• Workforce
  • Can Africa’s eHealth projects avoid human burnout?

    As countries’ health systems move towards Universal Health Coverage (UHC), a challenge is to afford a new and optimum and sustained balance of resources to meet the increased demand. It includes a mix of extra health workers, more and better eHealth, and resultant gains in quality, access and efficiency. It’s an extremely demanding, integrated strategy.

    It’s also starting from a modest base. Africa’s eHealth investment needs boosting significantly and recruiting and retaining extra health workers is a long-term challenge. A report from Athena Insight shows its starting point may have even more constraints.

    In The business case for physician capability, US doctors’ burn out is identified as “48% of physicians think they’ll have trouble maintaining their workload over the long term.” The equivalent in Africa’s health systems for all health workers doesn’t offer an effective platform for the sustained engagement needed to expand eHealth for UHC. The time needed away from clinical activities will exacerbate burn out.

    On these findings, it’s important to include in eHealth programmes initiatives to fix burn out. Better capability reduces burn out from about to 51% to 27%. It includes skills and organisational changes. Jessica Sweeney-Platt, the report author, says “In an organization that emphasizes capability, team members have clearly defined roles and responsibilities. Leaders listen to the frontline and prioritize training, communication, and alignment. Innovation is prized and rewarded — especially innovation that results in fewer administrative tasks performed by physicians and other providers.”

    While the report doesn’t offer the business case one would expect from its title, it sets out some essential themes for organisational development that successful eHealth depends on. 

  • Malawi uses eCCM app to combat child mortality

    In Malawi, Health Surveillance Assistant’s (HSA’s) serve as a link between the the local community and the national healthcare system.  They make use of the WHO and UNICEF community case management (CCM) clinical decision tool to identify those requiring urgent referral to hospitals and those who can be treated at the local points-of-care before going back home.  The Supporting LIFE project has created an mhealth app that replicates this CCM tool to ease decision-making and workload for HSA’s.  

    The app supports a similar workflow to the paper-based CCM tool, allowing the HSA to enter patient information on an easy to use touch-screen interface.  It’s developed for the Android platform and is functional in an offline environment, making it ideal for countries like Malawi, where internet connectivity is a problem.  Power was also an issue during the Malawi pilot, so HSA’s were also provided with mini solar powered chargers for their devices. 

    During the pilot 3 indicators were measured to assess the potential impact of the app;

    Improvement in the number of children correctly referred to a health facility as a result of using the app.Increased attendance rates, as a result of correct referrals made by HAS’s using the app; andDecreased re-consultation rates through correct diagnosis and referral from the app

    The results of the pilot were presented at an mHealth strategy workshop and provided the health ministry and key policy makers with valuable data to improve the health systems in Malawi.  HSA’s using the app reported mostly positive responses.  

    While such projects offer great community benefits and health system improvements, further assessment is needed around the feasibility of scaling nationally, as well as integration with core systems like the DHIS2.

  • India steps up certification training for medical device makers

    High quality medical devices are imperatives for healthcare. It may become more important as Africa’s health systems adopt more Internet of Things (IoT) initiatives. India’s first state-of-the-art medical devices manufacturing park in Visakhapatnam, the Andhra Pradesh MedTech Zone (AMTZ), organised a two-day industry training programme on quality certification. The aim’s to shorten the time and cost of achieving globally recognised quality certification for India’s medical device makers.

    A report in eHealth Magazine says the course was organised by Quality Council of India(QCI)  National Accreditation Board for Certification Bodies (NABCB) and Association of Indian Medical Device Industry. (AIMED). Medical device manufacturers, medical professionals and industry stakeholders were participants.

    There’s a need to fill the regulatory space in quality certification for India’s medical devices in the country.  The main themes included:

    ·       Interpretations and understanding of Conformité Européene (CE),  the European Commission (EC) the  labrynthine guidelines and regulations and product marking

    ·       Industry Indian Certification for Medical Devices (ICMED) certification 9000 and 13485

    ·       New Medical Device Rules 2017. 

    This could be a template for equivalent events for Africa’s device makers and users. As IoT expands, devices will have to keep up. Regulations and training are a vital ways to achieve it.

  • EAC plans to address its healthcare workforce shortfall

    Most countries in Africa struggle with a shortage of healthcare resources, including skilled staff. The East African Community (EAC) states are no different. The region has a serious shortage of qualified medical specialists, a recent minister's report shows, and reported in allAfrica.

    The report says the region currently has less than 44.5 physicians, nurses and midwives per 10,000 people, WHO say 44.5’s the minimum needed to attain the health-related Sustainable Development Goals (SDG).

    A health workforce of adequate size and skills is critical to achieving the population health goals. Countries at all levels of socio-economic development face challenges in educating, training, deploying, retaining their health workforces.

    Consequnetly, EAC member states struggle to provide quality healthcare without addressing the issue of training of human resources for health. "Our efforts to achieve SDG 3 on good health and wellbeing and in particular the universal health coverage is very much dependent on how we address existing human resources for health challenges," said Ugandan Minister of State for Health, Dr Sarah Opendi.At the recent EAC ministerial meeting on health, she said the population of the region had grown tremendously over the years without corresponding investment in healthcare staff training.

    To address the shortage, the EAC announced plans to establish a college of medicine and health professions. The facility will provide and award specialist postgraduate training fellowship qualifications in medicine and other health professionals in East Africa.

    The EAC has also established centres of excellence in the medical and health sciences, which would enable the partner states to address the shortage of medical staff. EAC has designated five centres of excellence in health and allied sectors in the region. These are the Health Institute (Tanzania), Cancer Institute (Uganda) and Nutritional Sciences Institute in Burundi. Others are Biomedical Engineering, eHealth and Health Rehabilitation Sciences in Rwanda and Kidney Institute in Kenya. This’s a model for other African countries to consider.

  • Does mHealth care for the carers?

    A recent eHNA post described a range of eHealth definitions. It included Acfee’s, which extends eHealth to mHealth and a wide range of stakeholders that includes patients, carers and communities. A report in mHealth Intelligence says a study in the US found that mHealth initiatives for older people often neglect the role of, and benefits for, their carers. It’s an important finding for Africa’s mHealth for all patient groups.

    This seems to have resulted in barriers to technology adoption for carers who see a lack of awareness, cost, and time. It’s more pronounced for carers aged over 49. Carers younger than this want to use mHealth more than their older peers.

    Despite this, they’re clear on what they’d use mHealth for. It’s: 

    mHealth that offers peace of mind’s their top priority Tools to ensure medications are managed accurately and easily Help to monitor a loved one Access to trusted online services and advice.

    They also want mHealth that:

    Is based on integrated, interoperable, multi-faceted platforms that help them to coordinate tasks and disseminate appropriate information Isn’t too expensive and complex, so should be worth the investment of time and money, especially for mHealth that’s only useful rarely and in emergencies.

    While these goals can be included in Africa’s health systems’ eHealth strategies, they need reinforcing in each mHealth project. One requirement needs health ministries to take direct action on standards. Moving mHealth into an interoperable and integrated setting needs a set of standards that extend across projects and into other eHealth initiatives, such as EHRs. As mHealth expands in Africa, this will become an increasing requirement. It’s better to start now.

  • Medical Aid Films help transform health worker training in Nigeria

    Medical Aid Films, InStrat Global Health Solutions, Digital Campus and mPowering Frontline Health Workers, are teaming up to work with Nigeria’s Ondo State Primary Health Care Development Board to launch a new maternal and child health training curriculum for nurses, midwives, and Community Health Workers (CHW). The initiative will use tablets to access the training films.

    The twelve-week pilot programme will support in-service training for 200 health workers in 18 health centres in Ondo State. It’ll provide high quality film-based training in English and Yoruba.   Topics’ll include antenatal care, managing obstructed labour and resuscitating newborns. The goal’s to scale this programme to all Ondo State’s 550 health facilities and train 5,400 health workers who provide services to 1.4 million women.

    At the programme launch, Dr Dayo Adeyanju, Honorable Commissioner for Health for Ondo State, said “We hope to adopt this tool in our health institutions such as the Schools of Nursing, Health Technology and University of Medical Sciences. Getting to train workers has been quite challenging and this will help in solving this challenge. This will surely save cost and extend training coverage."

    Four other State Primary Health Management Boards in Nigeria have expressed interest in the programme, significantly expanding its potential benefits. It can be translated into other Nigerian languages for use across all the country’s States to play a core role in providing millions of women and children with access to high quality care and improve their survival rates and general health.

    Ondo State Primary Health Care Development Board’s Director of Planning, Research and Statistics, Dr Yetunde Olagbuji, said “This is an innovation we will adopt and enforce to be a method for our trainings. We will also go further in exploring the opportunities it presents and put it to effective use. This will surely cement Ondo State's agenda of delivering quality health care services."

    Nigeria is one of Africa’s economic powerhouses, but is in a global group of countries with the highest rates of maternal mortality. The new training programme will support better health worker training across all of Nigeria and enable them to identify and manage complications early and provide better quality care during pregnancy and childbirth.

    eHNA will provide updates on progress. It can see the potential for the initiative across all-Africa.

  • Three ways to gain doctors' support for eHealth

    Doctors, like many of us, don’t like change. They are also hesitant to use new technologies that claim to make their lives easier, save time or cut cost, and who can blame them? The truth is, many eHealth initiatives can help make data capturing more effective and support decision making, but some may require more time and work from doctors and nurses.

    To move beyond doctors’ reluctance, and to engage with telemedicine, Robert Pearl, MD, executive director and CEO of Permanente Medical Group and president and CEO of the Mid-Atlantic Permanente Medical Group, says "crucial steps" must be taken to encourage doctors to embrace the new technology, says an article in Fierce HealthIT.

    The three steps are: 

    Explain the value: guidelines alone won't attract doctors to telemedicine; they must know how it will help their patients and why it's an important step forward in effective care Consider workload: if doctors see telemedicine as added work, they’ll be less likely to accept it, so to lessen the burden, practices should consider having staff to help with virtual visits and reward specialists for adding new consultations no matter whether they are in-person or virtual Remember culture: at Permanente Medical Group, Pearl says they make sure doctors know they’re supported and won't be penalised for using telemedicine, such as the initiative to give its doctors iPhones and pay for data plans so they can communicate with colleagues and patients at no extra cost. 

    These simple steps may go along way to encourage doctors and healthcare workers buy in. It’s key for telemedicine and all eHealth services. Without support of healthcare workers, these initiatives can’t succeed, so it’s crucial to secure their input and support throughout the implementation of any eHealth project to make sure they deliver real value and meet users’ needs without adding extra pressure, anxiety and strain on their time.

  • IntraHealth helps many African health workers

    As an aid agency, IntraHealth International has a very wide range of healthcare activities. Digital health’s one of them. With extensive USA leadership, IntraHealth aims to develop technology solutions that help health workers around the world provide high quality services. It encourages open source, data-driven, sustainable and collaborative eHealth and is a pioneer of health workforce informatics. This is using technology, information and analytics to support the people at the heart of health systems.

    A combination of systems approach and technological expertise builds on goals to:

    “Foster local capacity, ownership, and talent in health information technologies Create national health information ecosystems that use open and convergent standards and approaches to eliminate technology and data silos Help health officials make better, more informed decisions about health workforce policy, planning, training, regulation, and management Help health workers deliver better health services through effective mobile, decision-support technologies, telemedicine, and related approaches Provide health workers with access to digital learning and online knowledge resources to ensure appropriate just-in-time information Broaden the reach of health workers by facilitating communication and coordination among peers, clients, managers, and experts around the world.”

    Its services include:

    iHRIS, to help countries track and manage their health workforce data OpenHIE Health Worker Registry, to help to understand the scope of their health workforces, and provide information on health workers.

    Commentaries on the range of eHealth set out their features and impacts. They show the benefits that they offer to the 21 African countries where it works. They’re Benin, Botswana, DRC, Ethiopia, Ghana, Kenya, Lesotho, Madagascar, Malawi, Mali, Mozambique, Namibia, Nigeria, Rwanda, Senegal, South Africa, South Sudan, Swaziland, Tanzania, Uganda and Zambia. 

  • A medical Prof has a fresh eHealth vision

    Gurpreet Dhaliwal is Professor of Medicine at University of California, San Francisco. He’s also a physician at the San Francisco VA Medical Center. He’s described his different eHealth vision in the Wall Street Journal. It fits the way that African countries can approach their eHealth initiatives.

    It starts from his view that technology has a lot to offer doctors, but it’s different to the healthcare technology in the news, such as Big Data, EHRs and the connected patient. Improving and restoring health needs more than this physical capital. It needs investment in human capital too.

    First, Big Data using correlations in huge data sets seldom changes clinical and working practices. They’re more akin to preliminary research findings, so not ready to apply until they’re confirmed, scrutinized and distilled by conventional, rigorous testing. Clinicians need constant exposure to findings from high-quality studies and synopses. Twitter can disseminate these.

    EHRs are forensic document, billing and communication tools. They’re not learning tools. Patient lists and reminders are good, What’s needed now is a real time message service triggered by patients using healthcare, such as when they’ve had tests or outpatient attendance.

    Prof Dhaliwal wants a connected patient service where updates are from his patients. It needs routine use of SMS, text, email and videoconferencing follow-ups. Many doctors do it, so already have a foundation to build on.

    If African countries follow a more traditional eHealth route, it could diminish the benefits they realise. Building on Prof Dhaliwal’s vision can help them to achieve more.


    Image from the New York Times

  • EHRs may need extra staff

    A claim for EHRs, and eHealth in general, is that they save time. They may save some staff time, but they also need extra staff. A report in Market Place Health Care says “The medical scribe industry has been booming in recent years, fueled largely by hospitals around the county switching to electronic medical record systems.”

    It refers to Cheyenne Regional ER Doctor Amy Tortorich saying that EHRs are much more comprehensive than the paper files or computer spreadsheets the hospital used to use. They also take much longer, needing about 10 minutes per patient. She usually sees about 30 patients a day. “That’s an extra five hours charting. So half my shift, almost half my shift.”

    This is only part of the story. She also says she sees more patients, who usually leave happier, making medical scribes well worth their cost. From an African perspective, the increased EHR workforce results in affordability challenges that lead to productivity gains. This makes the benefits of EHRs harder to assess.

    An indication of the affordability challenge is from Scribe America, one of the biggest USA medical scribe companies. It’s tripled its growth in a year to almost 7,500 employees in 47 states. iHealth Beat says the American College of Medical Scribe Specialists estimates that the number of medical scribes in the U.S. will increase from about 20,000 today to about 100,000 by 2020. Their job includes entering patient data using medical terminology and billing codes and recording physicians’ notes during consultations.

    As Africa’s eHealth moves on, it’s important it knows how these features need building in. An optimal relationship between affordability and productivity’s not easy to find.