• Workforce
  • Successful eHealth needs capacity building

    Africa’s health-care system is undergoing an eHealth revolution. The technology is new, but it must be used by the existing health workforce.

    A critical finding in my master’s research, is that eHealth needs better investment in educating and capacitating users of eHealth. Another report by the British National Health Service found that a lack of training for healthcare providers created barriers to eHealth care. In Africa, we face the same challenge. 

    Technology on its own, no matter how effective, cannot bring about healthcare revolution without acceptance and proper use by healthcare workforce. An implementation strategy which addresses the barriers to effective adoption of these technologies will be critical to their success.

    Capacity development has multi-layer benefits;

    For staff it can increase overall job performance and satisfaction. For the healthcare organization or facility, it can improve effectiveness and profitability.Even at the societal level, training and development can increase the quality of the labour force, which in turn is a contributing factor to national economic growth.

    By developing a workforce that is able to confidently use eHealth technologies and services, African countries could implement their national eHealth more successfully and move closer to achieving universal health coverage.

  • Rome Business School has a short course on using the Digital Health Investment Framework

    eHealth finance and economics are core components of the  Masters in eHealth and Telemedicine Management at Rome Business School. The module includes an assignment on using outputs for the Digital Health Investment Framework (DHIF), an Asian Development Bank initiative.

    An important theme in DHIF is equipping users with the skills and knowledge to begin using it to support eHealth investment decisions. Building on this, the School now has a short course of five sessions on DHIF, all available online.

    The first course starts in February 2019. Participants can Enrol now.

    The course objectives are:

    Identify the architecture, characteristics and the roles of a DHIF modelUnderstand the concepts and methodology using illustrative DHIF modelsApply DHIF to real-life projectsReview DHIF illustrative models.

    Learning outcomes are:

    Understand and develop investment goals of health, healthcare, and digital health strategiesDefine different stakeholders’ types, user requirements and required functionalityHow to develop DHIF architecture and contentIdentify appropriate network requirements, and data and capacity dependencies from other eHealth investmentsDevelop personal skills in stakeholder engagement, human capacity building in using the DHIF and change management skills

    Contents are:

    Introduction to DHIFIntroduction to eHealth costs and benefitsIntroduction to decision makingPutting it into practice, using participants own DHIF models.

    Two organisations, Società per la Salute Digitale e la Telemedicina (SIT) and Acfee are patrons of the School's Masters in eHealth and Telemedicine Management. The DHIF short course is linked to its eHealth finance and economics module.

    The DHIF course is appropriate for Acfee’s eHealth Investment Model for Africa (eHIMA), reported in eHNA. It will enable participants from Africa’s health systems to achieve a fast start up.

  • Can Africa’s eHealth 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.