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The CommonwealthThe Commonwealth

53 nationsone community

ECOSOC Africa Regional Ministerial meeting on e-health – use of information and communication

technology for health10-11 June 2009

Accra, Ghana

A presentation by the Commonwealth Secretariat

Addressing e-health policies and strategies in the Commonwealth

by

Dr Joseph Amuzu

Adviser, Health Section

Commonwealth Secretariat

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Where are we?

The May 2008 Commonwealth Health Ministers Meeting (CHMM) focused on e-health.

An e-health survey results from the Commonwealth was presented at the meeting.

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Challenges identified in the survey E-health initiatives

varied widely

Isolated e-health

Change management

The scale and time of implementation

Financing e-health

Technological challenges

Ethical Challenges

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Varied e-health initiatives Multiple examples of e-health in health

manpower training, development of HIS

Fewer examples for procurement/logistics, leadership training, clinical service delivery

Initiatives not linked to coherent strategy, uncoordinated, donor supported, mainly with NGOs

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Change managementE-health is “additional work without remuneration”

“We need to perceive technology as an additional tool to facilitate improved efficiency in the delivery of

health care and not as a ‘monster’ waiting to expose us”

“ The need for training for Ministry staff and service providers in computer literacy; the design of new clinical and working practices; user support and project management.

A lot of technophobia among staff and senior officers.

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Financing e-health

Commonwealth countries report that the main financial challenges relate to equipment and telecommunications infrastructure

Projects were financed by a mixture of public and donor funds.

The benefits of e-health for developing countries are well known but the financial costs are not.

Few case studies on the financial costs of e-health in developing countries.

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Predominant issue identified in survey

was patient privacy and confidentiality of medical records

There may be a trade off between improved quality and access versus the risk of reduced security and confidentiality

Intellectual property rights between public and private sectors must be clarified

Legal and ethical issuesLegal and ethical issues

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E-health requires long term planning between Health, Finance and Technology Ministries/sectors

Simpler technology often produces better results

Financial sustainability can be a challenge for e-health

ICT that reaches rural areas may contribute more to MDGs than urban interventions

Lessons LearnedLessons Learned

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The CHMM 2008 mandated the Commonwealth Secretariat to work in e-health.

The specific mandates were:

Convene high-level consultations involving Ministers of Health and Ministers with responsibility for ICTs;

Promote the exchange of e-health expertise between Commonwealth countries;

Seek funding to support interventions.11/04/23 Commonwealth Secretariat

1. Ministerial Dialogues

One Dialogue held for Ministers of Health & Ministers responsible for ICT from the East, Central and Southern Africa (ECSA) region.

The aim was to: Enable ministries for health and technology to

share information and collaborate effectively; Support health ministries in developing realistic,

affordable e-health strategies and investment plans;

Expand e-health capacity and capabilities.

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Outcomes of the Dialogue Ministers identified some issues of concern

ICT and health policies and strategies e-legislation in the ECSA region e-health standards e-health infrastructure Capacity and the need for capacity-building in ICTs

They requested reviews of these challenges They identified priority areas for action and Set up a technical working group on e-health

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The priority actions

Ministers requested the Commonwealth Secretariat and its partners to help:

countries develop their policies and strategies

countries develop guidelines on equipment procurement and ICT sourcing strategy

in designing tools for auditing existing health informatics and telemedicine training

establish health sector-wide training programmes including leadership training on e-health and ICT

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2. The technical working group

The TWG included representatives from Uganda, Kenya, Mozambique, WHO/AFRO, AU and was supported by an expert from South Africa.

The TWG was tasked to: review the main approaches to e-health policies and

strategies and to draft a framework for an assessment of the status

of e-health in the region.

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Results A methodology and templates for e-health policies

and strategies developed

A questionnaire for the assessment of the status of e-health developed

It is a tool for auditing existing e-health infrastructure and capacity based on WHO and Bellagio frameworks.

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The methodology The methodology involves bringing

together all stakeholders: Ministries of Health, ICT and Finance, civil society, the private sector mainly telecom companies, doctors and nurses associations and development partners.

The information from the templates proves to be useful in developing the policy and strategy.

The Templates Is based on e-health Strategy Loop

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E-health Strategy Loop

Benefits Realisation Plan

eHealth Investment Plan

Affordability and Finance

Change ICT Possibilities

Leadership

Health and Healthcare Strategies

ICT Priorities Implementation

General Development

Plans

Evaluation Review and Feedback

Capacity

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Leadership

Who are the leaders?

Who should they lead?

What skills and knowledge do they need?

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Change management

Identify stakeholders & needsContinuous stakeholder engagementExplain the changes, the new ways of working new competences

use of technologychanges in procurement modelsincrease need for programme and

project managementmore training

It is a whole organisational culture change

ICT possibilities

Citizens’ and Patients’ Identities

Logistics Information Regional Networks of Clinical Information

Secondary Non-clinical Health Information

eLearning

Healthcare Professionals’ Identities

Clinical Information and Records

Billing and Management

Telecare, Telehealth and Telemedicine

Services

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Rockefeller Foundation - Survey of eHealth Application Prioirities

0 5 10 15 20 25 30 35 40 45 50

Disease surveillance

Mobile health

National systems

Knoweldge access

Decision support

eLearning

Telehealth

Pharmacy

Laboratory

Inventory management

Administration

Top Three Application Prioirities

3. Collaboration with Kenya The methodology and templates for e-health

policies and strategies were pretested by the Kenyan Ministry of Medical Services.

A strategic planning workshop was held in Kenya, taking forward two key issues that arose from the Ministerial Dialogue.

How to frame and develop an e-health policy and strategy for Kenya

Scoping and delivering an e-health readiness review in Kenya.

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Collaboration with ICT suppliers

Cisco Systems is supporting the Commonwealth Secretariat with the Ministerial High-Level Dialogues.

 The Health Section is also in discussion with Microsoft to identify collaborative work and funding support for the Secretariat eHealth programme.

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The next steps Strengthen partnerships, working together with

Ministries of Health & ICT, International Organisations, AU, Regional Health Organisations, private sector and civil society.

Initiate the cycle of work taking place in the ECSA region in West African and other regions of the Commonwealth:

Ministerial High Level Dialogues Support continental, regional and country e-health policy

and strategy development processes Support country level stakeholder consultations using the

Commonwealth e-health methodology and templates

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Thank you

The CommonwealthThe Commonwealth53 nations

one community