left tab on eHNA Home page.

    Investing in eHealth needs links to health and healthcare. It should seek to identify the impact of various types of eHealth in integrating and co-ordinating health and healthcare information for patients, carers, communities, health workers, managers and policy-makers. A diagrammatic summary from the AeF report shows the range of contributions.

    A starting point can be adopting appropriate themes from the following range of eHealth contributions with the aim to make eHealth a pillar of health system strengthening:

    Have an overarching goal to provide personalised and responsive healthcare for all Provide real-time and better quality data patients, families, carers, communities and health workers Share data between health workers and health and healthcare organisations Improve diagnostic abilities in primary health care Provide access to patient records for authorised patients and health workers Quantifying impact adequately, both in business cases and monitoring and evaluation Improve and expand surveillance Provide attendance reminders Support patients, carers, individual health workers and developing virtual healthcare teams Save health workers’ and patients’ and families’ time eLearning for professional training to minimise skills shortage Reduce technical barriers Rationalise routines, such as reporting and follow up Telemedicine for countries that lack specialists and have to refer patients to other countries, such as small countries and small island states Support health information research Develop and improve consistent referral systems and coordination.

    Fitting each of these to a countrys health and healthcare priorities requires a complex assessment model. Their impacts can change over time. A good example’s providing information for research. The short term benefits may be nil, but the long-term ones could be considerable. The case for specific types of research may justify it being pursued.

    The potential of some may be enormous, the probability after adjustment for risks may be modest. African countries need to assess factors like these rigorously before embarking headlong on an investment track. Headlong and investment are two words that are best not used together for eHealth investment.

  • AeF shows healthcare priorities have high level themes

    Africa has well known constraints in its healthcare. Not all priorities can be met within extremely constrained healthcare resources. For successful eHealth, it’s essential that it helps to deal with the high priority ones. It’s this strategic context that the African Centre for eHealth Excellence (Acfee) includes in setting eHealth policies, strategies and programmes.

    The dialogue with its Advisory Board and industry partners at the African eHealth Forum (AeF) identified the healthcare priorities that go beyond goals of health system strengthening. A wide range of integrated initiatives are needed, and eHealth’s role’s outlined the Advancing eHealth in Africa. You can access the report from the left tab on eHNA's Home page.

    Meeting more healthcare priorities needs more and better healthcare. It means improving its current capacity and capability and equipping it to deal with the growth in health needs and demands. There are a few main, longstanding themes, each of which has their own complexities and specific solutions. eHealth’s part of achieving these. It can help to:

    Improve healthcare commitment, quality, cost-effectiveness and efficiency Improve responses to epidemics, including prompt identification and recognition and resource deployment Reach rural communities for both basic and complex healthcare, including better post and ante-natal care Reduce reliance on health services in other countries.

    The diagram shows a summary from the report.

    Behind each of these, there’s a considerable array of changes and transformations needed across a wide range of healthcare activities. Each African country has its own relative healthcare priorities, and these need identifying and linked to specific contributions that various types of eHealth can provide.

  • AeF's report focuses on saving lives

    Africa has well known health problems and priorities. For successful eHealth, it’s essential that it helps to deal with the high priority ones. It’s this strategic context that the African Centre for eHealth Excellence (Acfee) starts from in setting eHealth policies, strategies and programmes.

    The dialogue with its Advisory Board and industry partners at the African eHealth Forum (AeF) identified the health priorities that include two overarching goals:

    Prevent avoidable deaths Improve health and productivity.

    These link to other priorities. One is to improve the widening mortality gap because women are living increasingly longer than men. eHealth also needs to help to provide for more people, especially:

    Children, to meet the needs of 50% more children in the next 35 years forecast by UNICEF High-fertility rates and increasing numbers of women of reproductive age, resulting in the birth of two billion babies in Africa over the next 35 years Doubling of continent’s population, and its under-18 population increasing by two thirds to almost a billion.

    The result will be immensely increased demand on healthcare and education arising from these demographics. These are outlined in Advancing eHealth in Africa, the report of Acfee’s first African eHealth Summit. You can access the report from the left tab on eHNA's Home page. It includes a diagram showing the wide range of health priorities that eHealth has to contribute to.

    The relative emphasis of these will differ between countries, and some will have additional priorities. Explicit links to eHealth plans are needed to set eHealth priorities and projects in a way that helps to meet countries’ health goals. Not all these provide immediate benefits, but projects need setting in a sequence that maximises sustainable, big scale, medium and longer term health gains. A checklist includes:

    Expanded access to reproductive health services, Greater empowerment of citizens over their health Better maternal and child health, including better pregnancy and ante-natal and post-natal care Improved rural populations’ health Meeting other MDG and SDG goals Continuing progress on infectious diseases Continuing improvements dealing within Communicable Diseases (CD) with more sustained action Increasing improvements in dealing with Non-Communicable Diseases (NCD) with new and sustained action Trauma services that cope with increasing demand Action to prevent illness, including reduced obesity Improved responses to epidemics, including expanded and improved eSurveillance Stronger civil registration and vital statistics systems.

    These are daunting priorities for Africa’s resource-constrained health systems. It’s essential that affordable and effective eHealth plays it role in full.

  • What does Acfee do?

    eHealth in Africa offers lots of promise, but achieving it within healthcare’s resources is extremely challenging. Collaborating, sharing and developing supportive tools are ways to compensate. It’s in this context that the African Centre for eHealth Excellence (Acfee) aims to help to advance eHealth in Africa. Acfee’s dialogue with its Advisory Board and industry partners at the African eHealth Forum (AeF) is part of it and ensures that Acfee can:

    Obtain guidance from eminent African health leaders to ensure that Acfee’s priorities are aligned to Africa’s health sector needs Clarify priorities, goals and challenges for eHealth in Africa Provide a mechanism to bring together leaders in health and eHealth in Africa.

    These are outlined in Advancing eHealth in Africa, the report of Acfee’s first African eHealth Summit. You can access if from a link in the left panel of eHNA’s Home page. Underpinning this is Acfee’s set of three main perspectives, discover, learn and lead:

    1.     DISCOVER:

    Share knowledge Disseminate information Share cost effective measures Identify opportunities and challenges

    2.     LEARN:

    Develop capacity of eHealth’s human capital Collect and understand findings on good and weak practices

    3.     LEAD:

    Advocate for eHealth resources Promote recognised eHealth standards and norms Develop eHealth leadership Expand human eHealth capacity Share best practice Help to improve eHealth strategies Encourage communication.

    This provides structure and direction for generic tools and methodologies for African countries to use in their eHealth endeavours. The dialogue at Acfee’s AeF helps to assess and review the model and its priorities. AeF 2015 identified several new themes to extend Acfee’s service. These’ll be summarised in subsequent eHNA posts.  

  • Why can eHealth leadership be so hard?

    It’s widely recognised that good leadership’s essential to change. With eHealth’s complexities, good eHealth leadership’s vital. The African Centre for eHealth Excellence (Acfee) sees it as a combination of three types of leader, clinical, political and executive, and they’re not limited to three people at the top of an organisation’s wiring diagram. The skills needed are a combination of generic leadership and the specific requirements of eHealth’s context. These are part of Acfee’s Future eHealth Leaders initiative for Africa’s health systems.

    Emotional Intelligence (EI) is a generic component. It has four main parts, described by Goleman et al in Primal Leadership published by the Harvard Business Review (HBR). They’re:

    Self-awareness Self-management Social awareness Relationship management.

    A core leadership theme’s about the exercise of power. “Friend and Foe: When to Cooperate, When to Compete, and How to Succeed at Both” is by Galinsky and Schweitzer from the Wharton School of the University of Pennsylvania. They emphasise the importance of a generic leadership phenomenon. With leadership, comes power, and power brings both increased self-confidence and self-centredness. It also increases their willingness to take risks. Colloquially, power goes to their heads.

    eHealth leaders need their EI to keep these in check. eHealth is a high risk endeavour, so EI is critical to avoid stepping up the risks unnecessarily. eHNA has numerous articles on eHealth projects that have suffered from unmitigated risks. It’s important that eHealth leaders don’t aggravate the dangers and mitigate the risks.

    Engagement is an essential component of eHealth success. It requires eHealth leaders to listen to and learn from others, especially health workers. Increased self-centredness makes this harder to achieve, so EI has to help.

    Both publications show that eHealth leadership isn’t about adopting a formula. It’s about developing leaders to cope with, and succeed with complex change to themselves, health workers, communities and health systems. It’s an especially tough assignment for Africa where eHealth resources and opportunities are constrained and challenges are widespread, as Acfee’s African eHealth Forum report "Advancing eHealth in Africa" revealed. You can access it via a link on the left panel of eHNA's Home page.

  • Acfee's African eHealth Forum report's out

    Towards the end of July, the African eHealth Forum (AeF) met for its first time in Cape Town. Its report was published today. You can access it by clicking the link in the left panel of eHNA's Home page.

    The Forum is where the African Centre for eHealth Excellence’s (Acfee) management team consults with its Advisory Board, industry partners and other stakeholders, to exchange their experiences of eHealth in Africa to seek better ways ahead. Advancing eHealth in Africa summarises the dialogue and proceedings.

    Its analysis is constructed around a process of:

    Health priorities Healthcare priorities eHealth contributions eHealth challenges eHealth solutions Acfee’s action plan.

    The core theme out of the Forum was that for African countries, successful, expanded eHealth investment depends on dealing with long-standing eHealth challenges.

    There are two sets of findings. One’s for countries; the others for Acfee’s medium-term action plan for its priorities and activities. For countries, the most important health goal is seen as saving lives, so eHealth has to contribute directly to this, and countries’ other health and healthcare goals.

    Achieving it needs countries to rebalance their eHealth strategies and plans in three ways.

    First, increase investment in meeting their eHealth challenges, not just investing in new eHealth applications Second, invest in a larger number of smaller-scale eHealth initiatives, not just large projects Third invest more in information at healthcare’s numerous points of care that benefit patients and health workers directly, rather than the current dominance of reporting and management information.

    Acfee thanks the members of its Advisory Board for the commitment and inspiration provided as we begin this journey of action 
for advancing eHealth in Africa together.

    eHNA will be summarising the report in a series of posts over the next few days.