WHO’s third global eHealth observatory report is a meaningful update on global developments and trends and poses important challenges for African countries embracing eHealth for their health systems’ transformation.
Helping to review content for the report, along with colleagues from the WHO eTAG and many other eHealth experts, I was exposed to the considerable work underway globally, and the extraordinary teams helping to explore eHealth's role in improving our health and health systems.
At Acfee, we're especially interested in the implications for Africa. eHNA will post separately on each of the eight chapters in WHO’s report. Each post will take an African perspective to offer an assessment of features of its eHealth and Universal Healthcare Coverage (UHC) opportunities and constraints.
It’s widely recognised that Africa has a considerable healthcare deficit and high disease burden. The combination creates a constant, long-standing struggle and much more than the policy and management euphemism of a challenge. 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%. These aren’t adjusted for the high disease burden, or the difficulties of providing healthcare to extremely remote communities. It’s unrealistic to expect Africa to achieve the huge productivity increase needed to provide UHC, provide the extra cash and capacity needed, or a combination of both over the medium-term.
Aiming to achieve UHC in this economic context is a lot more than demanding. The Global Observatory for eHealth (GOe) publication Report of the third global survey on eHealth Global diffusion of eHealth: Making universal health coverage achievable, says “It has become increasingly clear that UHC cannot be achieved without the support of eHealth.” I've heard similar sentiments expressed by African colleagues such as Liberia's Luke Bawo, speaking about his country's response to Ebola and Acfee's Ousmane Ly, describing the eHealth initiatives he's leading in West Africa.
It's a reasonable proposition, but for Africa, it’s not enough for all people to receive the high-quality health services they need without suffering financial hardship.
Africa’s UHC solutions are a combination of:
- Substantial and rapid economic growth
- Significant, sustainable increase in finance for health and healthcare
- Converting the extra cash into sustainable real healthcare resources, including all types of healthcare workers, medicines, medical and surgical supplies and extra and better facilities
- Proven eHealth, especially proven mHealth.
WHO’s report says 90% of eHealth strategies reference the UHC objectives or its key elements. This is for the 58% of countries that have eHealth policies or strategies, so about 52% of all countries. For Africa, 39% of countries report having an eHealth strategy, of which 58% have UHC objectives, so about 23% of countries. Consequently, Africa’s eHealth role in UHC isn’t specified formally yet, indicating the need to enhance or replace them.
Other limitations are that Africa’s eHealth strategies seldom integrate with related economic growth, healthcare finance and real resource strategies and plans, and none have sustainable, longer-term horizons. Africa’s eHealth strategies need upgrading for other factors either understated or not referred to in the report. Four are:
- Effective, consistent patient unique ID
- Interoperability (IOp), which is in its infancy across Africa
- Cyber-security, which is becoming an increasing global challenge
- eHealth governance, not yet well developed across Africa.
Acfee’s African eHealth Forum (AeF) report included these in its identified priorities. Acfee will release commentaries on cyber-security and eHealth governance early in 2017. It will also be able to offer health systems opportunities to participate in developing IOp use cases using a globally recognised methodology and standard.
Image from the global eHealth observatory report