• An ITU/WHO “how to” guide for building interoperable digital health infrastructure

    As we strengthen African national eHealth strategies, interoperability is gathering momentum too. It's a critical component of our national eHealth programmes. We are looking for a common, comprehensive framework, incorporating all data sources and information flows, both electronic and paper-based, providing a clear development and consolidation path for all components, along a digital development maturity model.

    Fortunately, there’s a handbook about how to do it: Digital Health Platform: Building a Digital Information Infrastructure (Infostructure) for Health, published by the International Telecommunications Union (ITU) in collaboration with the World Health Organization.

    The figure below provides a high level overview of the Digital Health Platform (DHP) concept, its components, and how users interact with it. 

    Figure: How a DHP interacts with external applications and users

    The handbook suggests that a well-designed DHP will help countries to achieve the following priorities:

    Overall quality and continuity of careAdherence to clinical guidelines and best practicesEfficiency and affordability of services and health commodities, by reducing duplication of effort and ensuring effective use of time and resources Health-financing models and processesRegulation, oversight, and patient safety resulting from increased availability of performance data and reductions in errorsHealth policy-making and resource allocation based on better quality data.

    The DHP Handbook illustrates how DHP components are derived from the National eHealth Strategy. It is a detailed guide including illustrative case studies from Liberia, Estonia, Canada, India and Norway. It’s essential reading for African countries’ as we invest in our national eHealth programmes.

  • WHO can help you keep up to date on global eHealth trends

    Awareness of eHealth achievements and dynamics from other users is crucial in framing eHealth strategies, investment decisions, benefits realisation and mitigating risk exposure. Finding the information’s often a challenge. A new publication from Johns Hopkins University Bloomberg School of Public Heath in collaboration with WHO can help.

    The first issue of Global Health: Science and Practice was supported by an Aetna Foundation grant. It deals with five themes:

    Establishing standards to evaluate eHealth’s impact on health systemsGovernanceFinancing UHC in low and middle income countriesWorkforceHealth service supply side and demand generation.

    These themes fit into WHO’s eHealth themes of information and research, governance, financing, workforce and health services. Africa’s health systems can use the findings to support the sustainability and direction of their eHealth trajectories.

    Within these, it’s important to avoid strategic mistakes identified by Rosabeth Kanter:

    Rejecting opportunities that initially seem too smallAssuming that new services and improved processes aren’t strategic goalsLaunching too many minor service changes the confuse stakeholders and increase internal complexity.

    These are some of her innovation traps. Africa’s health systems don’t need them.

  • The next WHO DG is from Africa - are these the main challenges and opportunities?

    It’s with considerable pride that eHNA can post about WHO’s next Director-General’s from Africa. Tedros Adhanom Ghebreyesus, a former health minister and foreign minister of Ethiopia, will be WHO’s next Director-General (DG). He’s the first African to lead the UN agency.


    The Thomson Reuters Foundation asked global health experts and charity leaders what the new DG’s priorities should be. Their answers are in an article in allAfrica.


    He’ll immediately be confronted by an extensive array of urgent, long-term public health challenges. They include:

    Outbreaks of highly infectious global epidemics such as Ebola, cholera, yellow fever, Zika and MERSGlobal rise in Non-communicable Diseases (NCD), such as cancer, diabetes and heart diseaseImpact of stress and hardship on mental health and wellbeingContinuing fight against HIV, malaria, TB and maternal, adolescent and child health.

    WHO must also help drive Universal Health Coverage (UHC) and bridge the divides between global, national and local communities’ health systems. These can determine the courses of outbreaks or health risks.

    Health challenges start and end in communities, so the new DG must be ready to put people at the centre. One way’s to give local communities a seat at the global public health table to contribute to building a stronger, more resilient and healthier world.

    Building on Africa’s health ministers’ recent eHealth leadership initiative in Geneva, reported on eHNA, is a specific priority for Africa. It includes leading advances in technology and using open access data bases and data warehouses, eHealth innovation and mHealth technologies. There’s an opportunity for WHO to embrace and promote these more effectively. This needs a context of WHO calling on new ideas and innovations if it is to meet the numerous health challenges facing communities.

    Other initiatives include:

    Expanding strong confidence in WHO’s role in rapidly responding to, managing and containing emerging and re-emerging infectious diseasesEnsuring there is international and national leadership regarding the major health threat of antimicrobial resistance and the management of drug resistant infections, including CDC’s outpatients antibiotic stewardship plans, reported on eHNAEmphasising healthcare workers’ protectionAddressing inequality in health by promoting quality healthcare to disadvantaged communities, especially women and childrenExpanding and broadening WHO’s funding base beyond the US and Europe

    The WHO has a tremendous opportunity to accelerate recent advances in global health. Tedros can spearhead a highly effective, efficient, and forward-thinking WHO that embraces innovation, to achieve a world where affordable, quality healthcare’s in reach of those currently denied it. It’ll take time. It’s a never ending journey. eHNA looks forward to the new DG taking Africa further along the road.

  • Big Data is not big in Africa’s eHealth - unpacking the 3rd Global Survey on eHealth

    As a relatively new part of eHealth, Big Data has a negligible effect on Africa’s health systems and eHealth programmes. Big Data insights are in Chapter 8 of the WHO and Global Observatory for eHealth (GOe) publication eHealth Report of the third global survey on eHealth Global diffusion of eHealth: Making universal health coverage achievable. WHO Global Survey 2015 provides the data source for the report.

    It hasn’t taken off globally yet. Fewer than a fifth of countries say they have a national policy or strategy for regulating Big Data in health and healthcare. In Africa, it’s about 2%. This Big Data deficit isn’t much of a cause for concern. As the eHNA posts about WHO’s report show, Africa’s health systems have many other eHealth priorities. One that wasn’t included in WHO’s survey is stepping up cyber-security. Acfee’s report from its African eHealth Forum (AeF) our priorities include  cyber-security and others, such as Interoperability (IOp), cloud computing, eHealth governance, regulation and capacity building are well ahead of Big Data.

    WHO found that a lack of integration, privacy and security are major barriers to Big Data adoption. It’s constructive that Africa’s health systems are focusing on these as part of their expanded eHealth initiatives. Acfee’s activities in 2017 will support them.

  • Africa’s social media for health looks strong - unpacking the 3rd Global Survey on eHealth

    Africa is using social media for health. Insights are in Chapter 7 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. WHO Global Survey 2015 is the data source.

    The main theme is that social media provides an important means to convey messages for health organisations and receiving and sharing information for individuals and communities. A downside is that there’s still plenty to do to understand how its potential can support Universal Health Coverage (UHC).

    Key findings include:

    Nearly 80% of countries say healthcare organisations use social media to promote health messagesNearly 80% say individuals and communities use it to learn about health issuesIn over 62%, individuals and communities use social media to run community health campaigns.

    While, as usual, Africa lags behind the global position, its social media use is relatively high. Health organisations using it to promote health messages as a part of health promotion campaigns is not too far below global rates. Individuals and communities using it to learn about health issues is close to global rates too. Other uses tail off.

    It reveals two goals for African countries; do more and find the best ways to use social media. eHNA finds, collects and posts on research and commentaries on social media. Some social media makes no difference to health, for some, it’s not clear what difference it makes, for others, it’s effective. All findings provide valuable lessons for Africa’s health systems’ endeavours to use social media for healthier Africans.

  • Africa’s eHealth legal framework needs developing – unpacking the 3rd Global Survey on eHealth

    Africa’s eHealth legal and regulatory framework is behind global trends, as eHNA has reported. More insights are provided in Chapter 6 of the WHO Global Observatory for eHealth (GOe) publication eHealth Report of the third global survey on eHealth Global diffusion of eHealth: Making universal health coverage achievable. The report's data source is the WHO Global Survey 2015.

    Key findings include:

    Slow but steady development of general eHealth regulation, with 33% of countries with  specific policies or legislation to define medical jurisdiction, liability or reimbursement of eHealth servicesAbout 47% have legislation to promote safety, quality and standards of health related dataAbout 78% have health data privacy legislation and 55% have legislation to protect the privacy of electronically patient data. They’re up from 73% and 31% since 2010, so a big step up for eHealth data laws.

    The survey focused on EHRs, which are dealt with in detail in Chapter 5. They are seen as the basis of eHealth systems, so a good indicator of general eHealth regulatory framework maturity. Consequently, countries that don’t have EHRs aren’t covered.

    Africa’s overall position’s about half the global average. Catching up is not easy, Much of the current eHealth regulation’s generic, such as data protection laws and telecommunications regulation. It takes time to find a slot in countries' legislative programmes. eHNA posted that Angola took some five years to complete its data protection laws. This’s a typical timescale that other countries have said is needed to move eHealth regulation on.

    The challenge is exacerbated because eHealth regulation extends well beyond EHRs. Examples are data transfer and communication using mHealth services and new regulatory aspects such as eHealth governance and cyber-security. African countries will be unable to set up comprehensive regulations for all eHealth settings in the medium term, so setting eHealth regulation priorities is crucial.

    From these, eHealth laws and regulations are needed alongside finance and resources for a regulatory body and compliance reviews. These have to compete with finance and resources for expanding eHealth services and emerging demands such as cyber-security and human capacity building. An important question for Africa’s how much eHealth regulation’s needed?


    Image from the WHO report

  • Africa’s EHRs are trailing – unpacking the 3rd Global Survey on eHealth

    EHRs are one of eHealth’s building blocks. WHO Global Survey 2015, the data source for the WHO and Global Observatory for eHealth (GOe) publication eHealth Report of the third global survey on eHealth Global diffusion of eHealth: Making universal health coverage achievable, provides insights for Chapter 5.

    Key findings include:

    Steady growth in adopting national EHRs over the last 15 yearsAbout a 46% global increase in the past five years.Over 50% of upper middle and high income countries have adopted national EHRsMuch lower adoption rates in the lower middle and low-income countries at 35% and 15%Most national EHRs integrate with laboratory and pharmacy systems at 77% and 72%, with Picture Archiving and Communication Systems (PACS) at 56%.

    Africa’s national EHRs match the low-income rate. Their integration with other information systems is lower than the adoption rate, so well below the global position. While some of the shortfall may be due to the definition of countries’ EHRs not matching WHO’s survey definition, so possibly understated, as the report mentions, it’s still a big gap.

    Catching up needs African countries to step up their investments. It also needs investment barriers to EHRs removing. WHO says these include lack of funding, infrastructure, capacity and legal frameworks. For Africa, parallel investment’s also needed in laboratory, pharmacy and imaging services and cyber-security, eHealth governance, business cases and M&E.

    Catching up alone isn’t a good investment goal. Adopting EHRs at a sustainable, affordable pace that results in healthier Africans and enables health professionals to improve their contributions are best.

  • WHO shows Africa’s health eLearning is trailing – unpacking the 3rd Global Survey on eHealth

    Both health and healthcare rely on intensive, continuing learning. Reaching everyone who needs it’s challenging for African countries. While eLearning can help, Africa’s trailing global trends. eLearning data from WHO Global Survey 2015, the data source for the  WHO and Global Observatory for eHealth (GOe) publication eHealth Report of the third global survey on eHealth Global diffusion of eHealth: Making universal health coverage achievable, provides insights for Chapter 4.                                                                                              

    It found at least two thirds of responding Member States use eLearning for health science education, both pre-service education and in-service training, with Africa at 48%, so about 70% of the global average. Putting this outlying performance in the context of healthcare spending per head shows it as a considerable achievement.

    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%. WHO’s eLearning score of 70%’s well above these, indicating a relative high priority accorded to eLearning in a stringent resource context.

    A global eLearning profile’s:

    Medical students education at 91%Doctors education at 84%Pre-service education at 80%In-service public health education at 68%.

    Five barriers to eLearning programmes supporting Universal Health Coverage (UHC) are, lack of capacity, availability of courses, human resources, finance and cost-effectiveness evidence. WHO’s report says evidence shows that eLearning for health professionals’ education is effective or more effective than traditional teaching. This offers a good case for advancing eLearning if Africa can ease through the other barriers.

  • WHO’s telehealth view is optimistic – unpacking the 3rd Global Survey on eHealth

    French and English speaking African countries have long associations with telehealth. Réseau en Afrique Francophone pour la Télémédecine (RAFT) Project involved Geneva University Hospital and Health On the Net Foundation in developing a network for eHealth in Africa. It started in 2000 and is now across four continents.

    Telehealth data from WHO Global Survey 2015 provided insights for Chapter 3 of the WHO and Global Observatory for eHealth (GOe) publication eHealth Report of the third global survey on eHealth Global diffusion of eHealth: Making universal health coverage achievable. The report deals with five telehealth types:

    TeleradiologyTeledermatologyTelepathologyTelepsychiatryRemote patient monitoring.

    A country average was 3.7 telehealth programmes. At about 3.3, Africa had slightly fewer, about 90% of the global average. For the five telehealth types, Africa’s teleradiology in about two-thirds of countries has a score of some 60%, below the global rate of 75%. The other four types are below 45%, with telepsychiatry the lowest, about 20% of teleradiology’s rate.

    Telehealth evaluations are increasing in number. Criteria used to evaluate government-sponsored telehealth programmes were:

    Programme acceptance by providers73%Quality73%Access68%Programme acceptance by target groups64%Cost-effectiveness for providers55%Sustainability                    55%Health outcome50%Cost-effectiveness target groups46%

    Comprehensive evaluation using Cost-Benefit Analysis (CBA) could combine all these perspectives. It could also include efficiency and provide a direct link with telehealth financing. Global perspectives of barriers to telehealth investment may not match Africa’s, especially telehealth finance and infrastructure for connectivity:


    Very      NotFunding                <10%>70%Infrastructure  >10%>50%Priority                  <20%>40%Legal    >10%>40%Capacity>10%>40%Policy>20%<40%Cost-effectiveness>10%<40%Demand<20%    <40%Effectiveness>10%    <30%

    Since telehealth emerged on the scene, technology’s changed. The Internet and mHealth have created new and wider opportunities. Initiatives like Figure 1, described in an eHNA post, are changing its scope and range, and offer Africa’s health systems greater participation. 

  • WHO’s mHealth view is optimistic – unpacking the 3rd Global Survey on eHealth

    Africa’s eHealth initiatives accord an important role for mHealth services. There’s a very wide range of mHealth projects, but still plenty to do. African countries scored between 50% and 60% in the mHealth section of the WHO Global eHealth Survey 2015, the data source for 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. Its key findings for Chapter 2 on mHealth are:

    87% of responding countries say they’ve at least one mHealth programme80% of the low income countries say they’ve at least one mHealth programme91% of high-income countries have at least one mHealth programmeMore mHealth programmes operational for at least two years with finance for at least two moreOnly 14% of countries have an evaluation of a government-sponsored mHealth programme.

    These numbers say nothing about the utilisation or coverage of the programmes. The evaluations say nothing about their costs, benefits, net benefits or timescales needed to achieve net benefits.

    Africa’s average performance is below the average for low income countries. While this seems to indicate that more can be achieved, extra spending needs pursuing with considerable care. eHNA post about the American Medical Association (AMA) Executive Vice President and CEO’s view seems relevant - that it’s vital to separate digital snake oil from the useful, and potentially magnificent, digital tools, and quell the undesirable digital dystopia that doesn’t improve health, healthcare or make it more efficient. He includes Ineffective mHealth apps of questionable quality.

    While his vocabulary’s exotic, he emphasises an important theme of good mHealth investment. It’s challenging to produce rigorous mHealth business cases when the evidence is from 14% of countries. It’s not much more than the 12% found in 2010. African countries comprise about 18% of these, with three evaluations. eHNA has posted on several research findings that show that much of mHealth benefits are questionable or short term. It’s essential that mHealth business cases are explicit and about the net benefits expected, then followed by evaluations to add to mHealth knowledge.

    mHealth’s a multifarious term. It includes fitness wearables. Chapter 2 has 14 other types:

    Health call centres                                             Appointment remindersTelehealth                                                                Community mobilisationAwareness raising                                              Emergency accessEmergency management                               EPRsPatient monitoring                                             mLearningHealth surveys                                                      SurveillanceTreatment adherence                                      Decision support systems.

    Four future mHealth themes are seen as:

    Evaluate implementation and outcomesDevelop regional and global networks to share mHealth knowledgeDetermine the best areas for mHealth to help adoption and local innovationResearchers, health authorities and global entities promote mHealth indicators.

    Africa can lead on these. It needs the information.