Readiness (4)

Healthcare and chronic disease rates aren’t distributed evenly across Africa’s communities or countries burden. A report by a team from Aetna Foundation in the Journal of Public Health Policy, Population health-based approaches to utilizing digital technology: a strategy for equity may offer a way to use eHealth to even them up. More specifically, it proposes that mHealth can help.

mHealth has a big role in engaging individuals and their communities in health and healthcare. It extends across accessing the Internet to find information about health conditions, monitoring health and fitness. Africa already has a wide range of mHealth services with plans for more. It’s 59% score on the WHO 2015 eHealth survey shows a respectable strategic foundation.

Aetna Foundation takes a long-term, systematic view in making its grants. Its focus is promoting wellness, health and access to high quality healthcare. It evaluates bids for projects using “strong evidence-based criteria.” They include sustainability, scalability, potential for positive societal impact, leveraging available evidence such as population health data or healthcare data, and digital health technologies built on strong foundations of behavioural research or other applicable theories.

This business case approach can help Africa’s health systems take good mHealth decisions. With a large mHealth evidence deficit, business cases enable rigorous assessments assumptions and estimates. They also support a switch away from seeking to achieve potential benefits to identifying more modest and realistic probable benefits. They also provide an analytical foundation for subsequent M&E, so adding to the current limited evidence pool.

Acfee’s preparing guidelines for Africa’s health systems on using a proven methodology for preparing business cases. It also deals with the business case process as part of good eHealth governance. Both a methodology and a process are needed for business cases to fulfil their role in decision taking.

Encouraging mHealth’s supply side’s important too. Aetna Foundation mentors mHealth innovators. Its approach to mHealth training that brings together leaders, behavioural sciences and clinical researchers offers lessons for Africa’s health system. Ministries of health, technology and economic development can collaborate to develop countries’ mHealth industries by setting clear mHealth priorities and working with local mHealth suppliers to develop and provide solutions and services.

These themes combine into mHealth strategies that extend beyond healthcare and into the technology world of universities and business entities. This extended value chain offers a structure to expanding mHealth from the valuable progress achieved in Africa so far.

African countries have marked differences in their eHealth readiness. Acfee’s updated eHealth Readiness Index shows that for some countries, it’s changing over time too. The index now includes data from WHO’s 2015 eHealth Survey, produced by the Global eHealth Observatory.

Other data’s been updated too. The latest numbers for healthcare spending and the latest Ibrahim Index scores have been added. While some countries are shuffling around Acfee’s Index over the last few years, some have been reasonably consistent, especially those with high and low scores.

These differences point to the need for different, bespoke eHealth initiatives. They can range from updating strategies to deal with new events, such as increasing cyber-crime, to an emphasis on low cost, high value mHealth investment. 

Affordability is a common thread. Rigorous financial plans and business cases for eHealth are needed by every country. Acfee’ Index shows that all countries have to deal with eHealth financing constraints with a need to break out of short-term financial log-jams.

If you’d like to discuss the implications for your country, you can contact Acfee. An email setting out your perspective can start a dialogue and help you start to develop further options to your eHealth strategy and programme.

A survey of EU countries’ mHealth readiness for research2guidance lists five countries with the highest readiness score, and with mature markets. They’re Denmark, Finland, The Netherlands, Sweden, with the UK at the top because 55% of mHealth practitioners saying it’s due to its openness and positive attitude of many doctors in the UK for new technology and integrating mHealth solutions into patient treatments.

The survey is part of the mHealth App Developer Economics research programme.There were five readiness dimensions, each with a set of criteria. There are 26 of these in total. African countries can test how they rate on the five readiness dimensions including:

  1. eHealth adoption
  2. Level of digitalisation
  3. mHealth market potential
  4. Regulation
  5. Ease of starting a business.
  • eHealth adoption:
    • GPs transfer prescriptions to pharmacists electronically
    • Patients making an appointment using a website
    • GPs exchanging medical patient data with other  healthcare providers and professionals
    • Internet users seeking online health information 
  • Digitalisation:
    • Smartphone penetration
    • Tablet penetration
    • Average number of apps in use
    • Mobile Internet use
    • Regular Internet users 
  • mHealth market potential:
    • Population
    • Number of doctors and nurses
    • Number of hospitals
    • Health expenditure by population’s out of pocket
    • National health expenditure
    • Health expenditure per head
  • Regulatory:
    • Acceptance of ePrescriptions
    • Implementation of EHRs
    • Standards on EHR interoperability
    • Permission for secondary uses of EHR data
    • Permission of remote treatment
    • Existence of e and mHealth guidelines
    • Acceptance of health data transfer
    • Restrictions on mHealth data storage 
  • Ease of starting a business:
    • Time needed to start businesses
    • Number of procedures needed
    • Taxes.

A modest correlation is between market readiness and mHealth adoption and practitioner’s perspectives. It occurred in half the countries.

That means that mHealth companies have a realistic view on the mHealth market conditions in these countries. The survey also found a wide spread of results. For Africa, where will your country fit?

It’s well known that eHealth is more developed in high-income countries. A report available from the Electronic Journal of Information Systems in Developing Countries (EJISDC) reviews the position, especially eHealth’s integration, into the health systems of developing countries. It takes eHealth readiness as its perspective, and confirms the essential role of a readiness assessment.

The researchers, Billy M. Kalema and Mmamolefe R. Kgasi, both from Tshwane University of Technology in South Africa, propose an eHealth readiness model with several parts:

  • Core readiness, that identifies the core attributes of the target population that lead to the need for change, such as identifying needs, dissatisfaction and eHealth awareness
  • Structural readiness, for attributes related to institutional and human resources
  • Societal readiness, for the preparedness of health institutions and staff to participate in the networked world collaborative working and data sharing
  • Government readiness, where the nation state and government are prepared, committed and have a legal and regulatory infrastructure for eHealth
  • Acceptance and Use readiness, where medical and other health professionals are prepared to commit their time to eHealth for subsequent benefits.

The report sees core readiness as the most important for eHealth in developing countries. It also identifies several factors that need to be in place for eHealth to succeed:

  • Identifying eHealth suitability, appropriateness and affordability
  • Institutional preparedness to finance the costs of equipment, installation, training, maintenance and provision of support
  • Capacity building and human resource development to ensure sustained support and training
  • Identification of suitable legal and regulatory frameworks that are conducive to eHealth
  • Investment in high level preventive health and ensuring trust of health systems to the users and citizens.

They could’ve added dealing with obsolescence and the rapid emergence of new solutions and opportunities, such as Big Data and mHealth. The impact in Africa is different, and may be more important than in developed countries.