Roundtable in association with:



eHealth Agenda (AM)

The main objective of this debate will be to devise effective strategies for ensuring the sustainability of eHealth programmes in African countries, but with a specific focus on South Africa.

Central to the debate will be South Africa’s ICT Strategies for Health (eHealth), the core of which is the Department of Health’s policy for a national electronic health records (EHR) and Health Management Information System (HMIS) currently under way and developing standards for ensuring the interoperability of disparate and distributed existing systems. The aim is to build a national integrated eHealth System.

The immediate phase in implementing this eHealth strategy will be the integration of all existing health EHR and HMIS through a sophisticated but affordable “Enterprise Content Management System” (ECMS). The integration with and the creation of a National Health Insurance System (NHIS), on which the majority of South Africa’s healthcare spending will be required.

Of particular interest to the Department of Health (DoH) in South Africa is the UK’s Connecting for Health (CfH) programme. This has become a lengthy and expensive health project and was initiated to deliver better care to patients and to afford greater efficiency to the NHS. It involves the use of computers, telecommunications and software to improve how patient information is stored and accessed by patients and health professionals alike. Put simply, the aim was to standardise and integrate all electronic health, patient and prescription records to make the delivery of patient services more efficient. Teething problems have been encountered in this process, stemming from unrealistic expectations and the poor management of stakeholders and contracts with vendors. Notwithstanding, some considerable success has been achieved with the deployment of a national picture archiving system (PACS), a telemedicine application that was not part of the initial plan.

At the centre of the CfH is the “Spine”. This is a technological and architectural innovation devised for integrating the distributed configuration and organisation of the National Health Service (NHS) in England.  So, the “Spine” should also be seen as an organisational management platform for integrating large amount of health data from multiple and disparate sources.

Though the NHS itself is a monolithic organisation with some power devolved to local trusts and authorities, the delivery of expected promises and benefits of this system are yet to be seen. This shows that building a national eHealth system is not about the technology but about careful planning, needs driven by needs and available resources with targeted management during implementation.

Moreover, the marked differences in health system configuration and economic status between South Africa and England – the former with high rural and underprivileged population with inadequate access to healthcare – further reinforces the need for cautious procurement and deployment. Lessons from other countries with similar ambition and programmes, such as the USA, Canada and Australia support this.

Of course, the provision of healthcare in South Africa and other African countries faces unique challenges that must be addressed. Rising healthcare costs in the face shrinking finances; the need to deliver quality services to both urban and rural populations through the integration of both public and private providers make the case for South Africa to build a cost-effective and efficient system based on its national priorities.

Therefore, the roundtable is bringing together relevant stakeholders to answer the specific questions that need to be addressed, which include the following:

• How can all the relevant and distributed health information systems from all the various public health authorities and the private providers be integrated into one system and what should this system look like?

• Given that the majority of healthcare is delivered at a local level, is a national eHealth system appropriate for South Africa and other African countries or would some form of federal system (that could be integrated at a later date) be more appropriate?

• Should telemedicine applications be integrated to the National eHealth strategy or plan as it is becoming of policy and practice in other countries of similar ambition?

• Is there a business argument for working with common standards rather than forcing through a system that may not address issues like personalised healthcare and disease management or extend healthcare to rural populations?

• How should the private and public sectors work together to ensure effective integration of health systems? There are many views on how best to achieve this! PPPs, for example, are generally agreed as good for eHealth development and implementation, but who should take leadership and provide stewardship?

• What does it take to best leverage technology to make healthcare more efficient? Are the right strategies for training and change management in place?

• As the availability of healthcare goes up, then so does demand. How do we best close the gap between resources and demand and how can technology help? Will anyone ever acknowledge this gap and start rationing healthcare?

• What is the best way to achieve the public and private investments and sustainable business models that are required for transiting from pilots to large-scale eHealth implementation?

• How do you measure the success of your investment in an eHealth project from both the public and the private sector perspective? Does healthcare, in fact, ever work as a business?

• Access to healthcare services is limited in many African countries and IT infrastructure underpins the success of all eHealth plans. How can services be made more accessible? What technology can enable the healthcare provider on the ground in light of the specific challenges that face many parts of Africa, particularly rural areas?


eHealth Agenda (PM)

mHealth – the commercial opportunities in African countries

If eHealth is to deliver on its vast potential in Africa, we will need to leverage and maximise the potential offered by the almost ubiquitous mobile and wireless infrastructure (MWI) that exists. MWI is the most affordable and accessible platform for delivering eHealth services to African populations, especially those in rural areas. It is not all rosy, however. There are still problems with cost and the reliability of services, but the foundation exists on which to build and there are examples of the benefits MWI can bring in successful projects like Cell-Life, Simpill and Dokoza here in South Africa, all of which make patient management easier, although not less expensive.

Issues of sustainable business models, poor citizen uptake, appropriate service delivery models and devices, software and infrastructural limitations are still present and we need to address these during this session.
With direct access to citizens or patients regardless of their location, financial means and age, health services can be delivered empowering people to take care of their health. mHealth can also empower health workers and improve their performance and health system efficiency, as has been demonstrated in the UHIN project in Uganda and TRACnet in Rwanda.

But ingenious technological innovations by researchers and budding techno-entrepreneurs have resulted in models which have adapted to these constraints. Most of these are limited to SMS applications for EHR, as in CommCare, which is being piloted in Tanzania and HMIS, as used in frontline SMS applications. But SMS is limited to 160 characters per text, so usage for advanced applications is limited.

With increasing deployment of high bandwidth infrastructure such as GPRS/3G and the availability of high-end and mid-range smartphones, the time is ripe for more advanced services. Even though, for the vast majority of Africans, SMS-based applications will still be the norm for some time to come, advanced services can and should be directed at rich and middle class urban populations.

This focus is also crucial to the national eHealth plan, in that mHealth applications can be developed for providing access to data located in a central database. Health professionals, patients and citizens alike will be able to probe, retrieve and even contribute to information on the database.

A summary of existing applications for MWI are:

• Education and Awareness
• Remote Data Collection
• Remote monitoring
• Communication and Training for Health
• Disease and Epidemic Outbreak Tracking
• Diagnostic and Treatment Support

It is widely accepted, therefore, that to accelerate mHealth momentum and realise the potential of mHealth services, multi-sector collaboration between groups as diverse as governments, multilateral governmental organisations and NGOs, mobile operators, device manufacturers, global software giants, universities and small businesses is needed now.

Discussion focus
There are two main parts of this session:

1. The need to discuss the creation of a workable and interoperable national eHealth infrastructure, with common standards that will integrate different mHealth devices, software and networks.

2. The second focus is how mHealth services and applications can be made more affordable and accessible through commercialisation. Success with mBanking as demonstrated in M-Pesa in Kenya, Wizzit in South Africa and different applications in Nigeria is also worthy of emulation in the health sector. The interest shown by mobile operators, SMEs and multinational software businesses also is another positive sign that the time is ripe. There is huge commercial potential in mHealth for these business entities.

The panel and audience of governments, multilateral organisations and the private sector will give us the perfect platform from which to examine all the issues relating to successful mHealth projects and with a clear understanding of the need for private sector involvement and the need for ROI.